Government scientists are beginning to look at the brains of people trapped in the nation's opioid epidemic, to see if medications that try to treat addiction, such as methadone, only relieve desires and withdrawal . Are they cured a brain damaged by addiction? And what works best for which patient?
These are fundamental questions given that too few of the 2 million opioid users who need addiction medications actually receive it.
One of the reasons: "People say that they are changing one drug for another," said Dr. Nora Volkow, director of the National Institute on the Consumption of Drugs, who directs this first study. "The brain responds differently to these drugs than to heroin. It is not the same".
Science has made it clear that three medications (methadone, buprenorphine and naltrexone with prolonged release) can effectively deal with what specialists prefer to call opiate use disorders. According to a report from the National Academies of Sciences, Engineering and Medicine, patients who fit methadone or buprenorphine in particular reduce their chances of death in half.
Addiction to opioids changes the brain in ways that even when people stop leaving them vulnerable to relapse, the changes that researchers believe will diminish with long-term abstinence.
Volkow's theory: medication-based treatment will help damaged neuronal networks begin to return to normal times faster than going alone. To demonstrate this, you must compare the brain scans of the participants in the study as the woman who left the heroin thanks to methadone with users of active heroin and with people who are in initial stages of treatment.
"Can we recover completely? I do not know," Volkow said. But with the medications, "you are creating stability" in the brain, he said. And this helps to return to respond to everyday pleasures.
Now the challenge is to find people sufficiently willing and sufficiently healthy to be able to scan the brain while fighting to quit smoking.
Addiction is a brain disease, "it is not a choice, not a defect of personality, not a moral defect," said Dr. Jody Glance, an addiction specialist at the University of Pittsburgh Medical Center, who expects NIDA brain scans to overcome some of the barriers and improve the public health response to the opioid crisis.
Not offering medications to someone who needs them "it's like not offering insulin to someone with diabetes," he said.
HOW OPIOIDS CHANGE THE BRAIN
When you feel something nice, a special song, the touch of a loved one, a meal like Volkow's favorite chocolate, the brain releases a natural chemical called dopamine, which essentially trains the body to remember it. "
This is the reward system for the brain, and opioids can kidnap it by triggering a greater dopamine increase than nature could ever do. Repeated uses of opioids overload circuits in multiple regions of the brain, including those involved in learning and memory, emotion, judgment and self-control. At the same time, the brain gradually releases less dopamine as a response to other things that the person found once pleasant. Finally, they are looking for more medication because they are not tall, but to avoid feeling constantly low.
TESTS AS A SUPPORT OF ADDITIONAL MEDICINE
Volkow aims to test 80 people, a mixture of untreated heroin users and patients using different medication-based treatments, within the brain scanners of the National Institutes of Health research hospital. Your team measures brain capacity differences to release dopamine as treatment progresses, and how the functioning of other neuronal networks changes to respond as study participants perform various tasks .
For example, a patient's brain is still set to "signals" related to the use of drugs, such as seeing an image of heroin or starting to react again with normal stimuli such as the sight of a cupcake?
Another test: ask if a patient would take an offer of $ 50 now, or $ 100 if they could wait a week, checking how much motivation and self-control they can gather.
"You need to be able to inhibit the need to recover," Volkow said. "We take for granted that people think of the future. Not when you are addicted."
As in any illness, each medication can work better for certain people, since brain circuits do not react in exactly the same way as opioid mistreatment, but this has not been studied. Volkow suspects that buprenorphine will improve the atmosphere and emotional responses to addiction better than methadone, for example, due to subtle differences in the functioning of each medication. Above all, he wants to try the people who fall for, to try to detect any difference in treatment.
Methadone and buprenorphine are weak opioids, the reason for misperception that they substitute for addiction on the other. In slightly different ways, they stimulate the dopamine system more gently than other opioids, leveling the tears, so that there is no high spirits and less. People can use them for years. In contrast, naltrexone blocks any opioid effect.
IT IS A LONG SELL
The Volkow team has selected more than 400 people who expressed interest in the study, but only found three dozen possible candidates, seven of whom have been enrolled so far.
The main problem: the participants in the study should not have any other health problems that may affect the chemistry or the functioning of the brain. This excludes people who use drugs such as antidepressants and those who have a number of illnesses such as high blood pressure or diabetes.
Volkow said it is worth fighting to find such a rare volunteer if the previous and later explorations end up displaying really different brains as they are treated.
"You should be able to see it with your eyes, without having to be an expert," he said.