The spiral of opioid addictions and overdoses is unrelenting. But there are bright spots all across the country: Men and women working in classrooms and courtrooms, in private labs and public offices, in clinics and on the street — all trying to find the next big way to save lives.
STAT has identified 12 potential game changers that could begin to bend the curve of the opioid epidemic. Some of these are experimental ideas, not yet subjected to rigorous clinical trials or peer review. But they’re intriguing enough that public health experts and addiction counselors are eager to learn more.
THE SCIENTIST: Gary Matyas
Chemist Gary Matyas is working on a vaccine to help heroin users stay off the drug. It works, at least in theory, by tricking the immune system into thinking the heroin is a foreign invader. The system then releases antibodies that attack the heroin, blocking it from getting into the brain. That makes it much harder to get high, which (again, in theory) can help break the cycle of craving and withdrawal. “It gives a window to an addict who wants to overcome addiction,” said Matyas, a chemist at the Walter Reed Army Institute of Research in Maryland. One shortcoming: The vaccine is specific to heroin, so recovering drug users would still need access to medication-assisted treatment to combat cravings for other opioids. Kim Janda, a chemist at the Scripps Research Institute in California, is developing a similar vaccine for heroin, as well as vaccines for various synthetic opioids. Both chemists have seen early success in animal testing, and both believe their findings could lead to a clinical trial within two years. All they need is the money — they’re each trying to find up to $5 million — to get such trials off the ground.
THE COMMISSIONER: Dr. Leana Wen
More than 600 drug users died in Baltimore last year. It could have been far worse. Since taking office in 2015, Health Commissioner Dr. Leana Wen has issued a blanket naloxone prescription so that all Baltimore residents trained in using the overdose antidote can get it. Her department has also trained 20,000 residents to revive overdose victims. And she’s launched awareness campaigns that reflect urgency of the crisis (one is aptly named “Don’t Die”). An emergency physician, Wen discusses opioids with doctors on grand rounds and is pushing for programs like a 24/7 emergency center to get drug users into treatment in their exact time of need. Focused as she is on solutions, she’s also unafraid to speak truth about the crisis in her majority-black city. “We have to be honest about structural racism: The reason why this is suddenly a national crisis is white people dying in suburban and rural areas,” Wen said. “There’s been a sea change in seeing addiction as a disease, but this is not new for us in Baltimore.”
THE INTERVENTION: Public naloxone boxes
Dr. Geoff Capraro has seen far too many preventable overdose deaths in Rhode Island. He wondered why the antidote naloxone isn’t more readily available in public places — like cardiac defibrillators. So Capraro, an assistant professor of emergency medicine at Brown University, is taking action. He’s installing nearly 50 naloxone boxes at community organizations and treatment centers in Providence. “The biggest impact will be the message,” Capraro said. “This gives a bystander the best chance to save their neighbor.” The city of Cambridge, Mass., is testing a similar idea, with locked, temperature-controlled boxes that could be set up outdoors. Bystanders who see an overdose in progress would call 911, receive a code to unlock the box, and revive the victim. First responders would follow right behind. “This is a surrogate for EMS,” said Dr. Scott Weiner, an emergency room physician at Brigham and Women’s Hospital in Boston. “But we don’t want to replace EMS. It’s a highly teachable moment.”
THE PROSECUTOR: Eric Schneiderman
Insurers are one of the biggest roadblocks to getting addiction treatment. Eric Schneiderman, New York’s attorney general, wants to change that. He successfully pressured insurance giants Cigna and Anthem to end requirements that doctors obtain “prior authorization” before getting patients into medication-assisted treatment. The process often took days — during which people hoping to quit drugs fell back into addiction. “Getting people into treatment faster, and when the window of opportunity is open, is vital to stemming the opioid addiction crisis,” Schneiderman said last year. The American Medical Association has urged other state attorneys general to fight for similar settlements. “There is no medical, policy, or other reason for payers to use prior authorization for MAT,” CEO Dr. James Madara recently wrote in a letter, “and we hope that New York’s efforts will be the first of many similar ones across the nation.”
STAT forecast: Opioids could kill nearly 500,000 in U.S. in next decade
THE CYCLE BREAKERS: PATHways
This scrappy Lexington, Ky., clinic has provided expectant mothers opioid addiction treatment alongside prenatal care since 2014. “The program gives them hope to be a mother, and to be present for their children,” said Kristin Ashford, assistant dean of research with the University of Kentucky’s nursing school. So far, more than 150 pregnant mothers have received medication-assisted treatment — something that’s hard to come by in a region lacking evidence-based options — as well as counseling and peer support. In a judgment-free environment, professionals work with mothers to reduce their risk of harming their children and give them tools to create stable homes. “We’re all fighting for the same thing,” said Jason Joy, a substance abuse counselor at PATHways, which is run by UK Healthcare. “Long-term sobriety and a shot for the next generation.”
THE EDUCATOR: Dr. Martin Klapheke
Dr. Martin Klapheke is well-aware that too many doctors overprescribe opioids for pain. His answer: revamping the curriculum at the University of Central Florida’s College of Medicine, where he’s an assistant dean. Education about opioids is now woven through the curriculum. Students learn about substance use disorders in their first year. On their pediatrics rotation, they observe the tremors, seizures, and incessant high-pitched wails of babies born with opioids in their system. They role-play talking to patients about alternative pain management. And they hear from psychiatrists about how to use medication to help patients try to break the grip of addiction. The curriculum is so well-regarded, UCF is now sharing it with eight other Florida med schools. “It’s going to take time for the culture to change,” Klapheke said. “I’m hopeful there will be a sea change.”
THE INSURER: Cigna
Last fall, insurance giant Cigna pledged to cut its customers’ opioid use by 25 percent over a three-year period. The company started with its doctors — more than 82,000 of them. They are shown reports explaining how their prescribing stacks up against their peers — and they’re encouraged to seek out advice from those peers on best practices to taper patients off painkillers. “Physicians can see how they’re doing,” said Dr. Doug Nemecek, Cigna’s chief medical officer for behavioral health. “They can take action. They can take care of patients. They can learn from each other.” Cigna is already halfway to its goal.
THE DRUG DESIGNER: Inspirion
Drug users cut, crush, and grind prescription pills hoping to get high. So the FDA has urged companies to make such abuse more difficult. This past spring, Inspirion became the first drug maker to be allowed to market an opioid’s “abuse-deterrent” properties. The company touts its immediate-release oxycodone tablet, marketed as Roxybond, as having inactive ingredients that are “more difficult to manipulate.” And even if these pills are broken, Roxybond’s “viscous material” makes it resistant to passing through a needle. Dr. Jeffrey Gudin, director of pain and palliative care at Englewood Hospital in New Jersey (who works with Inspirion), has said in a press release the tablet can “offer clinicians a new approach for treating patients in pain while also fighting against the potential for abuse.” And, with nearly 18 million patients in the U.S. alone getting oxycodone each year, more formulations of this kind are likely to follow.
THE POLICE: Ross County Post Overdose Response Team
Every Wednesday, officers and addiction specialists in this Ohio county review the past week’s overdose incidents. Then they fan out to knock on the doors of those who have overdosed. “We provide them literature and a counselor. If they want immediate help, we can link them to detox or treatment programs,” said Chillicothe Police Detective Bud Lytle. So far this year, police have visited nearly 170 homes and talked to drug users or their family members at about half of them. Ten have gone into treatment. The program has changed the way people with addiction view authorities: “Individuals are hugging us,” Lytle said. “Some people say: ‘You’re cops, you should lock people up.’ But I took an oath to do everything I can [to save lives]; we’re going to do whatever it takes, even if it’s not traditional law enforcement efforts.”
THE ACTIVIST: Gary Mendell
When Gary Mendell’s son committed suicide in 2011, amid a long struggle with the shame of addiction, the Connecticut hotel exec turned to activism. He launched a nonprofit, Shatterproof, which has pressed for state laws to increase naloxone access and provide immunity for drug users should they call 911 to report an overdose. Now comes his most ambitious effort. He’s assembled an army of health care influencers — including President Obama’s former drug czar — to evaluate dozens of addiction treatments. Armed with that information, Mendell intends to convince payers to cover evidence-based treatments for addiction just as they would cover established therapies for cancer or diabetes. “We know what should be done,” he said. “Now we have to get it done.”
THE SANCTUARIES: Drug injection sites
There are about 100 supervised-injection sites in the world. None are in the U.S. But cities like San Francisco and Seattle are trying to change that. It sounds audacious for public officials to give people a safe place to use illegal drugs. But advocates say stationing medical professionals at such sites can save people from fatal overdoses and eventually steer addicts toward treatment. Indeed, studies of such sites abroad show a reduction in overdose deaths. “Some people think it’s enabling, but it’s going to help [drug users] and surrounding neighborhoods,” said Alex Kral, an epidemiologist with the nonprofit research institute RTI International. A task force in San Francisco is currently studying the issue. Officials in the Seattle area are looking for spots to build two facilities. “Regardless of the political discomfort I think it is something we have to move forward,” Dow Constantine, the executive of King County, which includes Seattle, told reporters.
THE ADMINISTRATOR: Tracy Plouck
As head of Ohio’s mental health and addiction services department, Tracy Plouck earns nearly much as Gov. John Kasich. It’s easy to see why. A member of Kasich’s cabinet since 2011, Plouck helped unite Ohio’s state agencies behind a nearly $1 billion plan featuring an aggressive series of initiatives to combat the opioid crisis, including youth prevention programs, treatment for the incarcerated, recovery support efforts, and increased naloxone access. In a state with one of the highest fatal overdose rates, Plouck has also pushed for more funding from D.C. while touting the benefits of Medicaid expansion, which she said has connected 500,000 low-income residents to addiction and mental health treatment. The state, though, doesn’t see its role ending at treatment: Ohio recently devoted $12 million to build housing for recovering addicts in underserved areas. “This helps people who’ve completed treatment not go back to the environment where your friends are still using,” Plouck said.