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Novartis’ generics and biosimilar unit Sandoz announced on Monday a new agreement with Durect Corp. for one of the small drug developer’s pain medications — Posimir (bupivacaine), a post-surgery pain reliever currently in late-stage testing. The candidate caught the eye of Novartis, which is paying $20 million upfront for U.S. commercialization and development rights. Durect can also receive $273 million in milestones, with $43 million for R&D achievements and another $230 million for meeting sales goals, as well as tiered double-digit royalties should the drug make it to market.

The Cherokee Nation is suing top drug distributors and pharmacies — including Wal-Mart — alleging they profited greatly by "flooding" communities in Oklahoma with prescription painkillers, leading to the deaths of hundreds of tribal members. The suit includes the nation's three largest pharmaceutical distributors: AmerisourceBergen, McKesson and Cardinal Health.

Nearly 1.5 million Americans were treated for addiction to prescription opioids or heroin in 2015, according to federal estimates, and when those people get seriously hurt or need surgery, it's often not clear, even to many doctors, how to safely manage their pain. For some former addicts, what begins as pain relief ends in tragedy.

There is a great need for new pain medications and a number of strategies for developing them. Award-winning AP medical writer Marilynn Marchione paints the current landscape.

New, persistent opioid use after surgery may be associated less with surgical pain than with other addressable, patient-level predictors, according to a study conducted by researchers from the University of Michigan Medical School, Ann Arbor. "New, persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness," the authors write.