Opioids – Reducing body pain but increasing pain for regulatory authorities
Opioids are narcotics that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain management and treatment of diarrhea and cough. Agonist and antagonist are the two types of Opioid drugs. Codeine, Fentanyl, Meperidine, Methadone, Morphine, Hydrocodone, Diphenoxylate, Hydromorphone, Methylphenidate, Oxycodone, and Oxymorphone are classified as agonists. Buprenorphine, Naloxone, Naltrexone, Methylnaltrexone, and Nalbuphine are classified as antagonists. Opioids are rampantly overused worldwide, owing to easy availability and the situation is more critical in developed countries, such as the U.S. This has led to government or regulatory intervention in sale and prescription of opioids in various countries. The prescription pattern of the drug is closely monitored by government and regulatory bodies. Moreover, stringent guidelines are published for opioids prescription along with public awareness about adverse side effects of opioid such as dependence on the drug on regular use. Furthermore, government bodies have directed drug-stores to limit opioids delivery and participate in government activates in addressing the opioid crisis.
The incidence of opioid prescription has increased rapidly in last two decades worldwide. However, the rate of prescription is much high in the U.S, owing to high prevalence of chronic pain and other related conditions. Moreover, majority of these prescriptions in the U.S are for patients addicted to this drug. According to World Drug Report 2017, 29.5 million people suffered from drug overuse disorder worldwide, of which around 70% were registered in the U.S. The U.S recorded around 59,000 to 65,000 deaths due to drug overdose in 2016, of which around two-thirds were due to opioids overuse.
The global opioids market was valued at US$ 28,252.3 million in 2016 and is expected to witness a CAGR of 5.3% over the forecast period (2016 - 2024).
Figure 1. Global Opioids Market, by Region, 2016 (US$ Mn)
Increasing incidence of chronic pain is expected to drive the opioids market growth
Incidences of chronic pain is on the rise across the globe, with the rate being much higher in developed economies such as the U.S., UK, Germany, and Canada. According to a study published by BMJ (British Medical Journal), in 2013, around one-third to one-half of the population in UK suffered from some kind of chronic pain. The situation is not quite different in other developed economies such as the U.S. and Japan. According to a study published in NCBI, in 2015, prevalence of chronic pain is estimated to be as high as 20% (one in five) in Japan. The aging population is rapidly increasing in all in developed economies, which is thus expected to further increase incidences of chronic pain, in turn increasing consumption of opioid drugs.
Cannabis as potential alternative for pain relief
Cannabis has recently gained attention from a diverse range of people, including medical professionals, independent health advocacy groups, and government organizations. Cannabis is projected to emerge as a potential alternative therapy to opioids, as it controls nausea associated with intake of opioid drugs, as well as vomiting and dizziness that often accompany severe, prolonged pain. Moreover, risk of addiction associated with cannabis intake is much lower as compared to that of opioids. A poll conducted by the New England Journal of Medicine, in 2013, found that 75% (3 out of 4) clinicians in the U.S. recommended the use of cannabis for hypothetical cancer patients. Currently, medical marijuana is legal in 28 states and the District of Columbia, even though it is illegal under federal law. According to a research published, in 2017, in Annals of Internal Medicine, cannabis, which is also called medical marijuana, is used for pain management for 45-85% cases. However, the same research argues that there is little evidence to show that cannabis helps control chronic pain. Hence, an urgent need is experienced for high-quality clinical trials to test the clinical efficacy of marijuana in pain management. If clinical trials prove marijuana effective beyond a reasonable doubt, it is expected to emerge as a replacement for opioids.
Some of the major players operating in the global opioids market are Purdue Pharma, Titan Pharmaceuticals, Inc., Boehringer Ingelheim GmbH, Janssen Pharmaceuticals, Inc., Sanofi S.A., Sun Pharmaceutical Industries Ltd., Mallinckrodt Pharmaceuticals, Egalet Corporation, Endo Pharmaceuticals Inc., Allergan, Plc, and Pfizer Inc.
Opioid drugs bind to opioid receptors that are present in several areas of the nervous system such as the brain and spinal cord. Medically, they are primarily being used for pain relief. The drug class primarily used in relieving pain includes natural, semi-synthetic, and synthetic opioids. However, its application is not limited to pain relief alone and has been successfully used for treatment of various other medical conditions such as diarrhea and cough. Opioid drugs can be broadly divided into two categories, mild and major opioids, on the basis of its efficacy. Opioids can be administered as oral pills, parenteral, liquids, patches, or lozenges. Overdose and drug abuse is a major concern, with the situation alarming in developed regions. According to World Drug Report 2017, 29.5 million people suffered from drug use disorders in 2015 and staggering 70% of this 29.5 million were attributed to opioids only.
Incidence of chronic pain, which is primarily treated by opioids has witnessed continuous growth over the last decades. According to a report titled Pain in Europe, published in 2006, chronic pain affected around one in five (19%) adults, and prevalence was recorded to be the highest in Norway, Poland, and Italy, where one-fourth of adults were suffering from chronic pain. According to a study titled Prevalence of Chronic Pain in the UK, published in The BMJ (British Medical Journal), in 2013, chronic pain affects between one-third and one-half of the population in the U.K, indicating high prevalence rate. Prevalence rate is similar in other developed countries such as the U.S. Rapidly increasing incidence of chronic pain is thus expected to boost growth of the opioids market over the forecast period.
However, increasing usage of opioids, has led to increase in its overuse or abuse over the recent past. To tackle this situation, CDC published guidelines for prescribing opioids for chronic pain. Similar efforts to curtail opioid overuse are underway in developed economies of Europe. Such intervention by regulatory bodies are expected to obstruct growth of the opioids market.
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