Combating the opioid epidemic in North America with Nobel Prize winning research

American Researchers Dr. David Julius and Dr. Ardem Patapoutian from California were awarded the Nobel Prize in medicine for their path breaking work on the development of non-opioid painkillers, showing immense promise for combating the epidemic.

The opioid epidemic in North America is a catastrophe!

The United States is in the throes of an unprecedented opioid epidemic with more than two million Americans struggling with this addiction, resorting to the abuse of prescription pain pills and similar drugs available on the street.

What are opioids and why are they so addictive?

The word “opioid” is derived from “opium.” Opioids are drugs formulated to reduce pain like opium. These include both legal painkillers like morphine, hydrocodone and oxycodone usually prescribed by physicians for acute or chronic pain, as well as illegally produced drugs sold on the street like heroin and illicitly manufactured fentanyl.

Prescription and illegal opioids are abused extensively because they are so addictive. Opioid medications and drugs bind to the pain and emotion controlling areas of the brain, triggering levels of serotonin and dopamine, culminating in a feeling of utter euphoria. Excessive use of these dangerous substances leads to death.

During 2016, there were more than 63,600 overdose deaths in the US, including 42,249 that involved an opioid (66.4%). That’s an average of 115 opioid overdose deaths each day. Recently released data by the CDC show that drug overdose deaths reached a record high of 93,331 in 2020! While these estimates are not final, this is more than 20,000 deaths above the previous high in 2019 and the largest single-year percentage increase on record since 1999. It is evident that the COVID-19 pandemic, and the isolation and mental health issues this has triggered, has significantly exacerbated the Opioid epidemic as well.

The Centers for Disease Control and Prevention (CDC) estimates that the total “economic burden” of prescription opioid misuse alone in the United States is over $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. While the US has the largest Opioid abuse epidemic amongst developed nations, Canada follows the US in terms of consumption of opioids in doses per million people per day!

What is the impact of the 2021 Nobel Prize in medicine on combating the opioid epidemic?

The 2021 Nobel Prize in medicine has been awarded for the development of Alternatives to Opioids (ALTOS) as viable painkillers to address this crisis.

The Nobel Prize in medicine was recently awarded jointly to Dr. David Julius and Dr. Ardem Patapoutian, two American scientists from California, whose work identifying how people sense heat, cold, touch and their own bodily movements has opened the door to the development of non-opioid painkillers.

Dr. Julius, a professor of physiology at the University of California, San Francisco, Capsaicin, used a key ingredient in hot chili peppers to identify a protein on nerve cells that responds to uncomfortably hot temperatures.

A biochemist and molecular biologist, Julius’s work has focused on how our bodies sense heat, cold, and chemical irritants, leading to new insights about the fundamental nature of pain and new targets for pain therapy, especially the development of alternatives to opioids.

To understand how signals responsible for temperature and pain sensation are transmitted by neural circuits to the brain, Julius and his UCSF laboratory have taken advantage of a variety of noxious substances produced by animals and plants – including toxins from tarantulas and coral snakes; capsaicin, the molecule that produces the “heat” in chili peppers; and the chemicals underlying the pungency of horseradish and wasabi.

Guided by studies of how these natural products and other compounds trigger sensations of heat, cold, and pain, Dr. Julius has focused on a class of proteins called TRP (pronounced “trip”) ion channels as key players in the nervous system’s pain-signaling apparatus. One indication of the importance of this work to medicine is the intense interest in TRP channels by the pharmaceutical industry as potential targets for new painkillers.

Dr. Patapoutian, a molecular biologist at Scripps Research in La Jolla, California, led a team that, in poking individual cells with a tiny pipette, identified a receptor that responds to pressure, touch and the positioning of body parts.

Patapoutian and his colleagues identified pressure-sensitive ion channels known as Piezo1 and Piezo2—specialized protein molecules embedded in the membranes of some cells that enable them to transmit signals in response to touch or pressure. To find them, the researchers methodically deactivated individual genes in pressure-sensitive cells until they found ones that instruct the cells to make these ion channels, turning off the cells’ ability to respond to touch. Then they inserted those genes into cells that were not sensitive to touch and showed that the cells had gained this sensitivity.

Why is this Nobel Prize winning research significant for combating the opioid epidemic?

“This knowledge is being used to develop treatments for a wide range of disease conditions, including chronic pain,” the Nobel committee said in a news release.

The pair made breakthrough discoveries that began intense research activities that in turn led to a rapid increase in our understanding of how our nervous system senses heat, cold and mechanical stimuli. The laureates identified critical missing links in our understanding of the complex interplay between our senses and the environment.

This research is significant since this will potentially culminate in the development of alternatives to opioids (ALTOS), pain killers that are non-addictive and will lead to thousands of lives saved. This is a significant step forward in our battle against the proliferation of opioids and holds immense promise in combating this precarious epidemic that is taking its toll on tens of thousands of Americans annually.