4:44 PM
Oct 18, 2018
 |  BC Innovations  |  Targets & Mechanisms

Volkow: why pain and addiction will go personalized

Why NIDA director Nora Volkow thinks pain and addiction need personalized approaches

While addiction still carries a social stigma, neuroscience research not only supports the view that it is a disease, but is starting to paint a more nuanced picture of the variety of mechanistic pathways involved. Nora Volkow, director of NIH’s National Institute on Drug Abuse, thinks a personalized approach to the condition is warranted to address the different biological disease processes operating in different patients.

Volkow has headed up NIDA since 2003 and has championed a complex definition of addiction that neither reduces it solely to a behavioral problem nor to a biological one. She has also advocated for a multipronged approach to therapeutics development, as there is likely to be no one-size-fits-all solution (see “Addiction Camps”).

According to Volkow, the preponderance of evidence suggests that individuals have different susceptibilities to addiction, based on a constellation of biological, behavioral, social and economic factors. Moreover, the biological risks are diverse, involving genetics, epigenetics, and the wiring and fine-tuning of synaptic circuits throughout the brain, not just dopamine signaling.

That means engaging in drug taking is riskier for some people than for others, and that not everyone comes to the disease via the same mechanistic path. What’s consistent is that continued drug taking rewires brain chemistry and circuitry in ways that strip people of the ability to control their behavior.

The opioid crisis has cranked up the urgency of the search for less-addictive opioids, non-opioid analgesics and medications to treat addiction and overdose. NIDA is supporting all of these goals, as well as others.

Ideally, says Volkow, physicians would have a variety of medications in their tool kit and biomarkers for matching patients to the right ones.

“What we’re also seeing is increased recognition by the healthcare system that they actually should be treating addiction. That has been very, very slow in coming.”

Nora Volkow, NIDA

BioCentury spoke to Volkow about the state of addiction and pain research, the targets and approaches NIDA is most excited about, and the possibility of applying personalized medicine concepts to both conditions.

Edited excerpts from the conversation follow.

BioCentury: You’ve had a back and forth with some physicians over whether there should be a pharmacological approach to dealing with addiction as opposed to a...

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