Are Non-Addictive Pain Medications Possible? Alternatives to Opioids for Chronic Pain Management

President Trump Calls for Opioid Alternatives

President Trump recently spoke on the opioid crisis, citing the fact that more people die from drug overdose than any other unintentional death in the U.S. The audience applauded his statement, “We can be the generation that ends the opioid epidemic. We can do it.”

The president went so far as to declare the opioid crisis a national public health emergency under federal law. This frees up billions of government dollars, some of which are meant to be allocated to finding painkillers or pain treatments that do not carry the risk of dependence and addiction.

Opioid abuse and addiction are so prevalent now that almost every American knows someone affected by the tragedy.

Are Non-Addictive Pain Medications Possible?

Is it possible to research and discover or create a painkiller that does not have these inherent risks of addiction and habit-forming properties?

Originally derived from poppy plants, opioids have been around for thousands of years. Two centuries ago, morphine was administered for pain. A century ago, people were addicted to smoking opium pipes in Victorian parlors. Today, patients become addicted to prescriptions like Vicodin and Percocet, some moving on to hardcore heroin.

Over time, experts have sought different solutions to amend the problem, but this has only resulted in the implementation of different but equally-potent and equally-addictive pain reliever.

So, we have an age-old problem that seems to only morph from one addictive drug to another.

The Answer Scientists Seek

Modern science has been searching for effective and non-addictive painkillers without much success until now. There’s still so much we don’t understand about pain mechanisms within the human body.

What we do understand is that the leading treatment for chronic pain management (opioids) is killing us.

Scientists and researchers fall into one of two major philosophies on finding an alternative to opioids for pain, as we’ll explain below. The key to success seems to be focusing on relieving pain in a way that avoids stimulating the opioid receptors in the brain in the manner that current opioid medications do.

Avoid the Opioid Receptors in the Brain

The first philosophy is to focus on developing medications that affect the pain receptors in the brain differently. Many researcher consider our understanding of mu receptor function to be central to the development of addiction therapies.

A new pain medication could involve targeting the opioid receptors more finely, whereas current opioid medications hit a broad-based target of receptors. Or a new medication could avoid the opioid receptors entirely, narrowing in on other receptors in the brain that could affect the perception of chronic pain.

Finally, the path to a successful alternative could involve finding a way to stimulate the brain’s opioid receptors without causing addiction.

There may be hope on the horizon, indeed. Last year, a compound derived from orvinol appeared to produce analgesic responses in primates without the addictive potential.

A Different Type of Fentanyl?

Additionally, another team of researchers from Germany found that a fluorinated derivative of fentanyl offered pain relief specifically and only at the site of injury in rodents. Because it does not work through the whole nervous system, the derivative does not carry the classic side effects, risks and habit-forming potential of opioids.

Especially noteworthy, the new compound derivative of fentanyl shows no respiratory depression or sedation, which are two of the most concerning side effects of current opioids on the market. Respiratory depression and marked sedation lead to cessation of breathing, which is responsible for many deaths associated with accidental overdose.

This German team’s research noted that inflamed tissues in the brain have a different pH than normal tissues. They theorized that the mu-opioid receptors might behave in a different way when inflamed. Therefore, changing the pH of inflamed tissues may be a way of calming the mu-opioid receptors and getting a more specific response to the pain site.

Also worth noting is the company Regulonix in Arizona is in the early stages of developing at least two alternatives to opioid painkillers. So far, the results of Regulonix’s non-opioid compounds are promising. These alternatives work on different pain pathways and offer little chance of overdose or addiction.

Harness or Mimic the Body’s Natural Opioid Chemicals

The second school of thought is to harness the body’s naturally occurring opioids, endomorphins, into a new medication. The most effective painkillers act on the mu opioid receptor, so using these naturally produced endorphin-morphine-like chemicals could trigger the same benefits.

According to the journal Neuropharmacology, scientists have already developed one such painkiller. Researchers from Louisiana’s Tulane University have managed to produce a number of endomorphin variants as strong as morphine but unlikely to yield the same side effects and addictive properties.

They have taken these variants of naturally occurring neurochemicals and made them into a new peptide-based painkiller. The new drug does not produce spinal glial cell activation, an inflammatory effect of morphine known to contribute to tolerance. Scientists have conducted several experiments to see if this test drug produces addiction in rats, and that has not been the case so far. The test drug is expected to go to human trials soon.

Testing has shown that endogenous opioids, like endomorphins, are especially effective in neuropathic pain, one of the most commonly treated conditions in pain management.

In the Meantime

While scientists are busily looking for viable alternatives to our opioid epidemic, we at Elevate Addiction Services are helping people recover from a prescription painkiller addiction, taking a holistic approach to recovering health in mind, body and spirit.

Whatever comes of the president’s intentions, the politics of medicine and the coinciding funding, opioids will continue to impact American lives one way or the other. We can indeed hope that non-addictive pain treatment options will become a real possibility soon.

Read: Managing Pain in Recovery Without Opioids

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