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Vision loss

Opioids inhibit NOS (Kampa et al., 2001), and this inhibition may need to be well-correlated with other effects of opioids (perhaps at NMDA coincidence detectors?) in order for the plasticity required for tolerance to occur

In practical terms: using a degraded vial may mean youre administering a lower-effective dose, or in worst case, a contaminated or inactive product

Thats a mechanistically different target than NSAIDs (nonsteroidal anti-inflammatory drugs), or corticosteroids, which partly explains why the compound has attracted interest in cases where conventional anti-inflammatory approaches have failed or created downstream problems