CRAVING, CHEMISTRY, AND CO-MORBIDITY

It's time to realize that treating addicts is not a bad thing.
Michael Kuhar, Chief of the Neuroscience Division at Yerkes Regional Primate Center


The Academic Exchange Describe your research that may help addicted people resist craving.

Professor Michael Kuhar In the late 1980s, my group identified a cocaine receptor in the brain. A drug receptor is the molecular site where a drug interacts to produce an effect. It’s like a button that the drug pushes. I started working with chemists, in particular Ivy Carroll at the Research Triangle Institute. He makes cocaine analogues, and I test them. We have produced and characterized about five hundred analogues.

AE These are substances like cocaine?

MK They’re like cocaine but also different. That’s key. The idea is to give a chemical analogue to someone with reduced control—an addict—to reduce craving. These analogues get into the brain slowly and leave the brain slowly. Most substances with a high abuse liability get in and out of the brain quickly. The pharmacokinetics are different. Since the analogues are more selective and potent, they are less toxic. They’re more like medications.

The idea is someone coming to treatment could be given something that would reduce out-of-control behavior. Unless an addict can get some control, she is just going to become demoralized and relapse.

AE Would users always need to take the analogue, as heroin addicts need methadone?

MK We don’t know. It’s possible that some people may need to take it for a long time. Our intention is to use the analogue as a first-stage treatment to let the physician get control over the patient to make further treatment possible. The addict would have to come to the physician, as opposed to the drug dealer, to get the cocaine analogue. Since he’s not going to the drug dealer and stealing,
that cuts out a whole host of illegal behaviors.

AE Do the cocaine analogues cause a high?

MK They’ve never been given to people, so we have no idea. They’re still in development. We formed a company, Addiction Therapies, Incorporated, to
develop these compounds for use in humans.

AE What would you say to critics who might charge that this is just substituting a drug for a drug?

MK Is that so terrible if you’re giving people their lives back? Drugs—medications—are used to treat many things. The evidence is very clear that people who are on methadone for a long time have improved lives. The lives of people around them are better; the community functions better.
That question also assumes that there is something wrong with chronic medication. But people take lipid-lowering drugs chronically. Mentally ill people take drugs like lithium and antidepressants for long periods.

It’s time to realize that treating addicts is not a bad thing. Certainly, from an economic point of view, treatment is much better than incarceration or trying to interdict drugs coming across the borders, although that has its place, as well.
One of the most important developments in drug addiction in the last fifteen years is the realization of many that this is a disordered state worthy of treatment.

Did addicts do something wrong, take a wrong step, do something self-destructive? Yes. You cannot absolve people of personal responsibility. They decided to take a drug and repeat it. Then they reached a point where they had less control.

We need to ask if this is any different from people who refuse to control their weight and have diabetes or refuse to change their diet and sedentary lifestyle and suffer heart disease. Of course, there is the added problem that drugs are illegal. All this just shows that addiction, just like heart disease or any other complex disease, requires many different kinds of medication, treatments, and interventions. There’s not going to be a single, magic bullet.

AE What obligation do you feel to see that your work reaches public policy makers?

MK We are in an area where our work can and should affect policy. And it can and should affect people’s attitudes about each other. A lot of the things that are done and said about addiction and addicts are not science-based. They’re just not based on facts. And the public has a right to know, particularly since many
diseases such as cancer and mental illness may carry a stigma. Fortunately, that is lessening.

I think you can do a lot in the lab, but people live in their skin, and that’s where they hurt. That’s where they are wounded and feel the judgments. That’s where we try to help in the lab and elsewhere.

Michael Kuhar specializes in neuro-anatomy and molecular biology.