Faye Flam at fflam1@bloomberg.nethttps://www.bloomberg.com/view/articles/2017-07-21/neuroscience-offers-insights-into-the-opioid-epidemic
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Addiction changes the brain in lasting ways, and some brains are more vulnerable than others.
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 has 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 a still-enormous 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 currently 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 last month 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 in order 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 teens. 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 — is 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 policy makers take a more evidence-based approach to mental health issues, including addiction.
What is clear is that current drug policies in the U.S. aren’t working to stem the tide of opioid addiction. While rates of prescription 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.
Comment;
The all-important pre-frontal cortex and genetic underpinnings of the disease of addiction, we’re learning so much, have so far to go–especially in terms of law, insurance coverage and other areas.
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