Dr Iván Montoya is Clinical Director, Division of Drug Abuse Treatment Research, NIDA, EE. UU.
Dr Montoya presented the portrayal of the opioid epidemic in EE. UU, which has been going on for years. The evolution of deaths from 1999 to nowadays is an example of this growth, as it has increased tremendously, with an estimated 800,000 deaths in the last 20 years. This is due, among other factors, to the increasing prescription of opioid painkillers, as well as the pressure from pharmacologist companies. Since 2014-2015, the use of synthetic opioids has raised considerably, with fentanyl being the main opioid used. During the COVID-19 pandemic, overdose mortality has also skyrocketed.
In research, the top priority considered by NIDA is treatment for opioids, followed by cocaine, amphetamine, marijuana (with the issue of legalisation) and nicotine, the latter as a preventable risk factor associated with cancer.
Among drugs that were already being abused in EE. UU. in the late 19800s, there was already a serious problem, so in 1990 NIDA set up a division to research drugs to tackle the epidemic of overdose deaths. The programme looks for safe drugs and is also involved in the development of types of treatment such as psychotherapy. They are also trying to make up for the lack of interest from pharmaceutical companies in developing new drugs. This programme is similar to that of any drug research.
Entre las medicinas que se utilizan de abuso ya a finales de los años 80 del siglo pasado, en EE. UU. ya tenían un grave problema por lo que en el NIDA se crea en 1990 una división para la investigación de fármacos con los que enfrentar la epidemia de la muerte por sobredosis. El programa busca medicamentos seguros y también se ocupa del desarrollo de tipos de tratamientos como psicoterapia. Intentan, además, suplir la falta de interés de las compañías farmacéuticas a la hora de desarrollar nuevos fármacos. Este programa es similar al que se desarrolla en la investigación de cualquier fármaco.
NIDA also provides for prevention, treatment and diagnosis. In this respect, the institute faces a number of challenges. It is trying to increase the efficacy of treatments, patient adherence to treatment and minimise the side effects of these drugs, for instance, to ensure that they do not cause withdrawal symptoms. They also look at how to limit access to these drugs or how to mitigate the lack of training of clinicians in their use. It is often observed that the clinician has little specialization in the area of addictions, for example, the treatment duration is often unknown.
He pointed out that there are several reasons that difficult research into new drugs, despite the urgency to achieve effective treatments. He highlighted, among others, the requirements demanded by the FDA to authorise treatment, together with the low investment and the lack of interest in the pharmaceutical area.
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