I Came Across Dezocine

Hey friends 👋🏻

I had a random question the other day-

How does China practice pain management? Do they have an opioid of choice?

To give you a bit of historical background, my birthplace, Hong Kong, was colonized by Britain after China lost the Opium War. The British ruled Hong Kong for 156 years.

If there is one thing I know about Chinese culture growing up in Hong Kong, shame is one of the worst feelings a Chinese person or a Chinese family would avoid at all cost.

China learned a hard lesson by losing land because of opium.

So when I started looking into whether China has an opioid of choice, one name kept coming up. Dezocine. And I was stunned when I learned that dezocine occupies over 45% of the opioid market share in China.

Think about that for a second.

China either didn't learn the lesson and allowed a random opioid to dominate the market. Or there is something about dezocine that caught China’s attention.

So intuitively I asked myself the next question.

What is it about dezocine?

Dezocine is a partial mu receptor agonist, much like buprenorphine. What makes it even more interesting is that dezocine also has SNRI activity. It's almost like a buprenorphine fused with duloxetine. And because it is a partial mu agonist, it has a ceiling on respiratory depression.

If I had to critique dezocine, it only comes as an injection. That limits its use mostly to the inpatient setting.

So here is a final question for both you and me to sit with.

If we put the politics of buprenorphine aside, and simply look at the fact that a country that once lost land because of opioids now relies on a partial agonist as a mainstay opioid,

Is America just starting to catch up?

Thanks for reading 🙇🏻

SP

References

1. Childers WE, Abou-Gharbia MA. “I’ll be back”: The resurrection of dezocine. ACS Med Chem Lett. 2020;11(10):1825-1828.

2. Wang YH, Chai JR, Xu XJ, Ye RF, Zan GY, Liu GYK, Long JD, Ma Y, Huang X, Xiao ZC, Dong H, Wang YJ. Pharmacological characterization of dezocine, a potent analgesic acting as a κ partial agonist and μ partial agonist. Sci Rep. 2018;8:14083.