NIDA's Scientific Findings & Achievements of 2018

As we enter 2019, it is a good time to take stock of what NIDA accomplished over the past year. As always when I look back at the research being done by NIDA grantees and partners, I am amazed at the wealth of knowledge being created from our investments. Here I want to highlight just a few of the many outstanding developments in basic science, new therapeutics, and epidemiology and prevention research from the year that just ended.

Basic Science Advances

See caption
Courtesy of the ABCD Study. Adapted from Casey et al., 2018.
These brain images show the reward-related circuity in the cortical and subcortical regions of the brain that tend to be more active when a child is successful at achieving a reward. While all of the images show the regions of the brain that are active to reward, the regions in yellow and red are the most active.

Recent years have seen major advances in our understanding of receptor functioning. In March 2018, a team of researchers at NIDA’s Intramural Research Program (IRP) reported in Nature Communications on an advance in our understanding of G protein-coupled receptors (GCPRs), a large family of receptors that play important roles in the brain’s response to drugs, among many other functions. Often these receptors assemble into larger complexes, but it has been unknown whether those complexes are merely the product of random collision between signaling molecules as they move across the membrane or whether they pre-form into complexes that serve specific functions. The IRP team found that two common GCPRs in the reward pathway, adenosine A2A and dopamine D2 receptors (along with their G proteins and target enzyme), assemble into preformed macromolecular complexes that act as computation devices processing incoming information and enabling the cell to change its function based on that information. This knowledge could facilitate the development of more precise medication targets.

In June 2018, a team of NIDA-funded researchers at the University of California–San Francisco and colleagues in Belgium and Canada reported in Neuron that they had developed a genetically encoded biosensor that could detect activation of opioid receptors as well as map the differences in activation within living cells produced by different opioids. The fact that opioids bind to receptors on structures within the cell and not just on the cell membrane was itself a novel finding, but the team also discovered striking differences in how endogenous versus synthetic opioids interact with these structures. While endogenous peptides activated receptors on membrane-bound compartments within the cell called endosomes, synthetic opioid drugs activated receptor sites on a separate structure called the Golgi apparatus (which acts as a hub for routing proteins to various destinations in the cell). These very different patterns of activation within the cell may lead to greater understanding of why non-peptide opioid drugs produce tolerance as well as the behavioral distortions seen with opioid misuse and addiction whereas the body’s endogenous opioid peptides do not.

The same month, a team led by neuroscientists at UCLA studying narcolepsy reported research in Science Translational Medicine based on their serendipitous discovery that postmortem brains from individuals who had been addicted to heroin show greatly increased numbers of neurons producing the neuropeptide hypocretin (also known as orexin). Hypocretin helps regulate wakefulness and appetite, and a diminished number of cells in the brain producing it is associated with narcolepsy. The researchers went on to conduct a study administering morphine to mice, which as observed in the postmortem study produced increased numbers of hypocretin neurons. The results suggest that increases in these cells and in brain hypocretin could underlie the complaints of sleep problems in patients with an opioid use disorder (OUD). Since insomnia is a factor that contributes to drug taking in OUD (as well as other addictions), strategies to counteract hypocretin signaling might have therapeutic benefits.

Prevention and Treatment

Last year, NIDA-funded research resulted in new therapeutics and apps for OUD. In May, the FDA approved lofexidine (Lucemyra), the first medication approved to treat physical symptoms of opioid withdrawal; and in December, the FDA cleared the first mobile health app intended to help retain patients with OUD in treatment. reSET-O uses interactive lessons to deliver community reinforcement approach therapy and enables users to report cravings and triggers to their health care provider between office visits, along with whether or not they have used buprenorphine. NIDA funded the clinical trial that led to this app’s approval. A version called reSET was approved in 2017 to help with behavioral treatment of several non-opioid substance use disorders.

NIDA-funded research in epidemiology and prevention also added greatly to our knowledge of new drug trends in 2018. Last month’s striking MTF findings alerted us to escalating use of vaping devices among adolescents. Although most adolescents in 2017 claimed that they used vaping devices only to vape flavors, this year most reported they used them to vape nicotine; there was also an increase in vaping of cannabis.

Several other studies published in 2018 increased our understanding of factors that may lead youth to experiment with vaping. For example, a longitudinal cohort study by researchers at Yale and reported in Addictive Behavior found that exposure to ads for e-cigarettes on social media sites like Facebook significantly increased the likelihood of subsequent e-cigarette use among middle and high school students in Connecticut. In another study published in Preventive Medicine, the researchers also found that higher socioeconomic status was associated with greater exposure to e-cigarette advertising (which in turn was associated with increased likelihood of use)—important data that can help with targeting prevention efforts. Other work by UCSF researchers and published in Pediatrics found that e-cigarette use in adolescents was positively associated with being a smoker of conventional cigarettes, lending further support to the view that these devices are not diverting youth from smoking cigarettes but may be having the opposite effect in some users. 

Looking to the Future

This year the Adolescent Brain Cognitive Development (ABCD) Study successfully completed recruitment of 11,874 participants, ages 9-10, who will be followed for 10 years, through young adulthood. The study, which is being conducted at 21 research sites around the country, is using neuroimaging to assess each individual’s brain development while also tracking cognitive, behavioral, social, and environmental factors (including exposure to social media) that may affect brain development and other health outcomes. The first release of anonymized data was made available so that both ABCD and non-ABCD researchers can take advantage of this rich source of information to help answer novel questions and pursue their own research interests.  Last year alone, the data resulted in more than 20 publications.

The Addiction Science Awards winners at the Intel Science and Engineering Fair for high school students in 2018 revealed that the future of addiction science will be in very good hands. Our brilliant awardees in 2018 developed a bioinformatics program that can help identify underreported suicides linked to drug overdoses, a non-invasive tool to measure mouse movements during the preclinical phase of medication development, and a drug-likeness rule for natural products.

I look forward to many more exciting findings and achievements by NIDA-supported researchers in 2019. I am also excited at the launch of the NIH HEAL Initiative, and eagerly anticipate the many advances that the Initiative will bring in future years in the realm of prevention and treatment of opioid addiction and other substance use disorders.


While we recognize the achievements of the field, we should also remember luminaries in addiction science whom we lost this past year. Herb Kleber, who died in October, was truly a guiding light for our field, having been, among many other things, an early advocate for medications in the treatment of opioid addiction and a prolific mentor and inspiration for countless clinical researchers in addiction medicine. And on December 21, we lost Conan Kornetsky (15KB), another pioneer who got his start, like Kleber, at the Lexington Narcotics Farm. After working in Lexington and then NIMH in the 1950s, Kornetsky went to Boston University School of Medicine, where he was a professor in the departments of Psychiatry and Pharmacology. His research included studies on the cognitive effects of LSD, the causes of heroin use in youth, and drugs’ effects on the reward system.  

Dr. Nora Volkow, Director

Here I highlight important work being done at NIDA and other news related to the science of drug use and addiction.

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 Bill Perlman article

After reading the article written by Bill Perlman, on the work being done by Dr Huiping Ding and his colleagues, at the university of Bath, in the physiology and pharmacology dept, in the United Kingdom, on finding alternatives to opioids, i just wanted to personally thank these people, after personally suffering from chronic pain and addiction problems, for a long long time, it just gave me a feeling of hope that I haven't felt for a while, that there is research being done, and that there is hope on the horizon, that were not just chained to opiates, like methadone, buprenorphine, for the rest of our lives without going through hellish withdrawals for months on end, to then suffer from crippling depression, that will suck any joy of life out of you, also for what can feel like months on end, just to end up on antidepressants, or as equally horrible, something like gabapentin, that has its own list of terrible side effects, before you know it you've swapped one awful addiction for another!! All to try and get chronic pain under control so thank god for any Drs like Dr Ding, i would personally like to thank you, from the bottom of my heart, please keep doing your research especially on BU08028, or anything similar, it is more appreciated than you'll ever know, thankyou, from a little old girl from Christchurch, NewZealand. and thankyou to Bill Perlman, You gave me hope, great article!!

 Recent Marijuana Reports

I was shocked upon hearing of marijuana being placed upon the lists of drugs legalized "for recreational purposes," not only in Washington, DC, and California, but also is definitely considered for legalized sale and use here in New York. As a '60's "survivor" and someone who still has to take medication due to his activity in those years, when as a teen I was unaware of the inherent dangers involved with the use of narcotics (marijuana is still considered a narcotic, I believe) I am appalled! During the late '60s and the early '70s an all-out war seemed to be launched against tobacco, so why not something of the sort being done about the dangers of marijuana.? Believe me, it's not a glamorous drug like a few of its proponents seem to portray it, and, since NIMH was so much against tobacco use in the media back then, why is not anything with that broad a scope being done against marijuana these days? I feel that marijuana is very dangerous. Authorities seem to be just sitting back and lettting this disease grow. Why doesn't anyone speak up?

 NIDA Response

NIDA takes marijuana, its potential harms, possible therapeutic benefits (in some cases), and shifting policies around the drug very seriously. Our role is to disseminate accurate scientific information to the public so they can make the most informed decisions: But the decision to legalize (or not) at the state level is ultimately decided by voters.

 MJ recreational legalization

Based on 40+ years as a BHC clinician, I do support clinical MJ and am opposed to its recreational use. Real clients mix and match psychotropic agents. MJ exhibits a very wide dose range. At lower doses it acts more like a CNS depressant; while at much higher doses it can cause delusions of paranoia. I certainly caution against drugging and driving. I will clinically oppose its recreational use here in Pennsylvania.
Rich, MSW

 An insightful, informed decision, or Gobbledygook?

NIDA: ”Our role is to disseminate accurate scientific information to the public so they can make the most informed decisions".

Great- I’m game! The unusually high correlation between senseless, violent crime and past cannabis abuse is fascinating.

As we know, some individuals with troubled minds seek cannabis to self-medicate. They may have past trauma, a proclivity for violence or vengeful ideation. Cannabis offers them desperately needed mental solace. Yet this cycle of mental anguish followed by cannabis intoxication intensifies as tolerance builds up- a regular habit which might develop into dependence or addiction.

During periods of withdrawal, they may become so distraught, they might hallucinate, which some interpret as “demons” inside. They believe those demons are telling them to do horrible, violent things which they calm via more cannabis intoxication. A social reinforcing process results which equates the anguish of withdrawal to demons, while the pleasures of intoxication become a substitute for a desire to commit horrible acts of vengeance.

From previous association with cannabis, mere thoughts of vengeance can now trigger desired, pleasurable dopaminergic responses. And they are now walking time bombs. They may hallucinate regularly, have flashbacks and feel terribly distraught. Eventually, cannabis use alone does not offer the mental solace they desire, so they instead release all their pent-up anger and anguish by committing violent acts or terror.


 While a few studies have

While a few studies have shown aggression or violence associated with regular cannabis use, alcohol and some other drugs are much more associated with violent behavior. No scientific evidence substantiates linking cannabis use to mass violence or terrorism.

 If I may be so bold....

With regard to the remarkable correlation between cannabis abuse (and other drugs) and violent behavior, including rampage killings, may I be so bold to suggest the search for medical "causation" might be an ever elusive, if not futile task? Perhaps we are barking up the wrong tree.

An analogy might be drinking and fights at the bar. Can we ‘scientifically substantiate’ that alcohol actually "causes" fights since any particular fight might have occurred regardless of alcohol? Still, we can all reasonably agree that alcohol "enables" the unfortunate mental framework that is conducive to fighting. Without drinking, there probably would not have been a fight. Alcohol likely pushed those individuals over the edge.

Similarly with the link between cannabis abuse and homicide, perhaps instead of looking for “causation”, might a psychiatric approach be wiser? Can cannabis “enable” the warped perspectives of sociopaths? Perhaps they would otherwise have been able to contain their anguish and inner anger instead of committing violent acts of vengeance. But unfortunately, the chronic effects of cannabis abuse pushed them over the edge?

With calls for legalization and normalization, America is currently undergoing a huge transformation very favorable towards marijuana- a renaissance! It’s a new drug on the scene with unknown consequences, yet for many, it’s a religion and touted for its vast medical wonders.

And craziest of all, many claim marijuana renders users peaceful and non-violent. Yet some cannabis abusers are committing the most horrendous crimes in the world has ever seen!

Something is amiss here.

 1 time buprenorphine opioid detox & low dose naltrexone for OUD

Our group has had success with the above medications for OUD along with comprehensive psychiatric and pain treatment in a psychotherapy clinic. Funding for RCTs has been rejected. Any suggestions for funding? Are there alternatives to opioid maintenance that NIDA is studying or looking into? Our theory is that the low dose naltrexone seems to work in rebuilding the down-regulated opioid receptor system in OUD and the autoimmune attack on opioid mu receptors like in Fibromyalgia.

 Broadening the array of

Broadening the array of available treatments for opioid use disorder beyond the three currently available MAT treatments is a major NIDA priority. We currently support research that is studying novel medication approaches, new medication formulations, and non-medication treatments including devices like Transcranial Magnetic Stimulation, behavioral strategies, and more. Other NIH Institutes and Centers are also funding similar research, such as the National Center for Complementary and Integrative Health (NCCIH).