Beginning
with opium itself, natural and synthetic opioids have
been used as analgesics for over 8000 years and were likely abused
as drugs of recreation for that long as well. However, the “opioid
crisis” resulted in attempts to avoid or limit opioid analgesics
in favor of other therapies and methods. Mu opioid agonists can be
effective analgesics but suffer from addiction, tolerance, and dangerous,
sometimes fatal, side effects. One exception to this generalization
is dezocine (Dalgan), a mixed mu/kappa opioid partial agonist. Dezocine
is at least as effective as morphine in reducing acute pain in animal
models and clinical applications such as postoperative pain. And while
dezocine was discontinued in western markets in 2011, it has become
the favored opioid analgesic in China, capturing over 40% of the market.
Additionally, dezocine possesses norepinephrine uptake inhibitory
activity, which may synergize with mu agonism in the case of acute
pain treatment and possibly endow the drug with antinociceptive activity
in neuropathic pain conditions. This Innovations article summarizes
the history and properties of dezocine and presents evidence and rationale
for why dezocine has undergone a resurrection.