Why the Resistance to Addiction Meds?
(page 2)Willenbring is a proponent of the long-term use of opiates to treat addiction—possibly even lifelong (if no serious side effects get in the way or if science delivers a new breakthrough). For many people, Willenbring says, it’s a matter of “once you develop dependence, it’s there for life.” That means Suboxone, buprenorphine, and methadone may be the only chemical shield between an addict and relapse. Without the presence of opiate replacements, death rates shoot up to about 50% in severe addicts—mostly from overdoses. Not giving a severe opiate addict meds is “like telling a diabetic to go to a support group,” Willenbring says. When you have an insulin deficiency, a thyroid deficiency, what do you do? You replace it. Sometimes for life. And today that’s the answer so far for managing a chronic lifelong opiate deficiency.
Which isn’t to say, it’s a perfect answer. Maintaining opiate replacement therapy in the long run usually means taking a daily dose in pill form. And that means entirely likely events—like a missed pill, a forgotten prescription refill, or a lost vial—can be the thin line between a patient and a deadly relapse. And for some addicts, the sheer plausibility of forgetting to take a pill would be excuse enough to use again. While this only rarely occurs in the case of Suboxone or methadone because you would quickly go into withdrawal, for anti-alcoholism drugs, daily adherence is a high bar, so to speak. (Desire for a new way of life? Meet the cunning and baffling addicted brain.) Imagine staying on top of that for the rest of your days.
One new drug, Vivitrol, an injection of naltrexone that lasts 30 days, both eases the daily pressure to take one’s meds and ups the ante on the necessity to remember to do so in awkward 30-day increments. It’s a variation on a theme; not a new story.
“Industry has pulled back from investing in these medicines because new science isn’t there.”
As for real, new exciting scientific breakthroughs, don’t hold your breath. The science has slowed down—both in the private sector and in government. This is at least in part due to high hopes for watersheds in brain-imaging science and the human genome—innovations that would explode the science of addiction!—that never quite panned out. According to Willenbring, unraveling the genome—let alone divining helpful solutions to mental diseases like addiction—proved to be spectacularly more complex than scientists first appreciated. (Remember when we were going to decode the human genome in a decade?) Conversely, brain imaging, says Willenbring has been “grossly oversold.” All of those “very seductive pictures” of brains reveal something a bit more ho-hum: When “thinking changes, the brain changes.” Willenbring calls brain imaging the new phrenology.
So, all of the excitement many of us have heard about vaccines for addiction has tapered off. “Industry has pulled back from investing in these medicines because new science isn’t there,” says Willenbring. That’s why there are a lot of useful tweaks of existing drugs—such as Vivitrol or Suboxone—but nothing like a game-changer. “We need more investments,” says Willenbring. “Otherwise we’ll continue to see a bunch of these ‘me too’ drugs.” We can only hope that this dry drug pipeline does not persist as long as it has for the treatment of depression and related mental health problems, which has seen only variations in the Prozac-type class of antidepressants for three decades. Willenbring says that, in his view, the most promising place to look for an addiction advance is in drugs that affect stress-response systems.
Until then—or until some other “next big thing"—three things are certain. One is that, as Willenbring says, “The more we learn, the more complicated it gets.” Another is that the potential market for a cure—tens of millions of people—is only growing. And the third? The deep resistance of many in the recovery community to the medical treatment of addiction will do nothing to bring new and better drugs out of the lab and into the brains of the people who need them.
Sacha Z. Scoblic is the science writer at The Fix, the author of Unwasted and a Carter fellow for mental health journalism.