5 takeaways:
➀ Three lines of research offer promise for developing more effective medicines to treat opioid addiction. Methadone, which was introduced in 1964, has saved millions of lives, but better treatments are not far off, said Dr. Yasmin Hurd, director of the Addiction Institute within the Mount Sinai Behavioral Health System in New York. The new research goes beyond the longtime study of opioid pain receptors in the brain, known as the mu receptor. Now researchers are applying lessons from molecular studies of the brain, neuroimaging and studies on Alzheimer’s disease and cancer to better understand the neurobiology of addition. Two of the lines of research focus on so-called epigenetic changes to the brain, meaning changes in how DNA is turned on and off in response to environmental stimuli. “There’s a significant difference in that gene expression pattern in heroin users as compared to control,” Hurd said. The third strand of research involves use of cannabinoids to treat addiction.
➁ Some research targets a gene called FYN. “The most significant epigenetic change in people that died of a heroin overdose was a gene called FYN,” Hurd explained. Medications being developed for neurodegenerative disorders like Alzheimer’s target the FYN gene and its inhibitors. When lab animals are allowed to self-administer heroin but are also given an FYN inhibitor, they take less heroin. Researchers are working on developing medicines that reduce cravings for opioids in humans, without disrupting other impulses, such as the desire for food. FYN inhibitor is also being study for alcohol use disorder, Hurd said.
➂ Cannabidiol or CBD — but not marijuana — shows promise for addiction treatment. Marijuana contains more than 140 active substances in addition to the THC that makes users high. CBD is the most promising because it decreases anxiety in substance-use disorder patients without THC’s negative effects on short-term memory, judgment and motor coordination, Hurd said. In animals, CBD decreased heroin-seeking behavior. This matters because “it’s the craving, it’s the anxiety that triggers the relapse,” Hurd said. CBD reduced patients’ stress hormone levels, heart rate and anxiety, whereas THC often exacerbates anxiety. THC use in male animals produces changes that appear to increase propensity to use heroin, and these changes are inherited by their offspring into the third generation. “It’s really important that people understand that cannabis by itself is not the cure for opioid addiction,” Hurd said.
➃ Clinical trials are pairing CBD with methadone or buprenorphine. In clinical trials, methadone did not reduce drug-seeking behavior driven by environmental cues, but CBD together with methadone did. Researchers think a combination might help patients who need to stay on methadone get by with lower doses.
➄ Researchers use pharmaceutical-grade CBD. Don’t try this at home. People should not trust CBD purchased on the internet, which in some cases has been found to be laced with THC, lead and microorganisms, Hurd said. At the moment, CBD is only approved by the Food and Drug Administration for use in epilepsy. But doctors may begin prescribing it off-label as evidence accumulates about safety, efficacy, and dosage.
Speaker: Dr. Yasmin Hurd, Director, Addiction Institute at Mount Sinai; Professor, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai
This program was funded by the American Society for Addiction Medicine with support from Arnold Ventures. NPF is solely responsible for the content.
