Addressing the Opioid Epidemic in North America with Nobel Prize winning Innovation!

I would like to dedicate this blogpost to our fearless Doctors, Clinicians, Nurses, Technicians and First Responders in the US of A and across the World, as they put their health and their lives at risk to heal and save the rest of us, in the days and weeks ahead – God bless them!

Context:

American Researchers Dr. David Julius and Dr. Ardem Patapoutian from California were awarded the Nobel Prize for Medicine for their path breaking work on the development of Non-Opioid painkillers, with immense promise for combating the epidemic.

The Opioid Epidemic in North American is a catastrophe!

The United States is in the throes of an unprecedented opioid epidemic with more than 2 million Americans who have become addicted and abuse prescription pain pills and similar drugs available on the street. The word “opioid” is derived from “opium”.

What are Opioids and why are they so addictive?

Opioids are drugs formulated to reduce pain like opium. These include both legal painkillers like morphine, hydrocodone and oxycodone usually prescribed by physicians for acute or chronic pain, as well as illegally produced drugs sold on the street like heroin and illicitly manufactured fentanyl.

Prescription and illegal opioids are abused extensively because they are so addictive. Opioid medications and drugs bind to the pain and emotion controlling areas of the brain, triggering levels of serotonin and dopamine, culminating in a feeling of utter euphoria. Excessive use of overdose (OD) of these dangerous substances leads to death.

During 2016,?there were more than?63,600?overdose deaths in the US,?including?42,249?that involved an opioid (66.4%).?That's an average of 115 opioid overdose deaths each day. Recently released?data by the CDC?show that drug overdose deaths reached a record high of 93,331 in 2020 [Ref 1]! While these estimates are not final, this is more than 20,000 deaths above the previous high in 2019 and the largest single-year percentage increase on record since 1999! It is evident that the COVID-19 pandemic and the isolation and mental health issues this has triggered, has significantly exacerbated the Opioid epidemic as well.

The Centers for Disease Control and Prevention (CDC) estimates that?the total "economic burden"?of prescription opioid misuse alone in the United States is over?$ 78.5 billion?a year,?including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement [Ref 2]. While the US has the largest Opioid abuse epidemic amongst developed nations, Canada follows the US in terms of consumption of opioids in doses per million people per day!

What is the impact of the 2021 Nobel Prize for Medicine on combating the Opioid Epidemic?

The 2021 Nobel Prize for Medicine has been awarded for the development of Alternatives to Opioids (ALTOS) as viable painkillers to address this Crisis.

The Nobel Prize for Medicine was recently awarded jointly to Dr. David Julius and Dr. Ardem Patapoutian, two American scientists from California, whose work identifying how people sense heat, cold, touch and their own bodily movements has opened the door to the development of non-opioid painkillers [Ref 3].

Dr. David Julius, a professor of physiology at the University of California, San Francisco (UCSF), Capsaicin, used a key ingredient in hot chili peppers to identify a protein on nerve cells that responds to uncomfortably hot temperatures.

Dr. David Julius at his lab at the University of California San Francisco (UCSF). Image courtesy: UCSF.

A biochemist and molecular biologist, Dr. Julius’s work has focused on how our bodies sense heat, cold, and chemical irritants, leading to new insights about the fundamental nature of pain and new targets for pain therapy, especially the development of alternatives to opioids.

To understand how signals responsible for temperature and pain sensation are transmitted by neural circuits to the brain, Julius and his UCSF laboratory have taken advantage of a variety of noxious substances produced by animals and plants – including toxins from tarantulas and coral snakes; capsaicin, the molecule that produces the “heat” in chili peppers; and the chemicals underlying the pungency of horseradish and wasabi.

Guided by studies of how these natural products and other compounds trigger sensations of heat, cold, and pain, Dr. Julius has focused on a class of proteins called TRP (pronounced “trip”) ion channels as key players in the nervous system’s pain-signaling apparatus. One indication of the importance of this work to medicine is the intense interest in TRP channels by the pharmaceutical industry as potential targets for new painkillers [Ref 4].

Dr. Ardem Patapoutian, a molecular biologist at Scripps Research in La Jolla, California, led a team that, in poking individual cells with a tiny pipette, identified a receptor that responds to pressure, touch and the positioning of body parts.

Dr. Ardem Patapoutian from the Scripps Institute. Image courtesy: The Scripps Institute.

Dr. Patapoutian and his colleagues identified pressure-sensitive ion channels known as Piezo1 and Piezo2—specialized protein molecules embedded in the membranes of some cells that enable them to transmit signals in response to touch or pressure. To find them, the researchers methodically deactivated individual genes in pressure-sensitive cells until they found ones that instruct the cells to make these ion channels, turning off the cells’ ability to respond to touch. Then they inserted those genes into cells that were not sensitive to touch and showed that the cells had gained this sensitivity. [Ref 5]

Why is this Nobel Prize winning research significant for combating the Opioid epidemic?

“This knowledge is being used to develop treatments for a wide range of disease conditions, including chronic pain,”?the Nobel committee said in a news release.

The pair made breakthrough discoveries that began intense research activities that in turn led to a rapid increase in our understanding of how our nervous system senses heat, cold and mechanical stimuli. The laureates identified critical missing links in our understanding of the complex interplay between our senses and the environment.

This research is significant since this will potentially culminate in the development of alternatives to opioids (ALTOS) as pain-killers that are non-addictive and will lead to thousands of lives saved that would otherwise be lost! This is a significant step forward in our battle against the proliferation of opioids and holds immense promise in combating this precarious epidemic, taking its toll on tens of thousands of Americans annually [Ref 6].

As always, I welcome your comments on this blogpost and via twitter at @HITstrategy – please stay safe and blessed!

REFERENCES

?1.???‘The Drug Overdose Toll in 2020 and near-term actions for addressing it’, Blogpost by Jesse C Baumgartner and David C. Radley, The Commonwealth Fund, August 16th, 2021. <https://www.commonwealthfund.org/blog/2021/drug-overdose-toll-2020-and-near-term-actions-addressing-it>

2.?????‘Drug Overdose Deaths in the United States, 1999-2016, Centers for Disease Control and Prevention (CDC), NCHS Data Brief # 294, December 2017. <https://www.cdc.gov/nchs/products/databriefs/db294.htm?>

3.????Press Release: The Nobel Prize in Physiology or Medicine 2021, The Nobel Prize Committee, October 4th, 2021, Sweden. <https://www.nobelprize.org/prizes/medicine/2021/press-release/>

4.????‘David Julius wins Nobel Prize for Work on Pain Sensation’, Kristen Bole, in the University of California San Francisco Campus News, October 4th, 2021. <https://www.ucsf.edu/news/2021/09/421481/david-julius-wins-nobel-prize-work-pain-sensation>

5.????‘Scripss Research neuroscientist Ardem Patapoutian receives 2021 Nobel Prize fdor Physiology’, Scripss Research, October 4th, 2021 <https://www.scripps.edu/news-and-events/press-room/2021/20211004-ardem-patapoutian-wins-nobel-prize-in-medicine.html>

6.????‘Nobel Prize awarded for research about Temperature and Touch’, Benjamin Mueller, Marc Santora and Cora Engelbrecht, October 4th, 2021 in the New York Times. <https://www.nytimes.com/2021/10/04/health/nobel-prize-medicine-physiology-temperature-touch.html>?