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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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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Prescription, Nonprescription and Orphan Drugs01:02

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Prescription drugs require a prescription from a medical practitioner and can only be obtained from a pharmacy. They have many applications, including treating pain, anxiety, and hypertension.
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Opioid Receptors: Overview01:22

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Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
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Drug delivery methods like oral inhalation, nasal sprays, transdermal patches, eye drops, intravitreal injection,  and rectal administration provide localized effects with reduced toxicity.
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Towards opioid access without excess.

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Millions suffer from unrelieved pain, while others face opioid addiction, highlighting a global imbalance in opioid access. Addressing this requires a balanced approach to pain relief as a global public good.

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Area of Science:

  • Global Health
  • Public Health Policy
  • Pain Management

Background:

  • Palliative care recognized by World Health Assembly Resolution 67.19 as essential for comprehensive care and universal health coverage.
  • A decade later, a balanced approach to opioid access remains elusive, leading to persistent disparities in managing serious health-related suffering.

Purpose of the Study:

  • To describe the parallel global public health crises of unrelieved pain and opioid addiction.
  • To advocate for pain relief as a global public good.
  • To identify stewardship roles for achieving balanced opioid access.

Main Methods:

  • This viewpoint synthesizes existing data and policy analysis.
  • It examines the "opioid access abyss" affecting low- and middle-income countries.
  • It contrasts this with the opioid addiction epidemic in high-income countries.

Main Results:

  • Over 50 million people experience serious health-related suffering due to the "pain pandemic," primarily in low- and middle-income countries.
  • An estimated 39.5 million people globally struggle with opioid use disorder, predominantly in North America.
  • Significant disparities exist in access to essential pain relief and addiction treatment.

Conclusions:

  • Urgent need to close the global pain divide and ensure "opioid access without excess."
  • WHO member states and local actors must adopt stewardship roles for a balanced global health system approach.
  • Aligning efforts with Sustainable Development Goals 3.5 (substance abuse prevention) and 3.8 (universal health coverage) is crucial.