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Scientists look to non-addictive treatments for chronic pain

September 30, 2018

Scientists at the National Institutes of Health are “very optimistic” that sweeping opioid legislation moving through Congress will help them get moving on non-addictive treatments for pain, as the federal government tries to rein in the nationwide overdose crisis.

NIH is working with companies and research partners on devices that stimulate nerves or the spinal cord to suppress pain. In other cases, cell-based therapies that manipulate the immune system may help pain sufferers, and scientists are looking at proteins that attack pain without triggering key opioid receptors that are linked with addiction.

“We’re getting a greater understanding of the chemical pathways and cellular pathways involved with pain,” said Dr. Michael L. Oshinsky, program director for pain and migraine at the National Institute of Neurological Disorders and Stroke.

Yet it can take up to 12 years for NIH and its outside partners to turn a research idea into an actual treatment or product for patients.

Hoping to speed things up, the House passed sweeping opioid legislation Friday that would give NIH transactional authority to tap into a broader array of funding streams to solicit and support cutting-edge projects into pain treatment.

“It gives NIH the authority to spend the money in the most efficient way as fast as possible, and put it in the hands and direct it toward the research areas that are most appropriate, in the fastest way possible,” Dr. Oshinsky said. “Waiting for the normal development cycle, it’s just not going to work here in the crisis.”

Empowering NIH is just one component of the sprawling legislation that cleared the House, 393-8, on Friday and will expand Medicaid funding for treatment, assist addicted mothers and their babies and empower inspectors to root out deadly fentanyl from overseas.

Ebullient House members said it was a relief to link arms with the other side and address a problem for once, as senators across the Capitol feuded bitterly over Judge Brett M. Kavanaugh’s nomination to the Supreme Court.

“What a joy it is to be on the floor today. What a joy it is to be amongst a group of people that have set aside partisanship and have come together to address a crisis that is crushing our constituents,” said Rep. Peter Roskam, Illinois Republican.

The Senate plans to take the 660-page bill and pass it soon, giving President Trump the chance to sign a major bipartisan achievement into law in the run-up to the midterm election.

Opioid-related overdoses killed nearly 49,000 people across the U.S. in 2017, a record amount that’s spurring Congress to act.

Congress has thrown more than $8 billion at the fight this year, including $500 million for NIH to study opioid addiction and alternatives for pain management, though the latest bill turns the dials on policy.

Senate Health Committee Chairman Lamar Alexander says the development of non-addictive painkillers is the “holy grail” of the response.

“One hundred million Americans live with pain, 25 million Americans have chronic pain,” he said in a recent floor speech. “They need help. They need something other than an addictive pain medicine, something that works.”

The bill also would require the U.S. Postal Service to collect advanced electronic data on packages entering the U.S.

Private couriers like UPS and FedEx already procure advanced data, which U.S. Customs and Border Protection uses to target suspicious packages that might contain fentanyl from clandestine labs in China and elsewhere.

All packages from China, and 70 percent of the overall flow, must have the information available by the end of this year, and 100 percent global compliance is due by 2021.

The House and Senate previously acted on bills containing the measure, though negotiators had to smooth out differences in other areas of the legislation.

The final bill will let states lift an antiquated rule that had prevented large mental health treatment centers from claiming Medicaid dollars, hoping to create a new set of treatment options for those struggling with addiction.

Patients can seek treatment for any addiction not just opioids or cocaine, as an earlier bill had proposed though the waiver is only good for the next five years.

Campaign watchers say the opioid bill is unlikely to move the needle on Election Day, since both sides can claim victory and blaring headlines about Mr. Trump’s style will nudge it out of frame. Yet vulnerable incumbents in swing districts will be able to point to their contributions.

“In my district, this crisis has affected way too many. I’m also grateful that my bill was included in the final package before us today,” said Rep. David Brat, a Virginia Republican who cited his measure to assist children of drug-addicted parents. He is locked in a tight race against Democrat Abigail Spanberger.

Democrats fighting to retake the House in November said they supported the bill because it is “clearly helpful” but that reeling in the crisis will require more funding.

“These are all policies that have the potential to make a real impact on this epidemic. But our work here is not complete,” said Rep. Frank Pallone, New Jersey Democrat. “We have to do a lot more. The opioid epidemic continues to get a lot worse.”

Some progressives, including Massachusetts Sen. Elizabeth Warren, are calling for $100 billion over 10 years to beat back addiction.

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