Addiction and the brain

Presented by Kidney Care Access: The ideas and innovators shaping health care

Mar 04, 2024 View in browser   By Carmen Paun, Daniel Payne, Erin Schumaker and Ruth Reader Presented by THE NEXT CURES Nora Volkow's enthused about improved understanding of how addiction affects the brain. | Jacquelyn Martin/AP One day, people recovering from substance use disorder could take a pill that significantly reduces their chance of relapsing. Such a possibility has Nora Volkow, director of the National Institute on Drug Abuse, excited about a better scientific understanding of addiction — as the United States continues to grapple with a record number of overdose deaths. Volkow, who has led NIDA for more than two decades, talked with Carmen about the evolving science. This interview has been edited for length and clarity. How has an understanding of the science of addiction changed during your career? When I first started doing brain imaging to investigate which areas of the brain were affected by drugs, we were very limited. Now what we are doing is recognizing that the brain is this extraordinarily complex network. Addiction involves and disrupts multiple networks, so it’s not just the dysfunction of the reward system but also the way it interacts with the brain’s executive control and emotional networks. The imaging allows us to look into how people with substance use disorders differ from one another. We have tools that allow us to affect the way the brain works. And we can do that either invasively or noninvasively through neuromodulation. So you can put an electrode in the main reward center in the brain and then stimulate it, and that appears to reduce relapse. Are there any new drugs in development that could help people with substance use disorder? There’s one a lot of people are taking for obesity and diabetes: a glucagon-like peptide receptor medication. People taking it say they don't have the urge to drink or they have a much-reduced desire to smoke cigarettes or take drugs. Researchers are also working with monoclonal antibodies against fentanyl and monoclonal antibodies against methamphetamine that could potentially be used to prevent someone from relapsing or to reverse an overdose. Is any monoclonal antibody in the late stage of clinical development? They are in Phase I, Phase II trials. So that is early. There’s a lot of work that needs to be done to ensure that a drug is safe and effective. The effectiveness is ultimately determined by the FDA, and that can be challenging if the FDA says, “We want abstinence as the outcome.” Abstinence is incredibly difficult to achieve. We have interventions that reduce drug consumption, but people would still occasionally use drugs. So they were not abstinent, and that kills the product.   A message from Kidney Care Access: Dialysis patients and their families are being harmed. Employer group health plans can discriminate against patients with kidney failure, disrupting coverage for the patient and their family. A new bipartisan bill will restore essential protections as Congress intended – for these patients and their families. Congress: pass H.R. 6860, the bipartisan Restore Protections for Dialysis Patients Act. Protect patients and their families. Learn more.   WELCOME TO FUTURE PULSE Siena, Italy. | Shawn Zeller/POLITICO This is where we explore the ideas and innovators shaping health care. Many people are worried that AI will come for their job. But it may give them an extra day off instead. The BBC reports that AI could make the four-day work week inevitable. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp.     CONGRESS OVERDRIVE: Since day one, POLITICO has been laser-focused on Capitol Hill, serving up the juiciest Congress coverage. Now, we’re upping our game to ensure you’re up to speed and in the know on every tasty morsel and newsy nugget from inside the Capitol Dome, around the clock. Wake up, read Playbook AM, get up to speed at midday with our Playbook PM halftime report, and fuel your nightly conversations with Inside Congress in the evening. Plus, never miss a beat with buzzy, real-time updates throughout the day via our Inside Congress Live feature. Learn more and subscribe here.     FORWARD THINKING More data will help improve care for rare diseases, Monica Bertagnolli believes. | Francis Chung/POLITICO Making the electronic health records system work better for researchers and patients is among NIH Director Monica Bertagnolli’s big agenda items. Speaking at an event on rare diseases last week, Bertagnolli said she wants to make it possible for patients who walk into a clinic or doctor's office to easily permit researchers to use their health data. It would be a two-way street, she explained. Patients who share their records could be contacted if data relevant to them or their family — such as a new treatment or protocol — becomes available. “Think about what this would do for the rare disease community,” she said. Why it matters: Rare diseases, which affect 200,000 or fewer people, can be hard to diagnose and even harder to treat. Collectively, however, rare diseases aren’t that rare. Nearly 10 percent of the U.S. population — 30 million people, have one of 10,000 rare diseases, according to the NIH. Most are children. What’s next? It would take legislation to make Bertagnolli's vision mandatory, she said during her remarks. Still, she’s determined. “Amazon knows what kind of shampoo I use, for crying out loud. So why can't we make it possible for those people who need us to stand up and say, ‘Hey, I’m here.’”   A message from Kidney Care Access:   POLICY PUZZLE Calorie counts on menus make a difference, but it's a small one, a new study found. | Chris Hondros/Getty Images Calorie counts on menus could save lives, but not very many, according to a study published this week in The Lancet. The modeling study, conducted by the University of Liverpool, is the first to look at the potential outcome of British legislation that went into effect in 2022 requiring restaurant chains with more than 250 employees to list calories, our colleagues in Europe reported. The study found the legislation will likely: — Reduce obesity rates by 0.31 percentage points — Prevent or delay 730 deaths from cardiovascular disease from 2022 to 2041 The study says Great Britain could prevent or delay 9,200 deaths if it were to expand the rules to cover all restaurants. Across the pond: If food-labeling requirements have made any difference in combating obesity in the U.S., it’s on the margins. Americans continue to get heavier despite a nearly six-year-old rule requiring chain restaurants to list calorie counts on their menus. Side effects: While affected restaurants opposed the rules in the U.S., in Britain, some in public health are also skeptical. Calorie labeling on menus has concerned eating disorder groups, according to Duane Mellor, a dietitian and senior lecturer at Aston Medical School, who said it could be a barrier to eating out with family or friends for people recovering from an eating disorder.   A message from Kidney Care Access: A recent Supreme Court ruling now allows employer group health plans to discriminate against patients with kidney failure and disrupt coverage for the entire family – spouse and kids. The Bipartisan Restore Protections for Dialysis Patients Act reverses the negative, unintended consequences of the Supreme Court’s ruling by simply restoring long-standing protections put in place by Congress for patients and their families. Congress: restore what’s right. Pass H.R. 6860, the Bipartisan Restore Protections for Dialysis Patients Act. Learn more.     DON’T MISS POLITICO’S HEALTH CARE SUMMIT: The stakes are high as America's health care community strives to meet the evolving needs of patients and practitioners, adopt new technologies and navigate skeptical public attitudes toward science. Join POLITICO’s annual Health Care Summit on March 13 where we will discuss the future of medicine, including the latest in health tech, new drugs and brain treatments, diagnostics, health equity, workforce strains and more. REGISTER HERE.       Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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