How this biopharma company wants to change how we treat pain
Dr Steven Fox, CEO and chairman of biopharmaceutical company Akelos speaks to EPM about how his company wants to tackle the opioid epidemic through the development of non-addictive drugs.
In 2017 the US department of Health and Human Services (HHS) declared the country to be in the midst of an opioid crisis. In doing so it confirmed what many already knew: that for over 20 years, the US healthcare system has been gripped in an epidemic that has cost the lives of hundreds of thousands of patients.
The US has a long history of opioid abuse, with soldiers in the Civil War experiencing addiction after being administered morphine for injuries. More recently the country has been in the throes of an opioid crisis so severe, it’s estimated to have killed over 200,000 Americans between 1999-2017 - and that’s only from prescription opioids.
“Right now, we’re in the worst healthcare crisis in the history of the United States because of the opioid crisis. More people died last year [2018] from opioids than HIV, guns and automobiles and the Vietnam war,” says Dr Steven Fox, founder of Akelos, a biopharmaceutical company that wants to change the way pain is treated.
Akelos hopes that by developing a non-addictive, non-opioid alternative to treat chronic neuropathic pain, it can help combat the crisis that is costing so many lives across the US.
Neuropathic pain isn’t a small condition. Dr Fox mentions how it affects millions of people across the world, “people with diabetes, people with shingles, people with chemotherapy pain,” and it’s an unaddressed condition with no specific drug to treat it.
Currently, doctors prescribe everything from anti-depressants, anti-convulsants and of course, opioids, to try and help people with the condition.
The difficulty of developing a treatment for chronic neuropathic pain lies with a part of the body known as the blood brain barrier (BBB). The BBB protects the brain from foreign substances – including many drugs – which makes it difficult to treat neurological disorders.
Opioids are able to cross the BBB but in doing so release endorphins, neurotransmitters which dull our perception of pain and boost our feeling of pleasure. And of course, since the efficacy of opioids wears off through long-term use, users take more and more to treat their pain, and in doing so become dependant and addicted.
Akelos’ answer to this problem is a drug which targets the HCN1 receptor. The company wants to inhibit the HCN1 receptor – a gene which is, in part, responsible for blocking pain signals within the central nervous system. If the company can successfully develop a drug which blocks the HCN1 receptor without crossing the BBB, then it will have a non-addictive treatment for millions of people.
Dr Fox understands the stakes in which his company is operating, telling me how neuropathic pain is “an $8 billion a year unaddressed market” and that for those working in the sector, the condition represents “the holy grail”.
“Whoever develops a new drug for neuropathic pain will make medical history,” he tells me seriously.
Of course, the need for a non-addictive drug for chronic pain is borne from decades of suffering by patients who were never offered any other alternative.
“For 40 years we’ve never had a good drug to treat chronic pain. The only thing we’ve [doctors] had is an opioid and unfortunately it became an issue with the pharmaceutical companies pushing drugs that they know were addictive to people – the lobbyists in Washington, the distributors around the country,” Dr Fox says.
As a practising healthcare professional, Dr Fox has seen the opioid crisis first-hand, through family and friends, and even addicts breaking into his office to steal Vicodin. It’s an issue that isn’t going away anytime soon.
“They’re still selling them [opioids], the FDA still approves them, so I don’t see a dramatic change.”
Even counter measures such as educational awareness schemes aren’t enough to combat a dependence on opioids.
As Dr Fox mentions, opioids and indeed addiction cuts across all socio-economic barriers.
“It crosses the spectrum of all kinds of people. You know, you need a substitute for the issue not to exist and frankly if you’re in pain I’m not judging. If somebody is in pain, they’re going to take what they need to get out of pain.”
In essence, this is why the epidemic has blown up over the past two decades. With no other alternatives, pharmaceutical companies understood the demand for effective pain relief, and supplied accordingly – with or without all the facts.
Now, US states are filing lawsuits against pharmaceutical companies and distributors that misinformed the public about their opioid’s addictive properties, and they’re winning. Landmark rulings have caused major players to pay out hundreds of millions due to their part in fuelling the opioid epidemic.
And though the public’s perception regarding opioids might have changed, without an effective alternative, patients will still be at risk.
“You can be aware of it, but it doesn’t mean you’ll solve the problem until you have a new drug,” Dr Fox says.
That’s why he hopes Akelos will be able to develop something of an answer to the opioid epidemic. Even though the company is only targeting one condition, it’s a disorder which affects millions of people.
“The reality is if you’re having chemotherapy and you’re in tremendous pain, you need a painkiller. I need people to get behind what we’re doing and develop a new painkiller,” he adds.
The company, which is developing three alternatives to opioids, is raising capital on the investment platform WealthForge. And though it’s targeting what could be a potentially lucrative market, Dr Fox isn’t worried about competition.
“Right now on the market there is no competition because there is no drug that you can write for the pain. When people invented Asprin, Tylenol and Ibuprofen, there was plenty of room for everybody. So right now there is no competition in the sense that nobody’s on the market yet approved by the FDA.”
Let’s see if Akelos becomes the first company to change this.