Warren Bickel was a hopeful man working in the midst of hopelessness.
Bickel’s specialty was addiction recovery, a world full of relapses. He was diagnosed with pancreatic cancer, infamous for its low survival rate.
But it didn’t keep him from his work at Fralin Biomedical Research Institute at VTC, where he led the Addiction Recovery Research Center and Center for Health Behaviors Research.
“He was very upbeat,” said Michael Friedlander, the institute’s executive director. “He was working literally up until the day before he died. He was working here doing research on his projects. And he was even about to enter a clinical trial, and he was very positive that … there’s gonna be at least some more time to continue to contribute. Then cruelly, this horrible disease just took him rather fast and unexpectedly.”
Bickel died on Sept. 28, at 68 years old and with a widely admired legacy.
Urged an important FDA change and invented a registry to catalog recovery
His work was instrumental in getting the Food and Drug Administration to approve buprenorphine to treat opioid abuse disorder. The government’s Substance Abuse and Mental Health Services Administration defines buprenorphine as the first opioid abuse treatment medication that physicians can prescribe or dispense from their offices, “significantly increasing access to treatment.” It blocks the craving without the intensity of a dope high.
Bickel developed the International Quit and Recovery Registry, which catalogs more than 10,000 people on six continents, including each of the United States, while providing both a virtual community for people in recovery and research resources for scientists.
He was diagnosed in May, and colleagues quickly organized a Festschrift Symposium, often done to celebrate retirements in the academic world. Many former students and colleagues joined Bickel in September at Fralin Biomedical. At one point during two days of celebrating a life that made a difference, Bickel called Friedlander aside.
“He said to me, ‘Mike, I never thought I’d live to be at my own funeral,’” Friedlander recalled in a Thursday interview. “He said, ‘But it was really quite a great, exhilarating experience to be here with everybody,’ and I know it touched him very, very deeply.
“So I’m just very thankful that we’re able to have that for him before he passed.”
Bickel mentored 14 doctoral students and 30 postdoctoral researchers, according to information provided by Virginia Tech (the “VT” in VTC, with Carilion as the “C” in that acronym). He was on the editorial board at 16 scientific and medical journals. Bickel’s multiple prizes and awards include the 2016 Nathan B. Eddy Award, the highest honor bestowed by the College on Problems of Drug Dependence, according to Virginia Tech.
In the “publish or perish” academic world, Bickel’s publications numbered more than 500, and his work has been cited more than 50,000 times.
‘A walking encyclopedia’ saw the power of episodic future thinking to fight addiction
His work was not simply academic. In June 2017, he co-founded BEAM Diagnostics, which spun off from Fralin with digital tools to screen for substance use disorder. One of his co-founders was Sarah Snider, who had come to the institute three years earlier for her post-doctoral fellowship. BEAM is “one more scheduled clinical trial” away from FDA clearance and is in use in two Virginia hospitals, including Carilion Clinic, said Snider, the company’s CEO.
“He’s always thought very big and, you know, taught me to do the same,” Snider said. “All of our work to date has been bootstrapped and grant-funded through [the National Institutes of Health]. I 100% learned my grant-writing philosophy and strategy from Warren, and that has been the lifeblood of BEAM. So his legacy lives on through our grant success.” 
According to a Carilion Clinic publication, a BEAM tool called Beacon-Alc was three times better than current assessment methods at identifying the number of patients at risk for developing hazardous drinking habits or alcohol use disorder.
“With FDA clearance in hand … I believe that this tool is widely needed, and I think it will be very successful,” Snider said.
Bickel’s death has “a significant emotional impact to me,” she said. “He was a very close mentor to me over the last 10 years and significantly impacted my career and my career trajectory. … It’ll take some time to work through the emotional loss, but I’m also very proud to carry on his legacy through the work.”
Bickel appeared in the best-selling book “Dopesick: Dealers, Doctors, and the Drug Company that Addicted America” due to a chance meeting on an airplane with another Roanoke resident, author Beth Macy. She had just signed the contract for the book, which followed work including her breakthrough “Factory Man.” [Macy is a member of the Cardinal News journalism advisory committee.]
In “Dopesick,” he recounted what a patient had told him about opioid’s pull: “Nothing’s more powerful than the morphine molecule, and once it has its hooks in you, nothing matters more. Not love. Not family. Not sex. Not shelter. The only relationship that matters is between you and the drug.”
Macy reported Bickel’s calculation about an addict’s view of the future — nine days — compared to a non-addict’s view, which is closer to five years.
“He’s just a walking encyclopedia of addiction history,” Macy said. “I mean, he had a really broad view of it going back centuries and how a lot of people have a gene to get addicted to things, all kinds of things.
“And he had written some really cool historical papers, too. I remember him saying that medicine has advanced so much that we’re gonna come to a point where the main problems we have are not medical problems but … our things we cause ourselves by our own behaviors and addictions. I had never heard anybody say anything so sweeping and, you know, I think it’s right.”
His innovations included Episodic Future Thinking, or EFT, Friedlander said. It is an intervention that trains people to experience things into the future, arming the brain to make decisions by projecting your life into the future, leading to wiser decisions including about drugs, health and wellness, including whether one exercises or smokes.
Part of a $50 million gift from Richmond-based Red Gates Foundation to Fralin Biomedical centered on that aspect of Bickel’s work. He was leading a project to develop a smartphone app to help the brain consider future events to reduce smoking, and with it lung cancer, in military veterans.
“So again, using very innovative, scientific tools, he came up with ways to use these things and not only publish them in the scientific literature and share it with his colleagues, but get it out into the world for use,” Friedlander said.
Friedlander was in Roanoke, founding the institute, in 2010, and he had Bickel there by 2011. Bickel’s curriculum vitae included the University of Vermont College of Medicine and the University of Arkansas for Medical Sciences, according to Virginia Tech. Friedlander was grateful early on to the well-established and highly respected researcher for taking a chance on the institute before it was an internationally known organization, and later generating millions in research grants that have benefited the area’s economy.
“He’s really helped put Roanoke on the map in the world of health sciences and biomedical research,” he said.
But his impact as a “high quality human being” was the first thing that Friedlander mentioned when asked to remember his colleague, friend, and counsel.
“Warren is notorious for being a very, very widely read person. You know, he read not just science, he read about politics and philosophy and music and history … and he would give me books all the time to read on all kinds of subjects, way out there. I’d always kind of chuckle to see the next book coming in the door from Warren, and I’d read them and [they] expanded my horizons.
“I’ll miss his smile and sense of humor. So I miss him a lot. It hurts.”
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