Neu­ro­science of­fers in­sights into opi­oid epi­demic

Northwest Arkansas Democrat-Gazette - - STYLE - FAYE FLAM

Most Amer­i­cans say they’re in­ter­ested in sci­en­tific dis­cov­er­ies, but they may be think­ing of the kinds of find­ings that lead to new gad­gets and won­der drugs. When it comes to dis­cov­er­ies about haz­ards and risks — es­pe­cially the risks of those won­der drugs — Amer­i­cans seem more likely to tune out.

Such am­biva­lence might help ex­plain how opi­oid mis­use be­came such a prob­lem in Amer­ica. De­spite 20 years of warn­ings from sci­en­tists about the dan­gers of ad­dic­tion, the rate of pre­scrip­tions tripled be­tween 1999 and to­day. It hit a peak around 2012 and has started to de­cline slightly, go­ing from 81.2 per 100 peo­ple to 70.6 per 100, new data show. In­deed, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, U.S. doc­tors wrote 259 mil­lion pre­scrip­tions for po­ten­tially ad­dic­tive painkillers in 2014 — enough for every adult in the coun­try to have a bot­tle.

All the while, neu­ro­sci­en­tists have found that opi­oids can cause long-term changes in the brain even af­ter an ad­dicted per­son ex­pe­ri­ences the se­vere nau­sea and other with­drawal symp­toms typ­i­cally as­so­ci­ated with quit­ting. That lin­ger­ing haz­ard might have given pa­tients and pre­scrib­ing physi­cians pause.

But it’s not too late to start lis­ten­ing to sci­en­tists. Brain re­search can help in­form pol­icy on how to help the 2 mil­lion Amer­i­cans who are ad­dicted to pre­scrip­tion opi­oids, as well as the 1 mil­lion ad­dicted to heroin. Neu­ro­science “def­i­nitely has things to of­fer help­ing us un­der­stand the re­al­ity of the ad­dicted brain,” said Keith Humphreys, a pro­fes­sor of psy­chi­a­try and neu­ro­science at Stan­ford Univer­sity. He and sev­eral col­leagues urged a greater role for neu­ro­science in shap­ing pol­icy in a com­men­tary that ran in June in the jour­nal Science.

Neu­ro­science re­search has shown, for ex­am­ple, that ad­dic­tive drugs can al­ter the brain cir­cuitry that con­trols mo­ti­va­tion and re­ward, and they can wreak havoc on the brain’s de­ci­sion-mak­ing cen­ter, the pre­frontal cor­tex. And yet, he said, in­sur­ance providers tend to stop cover­age af­ter an ad­dict goes through de­tox­i­fi­ca­tion and with­drawal, based on the old idea that the dis­ease is over at that point.

Other treat­ment pro­grams re­quire peo­ple to prove they’re mo­ti­vated by ab­stain­ing for some pe­riod of weeks, he said, but it’s the mo­ti­va­tional cir­cuitry that’s dam­aged in the brains of ad­dicts. “It’s not that it’s hope­less,” he said, but treat­ment might save more lives if de­signed for deal­ing with ad­dic­tion as a long-term brain dis­ease.

Newer re­search also shows how en­vi­ron­men­tal cues can trig­ger crav­ings in peo­ple who have been ad­dicted. Other stud­ies pro­vide in­sight into why some peo­ple are vul­ner­a­ble to ad­dic­tion and oth­ers face no temp­ta­tion. Humphreys said that peo­ple don’t nec­es­sar­ily have to use th­ese drugs recre­ation­ally to be­come ad­dicted. It can hap­pen while pa­tients are fol­low­ing doc­tors’ or­ders. All this points to a pol­icy that pro­tects vul­ner­a­ble peo­ple by re­quir­ing doc­tors to ex­er­cise more care and re­straint in pre­scrib­ing.

Age and en­vi­ron­ment also mat­ter. There’s ev­i­dence from neu­ro­science that peo­ple in their teens and early 20s are more likely to be­come ad­dicted be­cause the pre­frontal cor­tex is still de­vel­op­ing, sug­gest­ing that stronger mea­sures need to be taken to pro­tect teenagers. A re­cent New York Times col­umn by psy­chi­a­trist Richard Fried­man brought up stud­ies that sug­gest low so­cial sta­tus also in­creases peo­ple’s risks of be­com­ing ad­dicted, not just to opi­oids, but also to other sub­stances and to overeat­ing. Fried­man im­plies that the so­lu­tion is in cre­at­ing a just so­ci­ety — a lofty goal, even if, in the shorter term, care­ful pre­scrib­ing is more prac­ti­cal.

Humphreys said there is some hope that neu­ro­science and re­lated fields, such as ge­net­ics and psy­chol­ogy, are start­ing to get more of a voice in the opi­oid cri­sis. The Stan­ford Neu­ro­sciences In­sti­tute, he said, is sup­port­ing an ini­tia­tive to al­low sci­en­tists to help pol­i­cy­mak­ers take a more ev­i­dence-based ap­proach to men­tal health prob­lems, in­clud­ing ad­dic­tion.

What is clear is that cur­rent U.S. drug poli­cies aren’t work­ing to stem the tide of opi­oid ad­dic­tion. While rates of pre­scrip­tions have ta­pered off a bit, rates of ad­dic­tion in­creased al­most 500 per­cent from 2010 to 2016. Opi­oid ad­dic­tion is now the lead­ing cause of death in peo­ple un­der 50.

Sci­en­tific dis­cov­er­ies do some­times re­veal the haz­ards be­hind what peo­ple thought were life-en­hanc­ing or life­sav­ing drugs. Peo­ple don’t have to use opi­oids recre­ation­ally to de­velop deadly ad­dic­tions. This may not be what peo­ple want to hear, but with 91 Amer­i­cans dy­ing every day from opi­oid over­dose, we have an obli­ga­tion to start lis­ten­ing.

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