Industry Voices—Opioids are killing us. We need safer painkillers

We all know the brutal trajectory of North America’s opioid crisis: prescription abuse, addiction, overdoses. In the past year, more than 50,000 people have died from opioid overdoses, a toll exceeding even road accidents. And it keeps getting worse.

News that the World Health Organization’s prescription guidelines were corrupted by opioid manufacturers. Record numbers of drug deaths in 2019. And now the COVID-19 pandemic, which has led to a spike in overdoses linked to isolated users and a less-safe supply chain.

In the United States, drug deaths are already up 13% over last year’s numbers. And in Toronto, where I live and work, 27 people died of opioid overdoses in July, the worst month on record. So much carnage from drugs that the world spends more than $25 billion (U.S.) a year to prescribe and use.

To be blunt, these horrible side effects are no longer acceptable. We need safer painkillers.

We keep using opioids, despite the risks, because we’ve been led to believe they are uniquely effective against severe pain. But this is wrong. While other drugs’ shortcomings have led many to settle for opioids, research has shown them to be less effective, especially for chronic pain. Moreover, opioids don’t address inflammation, which underlies many pain-causing conditions, such as osteoarthritis. 

Billions of dollars are being funneled into alternative therapies and technologies, but as a researcher in this space, I feel confident saying that the only true replacement will come from pharmaceutical research.

Yet, everyone wants to talk about cannabis.

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The U.S. National Academies of Sciences, Engineering and Medicine reviewed existing research in 2017 and concluded that while we lack evidence about health effects, marijuana appears helpful in treating nerve, cancer and multiple sclerosis pain. Studies elsewhere have added migraines and fibromyalgia.

But cannabis products lack standardization for effective scientific review. Concerns remain about intoxication, abuse, bronchitis, schizophrenia, dizziness, pregnancy effects, blood pressure and dependency. Acute pain, the principal indication for use of opioids, demands different intervention than chronic pain, where cannabis is typically used. So cannabis won’t solve the opioid crisis.

On the behavioral side, exercise, physio, counseling, meditation, yoga, acupuncture and other therapies have long been used for chronic pain, and most doctors would say they’re worthwhile if they make a person feel better. But they’re most effective in combination with more targeted measures.

RELATED: AMA report finds nearly 40% decline in opioid prescriptions, but overdose deaths continue to climb

Technology is also being used to address pain. Some devices offer nerve stimulation, electromagnetic pulsing or immersive distraction experiences. They help some who try them, but for many, they’re insufficient.

Some of the most promising advances aren’t direct pain relief, but diagnosis and prevention. These range from brain imaging and diagnosis to advanced surgical tools and techniques, such as minimally invasive surgery, that lessen nerve damage and reduce chronic postsurgical pain. But these alone can’t replace opioids and change behavior.

Even during the pandemic, the pharmaceutical industry has been racing to find safe and effective new treatments for inflammation and pain. New opioid alternatives are emerging on several fronts because pain arises from multiple sources—tissue damage, nerve damage, nervous system dysfunction.

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Some rheumatoid arthritis sufferers are trying biologics, which target specific parts of the immune system to relieve pain. But they are expensive and suppress the immune response, so infection is a common side effect.

Other lines of research include treatments that prevent the release of nerve growth factor, or that seek to eliminate opioid side effects, such as dependence or the slowed breathing that can lead to overdose deaths.

My own work involves a drug platform aimed at non-addictive relief of both chronic and acute pain. It remains firmly in development, subject to the outcomes of clinical trials and multiyear timelines. While we hope that our treatment will cross the finish line first, it’s hardly a certainty.

But for those who will require pain treatment in the future, it hardly matters who wins the pharmaceutical race—the important thing is that it’s being run. Someone, somewhere, will get across the line.

They have to. Opioids are meant to treat pain, but overdoses cause too much of their own brand of pain. Alternative therapies and technologies are helpful, but they won’t end the opioid crisis. For that, we need safer painkillers.

John L. Wallace, Ph.D., is founder of the Inflammation Research Network at the University of Calgary and chief scientific officer at Antibe Therapeutics.