Friday, July 12, 2024

New frontier: Predicting who will use opioids

The ideas and innovators shaping health care
Jul 12, 2024 View in browser
 
Future Pulse

By Daniel Payne, Carmen Paun, Erin Schumaker, Ruth Reader and Toni Odejimi

EXAM ROOM

This illustration image shows tablets of opioid painkiller Oxycodone delivered on medical prescription taken on September 18, 2019 in Washington,DC. - Millions of Americans sank into addiction after using potent opioid painkillers that the companies churned out and doctors freely prescribed over the past two decades. Well over 400,000 people died of opioid overdoses in that period, while the companies involved   raked in billions of dollars in profits. And while the flood of prescription opioids into the black market has now been curtailed, addicts are turning to heroin and highly potent fentanyl to compensate, where the risk of overdose and death is even higher. (Photo by Eric BARADAT / AFP) (Photo by ERIC BARADAT/AFP via Getty Images)

AI could help determine who's susceptible to addiction. | AFP via Getty Images

It might be possible to predict who’s at risk for opioid use disorder, an ailment driving tens of thousands of overdose deaths each year.

How so? Artificial intelligence systems built on machine learning offered “clinically valid and useful” insights into patients’ risk for OUD, according to a recent study published in JMIR Medical Informatics.

The AI software, using clinical, demographic and prescription data for 180 patients, sorted patients into three groups: not high-risk for OUD, high-risk for OUD and suspected OUD.

The system alerted care providers when patients were believed to be at high risk or thought to already be using opioids.

The AI system concurred with clinicians’ opinions about patients’ risk profiles at the same rate that two clinicians agreed with each other — about 70 percent of the time.

The researchers, from Harvard, Vanderbilt and other institutions, suggested the system could be a valuable tool for care providers to manage their patients’ OUD risks.

Even so: The research was limited by its reliance on older data to assess real-time risk.

Why it matters: Fatal opioid overdoses have skyrocketed since the Covid pandemic began, driven by illicit fentanyl, and health providers and policymakers have struggled to reduce the toll.

 

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WELCOME TO FUTURE PULSE

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This is where we explore the ideas and innovators shaping health care.

Two U.S. territories, American Samoa and the Commonwealth of the Northern Mariana Islands, will both get their first MRI machines in the coming days, thanks to grants from the Helmsley Charitable Trust.

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WASHINGTON WATCH

WASHINGTON, DC - SEPTEMBER 7: Sen. Rand Paul (R-KY) speaks to reporters in the Senate subway on his way to a vote at the U.S. Capitol September 7, 2023 in Washington, DC. The U.S. Senate is considering several nomination votes today. (Photo by Drew Angerer/Getty Images)

Rand Paul has a bill to boost oversight of risky research. | Getty Images

The Senate Homeland Security and Governmental Affairs Committee is contemplating how to regulate risky biological research in the aftermath of the pandemic, which many Republican members of the panel believe was triggered by exactly that type of experiment.

Rand Paul of Kentucky, the committee’s ranking Republican, has an idea: Setting up an independent body within the government to evaluate such research — often referred to as “gain-of-function” — and decide whether it should receive U.S. funding. Paul introduced a bill to that effect, the Risky Research Review Act, on Wednesday.

“My bill not only strengthens transparency, but also ensures that public health decisions are made in the best interest of the American people, free from financial motives and prioritizing national security,” Paul said at a hearing Thursday.

The chair of the committee, Democrat Gary Peters of Michigan, stressed the need for lawmakers to strike a balance between fostering scientific progress and minimizing potential harm, at a time when life science research is accelerating globally.

“Setting reactionary limits on federal research could have harmful consequences,” he said at the hearing.

The four witnesses testifying said more should be done to ensure risky research, the kind that could make pathogens more lethal or more transmissible, is better regulated in the U.S.

But their opinions ranged from pausing such research — which former CDC director Robert Redfield called for — to a softer approach including more standards and incident reporting, as laid out by Carrie Wolinetz, a former chief of staff to then-NIH director Francis Collins. Wolinetz left the NIH last year.

Kevin Esvelt, a MIT Media Lab professor who conducted an FBI-sanctioned experiment showing how easy it is to recreate the virus that caused the 1918 pandemic known as the Spanish flu, said scientists shouldn’t insist on regulating themselves if they want to regain public trust.

Gerry Parker, an associate dean at the College of Veterinary Medicine & Biomedical Sciences at Texas A&M, who is part of a federal advisory committee on biosecurity, said further regulation would strengthen the system and wouldn’t reflect badly on scientists conducting risky research.

“I believe that your responsibility to take legislative action to strengthen biosafety and biosecurity with independent oversight is not a condemnation of the scientific system,” he told the lawmakers.

 

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THE NEXT CURES

The Lerner Research Institute at the Cleveland Clinic is reflected in a doorway to the Clinic 10 May 2001 in Cleveland, OH, where Japanese researcher Takashi Okamoto had worked.  Okamoto, 40, and Hiroaki Serizawa 39, were charged under the economic espionage act 09 May 2001 for the theft of medical research materials in a conspiracy to provide Japan's Institute of Physical and Chemical Research (RIKEN) with DNA   samples and cell line reagents and constructs taken from the Cleveland Clinic Foundation. AFP PHOTO/David MAXWELL (Photo by DAVID MAXWELL / AFP) (Photo by DAVID MAXWELL/AFP via Getty Images)

The Cleveland Clinic is using NIH funds to try to improve rectal cancer care. | AFP via Getty Images

Care providers could learn how to more easily assess the response of rectal cancer tumors to treatment, thanks to a $2.78 million grant from the National Institutes of Health and the National Cancer Institute.

Researchers at Case Western Reserve University, the Cleveland Clinic and University Hospitals will use the five-year grant by employing artificial intelligence to analyze more than 900 medical images from patients with rectal cancer. They’ll combine that information with data from previous clinical trials to develop a method to identify tumor-free patients — and reduce unneeded surgeries for those patients.

Why it matters: Rectal cancer is the third-most common digestive system cancer, after colon and pancreatic cancers, with an estimated 46,000 people in the U.S. diagnosed each year, according to the American Cancer Society.

What’s next? If all goes well, such personalized treatment will increase the rates of rectal cancer survivorship and improve the quality of life for patients, the researchers say.

 

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Carmen Paun @carmenpaun

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Erin Schumaker @erinlschumaker

 

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