MORGANTOWN – Dr. Rahul Gupta returned to West Virginia on Thursday for a series of events addressing the state’s and the nation’s overdose epidemic.
He came to WVU to join with various leaders in a roundtable discussion and later toured the Rockefeller Neuroscience Institutes to learn about cutting-edge research on the brain and addiction.
Gupta is director of the White House Office of National Drug Control Policy and previously served as executive director of the Kanawha-Charleston Health Department from 2009-14 and as state health officer from 2015-18.
Gupta opened the roundtable by noting the shift in the types of abused drugs – from organics such as heroin and cocaine to synthetics such as fentanyl and xylazine (an animal tranquilizer).
The Biden administration, he said, has shifted national drug policy through the National Drug Control Strategy, to address untreated addiction and lack of treatment infrastructure, increasing access through such things as telehealth, and tackling drug trafficking by disrupting the supply chain and the profiteering arena. West Virginia will see $15 billion in federal funds for the work.
Panelist Lou Ortenzio said that as a physician he once played a role in the opioid epidemic by over-prescribing, and by getting addicted himself. Now he runs a homeless shelter and faith-based recovery center. “The faith community is an untapped resource,” he said, with people willing to volunteer their time and talents.
West Virginia Diocese Episcopal Bishop Matthew Cowden agreed. “People of faith are uniquely positioned to be able to help us through the crisis. The church is in it for the long haul.” All people are created in the image of God, he said, and the isolation and loneliness that help feed addiction can be combatted with community and connection.
U.S. Northern District of West Virginia Magistrate Judge Michael Aloi said the court system wasn’t designed with substance abuse disorder in mind. The criminal aspect of accountability has to be balanced with the mental health aspect. His treatment court addresses the underlying behavior, he said, and universities must focus on changing the thinking of lawyers and doctors to approach the issue from the human angle.
Bill Ihlenfeld, U.S. Attorney for the Northern District of West Virginia, said the majority of his cases are drug cases, and his office focuses on three areas: enforcement, prevention and treatment. In the enforcement area, its not unusual for them to prosecute a drug trafficker who’s never set foot in the state. But “prevention is our greatest weapon.”
He explained the appeal of xylazine. Traffickers can buy it for cheap and lace it into fentanyl, where it produces a stronger and longer high. Naloxone isn’t very effective to neutralize it.
On that topic, Gupta said the system tends to be reactive to drug issue. Xylazine is an imminent threat. “We need to get ahead of these things.”
Several WVU deans and leaders talked about educational and counseling approaches they’re taking to equip students to deal with addiction and to become community leaders to tackle the underlying problems.
WVU Student Government Association President Pro-Tempore and co-chair of the Mountaineer Fentanyl Education Task Force talked about how student-led efforts are effective in reaching fellow students. One example was a social media message burst following an area rainbow fentanyl drug bust that reached thousands of students.
Over at Rockefeller Neuroscience Institute, Gupta learned about several research and clinical areas devoted to addiction. Dr. Ali Rezai, RNI executive chair, vice president of neuroscience and associate dean, led the tour.
One area employs focused ultrasound to deliver neuromodulation energy deep into the brain – to the nucleus accumbens, a key structure in the brain involved in addiction and anxiety – to reduce the cravings that help drive addiction. “This is very unique because it’s non-invasive.” It’s a one hour procedure on an MRI table. … The MRI becomes the therapeutic tool.”
An ultrasound for looking into the womb has one or two probes, Rezai said, while this has 1,000 that beam into the head for pinpoint focus. “This allows you to target anywhere in the brain with a millimeter precision.”
Another area is transcranial magnetic stimulation – a noninvasive form of brain stimulation that targets the dorsolateral prefrontal cortex, which is connected to the deeper circuits of the brain – to improve the outcomes of those who have failed standard treatment for addiction.
RNI is also researching brain implants into the nucleus accumbens that detect and record electrical activity associated with cravings to establish biomarkers; and using virtual reality to induce, understand and reduce or treat cravings.
Dr. Clay Marsh, chancellor and executive dean for Health Sciences, said Rezai and the RNI team are pursuing WVU’s goal of “trying to focus our research efforts on solving real-world problems and coming up with tangible solutions to improve people’s lives,” for the people of West Virginia first, and the whole world.
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