Drug Tidbits

Pharma is ever maddening

SR-17018 is a novel drug which is getting increasing underground usage for quitting opioids. It is technically an opioid itself but produces an amount of euphoria which is somewhere between barely noticeable and completely nonexistent. While taking it people don’t get withdrawal symptoms from Fentanyl but their Fentanyl tolerance fades at about the same rate as if they were going cold turkey without the SR-17018. People have been successfully using it to quit opioid addictions and even keeping a stash of it around in case they relapse, which is bizarre behavior for usually addicts. Usually if there are any opioids around they’ll take them and it will cause a relapse, so this stuff must really not be much fun or addictive. Opioids for opioid quitting has a bad reputation because of Methadone, but swapping Buprenorphine for Fentanyl is a big improvement and SR-17018 seems to be truly good for cessation. Unfortunately because it’s technically an opioid and there hasn’t been any movement on getting it approved for cessation purposes (it was originally studied as a painkiller which it’s unsurprisingly not very good at) most likely it will get shoved into schedule 1 at some point, sanity and reality be damned.

Varenilicline is a good smoking cessation drug but causes nausea in some people. The obvious fix would be to give patients Ondansetron with it. This has been suggested but doesn’t seem to have been tried, not even a case study. There seem to be two problems here: The drugs in question are generic and there’s no incentive to develop treatment improvements which are very cheap, and there’s a general view that any treatment of addiction is super scary and the patients should have to suffer, even for fairly safe drugs with no reason to think they’ll have a bad interaction.

Sodium Oxybate is about to get orphan drug status, for the second time, for the same drug, which is already making more than a billion dollars a year and was neither discovered nor characterized by the company which got the orphan drug status the first time. Pharma has the deeply broken structure that exclusivity periods are the only form of reward for research but a start to fixing it would be to make it that formulation changes are both much easier to get through and give much less exclusivity. A bare minimum start to that would be to clarify that orphan drug status was never meant to apply to formulation changes. It would also be good to make sectors which are already making massive profits not qualify as orphan any more and to reduce the exclusivity period for formulation patents in general, with time release formulas and salt changes handled as specific special cases.