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What do you think the future holds for Opioids & pain management?

These companies do help a lot of people but will turn around and poison some for profits. I don't think that will change too much or at least not quickly. Purdue and OC's put more of a spotlight on the pharma sector but it has very far to go.

Some of these new drugs do have third party testing required by agencies like the FDA/MHRA, outside of the control of the pharma companies that develop them, although even that isn't a catch all. Even when the drugs are 'safe enough' for the conditions they're prescribed for, the marketing is another problem.

I def can't argue on Big Pharma not being highly corrupt as all of largest companies have paid hundreds of millions+ of dollars/ pounds in fines, but they consider that just part of doing business.
For Pfizer alone on one of their more benign drugs, Gabapentin (neurontin), plus another case for a few more, they forked over a pretty penny:

"Pfizer is fined $430 million for illegal marketing practices surrounding the drug Neurontin." " Pfizer adds another $325M to Neurontin settlement tally. Total? $945M"

"Pfizer must pay $2.3 billion to resolve criminal and civil allegations that the company illegally promoted uses of four of its drugs, the painkiller Bextra, Geodon, an antipsychotic; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug. ."

"Pfizer PFE will pay a criminal fine of $1.195 billion, the largest criminal fine ever imposed in the USA for any matter,Pfizer also has agreed to pay $1 billion in civil damages and penalties to compensate federal health-care programs for false claims submitted as a result of its marketing Bextra and the other four drugs (gabapentin being 2nd in false claims) for off-label use or at unapproved dosages."

"In one of the biggest health fraud settlements, Johnson & Johnson agreed in 2013 to pay $2.2 billion to resolve a case involving allegations that it conducted off-label marketing of the anti-psychotic Risperdal to doctors treating elderly dementia patients. The Department of Justice, in its criminal complaint, said the drug “increased risk of death among elderly dementia patients.” The department said Johnson & Johnson also played down, or fudged, findings that the drug raised the risk of strokes and diabetes".

"Big Pharma has written more than $30 billion in checks in the last 10 years to resolve the government allegations, according to statistics compiled by the consumer watchdog group Public Citizen. Nine drug manufacturers each forked over at least $900 million from 2006 through 2015."

"Yet those sums, Public Citizen says, are essentially petty cash for the drug giants. The advocacy group, which seeks stiffer sanctions against violators, says the settlements amount to less than 5 percent of the net profits raked in by the 11 largest global pharmaceuticals firms over a similar period. "

12294

Honestly as we keep going I think our difference in opinions are becoming less & less. You make some very good points about the state of the industry, but neither of us have a crystal ball (unless you're holding out on me ;) )

I agree it's also sad that they're going to take the 'magic' right out of 'em. We can tell stories to the youngins about being wankered and nodding off in the good ol' days.
 
What I see as the future of opioids is that they are going to continue to come up with interesting synthetics, some of which will have useful novel profiles of action but they will never be able to improve on morphine as a base not only for analgesics, but, they will eventually have to admit, psych meds as well . . .

Of course, there is 14-methoxymetopon, a million times more potent than morphine. Are there fentanils or benzimidazoles anywhere close? I remember sitting on a park bench reading about this invention of the Dr Schmidhammer organisation at the University of Innsbruck in Die Presse and thinking "Yummy!" and my mouth started to water and my spine began to itch. Note that it is a semi-synthetic not all that far from oxymorphone and as such is part of an old and venerable family of morphine derivatives going back to the invention of oxymorphone in 1914.
 
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I still think it comes down to more than sheer potency. Fentanyl or Carfentanil is up there on potency but doesn't offer the euphoric warmth of some of classic phenanthrenes. Not that it can be ruled out as a substance of interest for building on, I just don't agree that potency alone is the key. Again I'm coming back to the "best opioids" from a user standpoint vs a safer drug for the future.

Personally I'd like to see further work done with the Bentley compounds.
(for those unaware here's the wiki)

" The Bentley compounds are a class of semi-synthetic opioids that were first synthesized by K. W. Bentley by Diels-Alder reaction of thebaine with various dienophiles. The compounds are also known as thevinols, orvinols, or bridged oripavine derivatives, due to the characteristic 6,14-endo-etheno- bridge and substitution at the 7α position. Buprenorphine and etorphine are perhaps the best known of the family, which was the first series of extremely potent μ-opioid agonists, with some compounds in the series having over many thousands of times the analgesic potency of morphine."
 
Imagine a bridged oripavine derivative or 14-methoxymetopon relative so potent that the polymer and plastics chemists could make a working implantable pellet with 50 years' worth of medication in it for chronic pain folks.
 
Jekyl Anhydride said:
These companies do help a lot of people but will turn around and poison some for profits. I don't think that will change too much or at least not quickly. Purdue and OC's put more of a spotlight on the pharma sector but it has very far to go.

Some of these new drugs do have third party testing required by agencies like the FDA/MHRA, outside of the control of the pharma companies that develop them, although even that isn't a catch all. Even when the drugs are 'safe enough' for the conditions they're prescribed for, the marketing is another problem.

I def can't argue on Big Pharma not being highly corrupt as all of largest companies have paid hundreds of millions+ of dollars/ pounds in fines, but they consider that just part of doing business.
For Pfizer alone on one of their more benign drugs, Gabapentin (neurontin), plus another case for a few more, they forked over a pretty penny:

"Pfizer is fined $430 million for illegal marketing practices surrounding the drug Neurontin." " Pfizer adds another $325M to Neurontin settlement tally. Total? $945M"

"Pfizer must pay $2.3 billion to resolve criminal and civil allegations that the company illegally promoted uses of four of its drugs, the painkiller Bextra, Geodon, an antipsychotic; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug. ."

"Pfizer PFE will pay a criminal fine of $1.195 billion, the largest criminal fine ever imposed in the USA for any matter,Pfizer also has agreed to pay $1 billion in civil damages and penalties to compensate federal health-care programs for false claims submitted as a result of its marketing Bextra and the other four drugs (gabapentin being 2nd in false claims) for off-label use or at unapproved dosages."

"In one of the biggest health fraud settlements, Johnson & Johnson agreed in 2013 to pay $2.2 billion to resolve a case involving allegations that it conducted off-label marketing of the anti-psychotic Risperdal to doctors treating elderly dementia patients. The Department of Justice, in its criminal complaint, said the drug “increased risk of death among elderly dementia patients.” The department said Johnson & Johnson also played down, or fudged, findings that the drug raised the risk of strokes and diabetes".

"Big Pharma has written more than $30 billion in checks in the last 10 years to resolve the government allegations, according to statistics compiled by the consumer watchdog group Public Citizen. Nine drug manufacturers each forked over at least $900 million from 2006 through 2015."

"Yet those sums, Public Citizen says, are essentially petty cash for the drug giants. The advocacy group, which seeks stiffer sanctions against violators, says the settlements amount to less than 5 percent of the net profits raked in by the 11 largest global pharmaceuticals firms over a similar period. "

View attachment 12294

Honestly as we keep going I think our difference in opinions are becoming less & less. You make some very good points about the state of the industry, but neither of us have a crystal ball (unless you're holding out on me ;) )

I agree it's also sad that they're going to take the 'magic' right out of 'em. We can tell stories to the youngins about being wankered and nodding off in the good ol' days.
Click to expand...

Exactly mate you have put together an excellent post right here. I've saved that image too. Sums it up perfectly. I also agree the Bentley compounds are worthy of further research.

Oh and Lyrica is the brand name for pregabalin, Pfizer did indeed get sued for off-label marketing in the US. But as you've just explained perfectly, the fines are just an accepted cost of doing business and barely eat into profits at all. Purdue in particular is a fucking joke, they got fined $646 million meanwhile their revenue from OxyContin sales in the US alone is over $10 billion. The Sackler family are the biggest drug cartel on the planet. They make Pablo Escobar look like your local roadman.

As for Pfizer and Lyrica I believe they got fined because they marketed it for anxiety when it was not FDA approved for that condition. However it is approved for anxiety in Europe including the UK which is how it became the "new Valium" on our side of the pond. GP's were just throwing it at anyone and of course once word got around everyone was lining up to get a script.

Pregabalin was only just made a controlled drug in the UK a few months ago, just after the patent expired. The ACMD and the NHS had been warning the government about its abuse for years and years. Effectively the government just let it remain uncontrolled and widely prescribed for as long as Pfizer could keep profiting off it. And well being on this forum I'm obviously in favour of legalisation and regulation, but when it comes to medicines people trust their doctors and shouldn't be mislead and have addictive drugs just thrown at them as if it's paracetamol.

Here's a documentary about pregabalin addiction in Ireland if you're curious about what effect this has had. It was widely prescribed throughout the whole of the UK but Ireland had the most prescriptions. Thankfully there are subtitles for the accents ?

 
You guys think that they will ever come up with a drug that cures a physical addiction to opiates? I realize the psychological addiction is a whole different story, but something that removes the physical addiction would be a great first step.

Whatever happens, I just would like them to invent something that would allow me to stop taking Buprenorphine. I have been on it for about 13 years and I regret it everyday. I can't really take 2 months off my life to stop taking this drug so hopefully they can come up with something that would allow me to continue working while stopping.
 
Given that endorphins, and morphine, codeine, and hydromorphone themselves and probably more are already in the body and endogenous, I say no, because they are essentially neurotransmitters, not poisons. Like Vitamin D, insulin, dopamine, and so forth, some people's bodies do not make enough of these, hence humans and poppies found one another.

So it's like trying to cure a Vitamin C habit.

Dose them right, and you've got your substance mentioned by A Huxley . . . .

All of the above maybe goes for DMT and the like too, but I am still researching that.
 
I currently go to a pain management clinic and know of several other people who go to the same one.The doctor in charge wants to get anyone off oxycodone who is not going to have surgery unless they are a cancer patient..They will not give opiates and benzos together or even Soma with opiates..The goal i have been told is to get people on hydrocodone and then tapered off of it in time..The people i know were thrown to the Suboxone clinic downstairs and they refused subs as i would have. They only offer methadone to veterans i am told who have been taking it for decades already..Basically unless you have cancer they taper you down to hydrocodone and or time release morphine in low doses..So they will not give you what you need and plan to give you even less in the future..they are all about reduction of opiates now or not giving them out at all unless you are already taking them..It is the polar opposite of the pain clinics i went to in the mid 2000's where i was given 3 OxyContin and 3 Methadone and Soma or benzos per day. It is a sad state for those in pain. The pain clinic doctor even told me my state had medical marijuana legal now and i suppose that is the only option..meager doses of crappy opiates and lame muscle relaxers and medical marijuana..Since they will not give benzos and opiates out together except in certain casesm the medical weed seems like my only option.
 
Wilson Wilson said:
Yes very different drug cultures especially when it comes to pharmas. The pharma scene has always been bigger in the US because it's simply been easier to get prescriptions (historically at least) while in the UK abusable meds have been more strictly controlled as soon as they got popular on the street. Now pressed bars have become a thing suddenly we have a "pharma" scene again.

Oh yeah those "red devil" bars were a thing for a while. The original ones were actually very good quality presses containing 5mg alprazolam. Literally such a good press they seemed pharma with the shine and they were hard to break and evenly dosed. They all came from one darknet operation, the same one that started pressing regular 2mg bars here in the first place, all top quality, but the vendor got busted and since then the bars going about in the UK have been of... varying quality to say the least. No bars in the UK are legitimate pharmas and many don't even contain benzos at all recently but they're in demand anyway.

What's especially funny to me is that "lean" is also high in demand and stupid teenagers will pay dealers a big markup for it even though you can legally buy codeine syrup OTC here very cheaply and have been able to for decades.

The scheduling and prescription patterns don't always match up here either. Benzos are schedule 4 which is the lowest, but prescriptions are monitored very tightly. Stimulants for ADHD are schedule 2 but in practice are far easier to get scripted than benzos.

Only time I've come across barbiturates is when the vet gave phenobarb to my cat. I've never known a person to be prescribed them these days and never seen the rare "good ones" like secobarb.

In Australia it seems they have practically done that already with Xanax, and it's not on the NHS at all here, so it seems like it's the way things are going. But if so it'll only fuel the market for presses even further. China certainly has no problem pumping out kilos of alprazolam.

As for fent patches yeah the NHS is reluctant to give those out as well. They seem to be using bupe patches instead. The trend here seems to be more towards prescription of synthetic opioids over regular opiates driven by the (imo misguided) belief that they're less abusable. Tramadol was uncontrolled until not too long ago. But I think they've worked out they're just as abusable and more dangerous (e.g. tramadol causes seizures) and tend to stick more to morphine for take home scripts. However it will differ throughout the country as each local CCG makes its own guidelines. Some parts of the country hand out oxy surprisingly easily. Other parts don't give it out at all. It's part of what we call the "postcode lottery" where because each area's NHS service is run independently, the type of care you get can vary greatly. Different prescription patterns, varying levels of access to specialists and other treatments, etc.
Click to expand...
Yes the benzos are much harder to get than Schedule 2 ADHD meds are..If you have an injury or in the hospital they give me Valium orally last year but no script from doctors anymore and for certain not while taking opiates,..
 
DavisK4high247 said:
Yes the benzos are much harder to get than Schedule 2 ADHD meds are..If you have an injury or in the hospital they give me Valium orally last year but no script from doctors anymore and for certain not while taking opiates,..
Click to expand...

Surprisingly I was able to get opiates and benzos scripted at the same time without any trouble or even any warnings from the doctors, but I'm talking like diazepam and dihydrocodeine with small doses of oral morphine for breakthrough pain, so nothing very potent. They were reluctant to give me anything stronger in the hospital and my benzo script could very well have been why.
 
OP, I'm really into your intellectual direction. We share many of the same interests and curiosities, but unfortunately, I gotta do a little bit of housekeeping here. This isn't really the best place for folks to just show up and posit crazy-huge topics like "Where do you think the Opioid epidemic is heading", this is a place for discussing what I would call more acute topics concerning safety. We call it Harm Reduction for a reason ;) So, while I absolutely value your interests, this just isn't really the place for it. This is a place for helping adults who are choosing to use drugs, do so in a reasonably safe manner.

This is more like a discussion you might have with a friend. It's not like I enjoy censoring this stuff, it's just what I'm supposed to be doing. I'm going to move this to Drug Culture. Apologies in advance to the DC guys if you're not into it.
 
Since we're in DC now and can chat a bit more freely here's another interesting question...

If, as @Nicomorphinist suggests, we will end up in a world with purely synthetic prescription opioids in the future, what would be the geopolitical consequences of this? Consider that opium poppy cultivation makes up something like 50% of Afghanistan's GDP. They rely on that shit. Currently there is some effort to get that opium used in pharmas instead of processed into heroin. This is a possible solution because the pharma industry has a very high demand for opium and not enough supply to fulfil it.

However if in the future they go with synthetics instead, there is no need for opium. So what will happen with all those poppy fields? They certainly won't just disappear. All that will happen is more of that opium will go back into heroin production.

What happens then is you have a large supply of heroin doing the rounds. Purity goes up, prices go down. So then you have more smackheads.

Which would be necessary, because anyone who was used to getting high on codeine or oxy or whatever would find themselves with these hypothetical futuristic unabusable synthetic opioids instead, leaving heroin as the only option if you want an opiate high.

Or possibly, if it is economically viable, you could see a rise in clandestine labs set up to produce the ex-pharma opiates that are no longer officially available. I think this is less likely, because it'd be more expensive and less efficient, but it is possible if the demand is high enough. This would be pressed into pills and sold to the kind of people who think heroin is dirty but don't mind doing oxy.

That would be the real interesting shit right there.
 
Jekyl Anhydride said:
But have you ever seen a painkiller that works on the nociceptin/orphanin FQ peptide (NOP) receptor. The opioids you're mentioning were developed from 1913 to 1960. Even Buprenorphine was developed in 1965. You don't think some advances have been made in the last 55 years?



No opioid has ever been touted to have no side effects or abuse potential after the early 1900's. Name one.
Click to expand...

um, tramadol?
 
Jekyl Anhydride said:
I still think it comes down to more than sheer potency. Fentanyl or Carfentanil is up there on potency but doesn't offer the euphoric warmth of some of classic phenanthrenes. Not that it can be ruled out as a substance of interest for building on, I just don't agree that potency alone is the key. Again I'm coming back to the "best opioids" from a user standpoint vs a safer drug for the future.

Personally I'd like to see further work done with the Bentley compounds.
(for those unaware here's the wiki)

" The Bentley compounds are a class of semi-synthetic opioids that were first synthesized by K. W. Bentley by Diels-Alder reaction of thebaine with various dienophiles. The compounds are also known as thevinols, orvinols, or bridged oripavine derivatives, due to the characteristic 6,14-endo-etheno- bridge and substitution at the 7α position. Buprenorphine and etorphine are perhaps the best known of the family, which was the first series of extremely potent μ-opioid agonists, with some compounds in the series having over many thousands of times the analgesic potency of morphine."
Click to expand...


There is a class of open chain opioids, the ampromides, which includes diampromide, phenampromide, and propiram which have structural resemblances to fentanils, and I wonder if newer ones could be intermediate in potency betwixt diampromide, which is 85 per cent as strong as morphine, and some of the fentanils. The late Dr Shulgin pointed out that piritramides and moramides have potential as well, and I would really like to see an über-dipipanone/phenadoxone and always wondered if there were propoxyphene analogues out there which are really powerful.

Speaking of Bentley Compounds, is there really any reason why diprenorphine cannot be used in humans? With buprenorphine becoming so big and some countries trying dihydroetorphine as well for the same purposes, I can imagine mistakes and misadventures with those two drugs which naloxone may not be able to handle. For that and other reasons, I really hope that the Central European everything but kitchen sink approach is the wave of the future for maintenance and detoxification. I think it is Slovenia and/or Bulgaria which have more than ten drugs approved for the purpose ranging from Perduretas to Suboxone.
 
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People in chronic pain don't have time to wait for new drugs to be discovered and approved, they need relief right now. So that question is lost on the people it actually matters to. In the US I see either 1) increased heroin use or 2) the implementation of pharmaceutical opioids for three different specific purposes addiction, recreation, and pain, as has been done in civilized countries.

There really are no other possible options besides 1) and 2). We'll keep trying 1) for several more decades though likely.


I forsee the legitimate demand for opioids for pain increasing greatly also. People now days are doing all kinds of crazy shit. wild sports etc. dicksizing everything on social media. People are doing activities that they simply did not do 20 years ago, at much higher rates. This is going to result in more injuries and more demand. Obesity is also increasing thus the damage on joints and obese backs will increase and the drugs will be more in demand.
 
In the US there is a trend to block dual prescriptions of benzos and pain meds. The trend is just starting in one or two states that have (I say supposedly) a high rate of opiate overdoses. I take a particularly strong opiode for chronic pain, and I have been told I must get off my Xanax prescription immediately to continue getting my oxymorphone prescription. Since I have been on 6mg of Xanax ER for the better part of 23 years (I'm age 40), the pain managent is being reasonable about a taper. My general doctor that prescribes the xanax is very considerate of tapering. I have switched to two 2mg Xanax ER (from 6mg to 4mg). That is no problem. Having been kicked off my prescription and gone cold turkey before, I know the truth about the long term withdrawal symptoms that it seems no doctors consider or even understand. I have said I will end myself if ever going off Xanax again. I am facing this now due to the current pressure from the dea and local health services about opiates and benzos. They do not understand that I am ceilnged out in xanax. I do not feel any euphoria or high from it at any dose. But I must have it daily. I best describe the current pressure for pain doctors to get their patients off benzos as "NOT FAIR!" As much as I depend on xanax to have a chance of doing any socializing and not being agoraphobic and a mental wreck, I need my oxymorphone to be able to walk. Both my legs and knees have been smashed and been operated on to insert rods and screws to hold them together... One in car wreck and another from a horrible fall running from damn police. I have to choose to taper xanax-- to be very careful not to lose my oxymorphone script because it is the only med that works for me, and I would never get that med again if I were to forced to take another supposed equivalent or safer pain med. These stupid overdose statistics that I know damn well are half street drugs and most of the rest from people doing extremely dumb sh** to overdose. Patients taking their script just as they have for years don't overdose!

Another thing that baffles me is they let me have 600mg of Lyrica daily. It is far more intoxicating than my Xanax. They have even offered 900mg a day, and I am accepting it next week since Lyrica, pregablin, is generic and cheap now.

In the US they want to limit pain meds to a certain equivalent of morphine. They have no sympathy for people that need the meds they have taken with no issue for years. I'm stopping here because I'm pissed off thinking about these ignorant committees creating regulations that are spreading from state to state. It is not fair or justified. ftl
 
Wilson Wilson said:
Since we're in DC now and can chat a bit more freely here's another interesting question...

If, as @Nicomorphinist suggests, we will end up in a world with purely synthetic prescription opioids in the future, what would be the geopolitical consequences of this? Consider that opium poppy cultivation makes up something like 50% of Afghanistan's GDP. They rely on that shit. Currently there is some effort to get that opium used in pharmas instead of processed into heroin. This is a possible solution because the pharma industry has a very high demand for opium and not enough supply to fulfil it.

However if in the future they go with synthetics instead, there is no need for opium. So what will happen with all those poppy fields? They certainly won't just disappear. All that will happen is more of that opium will go back into heroin production.

What happens then is you have a large supply of heroin doing the rounds. Purity goes up, prices go down. So then you have more smackheads.

Which would be necessary, because anyone who was used to getting high on codeine or oxy or whatever would find themselves with these hypothetical futuristic unabusable synthetic opioids instead, leaving heroin as the only option if you want an opiate high.

Or possibly, if it is economically viable, you could see a rise in clandestine labs set up to produce the ex-pharma opiates that are no longer officially available. I think this is less likely, because it'd be more expensive and less efficient, but it is possible if the demand is high enough. This would be pressed into pills and sold to the kind of people who think heroin is dirty but don't mind doing oxy.

That would be the real interesting shit right there.
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They will probably end up with synthetics which do all manner of things, and maybe some that are good for certain conditions like organic gastro-intestinal trouble like diverticulitis, but I figure they will never really be able to improve on morphine and its derivatives. Look at fentanyl -- this drug and its relatives are anaesthetics which just happen to hit opioid receptors -- apparently ketamine can do the same thing too. I wonder if we will be hearing about cops uncovering hydroponic opium growing, or maybe not, since it grows all over the place -- in the Americas everywhere from above 60° N to within 350 km of the Patagonian ice cap, and apparently in all 50 states, all Canadian provinces and territories probably aside from Nunavut but it might be possible to grow in there after not too long, I suppose.
 
For information on managing chronic pain, maybe have a look here:

CHRONIC PAIN | +80 articles

For people suffering from chronic pain, Ketamine may be the answer by Torsten | 28 Aug 2005 At his worst, Brett Lovell, 32, experienced such searing pain that he couldn't straighten his arm, and the fingers of his left hand curled up like a claw. The pain had him downing 25 pills a day. Then...
www.bluelight.org www.bluelight.org
 
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