Opioid Antagonists: A Key to Many Disorders

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(DGIwire) – Illegal drug use in the U.S. has reached epidemic proportions. According to data published by Quest Diagnostics, the share of workers testing positive for illicit drug use has reached the highest level in a decade, driven by increases in detection of amphetamines, cocaine and heroin. Meanwhile, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that by the year 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability. Addressing the impact of substance use alone, says SAMHSA, is estimated to cost Americans more than $600 billion each year.

One player on the frontiers of research aiming to mitigate this crisis is Roger Crystal, MD, the Chief Executive Officer of Opiant Pharmaceuticals, Inc., a specialty pharmaceutical company. In a recent interview with The Wall Street Journal, Crystal outlined his company’s plans.

Opiant is studying the use of opioid antagonists in various delivery forms, in particular using nasal sprays, for the treatment of substance abuse disorders, eating disorders and addictive disorders. The company has planned a series of clinical studies in these fields. The company has already developed NARCAN® Nasal Spray, a version of naloxone, which is being marketed by its partner and licensee, Adapt Pharma.

As Crystal told the Journal, naloxone has been around for decades; however, prior to the development of the nasal spray, it was only available in approved forms as injectables—whether a syringe-based injection or autoinjector. In general, people don’t like injecting other people and are afraid of needlestick injuries even amongst trained and qualified professionals, so there was a motivation to develop a nasal spray version. Having achieved success on that front, Crystal and his team decided the same rationale held for other disorders.

“We believe we can use this class of drug—opioid antagonists—and deploy them for eating disorders and other types of disorders, recognizing that there is a reward system in the brain that is mediated by the release of opioids,” Crystal says. “So if we can block that reward system using opioid antagonists—especially delivered nasally—we think that’s a very compelling approach.”

The brain’s reward circuitry is thought to be what regulates the occurrence of substance abuse disorders, eating disorders and addictive disorders. Increased levels of certain chemicals called neurotransmitters—such as opioids, endorphins and dopamine—activate the brain’s reward circuitry. Opioid antagonists may block the effects of these chemicals and make these types of behaviors less tempting to those who would otherwise obsessively engage in them.

“Having demonstrated what a nasal spray formulation of naloxone can achieve for opioid use disorder, we believe we can expand its use to address the unmet needs in many other areas,” adds Crystal.

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