The Centers for Disease Control and Prevention (CDC) recently released its yearly examination of deaths attributed to drug overdose. This year's results were a sobering reminder of the continuing impact that illicit drugs have had on our society, though an encouraging trend may have emerged.
According to the report, more than 100,000 people died from drug overdoses in 2023. Of those deaths, over 81,000 were from opioids, and more than 76,000 were due to synthetic opioids. While these are still tragically high numbers, for the first time in five years the annual death rate related to opioid overdose witnessed a slight decline.
The hope is that these data are a first indicator that the collective effort by drug support groups, law enforcement, first responders, and various other groups have enacted real and meaningful changes to curtail the opioid epidemic. For the pharmaceutical industry, which must shoulder blame, the time to make positive societal change is now. The situation is analogous to what happened some 50 years ago in the automobile industry, when carmakers, alongside government regulators and safety watchdogs, shifted their outlook and brought meaningful changes to accelerate safety-minded innovation that saved countless lives.
The opioid crisis is a man-made epidemic. The dangers these compounds have wrought on society have many parallels to that of the auto industry in the previous century. Car crashes were killing tens of thousands of people every year for decades, a number that topped 50,000 per year in the U.S. for nearly a decade in the late 1960s and early '70s.
But cars didn't go away. Automobile manufacturing wasn't stopped, nor was the use of automobiles limited. Rather, pressure from the public led to government action, which prompted manufacturers to prioritize safety. Some early responses, like requiring seatbelts, almost seem quaint to us now. But together with regulators, the auto industry has worked for decades to adopt innovations like antilock brakes, airbags, and crash test rating standards. Continuous innovation created a culture of safety where we now expect continued evolution, with technologies like backup cameras and blind spot monitoring seemingly appearing in all new cars overnight.
Auto deaths peaked at over 56,000 in 1972 and haven't surpassed 50,000 since 1981. Moreover, with the growing population and the ever-increasing predominance of driving in our lives, deaths compared to the population and deaths per mile driven have precipitously declined.
For the last half-century, the auto industry has continuously upped its game on safety—a model that the drug industry can follow. Like automobiles that are vital to our way of life, opioid-based therapies are indispensable to our health care system for managing moderate-to-severe pain in all its forms. It makes sense to take a cue from the auto industry and commit to raising the bar for safety standards by developing better opioid-based pain treatments to make a real difference in slowing the opioid epidemic.
We can innovate better solutions to save lives in the man-made opioid crisis. As we continue to leverage the unmatched analgesic efficacy of opioids for pain patients, we must also strive to set higher safety standards internally and in partnership with regulators and the broader health care system. The first goal should be to produce clear and obvious solutions that are as fundamental and beneficial as seatbelts and airbags were to cars.
Like the lap-only seat belt, early efforts to develop safety features for prescription opioids—such as formulations designed to thwart crushing, snorting, and injection of opioids—have provided only marginal benefit. Drug developers also tried to create novel treatments with enhanced safety via molecular modifications such as prodrugs and ligand-biased agents, though these efforts have failed to meaningfully reduce abuse. More recently, developers have gained attention targeting non-opioid receptors, but the utility of these targets to adequately address moderate-to-severe acute pain remains limited. Notably, when prescribed doses of non-opioids fail to adequately relieve pain, patients quickly reach for increased doses, likely with a new level of safety consequences.
The pharmaceutical industry has also attempted to implement tech-based solutions and more mindful distribution methods, accounting for each dose with pill counting dispensers, and encouraging patients to return surplus doses with takeback programs. But hardly a dent has been made in the opioid epidemic. It is important to note that work is being done across the health care industry to improve safety, but it hasn't come close to matching the wide-scale shift achieved by the auto industry.
While well-intentioned, these efforts fail to address a basic driver of the problem—in our current system, patients are regularly handed vials with a high number of tablets that, if taken together—whether by accident or deliberately—can easily reinforce abuse patterns and result in overdose or death.
Automakers had to come to the realization that once the car rolls off the lot, certain aspects of safety are out of their hands. Some buyers will drive responsibly, others won't, and some might even let their irresponsible friend or family members get behind the wheel. Similarly, in the opioid industry, contributing factors in the ongoing epidemic include people using opioids irresponsibly or sharing and selling doses, mixing pills with other drugs and alcohol, and physically altering medications to be sniffed or injected.
The pharmaceutical industry made some efforts to prevent diversionary tactics, but, importantly, none of these technologies protect against the primary route of abuse, which is simply swallowing more tablets than recommended. Quite frankly, most in the pharmaceutical industry thought protecting against oral opioid abuse and overdose was an impossibility.
It's time for a new generation of safety innovations: ones that not only address non-oral routes of abuse but the bigger issue of oral opioid abuse. Developing novel molecular technologies that can provide a balanced solution to the opioid crisis offers the opportunity to introduce a new class of prescription opioids that provide necessary pain relief while mitigating the inherent risks of existing opioids—abuse, diversion, and fatal overdose.
Driving continues to present risks to motorists and passengers alike, but it is also indispensable to our society, making safety paramount. New factors could make it more dangerous, like the relatively recent and deadly habit of texting and driving. So, the industry and regulators must remain vigilant and continue to innovate with increasingly smarter, and perhaps eventually driverless, cars.
As the auto industry has been diligent in making improvements, the pharmaceutical industry must make it a priority to develop better, safer, and more effective pain medications, applying innovation to ensure that past failures are never revisited. With better technologies and a commitment to collaboratively raising the bar on safety, we believe we can offer patients suffering from moderate-to-severe pain safe, highly effective opioid-based pain management, while simultaneously reversing the trends of the opioid epidemic to save thousands of lives each year.
Greg Sturmer is Co-Founder and CEO of Elysium Therapeutics.
The views expressed in this article are the writer's own.
