Texas has taken proactive steps to combat opioid addiction while North Texas researchers look for a possible alternatives.
But opioid-related deaths are still occurring with frequency in the Dallas-Fort Worth area. People who are desperate for treatment are turning to the black market, buying fentanyl from China and having it shipped illegally to their house, said Dr. Ted Price, a biologist and neuroscientist.
“You’ve got people who have both problems, prescription drugs and getting drugs on the street,” said Dr. Carl Noe, a pain management specialist at UT Southwestern Medical Center in Dallas. “They’re patients but they have an illicit drug problem, too. We’re seeing more patients who have been on opioids but the doctor who was prescribing it is no longer comfortable with that because of the new evidence.”
The Texas Legislature has formed a task force to combat the problem while area researchers look for alternative ways to attack pain that isn’t habit forming and won’t cause deadly overdoses.
President Donald Trump declared the opioid crisis a public health emergency in October that included an initiative to develop alternatives to opioids, according to the New York Times. Trump also renewed efforts to block illegal fentanyl shipments from China.
Nationwide there are 16 million Americans on an opioid treatment.
One estimate showed as many as 59,000 to 65,000 people died of opioid overdoses in 2016, according to the New York Times.
Texas created a closed formulary, a list of medicines that can be prescribed, that requires permission before a doctor can write a prescription for opioids as a way to control cost and access to the drugs. It was implemented in 2011.
Patients who receive long-term prescriptions of opioids stay on disability three times longer than patients who don’t, costing businesses more money as they pay workers compensation claims, according to the Workers Compensation Research Institute.
“It’s a lot worse than people realize,” Noe said.
Painkillers can temporarily relieve pain but they’re also addictive by feeding reward receptors in the brain. That reward response leads to withdrawal, starting a dangerous cycle of addiction and possible overdosing.
UT Dallas startup discovers an alternative
Noe is on the front lines of pain management in Dallas where he frequently sees patients stuck in the dangerous cycle of addiction. Often, they are referred to addiction clinics for treatment. He said opioids are acceptable treatments for managing pain from cancer or in hospice situations.
“But for somebody that has chronic low back pain, there are safer and more effective ways to treat it,” Noe said.
Lower back pain is the main reason employees miss work and have to go on disability. The solution is to go to the source of the pain without activating the reward response in the brain, said Price.
With opioids, pain doesn’t just come back when patients stop taking it, the pain can even be worse because they’re hypersensitive.
“They become super sensitive to everything and respond to everything,” Price said. “How that change comes about, we’re trying to understand on a molecular level and have them go back to the way they were before.”
Opioids are not a good solution to pain, Price said, and he thinks he’s found better ways to treat it. He and others at UT Dallas actually have two areas of focus through the startup CerSci Therapeutics.
At the cellular level, pain signaling proteins are released whenever there’s an injury or any kind of pain. They are developing a drug that interrupts that process, meaning there’s less pain--without the risk of causing addiction or affecting breathing.
“We try to figure out what the pathologies are and find drugs that reverse that. So, instead of masking the pain with an opioid, we could stop the generation of pain during the surgery and eliminate the need for it,” Price said.
This drug is about halfway through the Food and Drug Administration trials, Price said.
A second area of research seeks to understand how the nervous system gets “rewired” when someone has chronic pain, causing excitability. He likened it to a fire alarm that goes off every time the heater kicks in because it’s too sensitive. The medical term is plasticity.
“People have chronic pain because of the changes that happen in the nervous system,” Price said. “They become super sensitive to everything and respond to everything. How that change comes about, we’re trying to understand on a molecular level and have them go back to the way they were before.”
Noe traces this current crisis to policy changes that occurred in the Texas Legislature in 1989. The Intractable Pain Treatment Act passed, which encouraged doctors to write prescriptions for opioids in whatever doses were necessary. This was first intended to treat cancer patients but it quickly spread to arthritis, back pain, headaches and then any type of pain, including dental work.
Despite Trump’s tough stance on the opioid crisis, Noe said the United States is still behind the curve on this issue. The public perception needs to change the same way that MADD changed attitudes toward drunken driving, he said.
“I think this problem is like an iceberg and we don’t know how bad it is and we don’t have a good plan for getting out of this mess yet,” Noe said. “You’d be amazed how many people who have been touched by this or even know someone who has died from it.”