Looking back at the past years show us that opioid abuse and addiction has increasingly gotten worse. Since 2000, there has been a 200% increase in deaths related to opioid abuse in the US. The worst year to date was 2016 where over 63,000 people died from overdose. Over 40,000 of those overdoses can be attributed to opioid use. There are more people dying from opioid addiction than there are deaths due to breast cancer. It’s clear that the opioid epidemic is not going away and great lengths need to be taken to fight back. With fentanyl causing even more overdose deaths than any other drug in history, experts know it’s time to find a solution. While the DEA is doing all they can to stop street abuse of opioids, the medical system is also looking to do its part. There are plenty of advocates that are thinking outside of the box in order to offer more sophisticated opioid treatments for opioid addiction in 2018.
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Combating the Opioid Epidemic
So what can be done to begin chipping away at the drugs that are wreaking havoc across the US? There is a list of ideas that could help turn things around in 2018. Experts have a protocol they’re focusing on in order to find the solution for opioid addiction treatment. Their aim is to find a more intelligent type of opioid that works to ease the pain but doesn’t affect the brain in the same way. They are also hoping to make it easier for people to get the addiction treatment drugs they know work. Lastly, getting the proper training for doctors so they can more easily help patients with opioid addiction. There is hope that these factors will help reduce the opioid crisis.
What Opioids Are Currently Doing to the Brain
To get an idea of why opioid addiction has become so problematic, you’d need to understand what they do to the body and mind. They act on your opioid receptors which are in many areas of your body. Opioids attach themselves to the receptors and then release a surge of dopamine. This is what blocks the pain. While it’s great for inflammation, it’s not good for healthy tissues. Opioids also attach themselves to receptors in the brain which is where the major damage is done. It can interact with your nerves which control your respiratory rate. It also affects the gastrointestinal tract, causing constipation. The addiction occurs because that dopamine release causes euphoria and a calming effect. This feeling can quickly cause dependency, tolerance and overall addiction. Even once the pain is gone, the body still wants the prescription opioid.
An Opioid Without Side Effects
Research has revealed that it’s possible to develop a pain-relieving opioid that doesn’t cause the traditional problems we’re being faced with right now. The most common side effects that come along with opioids include anxiety, nausea and dependency. The opioids being used today (and for the past century) will bind to all opioid receptors in the body. Researchers have been able to develop a new kind of synthetic opioid that will only target the inflamed tissues. The theory is that the drug would give pain relief to the area that is injured without the side effects or potential addiction. They created an opioid that will only bind to opioid receptors in acidic areas of the body. This has been the positive outcome of tests done on rats. Results of the paper written by the Free University of Berlin found that the risk of addiction and all the unwanted side effects were alleviated. These new opioids won’t attach themselves to nerves that affect the brain and gastrointestinal tract. The new opioid is currently known as NFEPP which is just a shortened version of its chemical structure. An interesting note is that NFEPP has shown to be just as effective for pain relief as prescription fentanyl.
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Vaccines to Target Opioids in the Bloodstream
There have been many efforts to create a vaccine that could be directed at opioid molecules. Up to now, these efforts have failed since the 1970s. Any vaccine being developed would only be able to focus on one kind of opioid. The theory is that if someone took a heroin vaccine, they wouldn’t experience a high when they used the drug. Antibodies would prevent the drug, and it’s metabolites that would affect the brain, from reaching their destination. The antibody would prevent any of the euphoria and would also stop breathing from being depressed which is the main cause of opioid overdose deaths. There hasn’t been a vaccination that has worked up to this point. There is hope, however. The most advanced opioid vaccine has been designed by scientists at the Scripps Research Institute. The vaccination is for heroin and has been the first to show it can neutralize doses of heroin in monkeys without problematic side effects. The doses effectively blocked heroin’s effects for one month and provided protection for a period of more than eight months. Currently, it is only effective for heroin but with the positive outcome, the Institute wants to continue studies for other types of opioids as well as cocaine.
Transcranial Direct Current Stimulation to Treat Opioid Abuse
The process of transcranial direct current stimulation is a non-invasive means of stimulating the brain and potentially treating opioid use disorder. The process, known as tDCS, uses electrodes to send a low direct current. It was originally used to help people with major depressive disorder and brain injuries. Again, this is just a theory at this time. However, a study did show a positive outcome when using tDCS to negate full opioid use after knee arthroplasty. The postoperative pain associated with a knee arthroplasty lasts a significant amount of time. A variety of tDCS has shown to be a promising treatment for pain conditions. The hope is that is can reduce the need to prescribe opioids long term after surgery.
Changing the Way Things are Prescribed
While there is a great deal of focus on getting people addicted to opioids into recovery, it’s also a case of prevention. There needs to be a greater attention to prescribing opioids in the first place. There also needs to be better access to the drugs that can get people off opioids. Currently it’s easier to get opioids than it is to get the helpful medication to get you off them. Buprenorphine is one of those options and opioid experts believe it’s the best treatment. Monthly injection is making it easier to maintain the treatment. Currently, physicians have to complete an eight-hour training course to get permission to prescribe buprenorphine. The DEA allows doctors to prescribe buprenorphine for the treatment of opioid abuse. However, they are limited to the number of patients they can treat with the drug. There are buprenorphine risks but it is reduced in comparison to opioid addiction. Many doctors in the US don’t take out insurance so they have to fund treatment themselves to give to patients. With this in mind, there is very little access for the drug that has been proven to work best in fighting the opioid battle.
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Educating People about Buprenorphine, Methadone and Naltrexone
A study recently stated that about 60% of rural US doesn’t have a doctor who is capable of prescribing buprenorphine. These are the same areas where prescribing opioids is high because they don’t have the resources to manage pain in a holistic way. A twelve-step program is not an effective measure for those addicted to opioids. Many experts believe medication-assisted treatment is the best alternative. This is coming from the Opioid Policy Research Collaborative at Brandeis University in Massachusetts. The general public isn’t aware that buprenorphine is an effective treatment for opioid addiction. There is also methadone and naltrexone that has been FDA approved to treat opioid addiction. There have been endless tests to prove their effectiveness and safety. Of course, there should be psychosocial treatments to coincide with any of these medications for the best chance at recovery. For those who have a challenge using buprenorphine, there is methadone maintenance. The downside to it is that people have to go to a clinic every day to get treatment. Suboxone has been very helpful and is comparable to buprenorphine. The main drug people have heard about is Narcan. While it is more available, it doesn’t stop users from using or overdosing again.
The Regulation Route
While experts in the opioid field believe there should be easier access to medication-assisted treatments, they also believe that prescribing opioids should be more regulated. There is a push to have doctors become trained in how they should administer opioids. Manufacturers should also be regulated in how they market their drugs to doctors. The fundamental reason for the opioid epidemic in the first place is due to aggressive prescribing by doctors. This was a response to a deceptive marketing campaign that made no mention of addiction at the time. An outcome should become available in 2018 to ensure this doesn’t happen again. The Pharmaceutical Research and Manufacturers of America (PhRMA) are working together with the Addiction Policy Forum. The report speaks of the vision they have to address addiction in America with an 8-point plan. The overall goals are to pinpoint what gaps there are in programs already in existence. They also believe education needs to be boosted and they want to make it easier for people to connect with treatment. The organization is also looking to propose policies that will put a limit on opioid medications. They want to mandate training for the prescriber. They will also look to get rid of any barriers of insurance coverage that is currently preventing addiction treatment.
A Multifaceted Approach
Experts believe there needs to be a variety of methods in order to combat the opioid crisis. Narcan distribution should be wider. There should be more funding to prevent and treat opioid related issues. There should be a focus on keeping the deadly opioid fentanyl out of the US. Societal issues play a part in people’s vulnerability to opioid addiction as well. These are not easy issues to iron out and there is no exact solution. This is why there is the need for a multifaceted approach. With organizations working together for the common goal, hopefully we’ll see less opioid addictions and overdose deaths for 2018.