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BETHESDA, MARYLAND – 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 sight of the drug she had fought for.
Government scientists are beginning to take a look at the brains of people suffering from the opioid epidemic in the country, to see if the drugs that have been proven in the treatment of the drug addiction, such as methadone, do more than relieve cravings and withdrawal. 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-addiction drugs actually get them.
One of the reasons: "People say you're just replacing one drug with another," said Dr. Nora Volkow, director of the National Institute for Drug Abuse, who heads this study, the first of its kind. "The brain reacts differently to these heroin medications.This is not the same."
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 therapy will help damaged neural networks return to their normal state faster than they would alone. To prove it, she will need to compare brain scans of study participants, such as the woman who stopped heroin through methadone, with active heroin users and people in the beginning. treatment.
"Can we recover completely? I do not know," Volkow said. 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 failure," said Dr. Jody Glance, an addiction specialist at the University of Pittsburgh Medical Center, who hopes that brain scans done by NIDA will help overcome some of the difficulties encountered. barriers and improve the response of public health 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, let's do it again. "
This is the reward system of the brain, and opioids can hijack it by triggering a larger dopamine surge than ever before. 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.
Test how addiction drugs 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 focused on the "signals" badociated with drug use – such as seeing a heroin picture – or does it begin to respond to stimuli? normal like the sight of a cupcake?
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 it for granted that people are thinking of the future, not when you're addicted."
As in any disease, each drug may be more effective 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 strong urge. People can use them for years. Naltrexone, on the other hand, blocks all the effects of opioids.
It's a hard sell
The Volkow team looked at more than 400 people who expressed interest in the study, but found only about 30 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 worth looking for such rare volunteers if the before-after scans ended up revealing brains of really different appearance when people were being treated.
"You should be able to see it with your eyes, without being an expert," she said.
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