A State Of Addiction: The Search For Alternative Painkillers

Nov 16, 2017

Marijuana and a compound from snail venom are being studied as alternatives to opioids.
Credit Wikipedia and University of Utah

LeAnn Williams was married for 31 years. She just lost her husband this past February to an overdose of Oxycodone. LeAnn gently turned through each page of a scrapbook. In her quiet way, she showed me pictures of falling in love with her college sweetheart, winters spent building snow caves in their yard, and growing a family with three beautiful children in Heber City, Utah.  

This particular scrapbook was extra special though. It’s one LeAnn’s husband Steve made for her on their 20th anniversary.

“It says ‘look how much we've done in twenty years, from 1986 to 2006’,” she said. “So, two years before the accident he put this together.”

It was in an instant that this family started their life-changing journey of chronic pain. In January 2008, LeAnn and Steve were in a car accident.

“My husband was permanently injured,” said LeAnn. “He had disc damage to his neck.”

After the accident, none of the surgeries and other medical procedures seemed to help, so Steve was continually prescribed opioids.

“His personality started to change,” LeAnn revealed. “He became more paranoid. He thought everyone was out to get him. He would pick fights with people. He didn't trust anyone.

“If you were to know him, even ten years ago, he was still this fun loving, caring husband, and caring father. He loved to do practical jokes on people and always looked out for people who were isolated and lonely,” she said as tears fell. “He was very generous and kind. And, he was fun…so fun. It just it broke my heart to see how this drug changed his personality and basically ruined our lives.”

It became a cycle for nearly a decade—once a month, he went to the doctor and got the prescription.  

“It wasn't like [the doctors] had a plan or protocol in place. Like, we're going to do this for so long see how it works and then we're going to try this. They didn't have any alternatives, so they were just meeting his needs and his demands,” expressed LeAnn.

"I think opioid abuse is common because chronic pain is common, and we don't have good alternatives for treatment of long-term chronic pain." -Dr. Michael McIntosh

Steve is one of about 30,000 Americans who have died from an opioid-related—prescription drug, synthetic opioid, or heroin overdose this year. There is risk involved with taking opioids, but it’s important to realize that the majority of pain patients with legitimate prescriptions do not misuse the medication or become addicted. The opioid crisis is complex and to address it, several steps are being taken, including a search for non-addictive alternatives. 

Drs. Michael McIntosh and Vikas Patel can find themselves between a rock and a hard place when it comes to helping patients deal with chronic pain. They understand how desperate people like Steve can be for relief, but also recognize the potential risks associated with long-term opioid use.

“I think opioid abuse is common because chronic pain is common, and we don't have good alternatives for treatment of long-term chronic pain,” said Dr. McIntosh.

“A lot of it, I think, goes back to the time when pain became what they called the fifth vital sign,” Dr. Patel said. “As physicians, we were pushed pretty hard to treat pain very seriously. And as such, if you don't treat it, you're neglecting patients.”

The concern, however, is that individuals respond differently to opioids, and some people are more prone to getting addicted than others. In Steve’s case, a physician assistant did express concern. And while he was never formally diagnosed, LeAnn said she now has no doubt that Steve was an unsuspecting victim of addiction.

“Medical researchers are trying to identify other targets that would also produce pain relief, but that wouldn't have these addictive properties like the opioids,” Dr. McIntosh said.

And that’s exactly what Drs. McIntosh and Patel are doing. They are involved in studies researching two very different compounds that have the potential to radically change people’s options when it comes to treating pain.

"We don’t know nearly as much as we should about the benefits as well as the harms of marijuana." -Dr. Vikas Patel

“Certainly, the marijuana and cannabis derivatives [are] of great interest,” Dr. Patel noted, “and we're trying to figure out if cannabis itself has a really good pain relieving effect or not.”  

Dr. Patel is a spine surgeon at the University of Colorado. He is involved in a study looking at the pain relieving effects of marijuana compared to opioids.

“We don’t know nearly as much as we should about the benefits as well as the harms of marijuana,” he said.

The problem is that it’s been a controlled and illegal substance for so long, opportunities to study it were limited.

“When the Marijuana Act was passed in Colorado and suddenly it was available to everybody for recreational as well as medical purposes, it set the stage,” explained Dr. Patel. “There [were] funding opportunities out there for real science in learning more about cannabis and its medical effects.”

Volunteers that do not regularly use marijuana or opioids are enrolled in an ongoing study with a research team that includes Dr. Patel. The volunteers undergo three different tests. In each test, their sensitivity to pain is determined after they’ve been given marijuana smoke, Oxycodone, or a placebo.

"Medical researchers are trying to identify other targets that would also produce pain relief, but that wouldn't have these addictive properties like the opioids." -Dr. Michael McIntosh

“Basically, they’re tested to see when a certain pressure becomes painful and then, we record those pressures,” Dr. Patel said. “Hopefully, we see similarities or differences between marijuana, Oxycodone, and placebo in how much pain a person can tolerate.”

While the potential of marijuana is on everyone’s radar as an opioid alternative, a newly discovered compound is also making its way into the limelight.

Dr. McIntosh is a psychiatrist and professor at the University of Utah. He is part of a team that discovered a potent painkiller produced by snails in the ocean.

“The snails face the problem of trying to capture a rapidly moving prey, when they themselves are quite slow moving, so they've had to come up with sophisticated arsenals of compounds to be able to accomplish that and some of those compounds act in unique ways,” explained Dr. McIntosh. “We're trying to capitalize on that.”

The team is still investigating exactly how this snail compound works. What they do know is that the compound targets a different pathway in the body than opioids, and it doesn’t appear to have addictive properties. Dr. McIntosh said the most surprising result is that the pain-relieving effects in mice lasted long after the drug had been administered and processed.

“So, the animals are not experiencing pain like they were, even though they're not on drugs,” he said. “Our hope is that the same thing can happen in the human state. That not only are you masking the pain, which is a good goal, but all the better is if you can repair some of the underlying pathology, so that pain is not even there in the first place.”

LeAnn’s husband Steve actually did try some alternatives, but she wonders if they gave up on those things too soon.

“He did try marijuana for a time, but then for religious and ethical reasons, he didn't feel good about that,” LeAnn recalled. “If I could go back, I would do everything that I could to avoid having him on Oxycodone.”

Steve (back right) and LeAnn Williams (back center) with their three children and son-in-law.
Credit LeAnn Williams

While potential alternatives for pain management offer some hope, they will never mask the pain that one experiences in losing a loved one to opioids. The day LeAnn shared her love story with me, a love story that ultimately turned into tragic loss, she sat down at her piano and played Amazing Grace—it’s a sweet reminder of why she’s able to go on.

“It means that everything's going to be okay,” she said.

This series is brought to you in part by the Association for Utah Community Health, providing training and technical assistance to health centers and affiliates across Utah. More information available here.