Minimizing Opioid Exposure: Q&A with Frank Lee

Pharmaceutical Executive: Why is minimizing initial opioid exposure essential to breaking the cycle of addiction?
Frank Lee:While multimodal non-opioid analgesic modalities have been established as a gold standard for pain management, opioids continue to be a mainstay of care. Up to a third of patients with knee osteoarthritis take opioids, with that number increasing as their disease progresses to the point of requiring a knee replacement. For surgical patients more broadly, nearly 94% are prescribed opioids after surgery and about one in ten of those patients develop long-term use or abuse. Early opioid exposure has been shown to be a key trigger for addiction, as four out of five heroin misusers started with prescription painkillers. Proactive pain management with safe, long-lasting non-opioid strategies can break this cycle. Minimizing initial opioid exposure is one of the most important levers we have to reduce the risk of misuse and addiction, particularly in the postsurgical setting.

That’s why the healthcare community has such a critical opportunity––and responsibility––to change how pain is managed from the outset. If patients and physicians have conversations about pain before surgery, they can plan for safer, non-opioid strategies up front. By making a pain management plan and introducing non-opioid options earlier, we can provide patients with effective relief while reducing unnecessary reliance on medications that carry serious risks. At Pacira, our mission is to advance innovative, non-opioid pain therapies that not only improve post-surgical recovery and chronic pain management but also help break the cycle of addiction before it begins.

PE: Can you discuss the shift towards more precise analgesics that provide localized relief?
Lee: We’re seeing an exciting evolution in pain management: a move away from broad, systemic treatments to localized therapies targeting the surgical site or surrounding nerves. Historically, opioids were used because they were readily available and inexpensive but they affect the brain and entire body causing side effects that can slow their recovery and increase risk of addiction.While significant progress has been made to move away from opioid-only pain management, there is more that needs to be done.

Furthermore, while systemic non-opioids can provide a safer alternative to opioids, they are not without risk. Localized therapies take a very different approach. Instead of blanketing the body with medication, these treatments target the site generating pain, the nerves transmitting pain signals, or the inflamed joint itself. Patients benefit from effective, longer-lasting relief with fewer systemic complications that can lead to better recovery.

Across our portfolio, we’re investing in multiple approaches that follow a localized, precise, and patient-first approach.We are pushing further with an investigational therapy, PCRX-201, that represents true innovation - the potential first gene therapy for osteoarthritis of the knee, which could deliver years of relief for broad populations. By delivering pain relief directly at its source, we’re aiming to help patients recover faster and return to their lives more safely, while reducing unnecessary reliance on opioids.

PE: How is treating pain at a molecular level safer than traditional opioid treatments?
Lee: Opioids work by flooding the brain and central nervous system with signals that dampen pain, but that blunt mechanism also triggers side effects like sedation, dizziness, constipation, and, most concerning, the potential for addiction. In contrast, therapies that treat pain at a molecular level are designed to act where the problem begins. That might mean calming the inflammation driving osteoarthritis, blocking nerve signals that carry pain messages, or delivering anesthetics directly to a surgical site. Patients benefit from effective, longer-lasting relief with fewer systemic complications that can lead to better recovery.

PE: How serious does the opioid epidemic remain to this day?
Lee: The opioid epidemic remains one of the most devastating public health challenges of our time. Since being declared a public health emergency in 2017, it has claimed more than 454,000 lives. While overdose deaths have decreased recently, the epidemic has become increasingly complex as prescription opioids continue to act as a gateway to addiction. What’s especially troubling is that postsurgical opioid prescribing remains a key driver even when safer alternatives are available.

At the same time, there is reason for optimism. Legislation like the NOPAIN Act, which expands access to non-opioid pain management options for millions of Medicare beneficiaries and scientific breakthroughs in targeted, non-opioid therapies are paving the way for effective and safer pain management and reduced opioid exposure. Pacira is proud to be at the forefront of this effort, from long-acting local treatments to novel devices and even gene therapies. To further solidify our commitment, we designed a comprehensive prospective observational real-world study titled Innovations in Genicular Outcomes Registry (IGOR) to obtain in-depth insights into the patient journey which we believe will support much-needed innovation for treating osteoarthritis pain.

The epidemic is still very real, but we are at an inflection point. By aligning innovation, access, and patient education, we can reduce unnecessary opioid exposure and fundamentally change the pain management and recovery paradigm for patients.

Minimizing Opioid Exposure: Q&A with Frank Lee

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