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Powerful DSUVIA Painkiller- Effective or Ripe for Abuse?

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The controversial DSUVIA painkiller is poised to upend the opiate market. Reportedly, 500 times more potent than morphine, DSUVIA is formulated to dissolve instantly, allowing it to act more quickly than other opioids. It was recently approved by the FDA despite reservations.

Acelrx, the company behind DSUVIA, believes that this drug represents an “important non-invasive acute pain management option.” Others are somewhat skeptical of the new drug.

“I find it truly surprising that in the midst of this nation-wide opioid problem, a new product is being considered for release that appears to be the ideal formulation for abuse of a very high potency narcotic with very little obvious clinical indication,” said Christopher Creighton, M.D., Physician Partners of America pain specialist in Richardson, Texas. He weighed in a few days before the FDA’s decision on DSUVIA.

Last year, the FDA rejected the drug’s approval. There were concerns that the drug could be administered improperly if it wound up in the wrong hands. This year guidelines have been included that require the drug to be administered only by trained healthcare professionals.

In the midst of the current opioid epidemic, lawmakers have serious concerns about the potential for misuse. Sen. Edward Markey (D-Mass.) believes that the FDA’s consideration of this new drug “makes no sense.” In a statement, Markey noted, “Even in the midst of the worst drug crisis our nation has ever seen, the FDA once again is going out of its way to approve a new super-charged painkiller that would only worsen the opioid epidemic.”

Pain management expert  and Chief Medical Officer with Physician Partners of America Abraham Rivera, M.D. echoes these concerns. He points out that DSUVIA is not a new drug. “It’s actually an oral formulation of Sufentanil. This drug was invented in the late 1950’s… It’s a ‘cousin’ drug to Fentanyl, Alfentanyl, Remifentanil, Carfentanyl, and a few others.”

When asked about the effectiveness of the drug as a pain management treatment, Rivera readily admits that it is extremely potent. However, he goes on to say, “In my opinion, it brings very little to the armamentarium of a pain management practitioner. It has a serious potential for abuse and misuse.”

Physician Partners of America has long focused on interventional pain management techniques that do not rely on opioids as a primary course of treatment.

Like Senator Edward Markey and others in the healthcare and political arenas who have seen firsthand the devastating effects opioid addiction has had on the community, Drs. Creighton and Rivera worry that people who want to abuse DSUVIA painkiller will find creative ways to accomplish their goals — regardless of the safety precautions the medical community or pharmaceutical companies put in place.

This is especially worrisome considering the potency of the drug. Dr. Rivera states: “This particular drug packs such a punch that I am afraid the recreational street chemists will get their numbers wrong and write their mistakes on gravestones.”

Non-oral forms of the DSUVIA painkiller are already being used in the operating room as an adjuvant anesthetic. In this setting, it has excellent cardiovascular stability at high doses, Rivera says.

He summed up his feelings about introducing DSUVIA to the market like this: “Taking this drug out of the operating room and putting it in an oral formulation reminds me of the making of small nuclear weapons. In times of conflict, some people thought that it would be a good idea. Drop a small nuke here and there and save money on bullets. Good thing somebody disagreed.”

 

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Physician Partners of America: Fighting the Opioid Crisis in the Surgical Suite

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The Commission on Combating Drug Addiction and the Opioid Crisis found that in the last 17 years, the number of opioid overdoses in the U.S. has increased four-fold, aligning with the number of opioid prescriptions sold. That’s no coincidence.

While opioid abuse remains a complex and burgeoning problem, the fallback solutions are avoiding the need for opiates in the first place and curtailing the amount a physician can prescribe. In addition, nearly every state has adopted a medication management program that allows regulators and doctors to track the number of opioids prescribed.

Another solution that flies under the public radar is familiar to surgeons: a piece of equipment that works quietly in the corner of many an operating suite, known as intraoperative neuromonitoring (IONM).

Neuromonitoring for Interventional Pain Procedures

IONM monitors electrical potentials from the patient’s nervous system during surgery involving the brain, spine and other parts of the body. In real time, the certified IONM technician can monitor and evaluate the function of the patient’s brain, spinal cord and nervous system. Intraoperative neural monitoring offers a set of eyes more accurate than the standard visual and x-ray assisted methods. It can detect nerve injuries before they reach a level that could lead to prolonged or permanent damage.

How Intraoperative Neuromonitoring Reduces the Need for Opioids

Specifically, IONM helps the surgeon avoid injuries that can cause postsurgical problems such as muscle weakness, hearing loss, paralysis, and loss of normal body functions. Many of these conditions can cause pain that in some cases indicates use of narcotic pain relievers.

In study after study, IONM has been shown to reduce the need for opioids post-surgery, because it reduces nervous system complications, pain and hospital readmission.

Neuromonitoring for Safer Surgeries

As a company that puts patient safety first, Physician Partners of America has embraced this technology to become a leader in performing IONM in many types of surgeries. In the past eight months, its certified technicians have monitored more than 400 operations related to interventional pain relief alone, making PPOA a leader in this application. The company is in the process of gathering case studies for pain-related surgery monitoring.

Along with medication management and pharmacogenomic testing, IONM is one more way Physician Partners of America is leading the charge in ensuring patient safety and battling the opioid crisis.

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