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This is an article of mine from Recursive Adaptation.  We are always looking for new collaborators as we expand our research and policy development!

Excerpts

 

The Problem

Suzetrigine is a novel non-opioid, sodium channel painkiller with no addictive potential, from mid-size pharma company Vertex. It has shown positive results in Phase 3 and is being submitted to the FDA for approval by the end of 2024 or early 2025. Suzetrigine is roughly equivalent in pain reduction efficacy to Vicodin (hydrocodone / APAP), which is one of the most commonly prescribed opioids. We recently reviewed the efficacy and promise of suzetrigine in this article.  There are other broad non-opioid painkillers in the pipelines of other companies that may arrive over the next few years.

This is great news—can we start removing opioids from medical treatment to prevent patients from developing addictions? Unfortunately, there’s a huge obstacle: like other new medications, insurance providers will not pay for suzetrigine unless a doctor can show that a patient has tried a cheaper generic drug first and it was ineffective. And the cheaper generics for pain are opioids.

Next year, as tens of millions of Americans are getting teeth pulled, having surgeries, and suffering from chronic nerve pain, they will needlessly receive opioid prescriptions while a much safer alternative sits on the shelf waiting for its patent to expire a decade from now. About 3-6% of those patients who are prescribed opioids will become dependent, generating millions of completely avoidable new opioid addictions every year (1, 2, 3). Non-patients will become addicted too, as many opioid addictions begin with prescriptions that were diverted from the original patient to someone else– leftover pills given to friends or discovered in a medicine cabinet.

 

Proposed Solution

Let’s make a wild guess and say that Vertex expects to earn $100 million from suzetrigine in the US next year as a second-line treatment. That $100 million cost is already being borne by the public— through insurance premiums, taxes for Medicare and Medicaid, etc.

Instead, if the federal government can step in and offer Vertex $120 million in exchange for making suzetrigine available at generic prices, that would be a win for everyone—Vertex would make more money and remain incentivized to develop safer pain treatments and the public would pay only an extra 20% to get the drug to 5X or 10X or 20X as many people. The result is that those patients are safer, addictions are avoided, and huge downstream costs from addiction are saved. Meanwhile, over the next few years, more non-opioid painkillers are expected to become available from other companies and once this arrangement is established, similar deals can be negotiated and renegotiated depending on market conditions.

This should be an obvious public health win. We should not be willing to accept a single day where suzetrigine is FDA approved but is being denied by insurance companies, forcing doctors to prescribe unnecessary opioids.

(More details of how this could be implemented are in the article)

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This sounds great! Have you given any thought to how we could make suzetrigine available to people in LMICs, or people who can’t afford it/don’t have health insurance?

I don't know much about painkillers in LMICs, but in my understanding the US prescribes many more opioids than other western countries (like Germany, where I'm from). So this idea/problem might be specific to the US.

@mincho: How does Suzetrigine compare to existing non-opioid painkillers?

I don't know of any head to head comparisons.  It's comparable to Vicodin according to the studies.  It seems likely that it can be safely combined with acetaminophen which would make it more effective. 

And yes, opioid over-prescribing is more of a US problem than most other places, but eventually getting opioids out of all medical systems over time will help reduce opioid addiction globally.

My brother developed an opioid addiction about five years ago, though I'm happy to report he's coming up on one year of sobriety. The specific story of my family aside, I've spent a lot of time trying to understand the opioid epidemic, the medical system, and any oft prescribed drugs with addictive potential. Opioids are by no means the only substance medically prescribed that can cause addiction issues. At the risk of sounding like a conspiracy theorist, I would argue that certain entities are very happy to profit from addicts who require more intensive and costly medical care over the course of their lifetimes. Consider all the money to be made from in-patient visits, out patient programs, and medications and drug treatments for substance use disorders. After my family's experiences and researching many drugs out there (Oxy, Xanax, Adderall, etc.), I would not trust any medical prescriptions without doing my homework first and really carefully weighing the risk of addiction. A drug like Suzetrigine should be an obvious public health win, but some may not view a potentially large disruption to the pharmaceuticals market as a good thing. Intertia and incentives keep companies and hospitals from adopting new drugs and making big changes. There are several really good Netflix and other documentaries and series about pharmaceuticals in the United States that might elucidate some of the more nuanced aspects of problems with prescription drugs 

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