A nonaddictive opioid painkiller with no side effects

January 5, 2018, University of Southern California
The findings show how USC Michelson Center scientists collaborate with other experts in multiple disciplines to conduct groundbreaking research. Credit: Janels Katlaps

What if scientists could develop an opioid-based painkiller that is not addictive and has limited side effects?

That is possible based on new findings by an international team of scientists that included contributions from top researchers at the USC Michelson Center for Convergent Bioscience.

The international team captured the crystal structure of the kappa opioid receptor—critical for providing pain relief—in action on the surface of human brain cells. The researchers also made another important discovery: a new opioid-based compound that, unlike current opioids, activates only the kappa opioid receptor, raising hopes that they may develop a painkiller that has no risk of addiction and, therefore, none of the devastating consequences and side effects that accompany it.

The findings were published Jan. 4 in the journal Cell. They are an example of how USC Michelson Center scientists collaborate with a range of experts in multiple disciplines to conduct groundbreaking research, including the opioid addiction.

First, do no harm

The current challenge facing scientists in drug research and development is twofold: develop new alternatives to ease pain while minimizing side effects. Amid an opioid addiction crisis, this is a tall order, and it is urgent. More than 1 in 10 Americans suffer chronic pain, according to the National Institutes of Health. At the same time, millions of Americans are addicted to opioids.

Captained by researchers at the University of North Carolina at Chapel Hill, the team of 24 scientists on this latest study included three USC Michelson Center scientists who are among the most-recognized names in research on the special receptors found on the surface of the neuron: Raymond C. Stevens, Vadim Cherezov and Vsevolod "Seva" Katritch. All three are affiliated with the USC Dornsife College of Letters, Arts and Sciences.

The G , found on the surface of the membrane, are the gatekeepers of communication with cells and are therefore the intended target of most therapeutics. The solution to pain, disease and other conditions begins with understanding—and seeing very clearly—the structure of the receptors when they are inactive and when they are active, interacting with a drug compound.

Typically, scientists determine the structure of receptors by forcing the proteins into a crystal lattice that they then expose to X-rays. Essentially, they want to create an accurate model of the receptor when it does and does not interact with a drug compound.

However, these G protein-coupled receptors are challenging to capture in a stabilized state with traditional X-ray crystallography. Like ill-behaving toddlers, they are highly dynamic, move frequently and very fragile. That is why Stevens, Cherezov and Katritch developed some breakthrough techniques for this special class of proteins that have led to more accurate crystallography.

At a cellular level, their work has led to a greater understanding of the receptors and their behaviors. From a holistic perspective, their research is explaining how humans respond to drugs. Furthermore, they have set the foundation for a new wave of therapeutics that are much more precisely targeted than their predecessors to address illnesses and conditions with fewer unintended side effects.

The power of three

Stevens is a molecular biologist and chemist hailed as a pioneer in solving the structures of G protein-coupled receptors. He developed a method of experimenting known as "high-throughput crystallography" in structural biology, which uses robotics, data processing and management software, as well as liquid handling devices and detectors to conduct millions of tests.

Cherezov is a structural biologist who developed new ways to herd capricious membrane proteins like the G protein-coupled receptors into well-behaved crystals. He uses lipids similar to those found in cell membranes to form a special "cubic phase." This technique ensures that the receptors behave as if they had never left their home on the membrane, even as they form crystals.

The Lipidic Cubic Phase technology has been successfully applied to a majority of the GPCRs that have been solved, including the previous kappa opioid receptor structure in its inactive state, according to Cherezov. By adding a stabilizing nanobody, the researchers are able to capture the structure in a fully active state, he said.

Katritch, a biophysicist and computational biologist, has developed computer models of receptor interactions with ligands that activate or inactivate receptors. This allows scientists to quickly test the receptor interactions with millions of ligands in a virtual lab—his computer—so that they may select the molecules that have the most beneficial therapeutic properties for more testing.

In the case of the kappa opioid receptor, his computer analyses enabled the scientists to modify the chemistry of the ligands so that eventually they developed ligands that affected only the kappa opioid receptor.

Currently, most opioids bind to several on the membrane of brain cells, which has its share of drawbacks. They alleviate pain but cause a range of side effects, from nausea to numbness, constipation, anxiety, severe dependency, hallucinations and even death by respiratory depression.

In this study, the computer models revealed the formulations that would create the strongest bond between the ligand and the kappa opioid receptor without affecting other .

Katritch said the latest research may pave the way for a major drug breakthrough.

"We have already found the structure of the inactive highly useful for discovering potential candidates for a new painkiller," Katritch said. "Now with the structure of the active receptor, we have a template for designing new types of pain medications that have no disruptive side effects for patients and would reduce the burden that addiction has placed on society."

Explore further: Scientists take a big step toward building a better opioid

More information: Tao Che et al. Structure of the Nanobody-Stabilized Active State of the Kappa Opioid Receptor, Cell (2018). DOI: 10.1016/j.cell.2017.12.011

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TheGhostofOtto1923
1.8 / 5 (5) Jan 05, 2018
The opioid addiction crisis is the hystertia created by the rash of illegal fentanyl overdoses. This crisis is creating markets for new and more expensive drugs that will continue drug company profits despite patent expirations on existing products.

Prior to the fentanyl flood there was no crisis.

So where is this poison coming from, and why are we not to suspect that the drug companies are in some way involved?

Methaqualone was a bizarre phenomenon. Black market supplies of genuine rohrer 714 pills must have rivaled legal distribution.

Where did they come from? Who made them available to the black markets?

And after this massive field test was concluded at the expense of what must have been 1000s of lives, why did all sources, genuine and counterfeit, dry up immediately? And despite its great popularity, why is it no longer available today on the black market?

Is it because it is a preferable substitute for opioids?

Who is not seeing manipulation here?
TheGhostofOtto1923
1.8 / 5 (5) Jan 05, 2018
The pharma industry has been losing market share to biopharm and other alternatives for years now. New and effective drugs are becoming harder to create. How many pharma companies might have gone bankrupt without opioid profits?

New drugs such as lyrica and neurontin are being marketed as viable replacements for opioids but they are much more expensive, have serious side effects, and are apparently ineffective as well. But medical facilities can now declare that they will only prescribe them for pain previously treated by opioids.

Antidepressants were some of the most widely prescribed drugs during their heyday, but subsequent study results issued after patent expiration declared them ineffective and dangerous. Luckily, the industry had new and more expensive replacements ready for sale, which now appear ineffective and dangerous as well.

These drugs were all declared safe but withdrawal was shown to be just as severe as with opioids. More deception, more manipulation.
Da Schneib
5 / 5 (9) Jan 05, 2018
People like @Otto who apparently don't live with chronic pain or someone who has to live with it are incapable of understanding its impact. "They should just live with it" is ignorant in ways it is impossible to explain, not to mention unethical.

Get some ethics, @Ottotheluser.

If these guys are successful there will be an answer to chronic pain that does not cause addiction and does not interfere with normal pathways. Why are you against that? Do you like making people suffer? What's the matter with you?
Whydening Gyre
5 / 5 (4) Jan 05, 2018
"A nonaddictive opioid painkiller with no side effects"
Man, their TV commercials are gonna be pretty short, then...
Da Schneib
5 / 5 (4) Jan 05, 2018
Painkillers are dangerous. You can hurt yourself and not know it. Drugs like this need to be monitored and mostly shouldn't be given outside a clinical setting, even without side effects and addiction risks.

I have had a lot of angioplasties, and standard protocol gives fentanyl. I wouldn't even consider taking this drug outside of a hospital with continuous monitoring. And I am... experienced.
TheGhostofOtto1923
1 / 5 (2) Jan 05, 2018
People like @Otto who apparently don't live with chronic pain or someone who has to live with it are incapable of understanding its impact. "They should just live with it" is ignorant in ways it is impossible to explain, not to mention unethical.

Get some ethics, @Ottotheluser
Da Scheide misses my point entirely. Big surprise.

I'm saying the opioid epidemic is totally contrived. Drug companies want them banned because they no longer provide the profit they once did, and they need funds to develop these new alternatives which I'm sure they will claim are harmless just like they did with opioids.

I LIKE opioids. The fentanyl that is causing all the deaths is black market fentanyl, often pressed into oxycodone tabs identical to the originals but many times more powerful. Not so hard to imagine machinations.

You didn't read the thread where I told the world that the last time I was at johns Hopkins they took out my gall bladder without telling me? Believe it or what.
TheGhostofOtto1923
1 / 5 (5) Jan 05, 2018
"A nonaddictive opioid painkiller with no side effects"
Man, their TV commercials are gonna be pretty short, then...
-And the brits developed heroin as a non-addictive alternative to opium. And methadone was developed as a safe heroin withdrawal aid immune to abuse.

Believe it or what.

The problem is that people cannot tell the difference between pleasure and relief from pain. Epicurus not otto coined this. I think most of us live with certain amounts of chronic subliminal pain that we're not aware of until these drugs alleviate it.

Perhaps the euphoria they describe is in some ways the way people are normally supposed to feel. Chronic inflammation and accruing nerve damage have robbed us of it.
Get some ethics, @Ottotheluser
Yeah and per your angina, get some exercise scheidemann.
Da Schneib
5 / 5 (4) Jan 05, 2018
@TheGOO your final response indicates exactly the attitude I said you had at the beginning, which you tried to bury at the end. Was that what you posted once you got drunk enough?
TheGhostofOtto1923
1 / 5 (1) Jan 05, 2018
Der Schwarzeloch said
They should just live with it" is ignorant in ways it is impossible to explain, not to mention unethical
And Otto replied
I LIKE opioids
-but der Muschi claimed that
your final response indicates exactly the attitude I said you had at the beginning...
otto baiting is what earned you your nickname in the first place as i recall.
Thorium Boy
1 / 5 (5) Jan 05, 2018
Stop worrying about drug addicts. A crackdown on pain killers will hurt only one type of person, those in chronic pain for the entire lives. Let the drug addicts die. In fact, do what William Buckley suggested decades ago; Legalize all drugs, make them cheap. For a year, you'd have bodies in the streets. But then the genetically predisposed to addiction would be dead, no more drug problem.
Whydening Gyre
5 / 5 (1) Jan 05, 2018
You didn't read the thread where I told the world that the last time I was at johns Hopkins they took out my gall bladder without telling me? Believe it or what.

That's what happens when ya go in for hemorrhoid surgery...
Whydening Gyre
5 / 5 (8) Jan 05, 2018
Stop worrying about drug addicts. A crackdown on pain killers will hurt only one type of person, those in chronic pain for the entire lives. Let the drug addicts die. In fact, do what William Buckley suggested decades ago; Legalize all drugs, make them cheap. For a year, you'd have bodies in the streets. But then the genetically predisposed to addiction would be dead, no more drug problem.

You DO realize opoids are addictive, right...? And that many of those it was prescribed to are now addicted.. right?
And that most of those opoid addicted were not lifelong chronic pain sufferers...right?
So, if it was your Mom in that position, you'd say "Just let 'er die...", right?
IronhorseA
5 / 5 (6) Jan 05, 2018
"-And the brits developed heroin as a non-addictive alternative to opium."

Otto, heroin was developed by the the company that makes Bayer aspirin. Its a German company. It was developed in 1895.
yep
not rated yet Jan 06, 2018
Cannabis and kratom are alternatives to opioids. Borh have shown efficacy in pain reduction and reduce deaths from opiods.
Da Schneib
5 / 5 (2) Jan 06, 2018
Sorry @TheGOO, not gonna argue process with you nor let you change the subject. You said what you said, I pointed it out, it's right there in black and white, and you're bobbing, ducking, weaving, dodging, and faking. Try not to be such an asshole next time.
TheGhostofOtto1923
1 / 5 (1) Jan 06, 2018
Otto, heroin was developed by the the company that makes Bayer aspirin. Its a German company. It was developed in 1895.


"Charles Romley Alder Wright FCS, FRS was an English chemistry and physics researcher at St. Mary's Hospital Medical School in London. He was the first person to synthesize diamorphine or heroin, in 1874."

"In quest of a non-addictive alternative to morphine, he had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride over a stove for several hours and produced a more potent, acetylated form of morphine, now called diamorphine, also known as heroin."

You can find this too by typing 'who invented heroin?' Into Google.

I usually know what I'm talking about.
Da Schneib
5 / 5 (5) Jan 06, 2018
Not this time, @TheGOO. From Wikipedia:
Wright's invention did not lead to any further developments, and diamorphine became popular only after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann. Hoffmann, working at Bayer pharmaceutical company in Elberfeld, Germany, was instructed by his supervisor Heinrich Dreser to acetylate morphine with the objective of producing codeine, a constituent of the opium poppy, pharmacologically similar to morphine but less potent and less addictive. Instead, the experiment produced an acetylated form of morphine one and a half to two times more potent than morphine itself. The head of Bayer's research department reputedly coined the drug's new name, "heroin," based on the German heroisch, which means "heroic, strong" (from the ancient Greek word "heros, ήρως"). Bayer scientists were not the first to make heroin, but their scientists discovered ways to make it, and Bayer led commercialization of heroin.
IronhorseA
5 / 5 (1) Jan 06, 2018
I wonder if this is just a case like Henry Cavendish where later discoverers were given credit for things that Cavendish discovered but never published. I just remember a picture of 'Bayer Heroin' tablets in a bottle in a science magazine I read back before the internet became public. The article stated that Bayer Pharmaceuticals was the inventor (without stating which employee did the work)
:)
TheGhostofOtto1923
not rated yet Jan 06, 2018
"Wright's invention did not lead to any FURTHER developments"

- But he did develop it none the less.

"Develop
start to exist, experience, or possess.
"a strange closeness developed"
synonyms: start, begin, emerge..."
PoppaJ
5 / 5 (1) Jan 06, 2018
I gave up reading after the first line. CLICK BAIT
Title says

"""A nonaddictive opioid painkiller with NO side effects"""

And the first line says

"""What if scientists could develop an opioid-based painkiller that is not addictive and has limited side effects?"""

You cannot have a title that is contradicted by the first line of the article and expect anyone to take is seriously!
humy
5 / 5 (6) Jan 07, 2018
I gave up reading after the first line. CLICK BAIT
Title says

"""A nonaddictive opioid painkiller with NO side effects"""

And the first line says

"""What if scientists could develop an opioid-based painkiller that is not addictive and has limited side effects?"""

You cannot have a title that is contradicted by the first line of the article and expect anyone to take is seriously!


Do you dismiss the whole of the scientists excellent research that could lead to pain relief in millions of suffering people just because of one trivial semantic error in this report?
Whydening Gyre
5 / 5 (1) Jan 07, 2018
"Wright's invention did not lead to any FURTHER developments"

Well, Wilbur and Orville's sure did...
cardzeus
2 / 5 (4) Jan 07, 2018
Although I haven't read the actual paper, there seems to be a glaring weakness in this research - or, at least, in the way it is described in this piece: there seems to be an assumption that opioid-related addiction is a product of opioid interaction with receptors distinct from the one to which this particular compound binds. If evidence to support this premise exists, we should be told what it is. If it does not exist, the suggestion that this type of research offers a path to relief of pain without risk of addiction is unjustified, and is the type of hyperbolic reporting that gives science a bad name.
PoppaJ
not rated yet Jan 07, 2018
I gave up reading after the first line. CLICK BAIT
Title says

"""A nonaddictive opioid painkiller with NO side effects"""

And the first line says

"""What if scientists could develop an opioid-based painkiller that is not addictive and has limited side effects?"""

You cannot have a title that is contradicted by the first line of the article and expect anyone to take is seriously!


Do you dismiss the whole of the scientists excellent research that could lead to pain relief in millions of suffering people just because of one trivial semantic error in this report?

No, and I did not say that. However To claim "excellent research" is dubious based on their inability to be completely honest in their reporting.
Captain Stumpy
not rated yet Jan 07, 2018
@ghost
The opioid addiction crisis is the hystertia created by the rash of illegal fentanyl overdoses
not really
this has been growing for well over a decade, especially in the VA system where opioids were prescribed for any chronic or moderate/severe and above pain after the first Gulf

current US medical systems tend to over-prescribe opioids for chronic non-cancer pain - https://www.ncbi....3280087/

And methadone was developed as a safe heroin withdrawal aid immune to abuse
depends on how it's used:
see also: https://www.ncbi....8187075/

http://mytopcare....also.pdf

https://www.scien...06003162

https://www.scien...07001005

it is remarkable that opioid treatment of long-term/chronic non-cancer pain does not seem to fulfil any of the key outcome opioid treatment goals
Captain Stumpy
5 / 5 (1) Jan 07, 2018
"A nonaddictive opioid painkiller with no side effects"
Man, their TV commercials are gonna be pretty short, then...
I don't care who you are - that sh*t is F*CKING HILARIOUS right there!
LMFAO

.

Stop worrying about drug addicts. A crackdown on pain killers will hurt only one type of person, those in chronic pain for the entire lives. Let the drug addicts die
@Thorium
the problem is that far, far too many addicts are being *made* by overprescription of opioids - as well as the fact that opioids can be very addictive

meaning: the medical establishment has been creating addicts of normal people

it's not really the same thing
Captain Stumpy
5 / 5 (1) Jan 07, 2018
I don't know why this didn't copy above, so I will add it
The TROUP (Trends and Risks of Opioid Use for Pain) study reports on trends in opioid therapy for NCPC in two disparate populations, one national and commercially insured (HealthCore Blue Cross and Blue Shield plans) and one state-based and publicly-insured (Arkansas Medicaid) population over a six year period (2000-2005).
... Use of short-acting Drug Enforcement Administration Schedule II opioids increased most rapidly, both in proportion of NCPC patients treated (HealthCore 54%, Medicaid 38%) and in cumulative yearly dose (HealthCore 95%, Medicaid 191%). These trends have occurred without any significant change in the underlying population prevalence of NCPC or new evidence of the efficacy of long-term opioid therapy and thus likely represent a broad-based shift in opioid treatment philosophy.


https://www.ncbi....2668925/
humy
5 / 5 (3) Jan 07, 2018


Do you dismiss the whole of the scientists excellent research that could lead to pain relief in millions of suffering people just because of one trivial semantic error in this report?

No, and I did not say that. However To claim "excellent research" is dubious based on their inability to be completely honest in their reporting.

That is an illogical assertion because "their reporting" doesn't come from the scientists themselves but rather from the author of this link thus that is not an indicator that the scientists research is "dubious".
I have also heard of inaccurate reports from journalists of Einstein's relatively but I assume you wouldn't say his good research is "dubious based on their inability to be completely honest in their reporting", right?
Journalists misquote and misrepresent (and even lie) all the time about scientists research [i]regardless[/i] of whether that research is good or bad.
PoppaJ
not rated yet Jan 07, 2018

"That is an illogical assertion because "their reporting" doesn't come from the scientists themselves but rather from the author of this link thus that is not an indicator that the scientists research is "dubious".
I have also heard of inaccurate reports from journalists of Einstein's relatively but I assume you wouldn't say his good research is "dubious based on their inability to be completely honest in their reporting", right?
Journalists misquote and misrepresent (and even lie) all the time about scientists research regardless of whether that research is good or bad."

The reporting comes from the University of southern California and the scientific research was done at the University of Southern California. The information comes from those scientists at the University of California. It was not written by "some journalist". It is the University of California attempting to sensationalize research that will go no where because opioids are bad no matter how you spin it.
TheGhostofOtto1923
not rated yet Jan 08, 2018
not really
this has been growing for well over a decade
The overdose surge began in 2014 and is due entirely to illegal 'synthetic opioids'. See the chart
https://www.cdc.g...dex.html

-Before then OD deaths increased with the number of patients being treated, ie a constant rate per capita before the surge.

"The truth about the US 'opioid crisis' – prescriptions aren't the problem"
https://www.thegu...riptions

Plus, per an article here on physorg not too long ago, something like 90% of the prescribed pills are never used. Mysteriously this statistic is impossible to find on Google.

But use rates commonly cited are based on prescriptions written, not actual usage.
katesisco
1 / 5 (2) Jan 08, 2018
All this and no reference to the fact that our bodies were made to function without constant pain.
So why the pain?
Well, there's fungal candidas that build up over years and actually rob us of our oxygen.
A huge percentage of us are being told that we have COPD, Crone's, constant low back pain and a multitude of others when we probably have a crushed immune system due to this parasitic load.

So basically the elite want a functioning slave but not too functional and having to pay for the privilege.
I actually saw a internet blurb that stated people were necessary for the production means in an economy. These kids learn the same we learned and it will take them 50 years to discover our sole requirement is to consume.
DrStig
not rated yet Jan 08, 2018
Kappa agonists for pain have been around for a while, but kappa receptor stimulation causes dysphoria, hallucinations, dissociation, and depression. Many consider those to be objectionable side effects, unless one wants a spiritual journey as well, since kappa stimulation is the mechanism behinds Salvia's hallucinogenic effects. There is already one kappa agonist analgesic that has completed phase 2 clinical trials that is purely peripheral acting to avoid the aforementioned CNS side effects. That would seem to fit with what the researchers hope to accomplish, but it's already been done. Still, more knowledge about the receptor is always a plus.
Captain Stumpy
not rated yet Jan 08, 2018
@ghost
The overdose surge began in 2014 and is due entirely to illegal 'synthetic opioids'. See the chart
you missed the point - so to clarify:

regardless of the surge, the "The opioid addiction crisis" started much earlier (as referenced), which was my point of clarification

this was a recognized crisis far earlier than the synthetic opioids surge charted

it is already a well-known crisis and suddenly we have a huge spike in deaths without a major change in prescription rates, hence the comment that the cause is "likely due to illicitly-manufactured fentanyl.2,3"

the "hysteria" really started with various trigger warnings which lead to the TROUP results, which eventually lead to the above CONSORT (CONsortium to Study Opioid Risks and Trends) studies and long-term CDC tracking (Drug overdose deaths in the United States, 1999–2016)

IOW - the "Crisis" started in 1999 when the medical establishment started the repeated warnings (AKA- Hysteria)
Captain Stumpy
not rated yet Jan 08, 2018
@kate
So basically the elite want a functioning slave but not too functional and having to pay for the privilege.
I actually saw a internet blurb that stated people were necessary for the production means in an economy. These kids learn the same we learned and it will take them 50 years to discover our sole requirement is to consume
WTF?

you saw an *internet blurb*?!

ROTFLMFAO

I saw an internet blurb that stated the earth was flat - and I saw a lot of repeat posts of that blurb too. does that mean it's real or true?

better yet:
if you google "Unicorn farts" you can find "About 549,000 results (0.37 seconds)" - does that mean unicorn farts, and thus unicorns, are real?

just because you can find information on the internet doesn't mean it's real or factual

LOL

TheGhostofOtto1923
not rated yet Jan 08, 2018
you missed the point
Did not did not.

The study BEGAN in 1999. There was no crisis as no one was taking steps to curb it or publicize it. And in fact prescriptions increased manyfold.

"In the late 1990s, around 100 million people or a third of the U.S. population was estimated to be affected by chronic pain. This led to a push by drug companies and the federal government to expand the use of painkilling opioids.[12] Between 1991 and 2011, painkiller prescriptions in the U.S. tripled from 76 million to 219 million per year."

It only reached crisis stage after illegal fentanyl hit the streets.

"Fentanyl-related deaths increased by 540 percent across the United States since 2015. This accounts for almost "all the increase in drug overdose deaths from 2015 to 2016", according to a study published in the Journal of the American Medical Association."

-At which time boards and committees were assembled, laws passed, and restrictions placed on scripts.
TheGhostofOtto1923
not rated yet Jan 08, 2018
Since your 'crisis' began, "Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014".

I guess your crisis demanded adding fuel to the fire.
Captain Stumpy
not rated yet Jan 09, 2018
The study BEGAN in 1999. There was no crisis as no one was taking steps to curb it or publicize it.
erm... why would one consider it prudent to track prescription vrs addiction and overdose if it's not already a concern (or crisis)?

more to the point: if no one was taking steps to publicize or curb it, why did they study and publicize it in order to determine a means to curb it?
LOL
Crisis (1996) Opioid Addiction..., Krausz, Degkwitz et al
I guess your crisis demanded adding fuel to the fire
isn't that how big pharma works?
but seriously: the medical establishment was attempting to regulate itself but there was a great deal of info being promoted by pharma companies stating that prescription opioids were safe - which proved to be wrong, especially with long-term pain use (esp. chronic pain- notice the early studies I linked re: efficacy of long-term opioid therapy?)

see also: Opioid epidemic in the United States (2012), Manchikanti et al
Captain Stumpy
not rated yet Jan 09, 2018
Did not did not
did too, did too!
LOL
but seriously: the problem is just getting a lot more mass media attention now
Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, an opioid epidemic with adverse consequences has escalated

...Over the past 20 years, the liberalization of laws governing the prescribing of opioids for the treatment of chronic non-cancer pain by the state medical boards has led to dramatic increases in opioid use.

...and finally, aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians.

The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards
Opioid epidemic in the United States (Pain Physician 2012)
humy
not rated yet Jan 09, 2018


The reporting comes from the University of southern California and the scientific research was done at the University of Southern California. The information comes from those scientists at the University of California.

Err, how does that equate with the report being MADE by those scientists that did the actual research? It doesn't. Thus they cannot be blamed for that bad report and such a bad report doesn't imply their good research is bad.

opioids are bad no matter how you spin it.

Who where said they were 'good'?
+Their point of their research is to make a GOOD one.
humy
not rated yet Jan 09, 2018

Who where said they were 'good'?

Edit-mess-up;
that should be;

"Neither me nor those scientists said all the current ones are 'good'."
TheGhostofOtto1923
1 / 5 (1) Jan 09, 2018
but seriously: the medical establishment was attempting to regulate itself but there was a great deal of info being promoted by pharma companies stating that prescription opioids were safe - which proved to be wrong, especially with long-term pain use (esp. chronic pain- notice the early studies I linked re: efficacy of long-term opioid therapy?)
The question remains - if it was a recognized crisis in 1999 why did the number of scripts increase afterword, and only after illegal fentanyl deaths skyrocketed, and press and politicians grabbed hold of it?
Who where said they were 'good'?
The profession that prescribe it, the companies that make it, and the patients who take it. It's good because it works where nothing else does, and it is uncommonly safe.
TheGhostofOtto1923
1 / 5 (1) Jan 09, 2018
isn't that how big pharma works?
erm no

"When serious adverse events occur, evaluation should be speedier than at present. In almost half of the cases, drugs that caused deaths were only withdrawn after two years had passed."https://blogs.bio...r-think/

- And they are lamenting 2 years as too long. If the opioids were declared a crisis in 1999, why did restrictions only start perhaps 10 years later?

My point being: this 'crisis' engineered for political and economic reasons by flooding black markets with lethal, illegal fentanyl which was often sold in pill form, indistinguishable from oxycodone, for the purpose of causing mass casualties.

"Although these powerful pain relievers can be addictive, opioids are safe for most people when used properly. ... "
Captain Stumpy
not rated yet Jan 09, 2018
...if it was a recognized crisis in 1999 why did the number of scripts increase afterword...
and again:
Over the past two decades, as the prevalence of chronic pain and health care costs have
exploded, an opioid epidemic with adverse consequences has escalated. Efforts to increase
opioid use and a campaign touting the alleged undertreatment of pain continue to be
significant factors in the escalation. Many arguments in favor of opioids are based solely on
traditions, expert opinion, practical experience and uncontrolled anecdotal observations.
Over the past 20 years, the liberalization of laws governing the prescribing of opioids for
the treatment of chronic non-cancer pain by the state medical boards has led to dramatic
increases in opioid use.
note the part " Efforts to increase opioid use and a campaign touting the alleged undertreatment of pain continue to be
significant factors in the escalation"

2Bcont'd
Captain Stumpy
not rated yet Jan 09, 2018
Cont'd
remember: "The purpose of this comprehensive review is to describe various aspects of crisis of opioid
use"
This has evolved into the present stage, with the introduction of new pain management standards by the ... (JCAHO) in 2000, an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses,
and finally, aggressive marketing by the pharmaceutical industry. These positions are based
on unsound science and blatant misinformation, and accompanied by the dangerous
assumptions that opioids are highly effective and safe, and devoid of adverse events when
prescribed by physicians.
again, note the part "...aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation..."

2Bcont'd
Captain Stumpy
not rated yet Jan 09, 2018
@cont'd
My point being: this 'crisis' engineered for political and economic reasons by flooding black markets with lethal, illegal fentanyl...
except that you're making the assumption that the "Crisis" started recently

the whole point above is this: you are correct in that there is a conspiracy involved, and it's economic in origin, but you're off as to the timing

*you can't track a crisis that you don't know about*

so to reiterate:
the medical profession tried to regulate itself
it failed because of aggressive marketing, misinformation, tradition, etc
regardless of the information provided, the problem grew due to the above
mass media finally get more heavily involved due to death spike
people think it's a recent crisis

all the while the "crisis" started in the 90's with the overprescription of opioids, hence the reason for the NIH and CDC tracking and analysis

it's not my opinion - it's in the med journals above
TheGhostofOtto1923
1 / 5 (1) Jan 09, 2018
it's not my opinion - it's in the med journals above
And have you read the new england journal of medicines many articles on th evils of firearms? You believe them as well?
Captain Stumpy
not rated yet Jan 09, 2018
it's not my opinion - it's in the med journals above
And have you read the new england journal of medicines many articles on th evils of firearms? You believe them as well?
I believe the date they were written

don't you?

it is very hard to write about a topic that doesn't exist, mind you... at least, from what I can tell, this is true for most people
TheGhostofOtto1923
1 / 5 (1) Jan 10, 2018
it failed because of aggressive marketing, misinformation, tradition, etc
Aggressive marketing based on studies published... in your med journals.

If they lie about firearms they can certainly lie about drugs. Both a result of pressure from special interest groups with 'studies' and 'data' to support their plausibility.
Captain Stumpy
not rated yet Jan 11, 2018
If they lie about firearms they can certainly lie about drugs
which is part of the point about the "studies" that were produced by the big-pharma

or did you miss that part?

that whole part lead to the "unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians."

none of that means the crisis didn't start earlier than you claim... it actually supports the argument that the crisis started when the CDC and everyone else started tracking the problem, as I noted above

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