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I asked this question on Fred’s post about the problems his family’s had filling his mom’s prescriptions for painkillers — medication she needs to treat the pain of advanced lung cancer. Moments after asking it, I began thinking, “Hey, wait — that’s a good question.”
Or maybe it isn’t, but I figured there could be no harm asking, because I bet I’m not the only one to wonder.
Why is it that the only really effective painkillers we seem to have are highly addictive and dangerous drugs that addicts love? The point of a painkiller is to make the pain go away, not to get you high, so why do we not yet have a class of drugs that only do the former? Or, to wit: We already do have many of them, such as aspirin, acetaminophen, and ibuprofen. And those are great, effective drugs, as anyone who’s had a headache or a sprained ankle knows. But apparently, they’re not effective enough to treat more serious pain.
So for those of you who know more about medicine, pain management, and drug development than I do: What’s the problem?
It seems to me that the long-term solution to the problem Fred and his family are confronting — one my family has also confronted, and I’ll vouch for the horror of trying to secure effective painkillers for a terminally ill relative and being treated like a common drug addict for doing so — is to create a better class of painkillers. We clearly need painkillers that treat pain but are of no special interest to people who want to get high.
In other words, isn’t this a medical research problem?
Can anyone here shed any light on the obstacles to creating that kind of drug? Is anyone close to doing it? Are any such drugs in testing? If not, who’s doing the most interesting research into the problem?
It seems to me the market for such drugs must be absolutely massive — if we consider “pain” a disease, it’s one we will all, almost certainly, face sooner or later. And short of dementia, I’d guess it’s also the one most of us most fear. Most of us would pay almost any amount of money not to experience terrible pain, or worse still, see a loved one in excruciating pain. So I can’t imagine there are no financial incentives to drug development: an orphan disease, this is not.
An effective painkiller that posed no risk of mental impairment or addiction would be (I would think) one of the most profitable drugs ever manufactured. It would leave Viagra in the dust. It would inherently be an obvious social boon, with a very significant secondary social benefit: There would be no reason strictly to control or limit its prescription.
Why is this problem so difficult, medically? Is the obstacle a known and thus-far insoluble medical one? Or is it a political, regulatory, or economic problem? Is it somehow related to the drug development process?
Does anyone here know?
As I was writing this, another question occurred to me. What would be the obstacle to creating drugs that get people as high as the opiate painkillers do — if that’s what they want to be — but that don’t impair mental functioning and judgment, and aren’t as likely to kill them if they overdose? Why, in other words, aren’t we fighting a war for drugs — much better ones?