There are about as many Americans living with addiction as there are Americans living with cancer — but you wouldn’t know it based on the world of venture capital.
In the past decade, investment firms have poured roughly 270 times more money into developing cancer drugs than addiction cures, according to a new report from BIO, the biotechnology industry trade group.
When it comes to opioid addiction in particular, there’s a simple reason for the lack of investment, according to David Thomas, BIO’s vice president of industry research: There aren’t many potential new drugs to invest in.
“There’s still a lot to be learned for identifying the underlying cause of addiction and being able to address that with a specific target,” he said. “That limits the shots on goal. If you look at the number of targets, there just aren’t that many at all. If there were, maybe that would incentivize investors to get behind more of the novel targets. But we just don’t see many there.”
The report suggests that, even though U.S. addiction deaths are hovering around their all-time high, drug companies and the investors who back them are unlikely to provide solutions anytime soon.
In the context of other diseases, the lack of investment is stark. Venture capital firms invested just $130 million into novel addiction treatments in the past 10 years, according to the report, compared to a nearly $36 billion bet on oncology.
The same was largely true in the field of pain treatment, with venture capital investments totaling under $1 billion, even amid unending scrutiny of opioid manufacturers like Purdue Pharma and a corresponding push to develop nonopioid painkillers.
The lack of investment in addiction continues despite broadening recognition that there are too few addiction-treatment medications and that they are chronically underutilized.
Currently, just three medications have been approved by the Food and Drug Administration to treat opioid use disorder: methadone, buprenorphine, and naltrexone. There are similarly few options for treating alcohol addiction — and no drugs at all exist to treat addictions to cocaine or methamphetamine.
Research into opioid addiction treatments has ticked upward in the past five years, according to BIO’s report, jumping from six to 17 clinical programs. But the survey found just one each for methamphetamine and cocaine.
Worse, perhaps, is that addiction drug candidates seem to stall out at high rates. BIO’s report was particularly stark when it came to phase II clinical trials for opioid addiction treatments. Of the 15 analyzed in the past decade, 14 failed — a success rate of under 7%.
“When you’re down in the sub-10% range, that’s pretty bad,” Thomas said.
Still, there’s little question that private sector efforts to treat addiction don’t seem to match the urgency of the crisis.
Key government officials have noticed: In recent years, former National Institutes of Health director Francis Collins began to cite addiction therapies and alternative pain cures as a priority. In 2018, the agency launched Helping End Addiction Long-term, commonly known as the HEAL Initiative, in an effort to accelerate new strategies and potential treatments.
Yet the National Institute on Drug Abuse, the sub-agency within NIH focused on drug use and addiction, has seen only marginal budget increases, receiving roughly $1.6 billion from Congress in 2022.
At the STAT Summit in Boston last year, NIDA director Nora Volkow also lamented the lack of private-sector investment in addiction drugs, but pointed to another culprit: insurers, and their unwillingness to pay for more expensive therapies.
In particular, Volkow cited new formulations of buprenorphine, which can be injected once every three months instead of taken orally once a day. While the new versions are more effective, they’re also more expensive — and some doctors have had trouble getting insurers to cover them.
“There has been a lot of stigma for investing resources to develop medications,” she said. “Part of the issue being: ‘I developed this medication, I put all of these dollars, and then it’s not being prescribed. And it’s not being prescribed because there’s no reimbursement.’”
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