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Innovative strategies crucial in opioid epidemic response

Sep. 27, 2018, 8:30 AM

by Bill Snyder

Reining in the nation’s opioid epidemic will require diverse and innovative strategies ranging from drug discovery to “policy translation,” according to speakers at a recent Vanderbilt Faculty Cutting-edge Discovery Lecture.

Stephen Patrick, MD, MPH, MS, assistant professor of Pediatrics and Health Policy in the School of Medicine and director of the Vanderbilt Center for Child Health Policy, is a national expert on neonatal abstinence syndrome (NAS), withdrawal symptoms that can occur in newborns exposed to opioids in the womb.

“We really don’t have good tools to differentiate which infants are going to develop the syndrome and which are not,” Patrick said.

Carrie Jones, PhD, and Stephen Patrick, MD, MPH, MS, delivered last week’s Flexner Discovery Lecture. (photo by Steve Green)

So he and his colleagues conducted a targeted medical review of more than 200,000 mothers and infants enrolled in the Tennessee Medicaid program.

They found that female infants and those with a lower birthweight were less likely to develop drug withdrawal, whereas those exposed to longer-acting opioids or whose mothers smoked or took other drugs during pregnancy or had hepatitis C, a marker for high-risk intravenous drug use, were at greater risk.

From these findings, the researchers developed a clinical prediction rule to help identify low-risk infants who can be safely discharged early with appropriate support.

Another multi-faceted, family-centered approach called Team Hope has improved outcomes and reduced length of stay and readmission rates.

Earlier this summer, Patrick and his colleagues met with key federal health officials and First Lady Melania Trump at Vanderbilt to discuss the potential impact of their research.

“One of our goals is to translate some of our findings for policymakers,” he said.

The other speaker at last week’s Discovery Lecture was Carrie Jones, PhD, assistant professor of Pharmacology and director of In Vivo and Translational Pharmacology in the Vanderbilt Center for Neuroscience Drug Discovery.

Opioid drugs like oxycodone can relieve pain but they also can “hijack” the reward circuit, leading to overuse and addiction, Jones said.

For several years, Jones and her colleagues have been developing compounds called negative allosteric modulators or NAMs that can turn down the activity of the M5 muscarinic acetylcholine receptor, which is involved in the brain’s addiction/reward circuitry.

Studies in animals suggest that these compounds can block the reinforcing effect of opioid drugs without affecting their ability to relieve pain.

While further research is needed before these compounds can be tested in humans, “selective M5 NAMs may provide a novel therapeutic approach for prevention and/or treatment of opioid use disorder,” she said.

For a complete schedule of the Flexner Discovery Lecture series and archived video of previous lectures, go to www.mc.vanderbilt.edu/discoveryseries.

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