! I’ll second that. © 2020 American Association for the Advancement of Science. Of course, anyone that is terminal, they definitely should not be restricted. I never got addicted to them. timeout I crashed my motorcycle at 60 mph and suffered compound fractures of both my femur and tibia, was unconscious for five days, in traction, with a head swollen up like a black and blue pumpkin. In your case, with Tramadol, the withdrawal from the monoamine reuptake inhibitor might have been worse than the opioid withdrawal, certainly after the first few days. I’d developed a relationship with most of those I’d referred for surgery (since it was never recommended, without a trial of rest — unless there were compelling reasons not to — trouble controlling bowels and bladder, progressive weakness etc. as long as you’re hitting the opioid receptors themselves, thus the long search for other pain targets. In 2016, Canadian customs intercepted a box labeled “printer accessories” filled with Laser Jet toner cartridges containing a kilogram of carfentanil, estimated to be enough to kill every resident of Canada. I was given opioids some 19 years ago when I hurt my back really bad. Unlike morphine, PZM21 is more efficacious for the affective component of analgesia versus the reflexive component and is devoid of both respiratory depression and morphine-like reinforcing activity in mice at equi-analgesic doses.”, Br J Pharmacol. This one’s embargo was spectacularly leaky, so everyone who’s really into this stuff had various kinds of advance warning, but the news certainly has made…, I’ve been emphasizing for some time that our efforts to find and deploy a coronavirus vaccine have to be as transparent as possible to increase the chances for success. }, I have read elsewhere that there is some evidence for addiction being connected to preexisting psychological issues. Good point! Outside of the opioid field, what is the strongest evidence that the biased agonism approach may ever work? Comes now the cold water. it might be possible for my doctor to prescribe a limited quantity of a more potent opioid to use for “breakthrough” pain if he is willing to go through the trouble of all the paperwork and potential for auditing. . This should not be seen as a conclusion that could be taken for granted because many observers expected disastrous consequences from the provision of medical heroin prescription. Can’t know. See Neuropharmacology. Perhaps drugs targeting the opioid receptors can be fixed? The lack of withdrawal symptoms may have been connected partially to high doses of gabapentin, also for the original cancer pain. The singularly unpleasant experience with the constipation that followed has made me refuse them ever since, even after a couple of major procedures when, to the dismay and some irritation of the doctors, I made do with ibuprofen and acetaminophen. The New York Times, citing a source with knowledge of the event, reported last night that this was transverse myelitis. © 2020 American Association for the Advancement of Science. So, it appears that Trevena tried to do the only thing really open to them – use an endpoint that clinicians use. but compouinds that strong are not easy to dose safely in a clandestine environment. It’s been apparent for decades that there are severe problems in the translational medicine of new analgesics, but we still haven’t been able to fix the problem, and such programs continue to evaporate in the clinic. I don’t have a care in the world. The problem is the over interpretation of the translatability of the original work. The advantage is to the supplier. (e.g., furanyl fentanyl and other fentanyls long imported and sold here as “China white”). Error of recency. Cara Therapeutics is ardently pursuing this approach (I have no connection with them). A contrast and comparison between the opiates, ibuprofen and acetaminphen suggests that ibuprofen reduces pain by inhibiting COX and inflammation outside the CNS. A new paper demonstrates that in mice that have had their key beta-arrestin-2 protein completely knocked out that morphine and other opioid ligands still produce respiratory depression (and constipation, for that matter). 2) When looking at Signal Bias writ large, morphine is vastly the outlier wrt non-addictive endogeneous opioids. All content is Derek’s own, and he does not in any way speak for his employer. Please reload CAPTCHA. It remains to be shown that one could build an opiate antagonist that similarly acts only in the gut. Why are all the old data being thrown out on the basis of a single study? ! We can probably rely on chemists somewhere in the world, if not China, to discover, mass-produce and sell our addicts new drugs with the same effects as the fentanyls currently sold on our streets (e.g., furanyl fentanyl and other fentanyls long imported and sold here as “China white”). Derek Lowe's commentary on drug discovery and the pharma industry. By Derek Lowe 5 October, 2020. Let’s recap. I’m very sorry to hear of your case. This latest paper, in fact, is a consortium across research teams in Germany, the UK, and Australia to re-examine this whole hypothesis due to all the conflicting results. . It certainly works in the case of psychedelics (5-HT agonists) – that’s how they produce their effects, while the usual 5-HT (serotonin) doesn’t. #1 I hate feeling like this. At no time did I take any opioid medications. So why hasn’t this experiment been run before? The k-selective compounds were zwitterions and had very poor oral bioavailability. Scripps guy, your bias is showing – you should have disclosed the numerous biased ligands you have at your institute. Every 6 months they had to increase the milligrams of the pain med I was taking. I’m going to incorporate some slightly reworked material from my July post in the introduction to each vaccine class, for reference, but everything on the candidates themselves is updated informat…, It’s not easy – especially when you’re a mere chemist – to picture what’s really going on inside a cell. Apparently two labs used the same source while the third had a different one. one part of the infection colonized my left knee with which i was already suffering moderate to severe arthritis. I hate to see that, as I think many less-than-ideal drugs could have a second or third generation that is much better and effective, but we might never know. It’s in a special issue of the Journal of Chemical Information and Modeling, devoted to how these disciplines have responded to the coronavirus pandemic. No idea. Drugs which act on the endocannabinoid system (FAAH inhibitors that block degradation of anandamide) have gone into clinical trials for various indications, including pain relief. This meant a hospital stay (unlike my ophthalmologist who had a microdiscectomy as an outpatient a few years ago). . Is this true ( or at least something which has supporting evidence )? “Opioids with fewer side effects would certainly be welcome. Now, as for you, J&J, Novavax, Merck, and all the others that are pushing into efficacy trials as fast as possible – don’t think for a moment that you won’t be exp…, We have a bit of human clinical data from the Eli Lilly/Abcellera collaboration to make a monoclonal antibody therapy against the coronavirus. = ); All my troubles are a million miles away as I just float along. In the Pipeline | Derek Lowe’s commentary on drug discovery and the pharma industry. Back in the day, disc surgery required general anesthesia, dissection of the back muscles down to the spine, sometimes chipping away at the bones of the spine to remove a bone spur (osteophyte) and/or removal of the offending herniated intervertebral disc. One of them, BIA 10-2474, put five patients in the hospital during a healthy volunteer trial in France, killing one of them and causing permanent brain damage to another. The variation in individual pain response to traumatic injury is mystifying. Looking back, my memory’s now more reliable than it was on the Schedule II drugs, and so is my judgment. But splitting out the constipation may be more tractable. Some of the highly biased Scripps Bohn/Bannister compounds clearly show full analgesia with NO statistically significant respiratory depression on overdose, and have no effects at all in mu opioid knockout mice. First, is there any evidence out there that would tend to *disprove* this hypothesis? Both are effective (if weak) analgesics. For severe, intractable pain we really have nothing to match them, despite decades of searching for alternatives. Learn how your comment data is processed. Gabapentin is known among users as an efficient medication to manage withdrawal symptoms. It’s the Cartesian dualism between flesh (opiate receptor) and spirit (whether you like what it does). “Structure-based discovery of opioid analgesics with reduced side effects … Structure-based optimization yields PZM21—a potent Gi activator with exceptional selectivity for μOR and minimal β-arrestin-2 recruitment. etc.). An editorially independent blog from the publishers of Science Translational Medicine. Portoghese showed back in the 80s that by quaternizing the amine, you can build opiates that don’t get out of the gut. In the Pipeline | Derek Lowe’s commentary on drug discovery and the pharma industry. Update: Moderna has now published their complete clinical trial protocol, and…, Here’s an article that will not be popular among some constituencies. The paper also mentions a recent conference presentation from yet another group that has failed to reproduce the results as well. The commercial guys insisted on oral bioavailability. #2 I love it ! This was the era of the discovery of the protein receptor for morphine and other opiates, and we were all hopeful that this would lead to the development of a nonAddicting opiate (narcotic). Doesn’t mean I would have developed an addiction if I had taken opioids again (I don’t know what the statistics are but I am guessing that a relatively small number of those who have been prescribed opioids become addicted to them) but you certainly can’t get addicted to something that you do not take. I awakened hours after the surgery, and felt immeasurably better. , Nature volume 537, pages185–190(2016). We have this preprint from several of the…, Coronavirus Vaccine Roundup, Early September, Cold Chain (And Colder Chain) Distribution, Thoughts On a New Coronavirus Test (And on Testing), Convalescent Plasma: The Science and the Politics, More Pfizer/BioNTech Data On Their Actual Vaccine Candidate, Encouraging News About Coronavirus Immunity, Hard Data on Remdesivir, and on Hydroxychloroquine, American Association for the Advancement of Science. But the cautionary tale of BIA 10-2474 seems to have slowed that research down. The wide variation in severity of coronavirus infection has been noted throughout the pandemic, and we already know about a few of the risk factors: age, of course, but also being male, and having pre-existing conditions such as obesity…, That title is the only way that I can describe the events of the last few days. Perhaps this is more a “political” than a scientific problem, as if your doctor was willing to take the risk you mention, it seems you’d have a palliative to your condition. The Opioid B-arr2 research is a story about Morphine… nothing more, nothing less. Far more pain and problems from the constipation than from the surgery! Like so many other things this year, what we’re seeing now at the top of the drug regulatory structure is unprecedented, and not in a good way at all. I’m used to being in control. You can also argue: why should a doctor put themselves at risk to treat a patient? So, considering the many known endogenous peptidic ligands for the mu opioid receptor, how do you establish a preclinical translational strategy to start understanding the in vivo effects of a drug candidate? Recent events make that more clear than ever – and not in a good way.
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