Replacement therapies for opioid drugs in pain treatment

Opioid painkillers, such as morphine and oxycodone, have proved incredibly successful for alleviating acute post-operative, and chronic pain. However, there is a growing realisation that serious health problems through dependency and misuse mean alternatives need to be identified.

This four-part series will look at some of the alternatives to opioid drugs in pain treatment and examine how successful developments have been to create a sustainable and effective solution. We’ll be looking at drugs which are currently approved and in early trials, as well as those over the horizon.

Effective pain relief – at a cost

Despite their ability to provide effective pain relief in the short term, there is a growing awareness that an overreliance on opioid drugs is not advisable.  The number of unwelcome side-effects that accompany opioid painkillers should be enough to flag concern. 

They can cause nausea, constipation and leave users drowsy, as well as supressing respiration and heart rate, which can cause serious problems for some patients. Worse is the fact that users become tolerant and in many cases dosages must increase over time to remain effective. Ultimately, the key problem is that long-term use of opioid painkillers leads to addiction with consequent problems of dependency and misuse, and withdrawal then leads to severe side-effects.

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From growing problem to public health emergency

This has created a serious health problem. According to the US Center for Disease Control and Prevention, between 1999 and 2016 more than 200,000 people died in the US alone from overdoses of prescription opioids, and it is estimated that around 2.1 million Americans have an opioid-use disorder, while more than 10 million people misuse prescription opioids annually. In 2016 alone, 42,000 Americans died from opioid drug overdoses. As a response to the escalating problem, in 2017 the US Government declared the opioid epidemic a public health emergency [Ref 1].

New formulations

As a response to the issue, the pharma industry has devised new formulations that use tamper-resistant opioid-based painkillers designed to deter abuse. These include reformulated OxyContin ER (extended release), and MorphaBond, an abuse deterrent formulation of morphine, which resists attempts to dissolve active components in water for injections, for example. Opioids are also being replaced by antidepressants, anticonvulsants, and combinations of conventional but safer painkillers such as paracetamol with anti-inflammatory drugs. Other alternative therapies are under development too, including a number of devices designed to stimulate and block nerve cells directly. To tackle the problem at source, there have also been a number of important policy changes including those aimed at cutting or controlling the prescription of opiates. 

Ending the over-reliance

To end the overreliance on opioid painkillers, developing alternative drug therapies is a key priority for all associated with the healthcare industry, but results have been mixed. In part two of this four-part series, we’ll examine some of the recent drug approvals and the immediate impact they have had on patient care and experience.

See the the other 3 parts of the Opioids discussion: Opioids: the future and challenging the epidemic, Opioids - Over the horizon, Opioids: The war on drugs.

Reference:
1. “A Brief History of the Opioid Epidemic and Strategies for Pain Medicine” Mark R. Jones et al. Pain Ther. 2018 Jun; 7(1): 13–21. Published online 2018 Apr 24. doi: 10.1007/s40122-018-0097-6.