‘No Single Fix’: U-M Efforts Attack Opioid Crisis from All Angles
Countless research projects to better understand the science of addiction are in motion. Those cross-disciplinary findings are informing prevention and treatment.
Opioid abuse is a national crisis — taking an average five lives every hour across the country — and Michigan has been especially hard-hit. In 2016, the state suffered the nation’s 10th worst opiate death rate as 1,762 people died from opioid overdoses.
That’s an increase of more than 300 percent since 2007.
Our state took an important step to address this problem when it prohibited doctors from prescribing more than a seven-day supply of opioids for patients suffering acute pain. A troubling but hopeful fact of this epidemic is that most people’s addiction began with prescription pills, which offers a greater measure of control than illegal drugs.
Ongoing research at the University of Michigan indicates that this approach should have a significant impact on reducing the number of people who become dependent on often vital pain relievers.
But experts also recognize that there is no single fix for this frightfully complex problem.
Addiction involves such a broad array of forces — from the biology everyone shares to the genetics that make each of us unique; from the cultural and economic forces that shape our communities to the vagaries of our individual psyches — that effective responses will hinge on harnessing the full breadth of scientific and medical insight.
That’s the approach we are taking at U-M. Last April, we started the Opioid Solutions community to help bring together researchers from across the university who are addressing various facets of this national epidemic. It now includes nearly 100 faculty members — in fields ranging from psychiatry, pharmacy and public policy to basic science, dentistry and law.
This multifaceted approach is one that we are embracing to address not just health care but a wide array of issues. As we have developed a greater appreciation of the complexity of the problems we are addressing — how they involve a range of behaviors and disciplines — we have been breaking down the silos so that experts from across universities can share their insights on common problems.
Input from all disciplines
Medicine is no longer the sole domain of physicians and biologists. Engineers, mathematicians, statisticians, physicists and computer scientists currently work on problems that run the spectrum from basic biomedical discovery to the development of new treatments for disease.
The opioid crisis demands such a full-bore response.
At their most basic level, substance addictions, and opiate addiction in particular, are rooted in biology and chemistry. Opioids — synthetic drugs such as oxycodone, hydrocodone and fentanyl, which mimic the effects of organic opiates like morphine and heroin — block pain by triggering the release of endorphins and neurotransmitters. This can be extremely effective in the short term, providing necessary relief for people in acute pain.
With sustained use, however, opioids can change the body’s chemistry so that it almost stops producing these chemicals on its own.
Those with opioid use disorder (opioid addiction) become physically and emotionally dependent on these drugs, developing strong cravings for them and suffering debilitating withdrawal symptoms without them. Moreover, data in recent years show that chronic opioid exposure can actually make pain worse, a phenomenon called opioid-induced hyperalgesia.
U-M researchers are addressing the complex forces at work through dozens of targeted research projects in various disciplines.
Basic research teams, for example, are exploring ways to inhibit the action of specific molecules to maximize the benefits of opioids while limiting the dangerous side effects. Some researchers are trying to develop new drugs to treat pain and to help those suffering addiction, while others are using neuroimaging to evaluate the impact of acupuncture on chronic pain.
Not all pain is the same, so a host of studies is examining the response of various population groups — those who have suffered major trauma or undergone different types of surgery (including hip and knee replacement, hysterectomy and dental procedures), as well as the differing responses to opioids by young children, adolescents, adults, older adults and veterans.
Informing education and practice
Education is key for patients, doctors and policymakers.
An ongoing chronic pain workshop informs chronic pain sufferers and their family members about the potential problems of using opioids. Recognizing that the opioid epidemic is so widespread and involves so many aspects of society, U-M has introduced a new required course that allows all third-year medical students to learn about the problem from a variety of perspectives, including doctors, policy experts, law enforcement officials and hospital administrators.
Another initiative aims to translate proven strategies for reducing opioid overdoses and addiction into effective policies and programs that can be implemented at the state and local level.
Because so many people with mental health and substance abuse issues wind up in the criminal justice system, another project explores strategies to develop jail diversion programs for people whose addictions lead to incarceration.
These are just some of the broad-based efforts underway at U-M. Our significant commitment to combating the opioid crisis — in combination with efforts at many other universities as well as private and public research labs and organizations — is a sign of both the seriousness of this problem and its complexity.
While there is no single magic bullet that will stop this scourge, we will make significant progress by attacking it from all sides.
Marschall S. Runge is executive vice president for Medical Affairs at the University of Michigan and dean of the University of Michigan Medical School.