The battle against one of the nation's biggest epidemics is now being waged on two fronts — and a fix is on the horizon.
Thousands of Americans are dying from opioid overdoses, but patients with chronic pain are finding it hard to get medications they need.
Recent solutions to the problem have focused on making pain pills tougher to abuse, but research suggests that's not enough.
Scientists are now focused on creating painkillers that don't cause feelings of euphoria.
In the last 16 years, more than 183,000 Americans have died from overdoses related to prescription opioids. As a result, policymakers have tried to make the medications harder to get.
Those efforts seem to have had a somewhat positive impact on the rate of overdoses, but have left patients with chronic pain in a tough spot. Not only is it sometimes hard for these people to get their medications, the increased public attention around opioid risk has made some of them concerned about taking the drugs in the first place — or even having them in the house.
That's why a handful of companies are focused on creating an entirely new type of painkiller — one that won't get people hooked. One of those companies is Nektar Therapeutics, which is currently studying a new drug candidate that enters the brain too slowly to cause the feelings of euphoria that many painkillers are known for.
"We have the possibility of being the first new opioid in almost 25 years," Dr. Stephen K. Doberstein, Nektar's senior vice president and chief scientific officer, told Business Insider. "I think we’ve reinvented the opioid molecule."
While drugs like oxycodone are excellent at reducing pain, they can also produce powerful feel-good sensations that can be addictive. But recent studies of Nektar's new painkiller, which is still in clinical trials, suggest that it wouldn't cause any such high.
The drug is called NKTR-181, though Doberstein likes to call it just "181".
On Monday, Nektar released the results of a new study designed to look at how well the drug can relieve chronic low-back pain.
The findings were very positive: More than half (51.1%) of the patients who took NKTR-181 said their pain went down by 50%, as compared to less than 38% of the patients who were given the placebo.
"Our answer there — to the question of whether we’re causing euphoria or not — is emphatically no," Doberstein said.
Nektar isn't alone in its quest to create a high-free opioid.
Epiodyne, a company started by a research team at the University of San Francisco's School of Pharmacy, is designing a pain drug that wouldn't trigger a surge in dopamine, a chemical messenger in the brain that is involved in emotions like desire and pleasure. Other companies have also been showing an interest in such research as opioid overdose deaths continue to spike.
Still, the vast majority of development has gone into making so-called "abuse deterrent" drug formulations — pills designed to be impossible to melt down and inject or smash and snort. Since 2010, the US Food and Drug Administration has approved a handful of these pills, and 30 more are currently in development.
"Everyone just wants to figure out how to lock it up in a pill better," Doberstein said.
But there's little evidence that those deterrents alone can stem the tide of overdose deaths. Promoting abuse-resistant drugs could encourage doctors to continue overprescribing them. And most of the new pills can still be abused when swallowed.
"I am not convinced that we can engineer our way out of this epidemic, and I would caution against over-relying on abuse-deterrent formulations to do so," Dr. Caleb Alexander, an associate professor of epidemiology at Johns Hopkins, told the Associated Press last year.
That's where Nektar hopes to come in.
"Our goal here is to have a safe and effective medicine that doctors and patients can feel confident that they’re not going to get high from," says Doberstein. "That's something I'm excited about."