Researcher Develops New Weapon in War Against Overdoses: An Implanted Device That Automatically Releases Lifesaving Naloxone

CHICAGO — An opioid overdose can be a lonely death.
People who use drugs often do so in private, and should they get a dose
stronger than they can tolerate, no one will be there to save them with
the overdose-reversing medication naloxone.

But now, a researcher at Northwestern University is developing a technological fix to that lethal conundrum.

John Rogers, director of the school’s Center for
Bio-Integrated Electronics, has helped to devise a gadget the size of a
flash drive that can be implanted under the skin. If a sensor detects
that a person’s blood-oxygen level has dropped to a dangerous level, it
automatically releases a stored dose of naloxone.

“It’s a fully autonomous system, almost like an
implantable emergency response system, providing a first responder’s
type of functionality but without human intervention,” Rogers said.

The idea has won a $10 million grant from the
National Institutes of Health’s Helping to End Addiction Long-Term
Initiative, which aims to find scientific solutions to the opioid
crisis. Animal testing is scheduled to begin in 2020, and clinical
trials in humans could come within five years.

Rogers and a colleague, Robert Gereau of the
Washington University Pain Center in St. Louis, have collaborated on
numerous gadgets designed to monitor bodily processes and intervene when
necessary. They include devices that electrically stimulate nerves,
release chemicals into the brain and tame overactive bladders.

Attacking opioid overdoses was a natural extension of
that work, Gereau said. Though numerous outreach efforts have put
naloxone into the hands of drug users and their loved ones, Gereau said
that approach has an obvious limitation.

“If someone’s alone and has an overdose, even if they
have (naloxone) in their house, it’s not going to help them if there’s
no one there to administer it,” he said.

Opioid overdoses depress breathing and cause
unconsciousness, so the device Rogers and Gereau developed works
automatically. Implanted beneath the skin, possibly in the small of the
back, it will use sensors to monitor blood oxygen level.

If three straight readings come in below a preset
threshold, an electrically triggered chemical reaction releases a dose
of naloxone (each device will contain four). The device will also be
tethered to a patient’s cellphone; a signal transmitted via Bluetooth
will have the phone notify 911 that help is needed.

Rogers said the main clientele he envisions using the device are those leaving incarceration or drug treatment.

“The problem there is that before they are pulled off
opioids, their bodies have developed a certain tolerance,” he said.
“That tolerance fades when they’re off of opioids, so when they come
back out, if they try to take opioids again, they can very easily
receive an accidental overdose.”

Some drug treatment and harm reduction experts
applauded the innovation behind the device, but suggested complications
could arise in the real world.

Anthony Trotter, a former long-term heroin user who
now works with a treatment program in Chicago’s East Garfield Park
neighborhood, said privacy concerns could prevent people from getting
the implant.

“(A user) might not be too keen about letting someone
put a device in him, because a lot of times, people don’t really want
their family to really and truly know they’re getting high,” he said.

Maya Doe-Simkins of the Chicago Recovery Alliance,
which distributes clean needles and naloxone to people who use heroin,
also thought privacy could be an issue, particularly since the device is
engineered to automatically alert paramedics.

She said some low-tech interventions, such as easily
accessible medication-assisted treatment and places where people can use
drugs under supervision, could accomplish the same goal with less cost
and intrusion.

“I find it interesting on an intellectual level, but
it feels like a perfect example of how we’ve bypassed all the simple
analog things we know absolutely work,” she said.

Dr. Gregory Teas, an addiction treatment specialist
with AMITA Health, questioned whether the researchers are targeting the
right clientele. He said some drug users have been known to dig
naltrexone implants, which block the effects of opioids, from beneath
their skin.

“(The naloxone implant) makes a lot of sense on the
surface, but these are patients whose addiction still controls their
behavior,” he said.

He said chronic pain patients might be a more stable
population that could benefit from the implant. They can be subject to
overdoses when they take large amounts of opioid pills, or mix them with
other prescribed drugs that can cause dangerous reactions, he said.

Rogers himself brought up another possible issue.

“If a patient has one of these devices, won’t that
make them more comfortable with pushing the limits?” he said. “That’s a
valid concern. It’s something we’ve thought about. At the end of the
day, I think the benefits will outweigh the risks.”

Gereau said while it will take work to ensure that
patients are comfortable with the implants, he thinks it will be a
valuable addition to the arsenal in fighting the overdose scourge.

“It won’t end overdoses,” he said. “But the goal of
the (NIH) initiative it to reduce deaths, and this can certainly make a
dent.”

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