Akhil Alugupalli

CAS 137
Professor Henderson

Killing the pain without killing the pained

Words: 1521

As a licensed EMT in Pennsylvania, I have seen some of the brutal effects of the opioid

epidemic. I have seen people that I personally knew in my own community, overdose right there

in a supermarket bathroom. The current standard of treatment that medical professionals follow

with opioid overdoses is to treat the patient with Narcan (an opioid reversal agent). Historically

due to the influx of opioid overdoses, both illegal and legal, Narcan was created and went

through the FDA drug approval process—the same process pharmaceutical companies initially

went through to approve the opioids in the first place—only to be approved for the indication to

stop opioids from having any additional effect on the body. A new generation of drugs

collectively known as “non-opioids” as a broad umbrella, are being developed due to the

prevalence of opioid overdoses. Through the current shift in pain management, an increasing

number of patients are being referred to non-opioid alternatives rather than the traditional

standard of care, opioid painkillers.

The baseline numbers on the opioid epidemic exemplify the severity of its effects in the

country right now. If one would like to quantify the opioid epidemic, here are the numbers: over

115 people overdose on opioids in the United States everyday. Over two million Americans

currently suffer from some form of an opioid addiction (National Institute on Drug Abuse). With

opioids, addiction does not discriminate whether one is a prior drug user or not. Unfortunately,

there are many cases of patients becoming addicted to opioid painkillers without ever using any

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sort of drug, including alcohol, prior to treatment (Mayo Clinic). This brings about the question

about why opioids were approved by the FDA, if they were “hyper-addictive”.

These numbers on the opioid epidemic can be alarming, however, opioids are not some

sort of “demon” drug created to kill people. They were initially created to help patients better

deal with pain. Stemming from the works of Thomas Kuhn, more can be understood deeper

through what we observe currently in the opioid epidemic. First, the pre-paradigm of opioids

should be analyzed. Before opioids, management of pain was very scattered, in that there were

many options and treatments. Pre-opioid treatments ranged from acupuncture to just regular

Tylenol. There was not really a go-to drug that doctors could prescribe for pain, especially for

more severe pain such as from surgery. With normal science and innovation, opioids were

developed and their key to function was that they blocked several pain receptors in the body. The

main point the pharmaceutical companies’ stressed were that opioids were non-addictive and had

little to no side effects. This led to the overall normality of doctors prescribing opioids and

medical schools teaching student-doctors to prescribe opioids for pain management.

“In the late 1990s, pharmaceutical companies reassured the medical community that

patients would not become addicted to prescription opioid pain relievers, and healthcare

providers began to prescribe them at greater rates. This subsequently led to widespread

diversion and misuse of these medications before it became clear that these medications

could indeed be highly addictive. Opioid overdose rates began to increase. In 2015, more

than 33,000 Americans died as a result of an opioid overdose, including prescription

opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.”

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 -National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH)

Now we have come to the stage that we presently face as a country: the crisis phase. In this

phase, the anomaly is the wide-stretching opioid epidemic that the United States and the rest of

the world is currently experiencing.

However in the next stage, revolution, we see a light at the end of the tunnel. Luckily,

there are pharmaceutical companies already working to slow down the ravages of opioids on our

communities. Millions of Americans are addicted to prescription opioid painkillers, and some

had never used any type of drug prior, including alcohol. They simply were prescribed opioids

such as for pain from a broken bone or illness. But now, more research is needed to find better

alternatives to opioids. There are a growing number of pilot-studies being initiated around the

United States and globe, to study how cannabis could potentially serve as a less addictive

alternative to opioids. Patients who are undergoing chemotherapy all the way to bone fractures,

are taking cannabis, or medical marijuana to help alleviate their pain. A positive aspect of

cannabis is that there has never been a recorded overdose in humans (US Drug Enforcement

Agency). What is interesting about cannabis treatment is that the active chemicals in cannabis,

known as cannabinoids, bind to two receptors in the human body. These two receptors form the

endocannabinoid system (ECS). The role of the ECS is to maintain overall homeostasis (balance)

in the body. The general hypothesis that supports cannabis pain treatment, is that the stimulation

of the ECS by cannabis can restore balance with pain receptors, effectively lowering pain. This

can partly explain why there is great interest to study this plant in regards to its potential as an

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opioid alternative. But, cannabis is not the only option becoming available to patients in need of

pain management.

A large reason why development of painkilling drugs that are non-opioid have been slow-

going is partly due to the fact that scientists do not fully understand the mechanism involved with

chronic pain (WebMD). In the current scientific field, it is known that there are many pathways

to chronic pain, which indicates multiple different drugs to act on each of these pathways.

Fortunately in the specific areas of chronic back pain and osteoarthritis pain, which are common

indications for which opioids are prescribed for, a new non-opioid chemical has been developed

by drugmakers.

“The FDA recently fast-tracked the drug tanezumab for approval. Federal regulators had

previously halted work on tanezumab and other drugs like it over concerns about side

effects. The non-opioid blocks the production of nerve growth factor, a substance that’s

needed for certain types of pain to happen. Several other anti-nerve growth factor drugs

are in clinical trials.

The bottom line is that opioids should not be the first thing doctors try in patients who

have chronic pain. The CDC’s latest guideline for opioid prescribing, released in 2016,

notes that most proof of how well opioids work is based on short-term pain. It directs

doctors to try nondrug treatments, such as physical therapy and talk therapy, as well as

non-opioid treatments first. If those aren’t enough, before adding opioids, doctors should

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 work with patients to set realistic goals for easing pain, with an emphasis on making the

body work better rather than eliminating pain.”

-Sonya Collins, WebMD Health News

In addition to the new CDC guidelines, the US Department of Health and Human Services

similarly released a “National Pain Strategy” document that reinforces the new shift in medical

pain treatment. It specifically discusses other alternatives other than new pharmaceuticals and

cannabis, such as both mental and physical therapy for pain.

The active involvement of the CDC and the HHS in the opioid crisis is essential in

allowing the shift away from the paradigm of opioids in managing pain. By two of the most

influential public health agencies in the world taking a stand on opioids, it sets a precedent for

innovators to step up and work to find a solution to this widespread issue. Without the new

guidelines of the CDC and HHS, many would be timid and afraid to stand up to “Big Pharma”, a

word that is used to describe the many pharmaceutical companies that produce prescription

opioids and other drugs. A common theme that is used within substance abuse treatment in

general, is accepting that one has an addiction problem. The statements of the CDC and the HHS

publicly accept that opioids are a public health issue. This is an overall step in the right direction,

if we aim to eradicate the opioid crisis.

Through the current shift in pain management, an increasing number of patients are being

referred to non-opioid alternatives rather than the traditional standard of care, opioid painkillers.

Rather than to follow the low evidence path of approval that opioids took initially to become

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approved, the new generation of pain treatments must follow a strict evidence-based research

approval pathway, in order to ensure a better alternative to opioids is created. The CDC and the

HHS have released new guidelines for medical professionals to be aware of, and that is to

explore non-opioid pain management options. This sets the pace for new and better pain

treatments to come to market, and become available to patients who truly need it. The effects of

the opioid crisis in the United States have been observed throughout our communities. However,

with proper research and both bureaucracy and industry collectively teamed up, we can eradicate

this epidemic. It is very possible that we will see a sharp decline in opioid overdoses, as we

continue to study and further develop better methods on how humans deal with pain in the

coming years.

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 Works Cited

Collins, Sonya. “Beyond Opioids: The Future of Pain Management.” WebMD, WebMD, 14 Mar.
2018, www.webmd.com/special-reports/opioids-pain/20180314/opioid-alternatives.

“Drugs of Abuse.” Drug Enforcement Agency, US Department of Justice, 2017, www.dea.gov/

sites/default/files/sites/getsmartaboutdrugs.com/files/publications/
DoA_2017Ed_Updated_6.16.17.pdf#page=76.

Mayo Clinic Staff. “Chronic Pain: Medication Decisions.” Mayo Clinic, Mayo Foundation for
Medical Education and Research, 14 Feb. 2018, www.mayoclinic.org/chronic-pain-medication-
decisions/art-20360371.

Mayo Clinic Staff. “How Opioid Addiction Occurs.” Mayo Clinic, Mayo Foundation for Medical
Education and Research, 16 Feb. 2018, www.mayoclinic.org/diseases-conditions/prescription-
drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372.

National Institute on Drug Abuse. “Opioid Overdose Crisis.” National Institute on Drug Abuse,
National Institutes of Health, 6 Mar. 2018, www.drugabuse.gov/drugs-abuse/opioids/opioid-
overdose-crisis.