5 ms·

It's worth noting here that not every opioid is metabolized the same. I can't speak for this medicine, but different metabolic pathways are used to process opi

It's worth noting here that not every opioid is metabolized the same. I can't speak for this medicine, but different metabolic pathways are used to process opioids.[1] Having more tools in your toolkit means that you are more likely to be able to treat a patient's pain. That being said, I think that one of the major uses for this drug will be to treat acute pain in chronic pain patients. Those patients aren't opioid naive and may need something that will "override" the tolerance these patients have developed. I'm guessing that they'd also work for patients on the opioid agonist/antagonist Buprenorphine, which is used for chronic pain, but tends to block other opiates. Lastly, while potent, this drug appears to wear off very quickly. That's going to be key here, because it's simply not useful unless you're able to administer a high quantity of the medicine. To boot, I believe that the manufacturer claims that this drug has less cognitive side effects than other opioids. [2] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704133/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704133/ [2] http://www.acelrx.com/technology/publications/arx-04/MHSRS%20ProjTeamPresentation%202016%20FINAL%2008_10_16%20MRC-0076.pdf http://www.acelrx.com/technology/publications/arx-04/MHSRS%2...

Johnny555 8y ago
To boot, I believe that the manufacturer claims that this drug has less cognitive side effects than other opioids I'd take manufacturer claims with a grain of salt, since their goal (actually pretty much a requirement for a public company) is to sell drugs and earn money, not heal people.
- etrevino 8y ago
  Fair enough.
jplayer01 8y ago
The last time these companies promised it wouldn't be as addictive as previous opioids, they were pulling numbers out of their ass and straight lying about it. I think we should all be alarmed if they're releasing a new drug that's even more potent.
- etrevino 8y ago
  It's definitely concerning, but that doesn't mean that it shouldn't be released. It's the sort of drug that will find an appropriate use, though pretty much only in edge cases.
  - jplayer01 8y ago
    > It's the sort of drug that will find an appropriate use, though pretty much only in edge cases. You're way too trusting. While I do think drugs like this should exist for those who really need it (particularly terminally ill patients), I'm incredibly worried about how these drug companies intend to profit from the drug (by selling these drugs to doctors in a way that encourages their use in circumstances that in no way warrant it). Their profit motive and the incredible expense of developing a new drug directly contradicts the need for restrictive and sparing use of the drug to appropriate contexts.
- candiodari 8y ago
  Look here's the issue. In people with chronic pain, there's a medical issue. Treating the medical issue ... is very expensive (I believe spinal operations would be pretty common). Giving them opioids ... "treats" the issue. Cheaply, even though yes, these people are from that point on dependent on opioids. They are of course addicted FIRSTLY because they went untreated, and SECONDLY because the medicine is addictive. Eliminating one of those reasons for addition is pointless. You cannot give these people nothing. You can't actually treat them (that's WAY too expensive). So what is your suggestion, exactly ? You can't leave them untreated and in sometimes incredible pain.
cpncrunch 8y ago
>I think that one of the major uses for this drug will be to treat acute pain in chronic pain patients (Assuming you're talking about long-term non-organic chronic pain here). Opioids are no more effective than Nonopiod painkillers for treating chronic pain [1] and the risks of addiction (8-12% of patients become addicted [2]) mean that the risks don't really outweigh the benefits. Psychosocial treatments seem to be more effective for chronic pain than opioids. 1. https://jamanetwork.com/journals/jama/fullarticle/2673971?format=txt https://jamanetwork.com/journals/jama/fullarticle/2673971?fo... 2. https://dtb.bmj.com/content/56/10/118 https://dtb.bmj.com/content/56/10/118
- etrevino 8y ago
  I was saying acute pain in chronic pain patients. i.e., those who temporarily needed greater pain relief. In any case, I only have experience in palliative care environments, where opioids are de rigueur and with good reason.
MetalGuru 8y ago
What are the cognitive side effects of opioids. I’ve always thought they weren’t very neurotoxic.
- etrevino 8y ago
  They're not, but they can cause depression and/or anxiety. Also, euphoria, agitation, et. al. In one person I noticed that she had developed terrible memory problems. She used to be an academic, but there's no way she could function in an academic environment now. The most pernicious side effects-- in my opinion-- that have fairly scary mental health ramifications are hyperalgesia [1] and uncontrollable itching [2]. I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. Unfortunately, I don't know how the story ended. The last I heard a dermatologist was talking about THC creams being investigated for this type of thing. But I have no knowledge of that. I only mention it because it sounds intriguing. Note: I'm not a doctor. I work in the US government and my job gives me a lot of experience working with pain management doctors and their patients. [1] https://www.ncbi.nlm.nih.gov/pubmed/21412369 https://www.ncbi.nlm.nih.gov/pubmed/21412369 [2] https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fulltext https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fu...
  - candiodari 8y ago
    > I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. You know, why did she take morphine in the first place. That's the big missing link here. People's actions make sense. If, for instance, she had a hernia and couldn't treat it (too expensive, even with insurance, or just no insurance), that would explain her behavior. Same with any other painful or degenerative condition, and in fact quite a lot of untreated conditions. More generally that is the problem there. Addiction, yes, but in the sense of psychological addiction, not substance abuse. If you're in chronic pain you've either got the willpower of an olympic athlete or you're "addicted".

Johnny555 8y ago

To boot, I believe that the manufacturer claims that this drug has less cognitive side effects than other opioids I'd take manufacturer claims with a grain of salt, since their goal (actually pretty much a requirement for a public company) is to sell drugs and earn money, not heal people.

etrevino 8y ago
Fair enough.

jplayer01 8y ago

The last time these companies promised it wouldn't be as addictive as previous opioids, they were pulling numbers out of their ass and straight lying about it. I think we should all be alarmed if they're releasing a new drug that's even more potent.

etrevino 8y ago
It's definitely concerning, but that doesn't mean that it shouldn't be released. It's the sort of drug that will find an appropriate use, though pretty much only in edge cases.
- jplayer01 8y ago
  > It's the sort of drug that will find an appropriate use, though pretty much only in edge cases. You're way too trusting. While I do think drugs like this should exist for those who really need it (particularly terminally ill patients), I'm incredibly worried about how these drug companies intend to profit from the drug (by selling these drugs to doctors in a way that encourages their use in circumstances that in no way warrant it). Their profit motive and the incredible expense of developing a new drug directly contradicts the need for restrictive and sparing use of the drug to appropriate contexts.
candiodari 8y ago
Look here's the issue. In people with chronic pain, there's a medical issue. Treating the medical issue ... is very expensive (I believe spinal operations would be pretty common). Giving them opioids ... "treats" the issue. Cheaply, even though yes, these people are from that point on dependent on opioids. They are of course addicted FIRSTLY because they went untreated, and SECONDLY because the medicine is addictive. Eliminating one of those reasons for addition is pointless. You cannot give these people nothing. You can't actually treat them (that's WAY too expensive). So what is your suggestion, exactly ? You can't leave them untreated and in sometimes incredible pain.

cpncrunch 8y ago

>I think that one of the major uses for this drug will be to treat acute pain in chronic pain patients (Assuming you're talking about long-term non-organic chronic pain here). Opioids are no more effective than Nonopiod painkillers for treating chronic pain [1] and the risks of addiction (8-12% of patients become addicted [2]) mean that the risks don't really outweigh the benefits. Psychosocial treatments seem to be more effective for chronic pain than opioids. 1. https://jamanetwork.com/journals/jama/fullarticle/2673971?format=txt https://jamanetwork.com/journals/jama/fullarticle/2673971?fo... 2. https://dtb.bmj.com/content/56/10/118 https://dtb.bmj.com/content/56/10/118

etrevino 8y ago
I was saying acute pain in chronic pain patients. i.e., those who temporarily needed greater pain relief. In any case, I only have experience in palliative care environments, where opioids are de rigueur and with good reason.

MetalGuru 8y ago

What are the cognitive side effects of opioids. I’ve always thought they weren’t very neurotoxic.

etrevino 8y ago
They're not, but they can cause depression and/or anxiety. Also, euphoria, agitation, et. al. In one person I noticed that she had developed terrible memory problems. She used to be an academic, but there's no way she could function in an academic environment now. The most pernicious side effects-- in my opinion-- that have fairly scary mental health ramifications are hyperalgesia [1] and uncontrollable itching [2]. I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. Unfortunately, I don't know how the story ended. The last I heard a dermatologist was talking about THC creams being investigated for this type of thing. But I have no knowledge of that. I only mention it because it sounds intriguing. Note: I'm not a doctor. I work in the US government and my job gives me a lot of experience working with pain management doctors and their patients. [1] https://www.ncbi.nlm.nih.gov/pubmed/21412369 https://www.ncbi.nlm.nih.gov/pubmed/21412369 [2] https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fulltext https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fu...
- candiodari 8y ago
  > I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. You know, why did she take morphine in the first place. That's the big missing link here. People's actions make sense. If, for instance, she had a hernia and couldn't treat it (too expensive, even with insurance, or just no insurance), that would explain her behavior. Same with any other painful or degenerative condition, and in fact quite a lot of untreated conditions. More generally that is the problem there. Addiction, yes, but in the sense of psychological addiction, not substance abuse. If you're in chronic pain you've either got the willpower of an olympic athlete or you're "addicted".