December 2, 2016
What to Do About Opiates and Pain Management?
BY Mary Mahoney
Despite quantum leaps in nearly every other area of medicine, pain relief depends heavily on an ancient remedy − opium and its morphine, codeine and synthetic derivatives, which doctors know may cause addiction and destroy the very lives they work to save.
Nearly half a million people died from drug overdoses from 2000 to 2014, according to the Centers for Disease Control and Prevention. Every day, 78 Americans die from an opioid overdose. Since 1999, the number of overdose deaths involving opioids has nearly quadrupled.
“Overdoses from prescription opioid pain relievers are a driving factor in the 15-year increase in opioid overdose deaths,” the CDC said. “Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled.”
Yet opioids are so effective in relieving pain that the pharmaceutical industry continues to churn out massive quantities of morphine, codeine and synthetic deriviatives, including hydromorphone, oxymorphone and oxycodone.
Their potentially addictive qualities notwithstanding, these drugs help millions of people cope with acute and chronic pain. Unrelieved pain can result in longer hospital stays, increased outpatient visits and decreased ability to function. Some pain sufferers ultimately lose their jobs and health insurance along with them.
The American Academy of Pain Management puts it this way: “The effects of pain exact a tremendous cost on our country in health-care costs, rehabilitation and lost worker productivity as well as the emotional and financial burden it places on patients and their families.”
A recent Institute of Medicine report concurs, concluding that pain is a “significant public health problem” that costs society at least $560-$635 billion annually − about $2,000 for ever U.S. resident. This includes $261 to $300 billion in health-care costs and $297-$336 billion in lost productivity.
So great is demand for effective pain relief that the pharmaceutical industry recently introduced a “super opiate” named Zohydro. The hydrocodone-based drug, which was approved by the U.S. Food and Drug Administration in 2013 to treat chronic pain, immediately raised alarm in the health-care and law enforcement communities.
A coalition of more than 40 health-care, consumer and addiction treatment groups urged the FDA to revoke its approval of the drug. “In the midst of a severe drug epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous, high-dose opioid,” the coalition told the FDA..
The advocacy group Physicians for Responsible Opioid Prescribing complained to the FDA that Zohydro represents “a whopping dose of hydrocodone packed in an easy-to-crush capsule” and predicted it will “kill people as soon as it’s released.”
The attorneys general of 29 states wrote to FDA expressing their “grave concern” about “this potentially harmful, hydrocodone-only drug without an abuse-deterrent formula.
Standard opiod formulations are designed to release their pain-killing effect gradually. But they can be altered to release their effect all at once. Illicit drug dealers and abusers typically do so by grinding the pills. An “abuse-deterrent formula” refers to a special formulation designed to resist such tampering.
In addition to abuse-deterrent opiod formulations, there are other glimmers of hope on the horizon. Duke University researchers recently discovered a non-opiod painkiller. The “small molecule” drug promises to block pain, without worry of addiction.
On another front, the magazine Nature recently described how scientists changed the structure of an opioid painkiller to create a much less addictive compound called PZM21. Another new drug, BU08028, was tested on primates who showed no signs of addiction.
No one can predict whether or when these new painkilling medicines may be perfected, tested and finally made available to the public. Unless and until that happens, doctors and their patients worldwide will struggle to balance the benefits of opiod pain relievers with the danger of addiction.