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BETHESDA, MD (AP) – Lying in a scanner, the patient watched the images appear one by one: a bicycle. A small cake. Heroin. Outside, researchers followed the reactions of her brain to the surprise of the drug she had fought.
Government scientists are beginning to take a look at the brains of the victims of the opioid epidemic in the country, to see if the drugs that have been proven in the treatment of drug addiction, such as the methadone, do more than relieve cravings and weaning. Do they also cure a brain damaged by addiction? And which one works best for which patient?
These are fundamental questions, given that too few of the 2 million opioid users who need anti-dependence drugs actually benefit from it.
One of the reasons: "People say you are just changing one drug for another," said Dr. Nora Volkow, director of the National Institute for Drug Abuse, who is leading this study, the first of its kind . "The brain reacts differently to these drugs with heroin. It's not the same thing. "
Science has clearly shown that three drugs – methadone, buprenorphine and naltrexone extended release – can effectively treat what specialists prefer to call opioid use disorder. Patients who consume methadone or buprenorphine in particular halve their chances of dying, according to a report from the National Academies of Science, Engineering and Medicine that explored ways to overcome barriers to these care.
Opioid addiction modifies the brain so that even when people who quit smoking can make them vulnerable in the event of a relapse, researchers believe that these changes are mitigated by long-term abstinence.
Volkow's Theory: Drug treatment will help these damaged neural networks return to their normal state faster than they would alone. To prove it, she will have to compare the brain scans of the study participants, such as the woman who stopped heroin with methadone, the active heroin users and the people who started treatment.
"Can we recover completely? I do not know, "said Volkow. But with drugs, "you create stability" in the brain, she said. And it helps to repackage it so that it meets the daily pleasures.
The challenge now is to find enough healthy and ready people to brainstorm for science, while struggling to quit smoking.
Addiction is a brain disease, "not a choice, not a personality defect, not a moral defect," said Dr. Jody Glance, an addiction specialist at the University of Pittsburgh Medical Center, who hopes that NIDA's brain scans will help overcome some of the barriers and improve the public health response to the opioid crisis.
Do not offer the drugs to someone who needs it, "it's like not offering insulin to someone with diabetes," she said.
HOW OPIOIDS CHANGE THE BRAIN
When you feel something nice – a special song, the touch of a loved one, a food like Volkow's favorite chocolate – the brain releases a natural chemical called dopamine that basically causes the body to get itself remember: "I liked that, remake it. "
This is the reward system of the brain, and opioids can divert it by triggering a surge of dopamine greater than ever. The repeated use of opioids overloads the circuits of several brain regions, including those involved in learning and memory, emotions, judgment and self-control. At the same time, the brain gradually releases less dopamine in response to other things that the person had previously found enjoyable. In the end, they are more interested in getting medication so that they do not become hyperactive, but to avoid feeling constantly weak.
TESTS HOW DRUG MEDICINE HELPS HELP
Volkow aims to test 80 people, a mix of untreated heroin addicts and patients using different drug-based treatments, using brain scans at the National Institutes of Health's research hospital. His team is measuring differences in the brain's ability to release dopamine as treatment progresses, and how other neural networks work in response when study participants perform various tasks.
For example, does a patient's brain remain obsessed with the "signals" associated with drug use – such as seeing a photo of heroin – or does it react back to normal stimuli such as vision? 'A small cake?
Another test: Ask if a patient would accept an offer of $ 50 now or $ 100 if he could wait a week, checking the degree of motivation and self-control he can muster.
"You must be able to prevent the urge to get something" to recover, noted Volkow. "We take for granted that people think of the future. Not when you're addicted. "
As with any disease, every drug can work better in some people – because everyone's brain circuits do not respond in exactly the same way to opioid use – but this has not been studied. Volkow thinks that buprenorphine will improve mood and emotional responses to addiction better than methadone, for example, because of subtle differences in the functioning of each drug. She particularly wants to test people who relapse, to try to detect differences in treatment.
Methadone and buprenorphine are weak opioids, which explains the bad perception that they substitute one addiction for another. In a slightly different way, they stimulate the dopaminergic system more moderately than other opioids, leveling the jolts so that there is no high desire. People can use them for years. Naltrexone, on the other hand, blocks all the effects of opioids.
IT'S A DIFFICULT SALE
The Volkow team looked at more than 400 people who showed interest in the study, but found only three dozen qualified potential candidates, seven of whom have registered so far.
The main problem is that study participants should have no other health problems that may affect the chemistry or function of the brain. This excludes people who use drugs such as antidepressants and those who suffer from various health problems, such as high blood pressure or diabetes.
Volkow said it was worthwhile looking for such rare volunteers if the before-after scans ended up showing really different brains as people were treated.
"You should be able to see it with your eyes, without being an expert," she said.
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