The opioid offensive: Fighting fentanyl

Any drug lord worth his salt knows he needs to stay one step ahead of the law. In today’s world, that means the chemists in his clandestine laboratories play a mean game of molecular hide-and-seek. For example, constantly tweaking the chemical structure of the potent opioid fentanyl to create novel analogs that evade forensic detection. Now, researchers have developed a new detection method using machine learning and computer-generated libraries to assist in the identification of fentanyl variants. Rachel Berkowitz looks through the proverbial microscope for SN.

🧪 Chemical catalogs to the rescue

The core challenge in identifying fentanyl variants is that while they all share a common molecular profile, the peripheral chemical groups can be endlessly modified, leading to billions of possible formulas. By digitally breaking up known fentanyl analogs into fragments and shuffling them into new combinations, scientists created a database of over 1 billion hypothetical fentanyl analogs. Then they applied machine learning to predict their real-world signatures in techniques including mass spectrometry. While the results have not yet been peer-reviewed, the accuracy with which the research team was able to identify fentanyl analogs in samples was promising for forensic labs that monitor the rapidly evolving synthetic drug landscape.

🤺 The opioid offensive

While detection is the first line of defense, there’s plenty of work to be done in proactive addiction prevention and overdose protection, notably:

• Fentanyl vaccines and monoclonal antibodies: These therapies, which are still in the research phase and not available to the public, aim to “train” the immune system to recognize and neutralize fentanyl in the bloodstream. They prevent the opioid from crossing the brain’s protective barrier, essentially blocking the user’s “high” — and the life-threatening slowdown in breathing — before they start.
  
• Longer-acting treatments: The more frequently people have to take a drug, the more likely it is that doses will get skipped — yet another challenge for individuals in recovery. Companies are advancing long-acting, injectable versions of medications like buprenorphine, which treat opioid use disorder. New nasally administered overdose treatments have the potential to last longer than the go-to therapy, naloxone.
  
• Digital Health Platforms: These are being designed to reduce the stigma of addiction treatment and provide frictionless access to support.

⛨ Prevention and protection pioneers

As the clinical-stage biotech sector tackles this multibillion dollar public health imperative, a mix of established players and venture-backed innovators are making strides:

• Indivior (Nasdaq: INDV): A dominant force in addiction medicine, Indivior continues to scale its long-acting injectables. These products deliver medication continuously over a defined period of time, reducing cravings and minimizing the risk of withdrawal symptoms. Indivior has a market cap of $4 billion.
  
• Cessation Therapeutics: This biotech firm is conducting clinical trials to develop antibodies for fentanyl and fentanyl analog overdose prevention, opioid use disorder, quitting smoking and cannabis overdose. The company is backed by NIH grants totaling over $14 million.
  
• Opioid Clinical Management provides an AI-driven software platform for health plans and employers to proactively identify and lessen risks associated with opioid misuse. Its suite of tools analyzes prescription data to detect worrisome patient behavior and problematic prescribing patterns. Then the company teaches flagged prescribers about best practices to prevent addiction and overdose. They’ve raised $550,000 in seed funding.

From crisis to triage to long-term strategy, we’re rooting for the opioid opposition every step of the way.

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