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Attenuating the Agent: Reducing Opioid “Virulence”

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Opioid Dependence

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Abstract

One strategy in addressing the opioid epidemic is to decrease or attenuate the “virulence” of the agent, i.e., render opioids less “pathogenic.” Historic approaches to such attenuation have largely focused on altering existing and commercially available drugs by converting them to an extended-release form and equipping them with tamper-resistant and abuse-deterrent properties. While certainly not without merit, these approaches cannot prevent misuse or abuse by excessive consumption and do not alter the fundamental characteristics of the agent (e.g., propensity to cause euphoria, dependence and addiction, respiratory suppression). They can only affect the delivery of the agent. Novel modifications or alternative strategies using the endogenous opioid system, such as peripheral-only agonists, endogenous ligand protease inhibitors (e.g., dual enkephalinase inhibitors), heteromeric ligands with biased agonism, allosteric modifiers, and agents targeting glia, may provide safer analgesics and in effect reduce the population of virulent agents.

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  1. Northern Anesthesia & Pain Medicine, LLC, Eagle River, Alaska, USA

    Heath B. McAnally MD, MSPH (Medical Director, Clinical Instructor)

  2. WWAMI Program, University of Washington School of Medicine, Anchorage, Alaska, USA

    Heath B. McAnally MD, MSPH (Medical Director, Clinical Instructor)

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McAnally, H.B. (2018). Attenuating the Agent: Reducing Opioid “Virulence”. In: Opioid Dependence . Springer, Cham. https://doi.org/10.1007/978-3-319-47497-7_5

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