Opioids and opioid-related deaths have been the in the news the past couple years as opioid deaths spiked. Because of this, researchers and doctors have been working together to make advancements in opioid research and development for safer and more effective pain treatment. Here are just a few of the most recent studies to paint a picture of the future of opioid research and development.

Rates of overdose

Evidence of the risks of prescription opioids continues to pour in, and this recent study highlights the gravity of the situation. A research letter published by JAMA Internal Medicine indicated that the majority of hospital visits for opioid overdose are caused by prescription opioids.

Many people think of drug overdose emergency as something that happens when a person takes too much of an illegal drug, but 67.8% of drug overdoses seen in emergency rooms are for legal prescriptions (including methadone). This number equates to 135,971 visits to the ER, with the greatest number occurring in urban areas (84.1%) and in the South (40.2%). Women made up the majority of overdoses (53%), but the majority of patients survived their visit to the ER (98.6%).

While emergency care was clearly successful, the financial burden of opioid overdose is extreme. Visits to public hospitals are subsidized by taxpayer dollars, and the cost of care totaled approximately $2.3 billion. Studies like this one are eye-opening both to the physical and financial dangers of prescription opioids. The letter authors agree:

“Opioid overdose exacts a significant financial and health care utilization burden on the U.S. health care system. Most patients in our sample overdosed on prescription opioids, suggesting that further efforts to stem the prescription opioid overdose epidemic are urgently needed.”

Easy breathing

Those who take opioids for pain management know that as a sedative, opioids can depress breathing and cause sleep apnea. This side effect is particularly dangerous for those patients also diagnosed with asthma or other respiratory ailments. The American Society of Anesthesiologists has been conducting opioid research on a promising new drug called GAL-021. GAL-021 works to prevent breathing problems for patients taking opioids.

The study tracked the breathing of 12 male volunteers who underwent breathing depression induced by opioids. After their breathing rate was decreased by 25-30%, GAL-021 was administered. All volunteers experienced an increase in the volume of the breath they could take in and the volume they could expel (tidal volume). There were no side effects with regard to pain relief or blood flow, good news for patients taking opioids.

The sample size is small, and researchers concede that more studies are needed. Albert Dahan, M.D., lead author and professor of anesthesiology at Leiden University Medical Center in the Netherlands believes that:

[t]he development of potent painkillers that do not increase the risk of respiratory depression seems still far away. Using an add-on drug that reverses or prevents respiratory depression caused by opioid use, without affecting pain relief, is currently our best option to treat this condition.”

Opioids without poppies

Even though opioid over-prescription has made headlines in recent news, there are still pertinent and useful applications for this powerful prescription pain reliever. Opioid production relies on poppy harvests, and poppies rely on climate conditions and other human conditions such as war (as is the case of the number one poppy-producing nation, Afghanistan). Until now. Christina Smolke, a bioengineer from the Stanford School of Engineering, is closing in on a process in her opioid research that would replicate all 17 steps of the opioid production process using yeasts and sugars in fermenting vats.

Smolke and two collaborators, Kate Thodey, a post-doctoral scholar in bioengineering, and Stephanie Galanie, a doctoral student in chemistry, added five different genes, two of which come from poppy cells, to yeast in order to replicate the cellular functions of the poppy cells. Smolke explains her work this way:

“We are now very close to replicating the entire opioid production process in a way that eliminates the need to grow poppies, allowing us to reliably manufacture essential medicines while mitigating the potential for diversion to illegal use.”

This opioid research was published in the August 24, 2014 edition of Nature Chemical Biology.

Morphine, codeine, and drugs such as oxycodone and hydrocodone are all derived from poppies. Poppies are only legally grown in a handful of countries, and the principal market for the harvest is pharmaceutical companies in the United States. This dependence on other countries can cause an increase in price if poppy harvests fail.

Even as prescription numbers drop, this technology is valuable for the future of appropriately-prescribed opioids. The process is not complete, but Smolke and her colleagues are well on their way.

Medical marijuana

Although still highly controversial, legalizing medical marijuana seems to have had a positive effect on the number of opioid-related deaths. The Perelman School of Medicine at the University of Pennsylvania lead a multi-disciplinary study with the results published in JAMA Internal Medicine. Researchers looked at rates of death between 1990, when opioid prescriptions began to rise, and 2010, four years after California became the first state in the U.S. to legalize medical marijuana. The 13 states with legal medical marijuana have, on average, a 24.8% lower annual rate of death due to opioids than states without medical marijuana laws.

These are important findings. An estimated 60% of deaths due to opioids are in patients with a legal opioid prescription, and prescription rates for non-cancer chronic pain have doubled since the early 1990s. Researchers believe that cannabis may offer some pain relief for chronic pain patients, but it also might allow those taking opioids to take fewer, thereby reducing side effects and risk of overdose.

Rates of opioid-related death continue to drop the longer legal medical marijuana is available. After the first year of legalization, a state’s risk of opioid death decreased by 20%. Five years later, the decrease was over 33%.

Opioids can be an important part of a pain management strategy, and current opioid research reflects the industry’s focus on safer, more effective ways to manufacture, prescribe, and combine opioids with other therapies.

Are opioids a part of your pain management strategy?

Image by tom heyes via Flickr