Finally! All the benefits of the opioids, with none of the dangers.
For clarity: I'm referring to all the previous attempts to "fix" the synthetic opioids, each of which ended up making a stronger, more dangerous opioid.
Not just OxyContin. Also Heroin, Meperidine and Tramadol.
We get another "morphine, but safe this time" in pretty reliable 40 year intervals. I guess someone decided OxyContin doesn't count and we are due for another one
On the one hand, I'm sure that the post you're responding to is referencing many previous failed attempts at making non-addictive opioid painkillers.
But on the other, non-sarcastic side... if addiction is the only remaining problem with them, should we care that much?
I.E. if both the chronic and acute health risks are gone (which I don't think they are for a second, but follow me along on this little thought experiment)... does it matter quite so much? Clearly addiction, in the abstract, is not exactly a good thing. But if it's not coupled to risk of death it seems to me it would be a great thing to transition addicted people to, and take away some of the urgency of the situation.
and the fun fact, the other new drug targeting the mid-receptor of acetyl-choline that functions like mu-opioid receptor also has the same exact addiction problems.
>each of which ended up making a stronger, more dangerous opioid
This is true of some early opioids like heroin, but with e.g. Oxycontin the problem wasn’t a stronger opioid, it's how it ended up being prescribed.
Purdue's marketing led doctors to prescribe it to more people, in higher doses, and for longer. Oxycontin isn't inherently more dangerous than the dose of immediate release oxycodone or morphine that would have an equivalent effect.
Innovation in opioids shouldn't just be written off. They're still the best (and sometimes the only effective) treatment for a huge number of people, and some new opioids like buprenorphine/combos like Suboxone have real advantages.
The lesson from Oxycontin is more about deceptive marketing and prescribing practices.
I mean if there were no safe dose or usage pattern then I would expect a lot of mothers to leave the hospital with both a newborn and a crippling addiction. The epidural is an opiate like fentanyl.
Adjacent medicines have seen major improvements: eg Ketamine was a significant improvement from PCP (notably, less psychosis and safe enough to use off the battlefield / with children)
“Removing the worst and most fatal danger” is a laudable goal with Fentanyl given the absurd rate of ODs
As have the opioids buprenorphine and Suboxone (buprenorphine/naloxone), which are genuinely useful treatments for addiction and have much lower risks of abuse.
We really could use better treatments for chronic pain.
I've found low dose naltrexone to be somewhat effective for severe chronic pain. Not as good as opiods.
THC can also help somewhat, but its action seems so dissociative. At an effective level for chronic pain, I'm sleepwalking though the day.
Opioids or their analogues cause or complicate bowel issues. Four years of 200mg/day Tramadol really helped me, but it shredded my gut. Getting off Tramadol wasn't hard for me. I'd stay on it were it not for the gut issues.
As an aside, lacing hydrocodone with acetaminophen is truly a horrific practice. Doctors prescribe this to patients on hepotoxic drugs and are shocked when they get liver damage.
I have 2 family members for whom Tramadol opened the door for severe addiction. One is now on regular morphine, the other had psychosis. I know it obvisouly depends on the individual, just to dilute your very rosy comment
Right. Opioids are an absolute terror to one's digestive system. When I had chronic pain I would rather have just accepted the pain than deal with the gut consequences.
LDN is an interesting one since it just stimulates your body to generate its own endorphins.
> I've found low dose naltrexone to be somewhat effective for severe chronic pain. Not as good as opiods.
When I could get 7oh, it worked well for moderate break-thru (ibuprofen) pain (muscle, joint). I also tried a month of using it regularly wasn't happy overall. I didn't get any withdrawal on stopping tho.
Is fentanyl even that big of an issue in a clinical setting? It's not like it's the go to opiate of choice for general pain anyway.
The problem with fentanyl is that it is easy to make and smuggle and we managed to leave a giant black market hole to be filled when we went ape shit about oxy, which was an objectively better situation than we are currently in with street opiates.
One of the big problems with anesthesia is balancing respiratory depression while medicating the patient enough to manage the symptoms. Fentanyl is used in anesthesia and it causes respiratory depression.
A strong pain medication that doesn't slow or stop breathing would significantly improve the safety of anesthesia.
It's a weird framing. Fentanyl is already very safe in a healthcare setting. It's only dangerous in off-label street use, where dosage is uncontrolled and use isn't being monitored by trained staff. Do we think cartel labs are going to switch to a safer novel opiate? I'm sure they don't care about any relevant patents, but they already have a pipeline/formulation for fentanyl.
As a recurring kidney stone sufferer I am very thankful for fentanyl for my lithotripsy procedures. I hope we continue to make progress on effective pain medications and don't knee-jerk take them away.
I have several naloxone kits in my house and my kids carry them in their backpacks. I'm pro harm-reduction.
With that in mind, what I'm "actually trying to say" is that
a) any time we can make a medication less harmful, that's a good thing; and,
b) if this new molecule relieves pain as well as fentanyl does, it will surely be used by people who are addicted to drugs or who are using drugs recreationally.
The bigger question that goes way beyond the scope of Scripps' research contribution is whether our society can begin to accept that people use drugs like fentanyl to treat depression, trauma, anxiety, and pain of all sorts. And that criminalizing their efforts to treat themselves does not lead to any improvement in their wellbeing or the wellbeing of our society.
I wonder if this modification brings it closer to the mitragynine from kratom, which has opiate like pain dulling effects with very minor or no effect on breathing.
I hope so because the administration is looking to really fuck over medical research by making the 7-OH stuff a schedule 1 narcotic, when it has so much potential for improving anesthesia and pain management by removing respiratory depression from the pain killing element of the anesthetic cocktail.
My understanding is that mitragynine is an mu-opioid partial agonist which limits its impact even in high doses. This is sort of in the same realm as Buprenorphine. Google claims it also doesn't recruit beta-arrestin but admittedly I'm out of my depth here. Presumably this proposed fentanyl replacement is still a full mu-opioid agonist for efficacy.
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For clarity: I'm referring to all the previous attempts to "fix" the synthetic opioids, each of which ended up making a stronger, more dangerous opioid.
Unless you’re being sarcastic and referencing the lies the Sackler family used to get OxyContin popular..
That being said it is indeed quite cool that they modified the drug to decrease the respiratory depression.
We get another "morphine, but safe this time" in pretty reliable 40 year intervals. I guess someone decided OxyContin doesn't count and we are due for another one
But on the other, non-sarcastic side... if addiction is the only remaining problem with them, should we care that much?
I.E. if both the chronic and acute health risks are gone (which I don't think they are for a second, but follow me along on this little thought experiment)... does it matter quite so much? Clearly addiction, in the abstract, is not exactly a good thing. But if it's not coupled to risk of death it seems to me it would be a great thing to transition addicted people to, and take away some of the urgency of the situation.
This is true of some early opioids like heroin, but with e.g. Oxycontin the problem wasn’t a stronger opioid, it's how it ended up being prescribed.
Purdue's marketing led doctors to prescribe it to more people, in higher doses, and for longer. Oxycontin isn't inherently more dangerous than the dose of immediate release oxycodone or morphine that would have an equivalent effect.
Innovation in opioids shouldn't just be written off. They're still the best (and sometimes the only effective) treatment for a huge number of people, and some new opioids like buprenorphine/combos like Suboxone have real advantages.
The lesson from Oxycontin is more about deceptive marketing and prescribing practices.
Dead Comment
“Removing the worst and most fatal danger” is a laudable goal with Fentanyl given the absurd rate of ODs
It's like that xkcd comic about unifying standards, now we have n+1 addictive opioids.
I've found low dose naltrexone to be somewhat effective for severe chronic pain. Not as good as opiods.
THC can also help somewhat, but its action seems so dissociative. At an effective level for chronic pain, I'm sleepwalking though the day.
Opioids or their analogues cause or complicate bowel issues. Four years of 200mg/day Tramadol really helped me, but it shredded my gut. Getting off Tramadol wasn't hard for me. I'd stay on it were it not for the gut issues.
As an aside, lacing hydrocodone with acetaminophen is truly a horrific practice. Doctors prescribe this to patients on hepotoxic drugs and are shocked when they get liver damage.
Tramadol isn't all that strong, but it does take the edge off. With a 6 week taper, my challenge was more about the resurgent pain.
I would not recommend Tramadol, the gut complications are debilitating and it's unclear ignoring the chronic pain served me well.
LDN is an interesting one since it just stimulates your body to generate its own endorphins.
LDN reduces "central amplification" of neuropathic pain, so it is a good fit for my disease profile.
When I could get 7oh, it worked well for moderate break-thru (ibuprofen) pain (muscle, joint). I also tried a month of using it regularly wasn't happy overall. I didn't get any withdrawal on stopping tho.
The problem with fentanyl is that it is easy to make and smuggle and we managed to leave a giant black market hole to be filled when we went ape shit about oxy, which was an objectively better situation than we are currently in with street opiates.
One of the big problems with anesthesia is balancing respiratory depression while medicating the patient enough to manage the symptoms. Fentanyl is used in anesthesia and it causes respiratory depression.
A strong pain medication that doesn't slow or stop breathing would significantly improve the safety of anesthesia.
Deleted Comment
If we got some safer painkillers that weren't insanely addictive, that would be Nobel Prize-worthy, in my layman's opinion.
What is it you're actually trying to say without having to say it?
With that in mind, what I'm "actually trying to say" is that
a) any time we can make a medication less harmful, that's a good thing; and,
b) if this new molecule relieves pain as well as fentanyl does, it will surely be used by people who are addicted to drugs or who are using drugs recreationally.
The bigger question that goes way beyond the scope of Scripps' research contribution is whether our society can begin to accept that people use drugs like fentanyl to treat depression, trauma, anxiety, and pain of all sorts. And that criminalizing their efforts to treat themselves does not lead to any improvement in their wellbeing or the wellbeing of our society.
I hope so because the administration is looking to really fuck over medical research by making the 7-OH stuff a schedule 1 narcotic, when it has so much potential for improving anesthesia and pain management by removing respiratory depression from the pain killing element of the anesthetic cocktail.