Painkillers That Don’t Kill
Travis Gustavson died in February, 2021 in Mankato, Minnesota at the age of 21. The morning of the day he died, he had a tooth pulled at the dentist’s office. Due to a drug history, the doctors didn’t prescribe him strong painkillers, so he was planning to white knuckle it through the day with ibuprofen, according to his mother. Instead, he called a guy who sold him illegal street heroin and fentanyl. In a text to the dealer, Gustavson sent a photo of the amount he planned to take and asked if he had gotten the dose right. “Smaller bro” and “be careful plz!” the dealer wrote back. Gustavson overdosed.
Gustavson, whose death was reported in the L.A. Times,1 is one of the many casualties of an opioid crisis that has ravaged the United States for over two decades. Opioid overdose deaths have claimed more than 600,000 lives in the U.S. and Canada since 1999, more than were lost in World War I and II combined. In both countries, 2020 was the worst year on record, in terms of total deaths and percentage increase from the previous year, precipitated in part by the anxiety, stress, and isolation of the COVID-19 pandemic.2
Their discovery opened a major new avenue for the treatment of pain.
The urgent need for safer, better painkillers could not be more apparent. In 2016, as the FDA grappled with how to curb the escalating crisis, the agency wrote new rules that limited opioid prescriptions. But given that no powerful clinical alternatives to commonly prescribed opioids exist, these new rules had the unintended effect of driving more people to desperate measures. Some chronic pain patients, after their doses were cut, died by suicide.3 Others sought relief in illict street drugs like heroin and fentanyl.
Though scientists have tried for decades to design drugs that are both more effective and less addictive than opiates,. At the heart of these failures lies a fundamental misunderstanding of the nature of pain, says Clifford Woolf, a leading expert in pain information processing from Boston Children’s Hospital. It is not a single phenomenon that can be addressed with a universal analgesic, but consists of distinct types that demand targeted therapeutic approaches.
