Progress in Analgesia

The lead article in this issue of Addiction Science & Clinical Practice focuses on the blessing and curse of opioids. Drs. Savage, Kirsh, and Passik offer invaluable practical advice, useful to both substance abuse clinicians and pain specialists, on negotiating the difficult clinical issues that arise as a result of opioids’ gift of powerful analgesia and their bane of addiction. While supporting these authors’ research to maximize the safe and effective use of opioids, NIDA is also fostering the development of new medications that may relieve severe pain without risk of addiction. Some approaches have already shown promise in laboratory studies with animals. They include inhibiting the neuron-regulating cells called glia and creating new types of compound molecules that simultaneously and selectively interact with multiple receptors. Some of the compounds under study suppress pain many times more powerfully than morphine. Success in these efforts will markedly advance NIDA’s mission to reduce the prevalence and the health and social consequences of drug abuse and addiction. Opioid abuse will not vanish, because, despite recent increases in the prevalence of prescription opioid abuse, many new addictions and new treatment presentations still involve illegal opioids. However, the incidence of prescription opioid addiction will likely fall. Hospitals and pharmacies will be able to stock fewer addictive medications, making fewer available for diversion. The issues Dr. Savage and coauthors discuss so authoritatively will not vanish, but many decisions in the treatment of both pain and substance abuse should become simpler.