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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Area of Science:

  • Public Health
  • Addiction Medicine
  • Regulatory Science

Background:

  • Analyzes parallel opioid crises (access and excess) impacting diverse global demographics.
  • Highlights knowledge gap between 20th-century drug regulations and 21st-century clinical advancements.
  • Opioid crises impede progress on United Nations Sustainable Development Goals (SDGs), particularly Goal 3.

Purpose of the Study:

  • To identify and analyze the parallel opioid crises.
  • To highlight the misalignment between outdated governance and scientific progress.
  • To advocate for evidence-based policies to address these crises and support SDG 3.

Main Methods:

  • Review and analysis of existing literature and regulatory frameworks.
  • Examination of clinical developments in public health, palliative care, and addiction medicine.
  • Assessment of the impact on UN Sustainable Development Goals (SDGs) and their targets.

Main Results:

  • Two distinct but interconnected opioid crises exist globally: one concerning lack of access, the other concerning overuse.
  • Current regulatory and health systems, coupled with stigma, exacerbate these crises.
  • These crises hinder progress towards SDG Target 3.5 (substance abuse prevention/treatment) and Target 3.8 (Universal Health Coverage/access to medicines).

Conclusions:

  • Realigning governance and science is essential to overcome the opioid crises.
  • Community regeneration, education, and governance reform are needed to replace politicized drug policies.
  • Quantifiable data on serious health-related suffering (SHS) supports a paradigm shift towards evidence-based, public health-focused strategies.