SAFE GC Coalition: NIDA Past and Future

This past year, the National Institute on Drug abuse (NIDA) commemorated its 50th anniversary, noting how far addiction science has come in a half century—from the nascent understanding of how drugs work in the brain, and only a few treatment and prevention tools, to a robustly developed science and multiple opportunities to translate that science into clinical practice. NIDA Executive Director Dr. Nora Volkow maintains the challenges we face around drug use and addiction have never been greater, with annual deaths from overdose that have vastly exceeded anything seen in previous eras and the proliferation of increasingly more potent addictive drugs.

According to Volkow, NIDA’s 50th year brought hope, as we finally saw a sustained downturn in drug overdose deaths. From July 2023 to July 2024, the number of fatal overdoses dropped nearly 17 percent, from over 113,000 to 94,000. All the factors contributing to this reversal is unknown, so investigating the drivers of this decline will be crucial for sustaining and accelerating the downturn. The decline is not homogenous across populations: Black and American Indian/Alaskan Native persons continue to die at increased rates. And 94,000 people dying of overdose in a year is still 94,000 too many.

As we begin a new year, Volkow envisions four major areas deserving special focus of NIDA’s efforts: Preventing drug use and addiction; Preventing overdose; Increasing access to effective addiction treatments; Leveraging new technologies to help advance substance use disorder (SUD) treatment and the science of drug use and addiction.

Preventing drug use and addiction:

The brain continues to develop into our 20’s, and substance/environmental exposures can influence that development. Prenatal drug exposure can lead to learning and behavioral difficulties and raise the risk of later substance use. Adverse childhood experiences, including neglect, abuse, and the impacts of poverty, as well as childhood mental disorders, can negatively impact brain development in ways that make an individual more vulnerable for drug use and addiction. Early drug experimentation in adolescence is also associated with greater risk of developing an SUD.

Early intervention in emerging psychiatric disorders as well as prevention interventions aimed at decreasing risk factors and enhancing protective factors can reduce initiation of drug use and improve a host of mental health outcomes. Research on prevention interventions has shown that mitigating the impact of socioeconomic disadvantage counteracts the effects of poverty on brain development, and some studies have even documented evidence of intergenerational benefits, improving outcomes for the children of the children who received the intervention.

Preventing overdose:

Volkow maintains NIDA also needs to continue research toward mitigating fatal overdoses. Comprehensive data on overdoses reported more than 92 thousand overdose reversals with naloxone in the year ending March 31, 2023, and this is likely just an underestimate of lives saved. We do not yet know the extent to which greater use of naloxone has played a role in the recent declines in overdose fatalities, but this medication, the first intranasal formulation of which was developed by NIDA in partnership with Adapt Pharma, is a real public health success.

Improving access to addiction treatment:

In 2023, only 14.6 percent of people with an SUD received treatment, and only 18 percent of people with an opioid use disorder (OUD) received medication. Stigma, along with inadequate coverage of addiction treatment by both public and private insurers, contributes to this gap. To fix this will require partnering with payors to develop and evaluate new models for incentivizing the provision of evidence-based SUD care.

Increased access to methadone is a particularly high priority in the era of fentanyl and other potent synthetic opioids. Studies show that risk of leaving treatment was lower for methadone than for buprenorphine. Risk of dying was similarly low for both groups. Currently in the United States, methadone is only available from specialized opioid treatment centers, but studies piloting access through pharmacies have shown promise.

Leveraging new treatments and technologies:

There are many promising new technologies that could transform the treatment of addiction. Using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), whereby Low-intensity focused ultrasound—a non-invasive method that can reach targets deep in the brain—is also showing promise for the treatment of SUD. Advances in pharmacology have also helped identify multiple new targets for treating addiction that are not limited to specific SUDs like Opioid Use Disorder (OUD).

The field of addiction science has progressed at a rapid pace. These advances could not have been made without the commitment of an interconnected community of people. Researchers, clinicians, policymakers, community groups, and people living with SUDs and the families that support them all play a role in collaboratively finding solutions to some of the most challenging questions in substance use and addiction research. Together, NIDA will look to the challenges and opportunities ahead in 2025.

SAFE, Inc. is the only alcohol and substance abuse prevention, intervention and education agency in the City of Glen Cove. Its Coalition is conducting an opioid prevention awareness campaign entitled, "Keeping Glen Cove SAFE," to educate and update the community regarding prescription and illicit drug use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencove or visit SAFE’s website to learn more about prescription drug use and the Opioid Epidemic at www.safeglencove.org.