But it’s not too late to start listening to scientists. Brain research can help inform policy on how to help the 2 million Americans who are currently addicted to prescription opioids, as well as the 1 million addicted to heroin. Neuroscience “definitely has things to offer helping us understand the reality of the addicted brain,” said Keith Humphreys, a professor of psychiatry and neuroscience at Stanford University. He and several colleagues urged a greater role for neuroscience in shaping policy in a commentary that ran last month in the journal Science.
Neuroscience research has shown, for example, that addictive drugs can alter the brain circuitry that controls motivation and reward, and they can wreak havoc on the brain’s decision-making center, the prefrontal cortex. And yet, he said, insurance providers tend to stop coverage after an addict goes through detoxification and withdrawal, based on the old idea that the disease is over at that point.
Other treatment programs require people to prove they’re motivated by abstaining for some period of weeks, he said, but it’s the motivational circuitry that’s damaged in the brains of addicts. “It’s not that it’s hopeless,” he said, but treatment might save more lives if designed for dealing with addiction as a long-term brain disease.
Newer research also shows how environmental cues can trigger cravings in people who have been addicted. Other studies provide insight into why some people are vulnerable to addiction and others face no temptation. Humphreys said that people don’t necessarily have to use these drugs recreationally in order to become addicted -- it can happen while patients are following doctors’ orders. All this points to a policy that protects vulnerable people by requiring doctors to exercise more care and restraint in prescribing.
Age and environment also matter. There’s evidence from neuroscience that people in their teens and early 20s are more likely to become addicted because the prefrontal cortex is still developing, suggesting that stronger measures need to be taken to protect teens. A recent New York Times column by psychiatrist Richard Friedman brought up studies that suggest low social status also increases people’s risks of becoming addicted, not just to opioids, but also to other substances and to overeating. Friedman implies that the solution is in creating a just society -- a lofty goal, even if, in the shorter term, careful prescribing is more practical.
Humphreys said there is some hope that neuroscience -- and related fields such as genetics and psychology -- is starting to get more of a voice in the opioid crisis. The MacArthur Foundation, he said, is supporting an initiative to allow scientists to help policy makers take a more evidence-based approach to mental health issues, including addiction.
What is clear is that current drug policies in the U.S. aren’t working to stem the tide of opioid addiction. While rates of prescription have tapered off a bit, rates of addiction increased almost 500 percent from 2010 to 2016. Opioid addiction is now the leading cause of death in people under 50.
Scientific discoveries do sometimes reveal the hazards behind what people thought were life-enhancing or lifesaving drugs. People don’t have to use opioids recreationally to develop deadly addictions. This may not be what people want to hear, but with 91 Americans dying every day from opioid overdose, we have an obligation to start listening.