Discussion Why make approve a drug stronger than fentanyl for pain?

Juicewrldfan

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So a few years ago the FDA approved a new opioid that’s taken sublingual and is 10x more potent than fentanyl. So this triggered a few questions.

Is there really pain that fentanyl can’t treat? I could see the benefit of this drug being fast acting sublingual for like a battlefield but why else?

Also, is there a certain limit that your opioid receptors can take? I mean I keep seeing stuff about a drug more 50 times potent than fentanyl on the streets and it’s like why? I’m genuinely curious but I assume it’s just like why take heroine if oxycodone isn’t doing it anymore? It gets you higher of course but is that the same once you get into fentanyl strength level opioids?
 
I would assume it has relatively less affinity for beta-arrestin - which is the sub-unit of the opioid receptor that lowers breathing rate, which is what kills you.

That's been a future goal for designing pain medications for awhile, creating a potent mu agonist that doesn't touch B-arrestin.

It probably has 10x the analgesic potency of fentanyl, but causes less respiratory depression, less other side effects, and is probabably generally less lethal.

Relative opioid potency is also difficult to translate from medical literature to subjective high strengths.
 
So a few years ago the FDA approved a new opioid that’s taken sublingual and is 10x more potent than fentanyl. So this triggered a few questions.

Is there really pain that fentanyl can’t treat? I could see the benefit of this drug being fast acting sublingual for like a battlefield but why else?

Also, is there a certain limit that your opioid receptors can take? I mean I keep seeing stuff about a drug more 50 times potent than fentanyl on the streets and it’s like why? I’m genuinely curious but I assume it’s just like why take heroine if oxycodone isn’t doing it anymore? It gets you higher of course but is that the same once you get into fentanyl strength level opioids?
Yes its called Dsuvia, and it's used for acute pain. Mostly for end of life type pain from cancer and illness. It's a synthetic opioid
 
Because of its extremely high potency, it is often used in surgery and post-operative pain management for patients that are heavily opioid dependent/opioid tolerant because of long term opiate use for chronic pain or illicit opiate use. It is also used in surgery and post-operative pain control in people that are taking high dose buprenorphine for chronic pain because it has the potency and binding affinity strong enough to displace buprenorphine from the opioid receptors in the central nervous system and provide analgesia.[10]

From wiki
 
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