ddn Online

The Blog of Drug Discovery News

The paradox of pain

The global market for pain-relieving drugs has either been approaching or surpassing the $50 billion as we’ve moved from around 2007 to the present day. It’s clearly a huge market, and especially attractive given the numbers of people who suffer from neuralgia, fibromyalgia and lower back pain.

I wrote recently about Pfizer extended its offer to acquire King Pharmaceuticals, largely out of a desire to get access to the latter company’s abuse-resistant pain medications.

And there we go with the crux of things: Abuse potential.

Bad enough that the pharma and biotech companies have to deal with ADME-Tox issues that can kill their drugs before reaching market (but no before eating up hundreds of millions in R&D costs), but now one of the more attractive markets is one in which some of the best pain-relieving drugs are potentially addictive. The question is: How many of the most promising experimental drugs in the pipeline now will be able to deal with the abuse and addiction issue while also answering patients’ needs for relief from their suffering.

This question weighs on my mind as I read a recent article from the Harvard Mental Health Letter:

Painkillers fuel growth in drug addiction, from the Harvard Mental Health Letter

BOSTON—Prescription painkillers kill about twice as many people as cocaine and five times as many as heroin. Nearly two million Americans are dependent on or abusing narcotic (opioid) pain relievers—nearly twice as many as are addicted to cocaine. Because opioid painkillers target the same brain receptors as heroin, causing euphoria, they carry the risk of addiction.

On television shows, drug addicts are often depicted as criminal characters making deals on dark street corners. In fact, people abusing opioid painkillers are most likely to obtain them from friends or family members rather than from any other source, reports the January 2011 issue of the Harvard Mental Health Letter.

Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, explains that treatment for a painkiller addiction is most successful when it consists of two phases: detoxification to reduce or eliminate withdrawal symptoms after opioid use stops, followed by a longer (and sometimes indefinite) maintenance phase. Although counseling is an important part of treatment, most people addicted to painkillers require treatment a medication such as methadone or buprenorphine during both detoxification and maintenance therapy. Although most people addicted to opioids make multiple attempts to kick the habit, it can be done.

This is a tricky situation, and as with so many things in my coverage of the pharmaceutical business realm, I find myself of multiple minds on the issue.

  • Are pharmas too eager to tap into this market, even though many of the best pain relievers lead to addiction and abuse in far too many people?
  • Are people themselves simply too eager to want a “magic pill” for everything rather than, as we might have been told once upon a time, “working through the pain”?
  • Am I overthinking this issue?

I’m not a person who wants to see suffering, so it is troubling that on the one hand, people might have to deal with pain while on the other hand, they might trade in agony for addicition.

It’s quite the quandary, as well as the paradox of pain: In helping people, pharmas may be hurting them as well.

On the bright side, though, pharmas like Pfizer are increasingly attracted to products that will reduced potential for abuse while still providing relief. Certainly, that is a potential profitable combination for them, and I wish them well.

But I continue to wonder how soon we’ll get to that point, and how many people will face this paradox of pain (and and for how many years) until we get there.


January 10, 2011 - Posted by | Academia & Non-Profit, Corporate | , , , , , ,

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