January Special - Episode#15 Opioid Crisis – Dr. Samuel Obeng

Dr. Barkha Yadav-Samudrala: 0:07

Hello everyone to another episode of nerd RX podcast and I'm your host Barkha. Today is our another special episode where I talk to a pie and ask the PI the question that what is one question they would like to get answered in your lifetime. And for today's episode, we have an old friend of mine from VCU doc, who is now an assistant professor, Dr. Samuel Obeng welcome Dr. Obeng to the show.

Dr. Samuel Obeng: 0:39

Hi, Barkha. Nice, thank you for the invite. And it's nice to be here.

Dr. Barkha Yadav-Samudrala: 0:43

Thank you so much for giving us your time. It's been so long, I have seen you how you doing?

Dr. Samuel Obeng: 0:49

I'm doing great. Hope you're doing well, too.

Dr. Barkha Yadav-Samudrala: 0:51

I am good. Thank you so much. So before we jump into the topic, we would love to hear about your experience. First, obviously as an undergrad or PhD student, and what led you to choose opioid as your research topic.

Dr. Samuel Obeng: 1:12

Okay, that's an interesting question. So, I first want to start from maybe when I transitioned from undergrad to grad school. So I had my undergraduate training in Ghana, okay. And I had my graduate training for my PhD at Virginia Commonwealth University. So at VCU, I had the opportunity of joining Dr. Hanson's laboratory, where he had his research was focused on opioid use disorder. So with that, and with the current crisis in related to opioid use disorder, opioid overdose, that made me see the need for research, to focus in that area to help solve this crisis. And that led me to pursue a postdoc again in opioid use disorder flowed out in West Florida, where I joined Dr. Christopher Marchetti and Dr. Lance McMahon to further study natural products that can be used as treatments for opioid use disorder as well as opioid withdrawal. So that so these transitions led me to my current research where I'm focused still on trying to find an eye treatment for opioid use disorder.

Dr. Barkha Yadav-Samudrala: 2:45

Wow, that's a big one. And throughout your career, you have stayed in opioid research. So it's been a long journey for you.

Dr. Samuel Obeng: 2:54

Yeah, yeah. From it's been nine years now in opioid use disorder research. Yeah. Oh, wow. Yeah.

Dr. Barkha Yadav-Samudrala: 3:01

That's great. So you are an assistant professor, where currently

Dr. Samuel Obeng: 3:07

I'm currently an assistant professor at Samford University in the McCourt, School of Pharmacy in Birmingham, Alabama.

Dr. Barkha Yadav-Samudrala: 3:15

Oh, nice. Wow. That's great. So opioid crisis, would you mind giving us how did this began? And why are we in this place right now.

Dr. Samuel Obeng: 3:32

So the opioid crisis, it's been since the 1980s. It was realize that then it wasn't a huge problem. But it was realized that in the 1980s, that doctors were not treating that much for pain, like the overlooking pain and pain. So what So now the solution was how can we help manage pain, and the best the currently the best treatments for pain are opioids, because they can be used in acute pain and also chronic pain conditions. Now, this resulted in an increase and prescription of opioids to treat opioid use disorder to treat pain. In addition to that, pharmaceutical companies also side pushing their products to doctors that yet my product is the best and this can be used to treat pain, and they didn't focus that much on the addictive effects of opioids. So now with this in mind, with this increased prescriptions, this led a lot of patients to become to become addicted to the opioids. Now, with time what happened in the early 20 The limbs about 10 years ago, and when to realize that people are abusing the prescriptions, though this significant decrease in the number of opiates that are being prescribed for pain. It is so this slide on you, right? That took them so long. I'm sure if you've listened to the news, it's just been recently that most of these Purdue pharma and even some of the other pharmaceutical companies as well have been, were sent to court to have them pay for this, like the crisis that resulted in prescription over the counter medications. So maybe just I didn't end in how right now it is now. So let me just start out with one in the prescriptions. The doctors stop prescribing opioids. Now patients now needed a substitute for that. So people now started using heroin, which they found on the streets, fentanyl, and heroin and fentanyl because it's much cheaper to make fentanyl man to make heroin. So a lot of these illicit manufacturers of these opioids would add some fentanyl to the heroine and fair of fentanyl is very potent as a result. Patient alarmed not a patient, like someone who is has opioid use disorder would only need a little bit of that heroin to get that high. Or on the other hand, fentanyl is very deadly, because it can decrease or inhibit your spirit respiration. And that is what causes the deaths from opioid overdose. So that's been the cerana. In the US it's a huge problems. For instance, even if you were to look at the pandemic, the COVID 19 pandemic. So just to give you numbers in 2019, do about 40,000 deaths in the United States from opioid use disorder alone. That's only opioid use the opioid overdose in 2020, it jumped to 70,000. From 40,000 to 70,020 21 to 80,000 people who died from opioid overdose. And that's a huge number. Because if, yeah, just putting that in perspective, let's, if you are to see the number of people who died from car accidents, the United States in 2021, that's about 40,000. Number of people died from even firearm stores about 47,000. So you can see that just opioid overdose alone is claiming a lot of lives in the United States.

Dr. Barkha Yadav-Samudrala: 7:52

Wow. And do you think this issue like I know, in the US, it's a huge issue? Do you think it is as Sirius all over the world, or it's particularly in the US?

Dr. Samuel Obeng: 8:06

It's, it's if you're looking at it, or say, globally, I'll say the United States and Canada have a huge opioid use disorder problem in Europe to the hub, this problem, but it's not as bad as it is in the United States. So that's the the thing that the differences and sometimes to in Europe, the substance of abuse, there is quite different from that in the United States, even in the United States just even give you an idea. opioid use disorder is not like generally all across, for instance, in the east part of the United States. That's where there's a lot of opioid use disorder. Okay. And in the western part, a lot of addicts usually tend to take cocaine. So it's, it's specific. Yeah. Yeah. It's really not specific. Yeah. Oh,

Dr. Barkha Yadav-Samudrala: 9:00

wow. Yeah. It's, like, you know, you think about opioid crisis. But when you actually hear the numbers, yeah, unbelievable. Like you mentioned 80,000, in one year, in one year. And after so many years of recognizing the problem, it's still the numbers are so high.

Dr. Samuel Obeng: 9:23

Yeah. And currently, drug overdose in general is the leading cause of death for Americans under 50. Yeah, so that's the leading cause of death currently, and because of this, there has been a decrease in the life expectancy of Americans because of drug overdose and mostly that is contributed by opioid overdose.

Dr. Barkha Yadav-Samudrala: 9:50

Wow. So let me ask you, what are your thoughts on how should v as a society and office To the scientists and the government, it's a team effort. How do you think we can address this issue and hopefully solve it one day

Dr. Samuel Obeng: 10:11

I would say we should see opioid use disorder as any other chronic condition. And that we, we would, for instance, just as you would see someone having suffered suffering from hypertension, if you see that patient to in that same light and not see it as if, as it's the patient's fault for that condition, that if we change our perspective, or thinking in how to treat this disease, it's going to lead into one patients are going to feel confident, and in approaching healthcare officials, or healthcare workers to help them solve the addiction. Because, you know, in opioid imminent generally, drugs, substances will abuse, these compounds, increase dopamine levels, in the reward centers in the brain. As a result, taking that medication is now even more important to them than taking food and other natural things that give us pleasure. So, if we are able to I see that this is a serious problem, which we have to see the patients as any other patients suffering from a chronic condition, and then combine pharmaceutical or pharmacological treatments with behavioral treatments, for instance, because most of the time they can be aware cues are the ones which would lead to patients relapsing into opioid use disorder or any other substance abuse disorder. So if we have combined pharmaceutical treatments with with behavioral or psychosocial treatments, that would be an awesome way of treatment. But in VA, but the ultimate goal, the ultimate goal is to find a treatment for opioid use disorder that would decrease relapse because currently, the for to treat opioid use disorder he patients are prescribed methadone and buprenorphine. Now, these compounds, although the have less rewarding effects, compared to heroin and morphine and other opioids, where they still have rewarding effects. So if we are able to make a compound that patients can take and feel like they are taking on opioids, but that compound does not produce a reward, in effect, that would be an ideal treatment. And, but just to further explain this, again, we have a drug discrimination study, or assay, the drug is commissioned study is used to identify whether a compound feels like another compound, yes, yes. So if if a patient can be given like a new compound, right, we can make any new compound, the patient will take it or not for that, it's like an opioid. However, that same compound does not cause self administration. Rewarding, that would be an awesome way of solving this crisis. And it will reduce the number of current relapses that occur due to opioid due to the current treatments that we have.

Dr. Barkha Yadav-Samudrala: 13:53

You kind of got a like you got a very good point about when I asked you this question that changing our perspective and how we see people, and that is actually so important, because I'm pretty sure most of the people who are addicted to opioids don't want to they can't control the reflexes, and they are quite often, you know, labeled as like, I hate to say this word, but junkies. And it's kind of you're, like, degrading them by just you're not helping them in any way. So changing the perspective and treating it as, like you said, a disease. And that is, I think, the first step we should take, you know, I was just at a conference about, like, endocannabinoids, which I work another class of drugs of abuse, by the way. So and then someone mentioned that now because this crisis is so out of control, like people should walk around with Narcan Yeah, you know that just as part of that is crazy.

Dr. Samuel Obeng: 15:04

Yeah, you guys with Narcan. Narcan is like a lifesaver. Yeah. If someone is overdose and an opioid without and that kind of person would go out would die in a few minutes. But if you administer Narcan immediately the patient or the pay them say the patient would recover and would, can be sent to the hospital for treatment. And I agree to as well have a napkin on hand is going to help save a lot of lives. It has

Dr. Barkha Yadav-Samudrala: 15:34

become like an epi pen like people with electric shocks, like they get an EpiPen. And that's like, imagine we are in a state where it's our like, as a society, it's our responsibility now to carry Narcan to help someone in crisis that is crazy to me.

Dr. Samuel Obeng: 15:54

And wanting to add one to mention about opioid, the opioid crisis is that especially the patients suffering from opioid use disorders that most of these patients were people who were prescribed prescription opioids, and maybe like you this is sometimes maybe we think when we think someone suffering from opioid use disorder always tend to think it's like someone who is, as you might say, as the word you use, like a junkie, but if you look, you'd carefully realize that this woman may be someone who was like working, doing a good job, or a teacher or a doctor or a nurse likes someone who was productive in society, but maybe had an injury, or had a pain condition where he, he or she was prescribed opioids, then with time the person got addicted onto those opioids. And when their prescription is decreased when normal been prescribed to the patient, that patient had to get something else to substitute and a personnel. Good started using heroin today using fentanyl and others. And that is what has resulted in a number of people suffering from this disorder, just that transition from opioid from prescriptions to street drugs is has been a big problem. Right?

Dr. Barkha Yadav-Samudrala: 17:15

And let me ask you this, how easily does it take to get addicted to opioid because I remember, like I had just few years ago, in my PhD, I had my wisdom tooth removed. I was prescribed opioids. I was so surprised what just for this wisdom to the extraction. I and I was like 100, the prescription with oxycodone? I think that's the most commonly used, how easily can a person get hooked to it?

Dr. Samuel Obeng: 17:49

So that one, I'd say it's it's variable. Some people would take opioids and or like, I'm not going to take this anymore. Yeah. Yeah. Because sometimes this drug can make you feel you'd want to throw up and all that. So most people don't want to take it. But others do. Some will take it and with time, maybe, let's say within a week, a month of taking this drug, then there will become a hook trip because opioids inhibit, we have GABA neurons that are involved in releasing dopamine in the reward center. And opioids, heavy those neurons. As a result, there's an increase in dope in dopamine, so it would take time for that dopamine to go, levels to go up. Now, once those dopamine levels go up with taking an opioid, then it's going to be a big problem in trying to reverse it. Because substances of abuse like opioids and even cocaine, these increased dopamine levels so much that natural things that would increase dopamine, no more produce any effect for you. Wow. Yeah.

Dr. Barkha Yadav-Samudrala: 19:09

It's kind of alternating your brain.

Dr. Samuel Obeng: 19:11

Yeah. So and as I mentioned, if we see the people suffering from opioid use disorder as a patient, that the substance is altered via the the function of their brain that way is we are going to see them I think, even in that way, we are going to see them as a human limit, put them in and then would have that we wouldn't have treatment for them. I think that we would be an awesome way of treating this disorder.

Dr. Barkha Yadav-Samudrala: 19:43

Right. So I know there are like so many other classes of drugs that now people are trying to substitute with opioid like compounds for example, endocannabinoids are a big one, because they are also very good in treating pain. And endocannabinoids have been like are being currently pushed a lot to replace opioids. So is there any favorite class you think would be? Oh, this looks good. You know, this is promising that this could replace opioids one day, according to you?

Dr. Samuel Obeng: 20:20

That's an interesting question. Because it gets in, you know, opioids are one of the medications that have been used for over 1000 years. I think that even that isn't there. If I can remember the date that isn't like, the one BC or so I've gotten that the exact date when the Sumerians said they're growing opioids, and they realized this is can be used to treat a lot of things. So opioids are means to treat pain, diarrhea, and other conditions for a very long time. And we've not been able to get an ideal replacement for opioids to treat pain, I'm talking about specifically pain, because that's what opioids are mostly used to. So if we can do that, I think that would be a good. So currently, to treat for opioids. My perspective would is this to use an opioid that has less abuse liability. Okay. I know the other other ways of treating pain for instance, alpha two adrenergic agonist tools also good ways of treating pain. And as you mentioned, cannabinoids are also good ways of treating pain. But at the same time, too, for acute pain. Most of the time, you would need an opioid correct and we've not had a very good substitute for opioids unless maybe you would want to completely block snap neurons by using sodium channel blockers like anesthetics that way but you know you cannot you cannot be on an anesthetic for a very long time here. So yeah, that's the major challenge in this field.

Dr. Barkha Yadav-Samudrala: 22:09

Wow. This is crazy. Like I was just drifting away for a bit I was actually doing an like my first special episode I was doing that with Dr. Aurijit Sarkar, you know him like, please do so. He was talking about drug resistance issue we have going on. And he mentioned something very interesting. And I immediately thought of you. And he said that opioid crisis is also in a way responsible for this drug resistance issue because of sharing needles.

Dr. Samuel Obeng: 22:48

Yeah. naddis near so it is a lot of sharing needles. Yeah. So one thing to that, even because that is now in among opioid use users, they have a lot of HIV, a lot of disease that can be transmitted, transmitted through needle sharing, there's a lot of that problem. And yeah, that's true. And I, we hope this can be managed. And, and I was going to say something which I've remembered. I think one way also, as you mentioned, the needle sharing is a big problem. So right now, one thing that is being done is by providing patience with opioid use disorder needles. So if I did, the person would not have to share a needle with another person. If I think because that one thing, we should realize that no matter what the opioid has altered the patient's immune function, so that person is even given maybe like a needle to help prevent these other patient from getting another disease, then with time, you'd now transition that patient from using that street, opioid heroin that doe inject into maybe a press print often, which is the current treatment for opioid use disorder, then with time as a patient now switches to to pain often, then they can later maybe completely be weaned off the opioid. So I think it's a it's a it's a humane way of treating of seeing this problem.

Dr. Barkha Yadav-Samudrala: 24:39

I think there is nothing like opioid crisis with just the thought of it like you providing them needles. It sounds crazy, but as you mentioned, it's the most humane way to you know, I don't think it's something like cigarette smoking that you could try in due course. Starkey and just quit one day, you know, it will require a long rehabilitation for these

Dr. Samuel Obeng: 25:07

patients. And even now we are clinics around where if someone has opioid use disorder, the person can go to that clinic, and the person who would be allowed to inject like given a needle, to inject the opioid. The people there to see that patient just to make sure that the person does not overdose right, then the person will go their way, right. So it's either mentioned, it's only human, we have seen it with that, the person would see that you are caring for that for him or health. And then that can lead to the patient, overcoming their addiction through treatment, through both pharmacological treatment and behavioral treatment.

Dr. Barkha Yadav-Samudrala: 25:55

Wow. So I think my one question like I've asked so many questions, but I think the most important question for this episode, what is that one question you would like to get answered in your career or your lifetime?

Dr. Samuel Obeng: 26:15

That's a very interesting question. And for me, I'd want to find out, can I separate out the discriminative effects of an opioid from the rewarding effects of an opioid? Well, if you can separate that out, then that means you we can get a good treatment of opioid use disorder.

Dr. Barkha Yadav-Samudrala: 26:44

Wow. So it's all up to the medicinal chemists of the world.

Dr. Samuel Obeng: 26:51

And be aware of a mycologist

Dr. Barkha Yadav-Samudrala: 26:53

Yeah. Totally. Yeah. Oh, my God. Yeah. And do you have any article you can suggest our listeners about about opioid or opioid crisis in general, so that I can put that in my show notes so people can go and read about it.

Dr. Samuel Obeng: 27:15

Like one people are recommend. I'd say not necessarily about the crisis, per se, but just the research that has been done in finding a treatment for opioid use disorder. Is a paper by think Smith. That's the title, the price bias factor and therapeutic window correlates to predict safer opioid analgesics. It's a paper that I think 2017 paper published in cell okay. Okay, so I can I can give the title and bias factor and therapeutic window correlate to predict safer opioid analgesics.

Dr. Barkha Yadav-Samudrala: 28:03

Perfect, I will make sure to have it linked down in the description. And I think with that, thank you so much Dr. Obeying It was so good to see you again. But the topic was a little sad, but we are hopeful because people like you are working towards cure.

Dr. Samuel Obeng: 28:26

Thank you to Barkha for the invite, and we hope we'll be able to get an ideal treatment for opioid use disorder. So this crisis will be solved to help save lives in the United States and around the world.

Dr. Barkha Yadav-Samudrala: 28:43

Yeah, yeah. Thank you so much, Dr. Obeng, and listeners. I will catch you next week on another episode of nerd RX podcast. And in meanwhile, if you have any suggestions about topic or if you would like to join me for an episode, please email me at Barkha@nerdrxpodcast.com. And remember, it's good to be a nerd bye