Ohio holds a singular place in America's opioid scourge. In 2014 it suffered more overdose deaths than any other state. Since then such fatalities have only swelled, with 4,050 in 2016—a 32.8 percent increase from the previous year, according to health officials. Fueled by prescription painkillers as well as heroin and fentanyl, the epidemic has overrun city morgues, forced thousands of children into foster care and turned Montgomery County, which encompasses Dayton, into the overdose capital of the U.S.
Last year Ohio poured nearly $1 billion into fighting the crisis through prevention, treatment and law enforcement. But the state keeps surpassing its own grim statistics. Exasperated, local authorities have begun confronting the disaster from another angle—technology. In May the state signed off on Gov. John Kasich's request to invest $20 million in accelerating high-tech scientific measures to address the situation. Universities, hospitals and medical device manufacturers are now vying for grant money with proposals that include implantable therapeutic meshes and systems that deliver electric nerve jolts.
Matthew Becker, an associate dean at the University of Akron's Department of Polymer Science, says personal outrage drove him to apply for grant money. When his wife underwent minor laparoscopic surgery earlier this year, she was prescribed roughly 60 doses of the opioid painkiller oxycodone for postoperative pain, at a cost of $6. The quantity of pills she was prescribed, at such a low cost, dismayed Becker. After they threw away the unused drugs, Becker began to wonder about nonopioid alternatives for pain management. So in May his research team—which has developed degradable polymers already used in procedures such as hernia repairs—began examining whether it could use this material as an implantable and more effective platform for existing pain medication. To Becker’s knowledge, the technology has never been used this way before.
The team’s challenge has been to load and stabilize a sufficient dose of nonopioid pain reliever in a polymer film, and to control the medication’s delivery using an implantable mesh. After successful in vitro testing, Becker’s team is seeking grant funding from the state to test the technology on animals. He hopes to have proof of concept on a small rodent model by December, and to deliver a functional submission to the U.S. Food and Drug Administration by next summer.
Meanwhile SPR Therapeutics—a company that makes an electric peripheral nerve stimulation system for pain relief—has already received FDA clearance for its product. A wire from the device pierces the skin near a nerve that is sending pain feedback to the brain, according to Maria Bennett, CEO and founder of SPR Therapeutics. The wire, she says, is connected to a wearable generator that stimulates the nerve, calming its overactivity.
Bennett says clinical studies of the device have shown other benefits. “Once the stimulation is turned off … we see a carryover or sustained pain relief effect,” she says. “It’s not 100 percent. I would say about 75 percent of the patients we see have the carryover effect.” SPR is preparing to sell the product commercially, and has submitted a proposal for Ohio grant money to fund more of its work. The grant would help enroll patients with lower back pain into those studies.
High-tech approaches to treating chronic pain—especially nerve pain—have bloomed in recent years, according to Einar Ottestad, an assistant professor at Stanford University Medical Center’s Systems Neuroscience and Pain Laboratory. “In terms of the chronic pain population, we’re certainly getting better at managing them without opioids,” Ottestad says. “And certainly there’s been a change in our practice. At Stanford, I would say we prescribe much less opioids now than we did even a few years ago.”
But Ottestad—who is not involved in the SPR project or Becker’s research—cautions the opioid crisis is primarily a behavioral and mental health issue. He notes that chronic pain technology, no matter how advanced, will struggle to eliminate opioid use among people already addicted to the drug, largely due to overprescription. Becker and Bennett readily agree.
Overprescribing has been widely blamed for the opioid epidemic in Ohio. After the state sued five pharmaceutical companies in May for deceptive claims about the addictiveness of its products, it was revealed that physicians prescribed 3.8 billion opioid pills between 2011 and 2015 in Ohio, a state with about 11.6 million people. In Ross County, one of the hardest-hit areas in the U.S., physicians prescribed over 1.6 million opioid pills—or 20.7 pills per resident—in 2015 alone. Nationally, prescription opioid sales nearly quadrupled from 1999 to 2014, according to the U.S. Centers for Disease Control and Protection.
For those already gripped by addiction, science may hold promise in the form of medication-assisted treatment, or MAT. For example, physicians generally laud the semisynthetic opioid buprenorphine for helping addicts confront opioid withdrawal. An optimal dose works as a partial agonist for opioid receptors in the brain, meaning it helps control cravings and withdrawal symptoms without producing the euphoric high that drives addiction. But for it to work effectively, patients using it need to stick to a strict prescription schedule. To help patients stay on the medication, the FDA last year approved Probuphine—a long-acting implant that consists of buprenorphine attached to a polymer and delivers low doses over a six-month period.
Some physicians, however, caution against labeling buprenorphine a magic pill. Much depends on how patients use it, says Gabriel Schonwald, a substance disorder specialist and professor at Stanford, who is not involved in the Ohio research. Schonwald says buprenorphine is often sold on the street—and can deliver a potent high in some doses. As for the Probuphine implant, Schonwald worries that addicts will rely too heavily on it and dismiss checkups, counseling and psychotherapy. “To me the biggest issue is the spiritual evolution,” he says. “It involves bio, psycho, social and not just treating one aspect of it. It’s the same drug, but it’s just sitting in your body somewhere—and you’ve checked out.”