Addressing Opioid Addiction

Dr. Joanna Fowler's work has helped the scientific world understand and address opioid addiction.

The sharp tip of a metal syringe disappears into the cushion of her pale flesh, dumping its contents into veins flecked with scars that tell a story of past transgressions.

With a tingle, this brown elixir ignites a wave of euphoria – a feeling of warmth, safety and blissful apathy.

After a while, the high wears off. The next time, she’ll demand more of this liquid ecstasy to feed an insatiable craving.

This perilous cycle called addiction often leads to drug overdoses, a major cause of accidental deaths in the United States.

About 6 in 10 drug overdose deaths involve opioids, a subset of controlled substances ranging from heroin to prescription painkillers routinely prescribed by doctors.

Since 1999, the number of opioid overdose deaths in the U.S. has nearly quadrupled, with 78 people dying each day, according to the Centers for Disease Control and Prevention.

“Today, we are seeing more people killed because of opioid overdose than traffic accidents,” President Barack Obama said at the National Rx Drug Abuse and Heroin Summit in Atlanta.

The statistic is the focus of both White House and Congressional initiatives aimed at helping more addicts receive treatment.

Such programs were largely unheard of decades ago when substance abuse carried a different stigma.

Back then, these people – these “junkies” – were often denigrated by society, dismissed for moral weakness or lack of self-control.

The late 80s, however, marked a turning point in the understanding of addiction.

A team of researchers – including 2008 National Medal of Science recipient Joanna Fowler – were able to scientifically demonstrate the physical and chemical changes to the brain caused by repetitive drug use.

“We’ve shown that the addicted brain is really different than the brain of a non-addicted individual,” said Fowler. “This is a disease of the brain that should be treated much like any other chronic relapsing illness.

Early in her career, Fowler and her team at Brookhaven National Laboratory synthesized flurodeoxyglucose (FDG), a radioactive drug that flocks to tissues, like the brain, which use glucose for energy.

The molecule, which celebrated its 40th anniversary this year, is injected during positron emission tomography, called “PET scans,” to perform studies on the brain.

As FDG gets broken down by the body, the process emits gammas rays that can be detected by the scanner, which develops a three-dimensional image.

Later, Fowler teamed up with Nora Volkow, a psychiatrist with an interest in addiction who began using PET scans on cocaine abusers.

Dr. Fowler and her team.

“They had holes in their brains with big areas of no bloodflow similar to what you’d see in a stroke victim,” Fowler said. “We wanted to understand why people take drugs.”

The team also investigated the possibility that some people, by way of biological predisposition, are more likely to get addicted.

Research shows that drug abusers have lower levels of dopamine receptors.

These parts of the cell bind to dopamine, a chemical associated with feelings of pleasure, and transmit signals to the brain.

Low dopamine receptors, Fowler said, signifies an “under-stimulated reward system.”

“They’re not feeling the same amount of reward for natural reinforcers like food and sex and normal things people get excited about,” she said. “This leads to poor judgement and the inability to control behavior.”

Since then, scientists have begun to explore the role genetics might play in making someone vulnerable to substance abuse.

“It’s probably not just one gene,” said Fowler, who retired from Brookhaven in 2014. “There are a lot of factors. It’s social, it’s familial. It’s your neighborhood. It’s the drug availability. It’s a fascinating problem but hugely complex.”

Unlike other drugs – sometimes limited by classist boundaries – opioid abuse spans the hierarchy of society, from the person who buys low quality “black tar” off the street to the CEO who gets hooked on Vicodin pills.

A November 2015 study published in the Proceedings of the National Academy of Sciences says that overdoses from prescription opioids is contributing to the rising death rate of middle-aged white Americans – many in rural areas and suburbs.

“So many people are dying. It’s not just poor people who are dying,” Fowler said. “Now it’s reached across the population.”

Dr. Fowler's work has opened the doors to a deep understanding of opioid addiction and it's affects on Brain Chemistry.

This, in part, is arguably responsible for the wave of addiction-quashing policy push, led by President Barack Obama in the twilight of his final term.

The initiative, centers largely around the anti-addiction drug buprenorphine, used to suppress cravings in treatment.

Previously, buprenorphine, an opioid itself, could only be prescribed to 100 patients per year by a properly credentialed doctor.

The Department of Health and Human Services is increasing that limit to 275.

A division of the National Institutes of Health, the National Institute on Drug Abuse – where Volkow now serves as director – has launched educational efforts and new studies to explore the science of addiction.

In addition, the White House is calling for $1.1 billion in new funding to be allocated for states to make the treatment more readily available.

In July, Congress passed the Comprehensive Addiction and Recovery Act, which allows the government to award grants to states for treating people addicted to opioids.

It also allows physician assistants and nurse practitioners to prescribe the drug buprenorphine, used to combat cravings.

“Everybody is worried,” Fowler said. “People are worried about their kids, all the drug overdoses in their community. These kids don’t know how dangerous these drugs are.”

Opiates can slow your breathing to fatal levels, she said, adding that a little education could go a long way in the battle to fight opioid – or any – drug addiction.

“When you take something from the street, you don’t know how strong it is,” Fowler said. “It’s so important that people realize these are extremely dangerous drugs.”