What interventions can increase innovation in addiction medicine?
There is virtual no pharmaceutical industry activity for novel addiction medicines.
For the past several months we, CASPR, along with our scientific advisors and many other experts and friends, have been developing a set of policy proposals to address what we believe is the most overlooked problem in the field of addiction: the near total lack of pharmaceutical activity to develop new breakthrough medicines.
Recursive Adaptation has thousands of subscribers who are scientists, doctors, and policy experts in this field. So before we publish our initial set of proposals, I wanted to put these questions to all of you:
What are the specific obstacles blocking pharma activity in the field of addiction medicine? Which specific parts of the process from basic research to investment decisions to trials to approval to sales and distribution are creating roadblocks or decisions not to pursue therapeutic programs?
What specific interventions could be made to increase novel medication development activity? These can be changes to federal law, new programs, agency policies, or anything else.
I won’t list our draft proposals until a future post, so that I don’t bias the scope of your suggestions. Have thoughts on these two questions? You can reply to this email or comment below or email me.
This is a very focused topic. There are a huge number of other issues in addiction policy that are being well addressed by other organizations, like ASAM. For example, there are important efforts underway to expand access to existing medications for opioid use disorder, like buprenorphine and naloxone, and to increase harm reduction efforts. But to reduce addiction at scale, we also need new and better medicines– not just for opioid addiction, but also for alcohol, cigarette smoking, cocaine, and methamphetamine. Only 3% of people with substance use disorders currently take medication, because of limited efficacy, limited access, and side effects.
To address addiction long-term, even as new illicit drugs are invented (as fentanyl was) and addictive behaviors become more accessible (as online gambling and marijuana have), we need a robust, ongoing process of new treatment development. There is no scientific or medical reason that we can’t halt addiction across substances with minimal side effects for anyone who wants treatment– but we won’t have new medicines that can do this if they aren’t being developed.
The Problem: Lack of Investment in Addiction Medicines
Without getting into a full diagnosis of why we’re here, I’ll just show this chart, one of my favorites. In a single image, it captures why we haven’t had a major new addiction treatment approved by the FDA in the past 20 years.
We can change this. And if we want better medicines , we have to.
We’d love to hear your thoughts on the questions above!
It's somewhat instructive that the current promise of the GLP-1s was an accidental discovery with respect to its application to broad-base addiction. My initial instinct was to suggest that intentionally developing an anti-addiction drug that is expected to have specificity may not be possible without first understanding the physiological mechanisms by which addictive substances effect dependence.
But perhaps with the emergence of GLP-1s, researchers could leverage on modelling its pharmacokinetic and pharmacodynamic properties to figure out some broadly applicable fundamental principles in their efforts to develop other drugs.
Not sure though if this makes any sense to those who are more knowledgeable in the field.