BETHESDA, Md. - Lying inside a scanner, the patient watched as pictures appeared one by one: A bicycle. A cupcake. Heroin. Outside, researchers tracked her brain's reactions to the surprise sight of the drug she'd fought to kick.
Government scientists are starting to peek into the brains of people caught in the nation's opioid epidemic to see if medicines proven to treat addiction, like methadone, do more than ease the cravings and withdrawal. Do they also heal a brain damaged by addiction? And which one works best for which patient?
They're fundamental questions considering that far too few of the 2 million opioid users who need anti-addiction medicine actually receive it.
One reason: "People say you're just changing one drug for another," said Dr. Nora Volkow, director of the National Institute on Drug Abuse, who is leading that first-of-its-kind study. "The brain responds differently to these medications than to heroin. It's not the same."
Science has made clear that three medicines — methadone, buprenorphine and extended-release naltrexone — can effectively treat what specialists prefer to call opioid use disorder. Patients who stick with methadone or buprenorphine in particular cut their chances of death in half, according to a report by the National Academies of Sciences, Engineering and Medicine that explored how to overcome barriers to that care.
Opioid addiction changes the brain in ways that even when people quit can leave them vulnerable to relapse, changes that researchers believe lessen with long-term abstinence.
Volkow's theory: Medication-based treatment will help those damaged neural networks start getting back to normal faster than going it alone.
To prove it, she'll need to compare brain scans from study participants like the woman who quit heroin thanks to methadone with active heroin users and people who are in earlier stages of treatment.
"Can we completely recover? I do not know that," Volkow said. But with the medications, "you're creating stability" in the brain, she said. And that helps recondition it to respond to everyday pleasures again.
The challenge now is finding enough people willing, and healthy enough, to have their brains scanned for science at the same time they're struggling to quit.
Addiction is a brain disease, "not a choice, not a personality flaw, not a moral failing," said Dr. Jody Glance, an addiction specialist at the University of Pittsburgh Medical Center, who hopes NIDA's brain scans will help overcome some of the barriers and improve the public health response to the opioid crisis.
Not offering the medicines to someone who needs them "is like not offering insulin to someone with diabetes," she said.
How opioids change the brain
When you sense something pleasurable — a special song, the touch of a loved one, a food like Volkow's favorite chocolate — the brain releases a natural chemical called dopamine that essentially trains the body to remember, "I liked that. Let's do it again."
That's the brain's reward system, and opioids can hijack it by triggering a surge of dopamine larger than nature ever could. Repeated opioid use overloads circuits in multiple brain regions, including those involved with learning and memory, emotion, judgment and self-control.
At the same time, the brain gradually releases less dopamine in response to other things the person once found pleasurable. Eventually they seek more of the drug not to get high, but to avoid constantly feeling low.
Testing how addiction medicine helps
Volkow aims to test 80 people, a mix of untreated heroin users and patients using different medication-based treatments, inside brain scanners at the National Institutes of Health's research hospital.
Her team is measuring differences in the brain's ability to release dopamine as treatment progresses, and how the functioning of other neural networks changes in response as study participants do various tasks.
For example, does a patient's brain remain fixated on "cues" related to drug use — like seeing a picture of heroin — or start reacting again to normal stimuli like the sight of a cupcake?
Another test: Ask if a patient would take an offer of $50 now, or $100 if they could wait a week, checking how much motivation and self-control they can muster.
"You need to be able to inhibit the urge to get something" to recover, Volkow noted. "We take for granted that people think about the future. Not when you're addicted."
Like in any disease, each medication may work better in certain people — because not everyone's brain circuitry reacts exactly the same way to opioid abuse — but that hasn't been studied. Volkow suspects buprenorphine will improve mood and emotional responses to addiction better than methadone, for instance, because of subtle differences in how each medicine works. She especially wants to test people who relapse to try to spot any treatment differences.
Methadone and buprenorphine are weak opioids, the reason for the misperception that they substitute one addiction for another. In slightly different ways, they stimulate the dopamine system more mildly than other opioids, leveling out the jolts so there's no high and less craving. People may use them for years. Naltrexone, in contrast, blocks any opioid effects.
It's a tough sell
Volkow's team has screened more than 400 people who expressed interest in the study, but have found only about three dozen potential candidates who qualify, seven of whom have enrolled so far.
The main problem: Study participants must have no other health problem that might affect the brain's chemistry or functioning. That rules out people who use medicines such as antidepressants, and those with a range of health conditions such as high blood pressure or diabetes.
Volkow said it's worth the struggle to find such rare volunteers if before-and-after scans wind up showing truly different looking brains as people get treated.
"You should be able to see it with your eyes, without having to be an expert," she said.
MILTON — Plans for the Grand Patrician Resort in Milton will not be affected by the bankruptcy filed last week by Jeff Hoops' company Blackjewel LLC, according to the chief financial officer of the investment company funding the development.
"First and foremost, absolutely the Grand Patrician Resort is still a go," said Clearwater Investment Holdings LLC's CFO Brent Walls.
Walls said Clearwater Investment Holdings is funding the entire project. Even though Clearwater is an unsecured creditor and owed $11 million by the mining companies that Hoops led, funding for the Grand Patrician is separate and not threatened by the mining companies' financial problems, he said.
Meanwhile, crews continue construction on the multimillion-dollar project at the site of the former Morris Memorial Hospital.
The structure of the former hospital is being converted into a hotel that will include standard rooms, large suites and a restaurant.
Walls explained that Clearwater is an investment holding company with a diversified portfolio of investments of various types, including interest in companies, partnerships and limited liability companies; stocks, bonds, and other securities and similar interests; and real estate and personal property investment and management.
"Clearwater is owned by the Clearwater Trust, a Hoops Dynasty Trust, which is controlled by the trustees of the Clearwater Trust," Walls said. "These entities are not owned by nor are they controlled by any of the debtors in the bankruptcy case or their ex-chief executive officer, Jeffery A. Hoops Sr. Additionally, Mr. Hoops is not a trustee or beneficiary of the Clearwater Trust."
A filing in 2017 for Grand Patrician Resort LLC listed under officers that M. Edward Cunningham II was organizer and Patricia A. Hoops, Jeffery Hoops' wife, was manager.
Walls said it has been perceived by some that the resort is being financed by the debtors and controlled by Jeffery Hoops.
"This statement is simply not true," Walls said. "While Mr. Hoops and his family have been a driving force behind the Grand Patrician Resort LLC, I can assure you that no funds have been taken from the debtors to finance this project or any other business, investment or financial interests of Clearwater."
Following the news that Blackjewel filed voluntary petitions for reorganization under Chapter 11 of the Bankruptcy Code in the U.S. Bankruptcy Court for the Southern District of West Virginia, there were many questions, Walls said.
Blackjewel, et al, as defined within Chapter 11 Case No. 19-30289, includes the Blackjewel LLC, Blackjewel Holdings LLC, Revelation Energy Holdings LLC, Revelation Management Corp. and Revelation Energy LLC.
"As chief financial officer of Clearwater, it is my duty to protect the financial interests and assets of the company and as an unsecured creditor with more than $11 million owed to Clearwater from the debtors, I have been closely monitoring the Blackjewel bankruptcy case and its proceedings," Walls said. "Neither the Grand Patrician Resort nor Clearwater Investment Holdings are affiliated with the Blackjewel LLC. Clearwater has made loans to the debtors; however, the funding of the project is not in jeopardy and the bankruptcy will not impact the project.
"Grand Patrician Resort has never received any funds from the debtors and never planned to receive any financing from them for the project. We will continue with the development as planned and uninterrupted by the Blackjewel bankruptcy."
In December 2018, the Cabell County Commission approved $10 million of tax increment financing revenue bonds (TIF) that will be used for infrastructure on the property.
"Otherwise, the entire project will be funded by Clearwater Investment Holdings," Walls said.
Additional plans for the resort include a wedding chapel, convention center, a 4,000-squarefoot spa, an indoor swimming pool, baseball fields and a golf course. In addition, the plan for the site proposed in early 2018 includes a retirement facility, an amphitheater, resort villas, condo units and lots for single family homes.
At one point it was thought the retirement facility would need to be in the old hospital structure because of National Historic Registry concerns, but that is no longer the case.
The projected grand opening date for the hotel, convention center and wedding chapel is set for the summer or late 2020.
Follow reporter Fred Pace at Facebook.com/FredPaceHD and via Twitter @FredPaceHD.
HUNTINGTON — After nearly three hours of testimony Tuesday in Cabell Circuit Court, a decision on whether Joseph Chase Hardin will remain behind bars for up to a year for battery of a woman on campus is still uncertain.
Hardin is currently serving three years' probation after entering a Kennedy plea to misdemeanor battery after being accused of raping Alicia Gonzales in a Marshall University residence hall in 2016.
Tuesday's hearing was set to decide if Hardin's probation should be revoked after a new indictment was returned of four counts of second-degree sexual assault in a case involving two new alleged victims, who said they were attacked off campus last fall in two separate incidents. An indictment does not establish guilt, but does indicate there is enough evidence against a person for the case to move forward.
The probation revocation also alleges Hardin used alcohol, which is also against probation guidelines.
Cabell Circuit Judge Alfred E. Ferguson said he had not expected Tuesday's hearing to last as long as it did and continued it until July 26. Despite defense attorney Kerry Nessel again asking for a bond for his client, who has been in jail for more than 30 days, Ferguson denied the request.
If his probation is revoked, he could be sentenced to up to a year in jail.
Huntington Police Detective Ted Backus; Hardin's probation officer; his sister, Olivia; and one of the new alleged victims all testified Tuesday and the second alleged victim is expected to testify at the next hearing. To prove there is reason for his probation to be revoked, prosecutors are required to show there is enough evidence to possibly lead to a conviction on the new charges.
Backus testified the first assault, which was reported to police in November, had occurred Oct. 7 in a vehicle in the parking lot of a Huntington museum. Some sexual acts had started out as consensual, but the victim withdrew consent quickly after it started. She was saving herself for marriage and what he did had been a violation of that, Backus said.
Nessel said any penetration, which occurred twice, had been an accidental slip and his client had stopped immediately when asked. Assistant prosecutor Kellie Neal argued otherwise. After the alleged assault occurred and the victim had taken Hardin back to his vehicle, she later texted him about injuries she had sustained and he laughed and said it would be fine in a few hours, Backus said.
Sometime later a second allegation was made against Hardin to police. That alleged rape occurred Sept. 1, 2018, at off-campus student housing in Huntington.
Backus said the pair was watching a movie in her room. He pulled her on top of him and started touching her, but she told him no. At that point he became violent and she told him to stop several times, but he did not, he said.
The victim in the Sept. 1 allegation testified Tuesday she was friends with Hardin's sister and had met him at a bar a couple weeks before the alleged assault occurred.
A couple weeks before the alleged assault occurred, the victim and Olivia Hardin were with a group of friends at a bar when the alleged victim met Hardin and the two exchanged numbers. Olivia Hardin said the alleged victim said she wanted to have sex with Joseph Hardin, but the victim denied that while testifying Tuesday.
Nessel presented Tuesday text messages exchanged between Joseph Hardin and the alleged victim in which they discussed the sexual encounter in a positive light after the alleged assault. The two still briefly talked after and he once brought her food.
The alleged victim said she had been in denial about what had occurred.
"I don't like Chase because of what he did to me," she said. "He violated my privacy. I didn't report it because I was in denial for a really long time that he couldn't have done this to me.
"I just tried to normalize what had happened to me to avoid having to deal with the issue."
Both victims did not immediately go to police to report the assaults, but individually decided to come forward after discussing the matter with friends. Both said they were scared of Hardin and embarrassed, and for those reasons did not come forward sooner, Backus said.
Hardin's probation officer also testified Tuesday. She said he admitted drinking a glass of wine, which is a violation of his probation, after a urine sample came back positive for alcohol.
In another alleged incident, a prior probation officer had been informed Hardin had thrown a woman against a wall and choked her while at his job at a Huntington restaurant, but the victim in that case did not want to move forward with the allegations because she was scared of Hardin, even though it was caught on video, the officer said.
The probation officer said the office was not even informed he had been working there until the owner contacted them, which is also a violation.
The probation office only requested the revocation based on the alcohol usage and new crime allegations.
The more recent assault allegations against Hardin were presented to a grand jury three times before an indictment was returned.
Nessel said this showed the weakness of the case, but Neal said it happened because there were not enough jurors to vote on an indictment and they had also requested additional information.
The three women and Hardin were Marshall students at the time the attacks occurred. Gonzales left the university after Hardin was allowed to remain on campus after her attack, and Hardin was expelled last month after the new charges were filed. Marshall University spokespeople have said they followed all federal and state guidelines and had a plethora of hearings in making the decision to allow him to remain on campus.
Attorneys for Gonzales and Marshall's board of governors are scheduled to appear in federal court Monday, July 15, ahead of an Aug. 6 trial date for a lawsuit Gonzales filed against the university for the handling of her case. Gonzales said she was forced to leave Marshall after they allowed Hardin to remain on campus. The university disputes Gonzales left because of the assault.
Follow reporter Courtney Hessler at Facebook.com/CHesslerHD and via Twitter @HesslerHD.