A new way to fight the opioid epidemic in Appalachia?
A new non-opioid pain medication was just approved by the FDA. Could it help curtail one of the biggest pathways to addiction?
I want to state at the outset here that we are not a fan of Big Pharma. If you’re a veteran Appodlachian, you will already know this, however I know we have a lot of new followers on this here Substack, so I wanted to make that crystal clear.
In fact, we did a 5-part series on the opioid crisis back in 2021 that I think still holds up pretty well, so I’ll link to the first episode below for those interested:
Alright, let’s dive into some news that flew way under the radar this past week.
(Make sure you make it all the way to the bottom, because I’ve started a new segment I’ll be doing each week!)
The FDA Approves “Novel Non-Opioid Treatment for Moderate to Severe Acute Pain”
Before jumping into this story, here is a small primer on the opioid crisis itself.
Many people become addicted to opioids because they were prescribed them for pain
For those who don’t already know, many people become addicted to opioids through legitimately being prescribed them. Imagine you are working in a warehouse1, and you mess up your back lifting heavy boxes, thus requiring surgery. Back surgery is extremely painful to recover from, and you’re prescribed hydrocodone (or oxycodone or something similar) to help with the pain — a very legitimate reason, and a very understandable one.2
Opioid pills, speaking from personal experience, are very effective in alleviating pain. For some people, it produces very pleasurable effects — some even experiencing euphoria. Here is a write-up from Johns Hopkins that characterizes it better than I can:
Typically, opioids produce pain relief and, for some people, euphoria ― a sense of heightened well-being. Experiencing euphoria after taking opioids may be a warning sign of vulnerability to opioid addiction. This euphoria can even occur in people using opioids as prescribed by their doctor.
Early in the process of opioid use disorder, people may take an opioid drug because of the pleasurable effect. Over time, the pleasant sensations diminish. A person may take opioids more frequently or at higher doses to restore the euphoria or, as the condition progresses, to avoid withdrawal symptoms.
As many as 1 in 4 people receiving long-term opioid therapy develop opioid use disorder, according to CurbtheCrisis.org — that’s a frightening statistic. It means almost anyone can find themselves addicted to opioids through no fault of their own.
Visualizing the crisis in Appalachia
Big Pharma saw dollar signs painted on the backs of the poor working-class in Appalachia, and they descended on the region like birds of prey.
The National Opinion Research Center (NORC) at the University of Chicago developed this tool to visualize the overdose rates in Appalachia on opioids versus all drugs from 2010-2019. The visualization is alarming. Some of the darkest blue counties are also some of the poorest in the region (and the country).
The new non-opioid pain medicine
Obviously, having a non-opioid alternative to pain management that can achieve the same or similar pain mitigation results without the risks of addiction, dependency, overdose, etc. would be a huge step toward ending the opioid crisis.
Last Thursday, the FDA approved Jounavx (no clue how the hell to pronounce it). Here is a snippet from their press release:
Today, the U.S. Food and Drug Administration approved Journavx (suzetrigine) 50 milligram oral tablets, a first-in-class non-opioid analgesic, to treat moderate to severe acute pain in adults. Journavx reduces pain by targeting a pain-signaling pathway involving sodium channels in the peripheral nervous system, before pain signals reach the brain.
Journavx is the first drug to be approved in this new class of pain management medicines.
Pain is a common medical problem and relief of pain is an important therapeutic goal. Acute pain is short-term pain that is typically in response to some form of tissue injury, such as trauma or surgery. Acute pain is often treated with analgesics that may or may not contain opioids.
According to Time, this is the first non-opioid painkiller to be approved in 20 years!
Look, I am not even remotely close to being an expert in any of this, so take what I say with a grain of salt, but that is a long-ass time. And feels like a shameful amount of time to be honest.
For you medical nerds who want to know more about how the medication actually works to target pain receptors, Time has a pretty decent blurb written in terms my medically-dumb brain can understand. (I’ll spare you the length of including it in here).
The truth isn’t a ball-buster, but it’s not a slam dunk either
I am, admittedly, a glass half-full kind of guy sometimes when I know damn well I shouldn’t be. I try my best to reign that side of me in, but at times I cannot help it because DAMMIT I want to believe good things CAN HAPPEN sometimes!3
While I think this is a good thing, I think it’s important to manage expectations. Based on my reading, this will most certainly not be replacing all opioids with non-addictive pain medicine overnight. However, it does appear to show some promise. Check out this blurb from the AP:
Studies in more than 870 patients with acute pain due to foot and abdominal surgeries showed Vertex’s drug provided more relief than a dummy pill but didn’t outperform a common opioid-acetaminophen combination pill.
“It’s not a slam dunk on effectiveness,” said Michael Schuh of the Mayo Clinic, a pharmacist and pain medicine expert who was not involved in the research. “But it is a slam dunk in that it’s a very different pathway and mechanism of action. So, I think that shows a lot promise.”
So what’s my TLDR?
I’ll try to do this with most of my longer posts so y’all have a decent summary:
Having a non-opioid painkiller, at least on its face, sounds like a good thing to me in general4
It isn’t capable of replacing opioids for the most severe kinds of pain, but there seems to be room for growth, discovery, and improvement upon this novel medication
My point with ALL of this
The need to alleviate pain isn’t going away any time soon.
Pain sucks ass. I’ve been there. It blows.
The risk of becoming addicted to opioid painkillers is terrifying (and obviously very real and shockingly common).
I think this could be the first step toward a future where even the worst types of pain can be treated with non-opioid, non-addictive medications
If that were the case, it would significantly curb future opioid use disorder cases.
Fuck Big Pharma as a blanket principle
So my glass half-full ass remains cautiously hopeful.
I’m starting a new thing on here where I plan to share what music I’m listening to this week — and you know it will have an Appalachian angle to it! Appalachian musicians and singer/songwriters are having a moment folks. I selfishly just want to talk about it and hopefully expose other people to music that I like, and sometimes we will even be featuring these artists on our podcast!
This week, I’m listening to Sierra Ferrell — specifically, her entire album “Trail of Flowers” (which, in my opinion, is a masterpiece).
Normally, I’ll plan to highlight slightly lesser-known artists, but I have to be authentic because I’ve been streaming Sierra non-stop, and she is my absolute favorite to listen to right now. She’s a native of Charleston, West Virginia, and has seen a ton of success recently.
She is difficult to categorize into one genre, but I would characterize her as blending Americana, Roots, a bit of Bluegrass, and a dash of Country. Her musical style is whimsical while being beautifully serious and thoughtful. If you want to truly understand the power behind her voice and musical presence, check out her cover of John Anderson’s “Years” — it is the best cover of any song I’ve ever listened to.5
She is a dream guest of the podcast (we’re going to make the ask this year and see if we can get her on)
Hope y’all have enjoyed this new section and my mindless ramblings.
Here is Big Dog celebrating Sad Girl Saturday.
Let’s say, for the sake of this anecdote, a distribution facility for one of the world’s largest mega corporations that is notoriously anti-union ;)
I also want to be clear, I am not inherently anti-opioids. I think they have served an important purpose, and should be carefully administered and heavily regulated. People in pain have also been exploited by greedy pharmaceutical companies like Purdue, who made opioid pills like OxyContin more addictive and marketed them in a deceptive and deadly way.
I’ve been known to run into this wish-casting problem a lot around election season…
A small update: As a reader rightfully pointed out, OxyContin was initially advertised as non-addictive. I think this is important context. My hope is that we have better safeguards in place to prevent that level of overt deception that occurred by Purdue Pharma, however I never want to be one to give Big Pharma the benefit of the doubt. I believe that the way this is being argued as non-addictive is through the targeting mechanism of the drug (i.e., it relieves pain by controlling the flow of sodium in and out of cells and targeting one sodium channel specific to pain neurons in tissues that are found throughout the body, but not the brain).
I don’t know why, but it genuinely moved me to tears when I listened to it for the first time. It’s rare that I have such a raw emotional reaction to a song like I did with this one.
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