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除了疫情,美国还面临止疼药危机

Joseph Stauffer
2020-12-21

美国需要加快研发的步伐,以发现有效的低风险止疼药。

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手术从来都不是什么有趣的事情。然而,在全球疫情期间进行手术尤为恐怖。当我最近因为疝气而被推上手术台时,在我不得不担心的潜在致命后果长篇清单中又多了新冠病毒一项。

长篇清单?是的:我和手术室之间的缘分由来已久, 10年前我进行了一次开胸手术,治疗主动脉瘤和钙化瓣膜。术后留下了很多潜在风险和隐患。我的胸腔内如今用的是一块钛瓣膜。我还在使用血液稀释剂,这意味着我无法使用传统的非甾体类消炎止痛药(NSAID),例如布洛芬、阿司匹林和萘普生,因为这类药物的副作用(包括肠胃穿孔和出血)可能造成身体的严重伤害或死亡。同时,我还不想使用阿片类药物,因为有成瘾风险,何况还有便秘和一系列其他副作用。

当我躺上手术台上时,我必须接受不适用于长效止疼的对乙酰氨基酚,而且对术后组织损伤引发的炎症也只能听之任之。真的是太疼了。

我希望自己是唯一有这种体验的人,但事实上很多人在这一疗法面前也面临着同样的痛苦和选择。《Pharmacy Times》最近的报道称,服用血液稀释剂的美国人达到800万之多。

然而,作为生物科技研究公司的首席医疗官,我对急性和慢性疼痛的用药要求有着高于常人的认识。我唯一了解到的事情就是:社会需要新的药物和疗法,以避免将普通的小病或常规医疗流程变为不必要的赌博。

在手术之后不能使用非甾体类止疼药确实是相当痛苦的事情。然而,这里还有慢性疼痛,有四分之一的成年人都会有这样或那样的慢性病。我会定期地出现全身性的疼痛,源于少年时的运动损伤、服役时受的伤,以及岁数渐长这个简单的事实。对那些同时具有多种风险因素的人来说,服错止疼药可能会引发严重的后果。我们有必要认真衡量一切所摄取药物的利弊。

有很多人尝试过阿片类药物,通常用于缓解中度到重度疼痛。然而,此举让更多的人陷入了北美肆虐的成瘾危机之中。2019年,7.2万美国人死于药物过量,其中有三分之二跟阿片类药物有关。

在我前半生担任美国海军医生期间,我曾经在费城北部很多初级医疗诊所和农村诊所兼职。在那里,我切身体会了阿片类药物对人类真实而充满了破坏性的影响。很简单,这种药物会让人成瘾。即便少量的误用也会导致严重的神经问题,包括昏迷、脑损伤或死亡,更不用说有关成瘾的顽固恶习。医疗专业人士和制药商应该发挥主导作用,在社区内提升人们对成瘾的认识,并开展戒瘾对话。

宾州的农场乡村、军队、商界,只要我待过的地方,我都曾经看到过阿片类药物成瘾现象。这一危机在城镇、农场和大厦中远近皆有,已经达到了肆虐的地步。如今,全球新冠疫情带来的不安、用药者的隔离、未污染药物供应的中断,以及医疗服务的收税,让阿片类药物危机更加致命。

当我最近一次做手术时,医生在手术后立即给我服用了阿片类药物。离开医院的恢复区之后,我就决定强忍着术后疼痛,不服用阿片类药物和非甾体类止疼药,美其名曰:不靠药物而活。我的决定以及随之而来的身体不适再次提醒着社会,我们迫切需要替代类药物。

幸运的是,我加入了一个强大的生物科技和医疗专业人士团体,他们一直在寻找非成瘾性止疼解决方案。

随着医疗界在接下来的几个月中推出新冠疫苗,我们需要加快研发的步伐,以发现有效的低风险止疼药。我自己的公司正在开发三种源自于传统非甾体类药物的止疼药,但它们对消化系统更加安全。

我们还需要更新传统的药物发现流程,因为这个流程是出了名的耗时。我们需要创建一种模式,这样,科学家可以从事他们的工作,与此同时,医疗专业人士则能够迅速地从研发转向临床试验,再到政府批准和替代药物上市的部署阶段。

我相信终有实现的这一天,就像我相信我们可以打败新冠病毒一样。我乐观地认为,像我经历过的手术在未来可能会成为一种常规性的手术,即便对于具有风险因素的人来说亦是如此。要获得成功,我们只需确保止疼药解决的唯一问题就是疼痛。(财富中文网)

约瑟夫•斯托弗是Antibe Therapeutics公司的首席医疗官。

译者:冯丰

审校:夏林

手术从来都不是什么有趣的事情。然而,在全球疫情期间进行手术尤为恐怖。当我最近因为疝气而被推上手术台时,在我不得不担心的潜在致命后果长篇清单中又多了新冠病毒一项。

长篇清单?是的:我和手术室之间的缘分由来已久, 10年前我进行了一次开胸手术,治疗主动脉瘤和钙化瓣膜。术后留下了很多潜在风险和隐患。我的胸腔内如今用的是一块钛瓣膜。我还在使用血液稀释剂,这意味着我无法使用传统的非甾体类消炎止痛药(NSAID),例如布洛芬、阿司匹林和萘普生,因为这类药物的副作用(包括肠胃穿孔和出血)可能造成身体的严重伤害或死亡。同时,我还不想使用阿片类药物,因为有成瘾风险,何况还有便秘和一系列其他副作用。

当我躺上手术台上时,我必须接受不适用于长效止疼的对乙酰氨基酚,而且对术后组织损伤引发的炎症也只能听之任之。真的是太疼了。

我希望自己是唯一有这种体验的人,但事实上很多人在这一疗法面前也面临着同样的痛苦和选择。《Pharmacy Times》最近的报道称,服用血液稀释剂的美国人达到800万之多。

然而,作为生物科技研究公司的首席医疗官,我对急性和慢性疼痛的用药要求有着高于常人的认识。我唯一了解到的事情就是:社会需要新的药物和疗法,以避免将普通的小病或常规医疗流程变为不必要的赌博。

在手术之后不能使用非甾体类止疼药确实是相当痛苦的事情。然而,这里还有慢性疼痛,有四分之一的成年人都会有这样或那样的慢性病。我会定期地出现全身性的疼痛,源于少年时的运动损伤、服役时受的伤,以及岁数渐长这个简单的事实。对那些同时具有多种风险因素的人来说,服错止疼药可能会引发严重的后果。我们有必要认真衡量一切所摄取药物的利弊。

有很多人尝试过阿片类药物,通常用于缓解中度到重度疼痛。然而,此举让更多的人陷入了北美肆虐的成瘾危机之中。2019年,7.2万美国人死于药物过量,其中有三分之二跟阿片类药物有关。

在我前半生担任美国海军医生期间,我曾经在费城北部很多初级医疗诊所和农村诊所兼职。在那里,我切身体会了阿片类药物对人类真实而充满了破坏性的影响。很简单,这种药物会让人成瘾。即便少量的误用也会导致严重的神经问题,包括昏迷、脑损伤或死亡,更不用说有关成瘾的顽固恶习。医疗专业人士和制药商应该发挥主导作用,在社区内提升人们对成瘾的认识,并开展戒瘾对话。

宾州的农场乡村、军队、商界,只要我待过的地方,我都曾经看到过阿片类药物成瘾现象。这一危机在城镇、农场和大厦中远近皆有,已经达到了肆虐的地步。如今,全球新冠疫情带来的不安、用药者的隔离、未污染药物供应的中断,以及医疗服务的收税,让阿片类药物危机更加致命。

当我最近一次做手术时,医生在手术后立即给我服用了阿片类药物。离开医院的恢复区之后,我就决定强忍着术后疼痛,不服用阿片类药物和非甾体类止疼药,美其名曰:不靠药物而活。我的决定以及随之而来的身体不适再次提醒着社会,我们迫切需要替代类药物。

幸运的是,我加入了一个强大的生物科技和医疗专业人士团体,他们一直在寻找非成瘾性止疼解决方案。

随着医疗界在接下来的几个月中推出新冠疫苗,我们需要加快研发的步伐,以发现有效的低风险止疼药。我自己的公司正在开发三种源自于传统非甾体类药物的止疼药,但它们对消化系统更加安全。

我们还需要更新传统的药物发现流程,因为这个流程是出了名的耗时。我们需要创建一种模式,这样,科学家可以从事他们的工作,与此同时,医疗专业人士则能够迅速地从研发转向临床试验,再到政府批准和替代药物上市的部署阶段。

我相信终有实现的这一天,就像我相信我们可以打败新冠病毒一样。我乐观地认为,像我经历过的手术在未来可能会成为一种常规性的手术,即便对于具有风险因素的人来说亦是如此。要获得成功,我们只需确保止疼药解决的唯一问题就是疼痛。(财富中文网)

约瑟夫•斯托弗是Antibe Therapeutics公司的首席医疗官。

译者:冯丰

审校:夏林

Surgery is never fun. But surgery during a global pandemic is an especially frightening prospect. When I went under the knife for a corrective hernia procedure recently, COVID-19 got added to the long list of potentially fatal outcomes I had to worry about.

Long list? Yes: The operating room and I go way back, which has left me with a lot of risk factors. I had open-heart surgery a decade ago to fix an aortic aneurysm and calcified valve. I have a titanium valve in my chest. I’m also on blood thinners, that means I can’t take traditional NSAID painkillers like ibuprofen, aspirin, and naproxen, because their side effects—which include gastrointestinal perforations and bleeding—could seriously injure or kill me. And I don’t want to take opioids, which pose the risk of addiction, not to mention severe constipation and a host of other side effects.

When I went under the knife, I had to make do with acetaminophen, which just isn’t suitable for durable pain relief—and does nothing for the inflammation that follows surgically injured tissue. It hurt like hell.

I wish I could say that my experience was unique, but many others face the same kind of pain and the same kind of choices around its treatment—8 million Americans take blood thinners, according to a recent report from Pharmacy Times.

However, as chief medical officer of a pain-focused biotech research company, I have better than usual line of sight into the requirement for medications for acute and chronic pain. And if I’ve learned one thing, it’s this: Society needs new drugs and remedies that don’t turn common ailments or routine health care procedures into unnecessary gambles.

It’s hard enough to be unable to use NSAID pain relievers after surgery. But there’s also chronic pain, which a quarter of all adults suffer from in one form or another. Again, my own story is relevant and not unusual. I experience regular pain throughout my body stemming from teenage sports and military service injuries, and due to the simple fact that I’m aging. For anyone with multiple risk factors, the wrong decision about what pain pill to take could have severe consequences. We need to seriously weigh the pros and cons of everything we ingest.

Many of us try opioids, which are often used for moderate to severe pain. But that risks turning even more people into statistics in North America’s raging addiction crisis. Opioids were a factor in two-thirds of America’s 72,000 drug overdose deaths in 2019.

In my previous life as a U.S. Navy doctor, I moonlighted in various North Philadelphia primary-care settings and rural clinics, where I saw the real and devastatingly human impact of opioids close up. They’re addictive—plain and simple. Even light misuse can lead to serious neurological effects, including coma, brain damage, or death—not to mention the persistent stigma around addiction. Medical professionals and pharmaceutical providers need to play a leading role in encouraging addiction awareness and stigma reduction conversations within communities like these.

Pennsylvania farm country, the military, the business world—everywhere I’ve spent time, I’ve seen opioid addiction. The crisis runs rampant in cities and towns, on farms and in mansions, far away and next door. And now, the global COVID-19 pandemic has made the opioid crisis even more deadly, by creating insecurity, isolating users, disrupting the flow of uncontaminated drug supplies, and taxing our health services.

When I had my latest surgery, I was given opioid medications during and immediately after the procedure. But once I left the hospital recovery area, I made the call to live with my postoperative pain, opioid- and NSAID-free, in the name of living beyond it. My decision, and the physical discomfort that came with it, was another reminder of how desperately we need alternative medications.

Fortunately, I’m part of a strong community of biotech and medical professionals looking for nonaddictive pain relief solutions.

As the medical community sprints toward rolling out COVID-19 vaccines in the coming months, we need to keep racing in parallel on the research and development required to introduce effective, lower-risk pain relief. My own company is developing three pain medications that are derived from traditional NSAIDs but designed to be safer for the gastrointestinal system.

We also need to renovate the traditional drug discovery process—a famously lengthy endeavor. We need a model that allows science to do its thing while empowering medical professionals to move quickly from R&D to trial to government approval to deployment phases of bringing alternatives to market.

I believe we’ll get there, just like I believe we’ll beat COVID-19. I am optimistic that future surgeries like mine will be as routine as it gets, even for people with risk factors. To succeed, we just need to make sure that pain is the only thing we’re killing with painkillers.

Dr. Joseph Stauffer is the chief medical officer at Antibe Therapeutics.

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