Opioid Symposium: Patients Under-Detected, Under-Treated, Says NIDA Speaker

On Nov. 27, attendees filled Kresge auditorium at the University of Cincinnati (UC) College of Medicine to hear from a variety of speakers about the opioid crisis, from local, regional and national perspectives. Betty Tai, PhD, director of the Center for Clinical Trials Network for the National Institute on Drug Abuse (NIDA), presented the keynote, which addressed NIDA’s perspective on the "Collision of Pain and Opioid Epidemics” and its challenges and possible solutions.

Tai explained that most drugs affect the brain's "reward circuit" by flooding it with dopamine. This reward system controls the body's ability to feel pleasure and motivates a person to repeat behaviors such as eating and spending time with loved ones. However, overstimulation of the reward circuit causes the intensely pleasurable "high" that can lead people incapable to quit a drug.  

"As a person continues to use drugs, the overly stimulated brain makes less of dopamine and diminishes the ability of cells in the reward circuit to respond to it,” she says. "This is the effect known as tolerance. Tolerance gives the need to take more and more of drugs to achieve the same dopamine high. The obsessiveness of getting more drugs cause them to get less pleasure from other things they once enjoyed, like food or social activities. Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.”

Another statistic Tai shared is that while drug poisoning deaths (i.e. overdoses) have increased across the U.S., Ohio and Kentucky have two of the highest rates, and the fentanyl-related deaths are beginning to rapidly surpass deaths by opioids or heroin, per 2016 data. 

The National Institutes of Health Opioid Research Initiative uses research to end the opioid crisis through a tripartite focused approach to pain management, opioid addiction treatment and overdose reversal. NIDA is studying safe, more effective strategies for pain management, whether it’s looking at cannabinoids or non-pharmacological treatments like neural stimulation or meditation. 

Tai emphasized that opioid patients are grossly under-detected and under-treated. Medication-assisted treatment (MAT) is evidence-based but is far too underutilized.

In summary, she posed some of the challenges we as a nation face in the opioid epidemic:

• 25.5 million adults have pain every day. 
• Opioids are overprescribed, often not effective for chronic pain.
• More than 2.4 million Americans are addicted to opioids, most started with prescription medicines.
• Medication Assisted Treatment (MAT), including treatment with methadone, buprenorphine and extended-release naltrexone, is available for the treatment of opioid use disorder. 
• But MATs are drastically underutilized.

She ended her talk with a final startling statistic: there are more than 20 million Americans age 12 and older who are dependent on alcohol or drugs; however, only 19 percent of them (3.8 million) had sought some form of treatment in the last year. 

A video of Tai's speech is available here, followed by other presenters providing a variety of perspectives on the opioid crisis both locally and nationally, including:

Tracy Plouck, Ohio Department of Mental Health and Addiction Services;

Denise Driehaus, Hamilton County Commissioner;  

Theresa Winhusen, PhD, professor and vice chair, Division of Addiction Sciences, Department of Psychiatry and Behavioral Neuroscience (begins at 50 minute mark in video.)

Christine Wilder, MD, assistant professor and medical director, Division of Addiction Sciences, Department of Psychiatry and Behavioral Neuroscience (begins at 1:08 in video).

Scott Wexelblatt, MD, associate professor, Department of Pediatrics and physician, Cincinnati Children’s Hospital Medical Center (begins at 1:24:34 in video).

Jennifer Brown, PhD, associate professor, Division of Addiction Sciences, Department of Psychiatry and Behavioral Neuroscience (begins at 1:34:48 in video).

George Smulian, MD, professor and director, Division of Infectious Diseases, Department of Internal Medicine (begins at 1:44 in video).

Michael Lyons, MD, associate professor, Department of Emergency Medicine (begins at 1:52 in video).

Other symposium presenters included Lisa Roberts, of the Portsmouth City Health Department, presenting innovative approaches in Scioto County (at 1:58:10 in video) and the co-chairs of the UC/ UC Health Opioid Task Force, who spoke briefly about efforts addressing the opioid crisis across the university and the health care system in the areas of clinical research, education, practice and treatment. 

The Center for Clinical and Translational Science and Training (CCTST) and the National Drug Abuse Treatment Clinical Trials Network Ohio Valley Node sponsored the event.

Community Meetings Cap NIDA Visit 

Tai and Geoff Laredo, a senior staff member also with NIDA, spent a second day in Cincinnati meeting with District 3 Cincinnati Police and representatives from Talbert House to discuss the quick response team (QRT) and join a short ride along. The QRT visits homes and families of overdose victims, hoping to prevent a future, even fatal overdose. That same morning, they attended a centering group with Wilder  at the UC Health Perinatal Addiction Clinic and toured a new facility at the Center for Addiction Treatment with director Sandi Kuehn. Tai and Laredo also had an opportunity to talk with patients in treatment in UC Health’s methadone, intensive outpatient and perinatal treatment programs. 

Winhusen appreciated the NIDA team’s focus on MAT, and there seemed to be consensus to build strategies for increasing MAT engagement. "Research suggests that inaccurate, negative beliefs about MAT are an important barrier to MAT engagement,” she says. "We are developing interventions designed to correct these beliefs and are currently conducting a NIDA-funded clinical trial testing one such intervention to improve MAT-engagement in individuals who have recently survived an opioid overdose.”