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Recently, Purdue Pharma filed for bankruptcy as part of a tentative multi-billion dollar settlement with state and local governments over lawsuits alleging that the company misled doctors and the public about the addictive nature of their well-known painkiller, Oxycontin. But Purdue Pharma's story is part of a pattern that has repeated itself throughout the history of the opium trade. It's a pattern documented by the book Opium: How An Ancient Flower Shaped And Poisoned Our World by Dr. John H. Halpern and David Blistein. The cycle begins when an opium product proves devastating to users. Innovators come along, promising a safer alternative, and virtually every time, they downplay the risks of addiction. Addiction ensues. Then come new innovators, promising something better and less addictive, and the cycle continues.

In the U.S., the opioid crisis is about too many opioids. In some other parts of the world, the opioid problem is about the exact opposite — a lack of access to powerful pain management drugs. As pharmaceutical companies are being sued in the U.S. for flooding the market with opioids, doctors in West Africa say they can't even get hold of those painkillers.

As the medical establishment tries to do a huge U-turn after two disastrous decades of pushing long-term opioid use for chronic pain, scientists have been struggling to develop safe, effective alternatives. When naltrexone is used to treat addiction in pill form, it's prescribed at 50 mg, but chronic-pain patients say it helps their pain at doses of less than a tenth of that. Low-dose naltrexone has lurked for years on the fringes of medicine, but its zealous advocates worry that it may be stuck there. Naltrexone, which can be produced generically, is not even manufactured at the low doses that seem to be best for pain patients.

EDITOR'S NOTE: This article demonstrates the importance of a drug maker's ability to charge and market appropriately for a medicine given the high costs, long path, and other challenges associated with regulatory oversight.

Opioid prescribing after minimally invasive surgery (MIS) remains unacceptably high, according to research conducted at the University of California, San Francisco (UCSF). Of nearly 400 MIS patients surveyed, 90% said they were prescribed opioids after surgery, and 13% of these patients asked for a refill as late as three months after the procedure. The study, which was presented at the 2019 annual meeting of the American Society of Regional Anesthesia and Pain Medicine (abstract 7353), demonstrates that despite efforts to tackle opioid prescribing, it remains a problem and can lead to significant hazards for patients. Solmaz Manuel, MD, an assistant clinical professor in the Department of Anesthesiology and Perioperative Care at UCSF, and her colleagues asked 393 adult patients who underwent ambulatory MIS at UCSF over an eight-month period whether they were prescribed opioids for postoperative pain control and whether they were taking them. The most common procedures were hysterectomy, myomectomy, salpingectomy, oophorectomy, diagnostic laparoscopy, hernia repair and cholecystectomy.

Novartis has quietly scrapped further development of olodanrigan for neuropathic pain. The Swiss company acquired the investigational therapy, also known as EMA401, through its US$200 million acquisition of Spinifex Pharmaceuticals in 2015.