Doctors have long taken for granted a devil’s bargain: Relieving intense pain, such as that caused by surgery and traumatic injury, risks inducing t

Imagine a Drug That Feels Like Tylenol and Works Like OxyContin

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2024-11-30 18:00:03

Doctors have long taken for granted a devil’s bargain: Relieving intense pain, such as that caused by surgery and traumatic injury, risks inducing the sort of pleasure that could leave patients addicted. Opioids are among the most powerful, if not the most powerful, pain medications ever known, but for many years they have been a source of staggering morbidity and mortality. After the Civil War, thousands of veterans became addicted to morphine and opium, which were used to treat battle injuries and illnesses. In the 1990s, overprescribing by doctors, along with aggressive and deceptive drug marketing by pharmaceutical companies, led to a deadly and ongoing opioid epidemic that has killed more than 800,000 Americans.

The devil’s bargain has radically shaped the practice of medicine in 21st-century America. Since the opioid epidemic began, doctors have cut down severely on the amount of opioid medication they prescribe. Inevitably, this means some patients with real need for pain relief go undertreated or completely untreated. Though estimates vary, one 2018 analysis found that about 5 percent of people who are prescribed opioids for pain will develop a dependence; for many doctors, easing some patients’ suffering just isn’t worth the risk of saddling them with a potentially fatal drug dependence.

New research, published today in Science Advances, suggests that using opioids to relieve physical suffering without risking addiction is in fact possible. In the study, a team of researchers led by the neuroscientists Francis Lee at Weill Cornell Medicine and Anjali Rajadhyaksha at the Lewis Katz School of Medicine at Temple University blocked the rewarding properties of opioids in mice while preserving the drugs’ analgesic effects. (I’m a clinical psychiatrist at Weill Cornell and Lee is the chair of the psychiatry department, but we have never collaborated on research.) These findings, although preliminary, could fundamentally shift the paradigm of pain. They offer an opportunity for doctors and researchers to seriously consider a future in which pain and pleasure can be isolated and independently controlled.