The Psychiatrist at the Center of the Opioid Crisis

An early adopter of using PET scans in neuroscience, Nora Volkow, MD, director of the U.S. National Institute on Drug Abuse, has a unique personal perspective on the opioid crisis in the United States, according to a profile in Nature.

Metal bit into her flesh. The pain was unrelenting. Finally, the fire service arrived to break her free and an ambulance rushed her to the nearest emergency department, where a doctor gave her Demerol, a powerful and highly addictive opioid painkiller also known as pethidine, which is similar to morphine.

Volkow had spent countless hours talking to people with addiction and had read hundreds of papers on the mechanisms of drug abuse. Neither prepared her for what happened next.

“It was extraordinary, those impressive sensations,” she says. A moment of ecstasy, one she describes as comparable only to long-lasting sexual pleasure, eclipsed all other feelings. She stayed on the medication for another few days and was sent home with more. But she decided not to take it. She was afraid — she knew many of her patients could not stop once they started. She would get through the pain without the help of drugs.

That night, a discomfort she had never felt before overran her body. She felt restless, agitated, desperate. Volkow took a painkiller and, like an apparition, the feeling faded away. “It was then that I realized how fast dependence develops,” she says. “It also made me realize that I’m very afraid of opiates.”

Twenty-five years later, Volkow’s name has become widely known in the addiction field and beyond. As a neuroscientist who has directed the US National Institute on Drug Abuse (NIDA) in Rockville, Maryland, since 2003, she has championed the idea of addiction as a disease of the brain rather than a moral failing. Under her direction, NIDA has prioritized research on the biological basis of addiction, and fought against the mistreatment of drug abusers in both the medical and criminal-justice systems.