Heron Therapeutics (HRTX) 10-K 12 Mar 24 2023 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Feb. 28, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Trading Symbol	HRTX
Entity Registrant Name	HERON THERAPEUTICS, INC. /DE/
Entity Central Index Key	0000818033
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Accelerated Filer
Entity Well-known Seasoned Issuer	No
Entity Common Stock, Shares Outstanding		150,328,585
Entity Small Business	true
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity File Number	001-33221
Entity Tax Identification Number	94-2875566
Entity Address, Address Line One	4242 CAMPUS POINT COURT
Entity Address, Address Line Two	SUITE 200
Entity Address, City or Town	SAN DIEGO
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92121
City Area Code	858
Local Phone Number	251-4400
Entity Interactive Data Current	Yes
Entity Incorporation, State or Country Code	DE
Document Annual Report	true
Entity Public Float			$ 119.5
Document Transition Report	false
Title of 12(b) Security	Common Stock, par value $0.01 per share
Security Exchange Name	NASDAQ
Auditor Name	WithumSmith+Brown, PC
Auditor Location	San Francisco, California
Auditor Firm ID	100
Documents Incorporated by Reference	Portions of the registrant’s Definitive Proxy Statement related to its 2024 Annual Meeting of Stockholders to be held on or about June 13, 2024 are incorporated by reference into Part III of this Annual Report on Form 10-K. Such Definitive Proxy Statement will be filed with the U.S. Securities and Exchange Commission within 120 days after the end of the fiscal year to which this report relates. Except as expressly incorporated by reference, the registrant’s Definitive Proxy Statement shall not be deemed to be part of this report.

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 28,677	$ 15,364
Short-term investments	51,732	69,488
Accounts receivable, net	60,137	52,049
Inventory	42,110	54,573
Prepaid expenses and other current assets	6,118	13,961
Total current assets	188,774	205,435
Property and equipment, net	20,166	22,160
Right-of-use lease assets	5,438	7,645
Other assets	8,128	15,711
Total assets	222,506	250,951
Current liabilities:
Accounts payable	3,240	3,225
Accrued clinical and manufacturing liabilities	22,291	24,468
Accrued payroll and employee liabilities	9,224	13,416
Other accrued liabilities	41,855	38,552
Current lease liabilities	3,075	2,694
Total current liabilities	79,685	82,355
Non-current lease liabilities	2,800	5,499
Non-current notes payable, net	24,263
Non-current convertible notes payable, net	149,490	149,284
Other non-current liabilities	241	241
Total liabilities	256,479	237,379
Commitments and contingencies (see Note 6)
Stockholders’ equity:
Preferred stock, $0.01 par value: 2,500,000 shares authorized; no shares issued or outstanding at December 31, 2023 and 2022
Common stock, $0.01 par value: 225,000,000 shares authorized; 150,285,044 shares issued and outstanding at December 31, 2023 and 119,154,538 shares issued and outstanding at December 31, 2022	1,503	1,191
Additional paid-in capital	1,870,525	1,807,855
Accumulated other comprehensive income (loss)	13	(19)
Accumulated deficit	(1,906,014)	(1,795,455)
Total stockholders' (deficit) equity	(33,973)	13,572
Total liabilities and stockholders’ equity	$ 222,506	$ 250,951

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	2,500,000	2,500,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	225,000,000	225,000,000
Common stock, shares issued (in shares)	150,285,044	119,154,538
Common stock, shares outstanding (in shares)	150,285,044	119,154,538

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Revenues:
Net product sales	$ 127,044	$ 107,672
Cost of product sales	65,105	54,874
Gross profit	61,939	52,798
Operating expenses:
Research and development	55,897	107,506
General and administrative	49,014	37,437
Sales and marketing	67,643	82,513
Total operating expenses	172,554	227,456
Loss from operations	(110,615)	(174,658)
Other income (expense), net:
Interest income	3,364	1,638
Interest expense	(3,868)	(2,474)
Other income (expense)	560	(6,530)
Total other income (expense), net	56	(7,366)
Net loss	(110,559)	(182,024)
Other comprehensive income (loss):
Unrealized gains (losses) on short-term investments	32	(13)
Comprehensive loss	$ (110,527)	$ (182,037)
Basic net loss per share	$ (0.8)	$ (1.67)
Shares used in computing basic net loss per share	138,135	108,876
Diluted net loss per share	$ (0.8)	$ (1.67)
Shares used in computing diluted net loss per share	138,135	108,876

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' (Deficit) Equity - USD ($) shares in Thousands, $ in Thousands	Total	Private Placement	Common Stock	Common Stock Private Placement	Additional Paid-In Capital	Additional Paid-In Capital Private Placement	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit
Balance at Dec. 31, 2021	$ 77,570		$ 1,020		$ 1,689,987		$ (6)	$ (1,613,431)
Balance (in shares) at Dec. 31, 2021			102,005
Issuance of common stock under Employee Stock Purchase Plan	1,444		$ 4		1,440
Issuance of common stock under Employee Stock Purchase Plan (in shares)			407
Issuance of common stock under equity incentive plan	(1,530)		$ 6		(1,536)
Issuance of common stock under equity incentive plan (in shares)			614
Issuance of common stock in a private placement		$ 75,145		$ 161		$ 74,984
Issuance of common stock in a private placement (in shares)				16,129
Stock-based compensation expense	42,980				42,980
Net loss	(182,024)							(182,024)
Net unrealized gain (loss) on short-term investments	(13)						(13)
Comprehensive loss	(182,037)
Balance at Dec. 31, 2022	13,572		$ 1,191		1,807,855		(19)	(1,795,455)
Balance (in shares) at Dec. 31, 2022			119,155
Issuance of common stock under Employee Stock Purchase Plan	904		$ 7		897
Issuance of common stock under Employee Stock Purchase Plan (in shares)			717
Issuance of common stock under equity incentive plan	(903)		$ 11		(914)
Issuance of common stock under equity incentive plan (in shares)			1,130
Issuance of common stock in a private placement		$ 29,755		$ 208		$ 29,547
Issuance of common stock in a private placement (in shares)				20,735
Issuance of common stock on exercise of pre-funded warrants	1		$ 86		(85)
Issuance of common stock on exercise of pre-funded warrants (in shares)			8,548
Issuance of warrants in debt financing	371				371
Stock-based compensation expense	32,854				32,854
Net loss	(110,559)							(110,559)
Net unrealized gain (loss) on short-term investments	32						32
Comprehensive loss	(110,527)
Balance at Dec. 31, 2023	$ (33,973)		$ 1,503		$ 1,870,525		$ 13	$ (1,906,014)
Balance (in shares) at Dec. 31, 2023			150,285

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Operating activities:
Net loss	$ (110,559)	$ (182,024)
Adjustments to reconcile net loss to net cash used for operating activities:
Stock-based compensation expense	32,854	42,980
Depreciation and amortization	2,899	2,889
Amortization of debt discount	133
Amortization of debt issuance costs	206	202
Accretion of discount on short-term investments	(1,739)	(736)
Impairment of property and equipment	617	209
Loss on disposal of property and equipment	10	74
Change in operating assets and liabilities:
Accounts receivable	(8,088)	(16,550)
Inventory	12,463	(6,191)
Prepaid expenses and other assets	15,426	1,010
Accounts payable	15	(578)
Accrued clinical and manufacturing liabilities	(2,177)	752
Accrued payroll and employee liabilities	(4,192)	(1,847)
Other accrued liabilities	3,343	12,898
Net cash used in operating activities	(58,789)	(146,912)
Investing activities:
Purchases of short-term investments	(87,658)	(145,683)
Maturities and sales of short-term investments	107,185	143,957
Purchases of property and equipment	(1,545)	(1,825)
Proceeds from the sale of property and equipment	13	227
Net cash provided by (used in) investing activities	17,995	(3,324)
Financing activities:
Net proceeds from sale of common stock	29,755	75,145
Net proceeds from notes financing	24,350
Proceeds from purchases under the Employee Stock Purchase Plan	904	1,444
Payments for stock issued under the equity incentive plan	(903)	(1,530)
Proceeds from warrant exercises	1
Net cash provided by financing activities	54,107	75,059
Net increase (decrease) in cash and cash equivalents	13,313	(75,177)
Cash and cash equivalents at beginning of year	15,364	90,541
Cash and cash equivalents at end of year	28,677	15,364
Supplemental disclosure of cash flow information:
Interest paid	$ 3,059	$ 2,250

Organization and Business

Organization and Business	12 Months Ended
	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Business	1. Organization and Business We are a commercial-stage biotechnology company focused on improving the lives of patients by developing and commercializing therapeutic innovations that improve medical care. Our advanced science, patented technologies, and innovative approach to drug discovery and development have allowed us to create and commercialize a portfolio of products that aim to advance the standard of care for acute care and oncology patients. ZYNRELEF ® (bupivacaine and meloxicam) extended-release solution (“ZYNRELEF”) is approved in the United States (“U.S.”) for the management of postoperative pain. APONVIE ® (aprepitant) injectable emulsion (“APONVIE”) is approved in the U.S. for the prevention of postoperative nausea and vomiting. CINVANTI ® (aprepitant) injectable emulsion (“CINVANTI”) and SUSTOL ® (granisetron) extended-release injection (“SUSTOL”) are both approved in the U.S. for the prevention of chemotherapy-induced nausea and vomiting. As of December 31, 2023, we had cash, cash equivalents, and short-term investments of $ 80.4 million. Based on our current operating plan and projections, management believes that the Company's cash, cash equivalents and short-term investments will be sufficient to meet the Company's anticipated cash requirements for a period of at least one year from the date this Annual Report on Form 10-K is filed with the U.S. Securities and Exchange Commission (“SEC”).

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Principles of Consolidation The accompanying consolidated financial statements include the accounts of Heron Therapeutics, Inc. and its wholly-owned subsidiary, Heron Therapeutics B.V., which was organized in the Netherlands in March 2015. Heron Therapeutics B.V. has no operations and no material assets or liabilities, and there have been no significant transactions related to Heron Therapeutics B.V. since its inception. Use of Estimates The preparation of financial statements in conformity with generally accepted accounting principles in the U.S. (“GAAP”) requires management to make estimates and assumptions that affect the amounts reported in the financial statements and disclosures made in the accompanying notes to the financial statements. Our significant accounting policies that involve significant judgment and estimates include revenue recognition, investments, inventory and the related reserves, accrued clinical and manufacturing liabilities, income taxes and stock-based compensation. Actual results could differ materially from those estimates. Cash, Cash Equivalents and Short-term Investments Cash and cash equivalents consist of cash and highly liquid investments with contractual maturities of three months or less from the original purchase date. Short-term investments consist of securities with contractual maturities of greater than three months from the original purchase date. Securities with contractual maturities greater than one year are classified as short-term investments on the consolidated balance sheets, as we have the ability, if necessary, to liquidate these securities to meet our liquidity needs in the next 12 months. We have classified our short-term investments as available-for-sale securities in the accompanying consolidated financial statements. Available-for-sale securities are stated at fair market value, with net changes in unrealized gains and losses reported in other comprehensive loss and realized gains and losses included in other income (expense), net. The cost of securities sold is based on the specific identification method. Interest and dividends on securities classified as available-for-sale are included in interest income within other income (expense), net. Our bank and investment accounts have been placed under a control agreement in accordance with our working capital line of credit (see Note 8). Fair Value of Financial Instruments A company may elect to use fair value to measure accounts receivable, available-for-sale securities, accounts payable, guarantees and issued debt, among others. If the use of fair value is elected, any upfront costs and fees related to the item such as debt issuance costs must be recognized in earnings and cannot be deferred. The fair value election is irrevocable and generally made on an instrument-by-instrument basis, even if a company has similar instruments that it elects not to measure based on fair value. Unrealized gains and losses on existing items for which fair value has been elected are reported as a cumulative adjustment to beginning retained earnings and any changes in fair value are recognized in earnings. We have elected to not apply the fair value option to our financial assets and liabilities. Financial instruments, including cash and cash equivalents, receivables, inventory, prepaid expenses, other current assets, accounts payable and accrued expenses, are carried at cost, which is considered to be representative of their respective fair values because of the short-term maturity of these instruments. Short-term available-for-sale investments are carried at fair value. Our convertible notes and non-current notes payable outstanding at December 31, 2023 and 2022 do not have a readily available ascertainable market value, however, their carrying value, which is measured at carrying value less unamortized debt issuance costs or debt discounts, is considered to approximate their fair value. Concentration of Credit Risk Cash, cash equivalents and short-term investments are financial instruments that potentially subject us to concentrations of credit risk. We deposit our cash in financial institutions. At times, such deposits may be in excess of insured limits. We have not experienced any losses in such accounts and believe we are not exposed to significant risk on our cash, cash equivalents and short-term investments. Any loss incurred or a lack of access to such funds could have a significant adverse impact on our financial condition, results of operations, and cash flows. We may also invest our excess cash in money market funds, U.S. government and agencies, corporate debt securities and commercial paper. We have established guidelines relative to our diversification of our cash investments and their maturities in an effort to maintain safety and liquidity. These guidelines are periodically reviewed and modified to take advantage of trends in yields and interest rates. ZYNRELEF, APONVIE, CINVANTI and SUSTOL (collectively, our “Products”) are distributed in the U.S. through a limited number of specialty distributors and full line wholesalers (collectively, “Customers”) that resell to healthcare providers and hospitals, the end users of our Products. The following includes the percentage of net product sales and accounts receivable balances for our three major Customers, each of which comprised 10% or more of our net product sales: Net Product Accounts Year Ended As of Customer A 43.3 % 42.1 % Customer B 36.8 % 36.1 % Customer C 19.0 % 21.5 % Total 99.1 % 99.7 % Accounts Receivable, Net Accounts receivable are recorded at the invoice amount, net of an allowance for credit losses. The allowance for credit losses reflects accounts receivable balances that are believed to be uncollectible. In estimating the allowance for credit losses, we consider: (1) our historical experience with collections and write-offs; (2) the credit quality of our Customers and any recent or anticipated changes thereto; (3) the outstanding balances and past due amounts from our Customers; and (4) reasonable and supportable forecast of economic conditions expected to exist throughout the contractual term of the receivable. As of December 31, 2023 and 2022, we determined that an allowance for credit losses was not required. For the years ended December 31, 2023 and 2022, we did not have any material write-offs of accounts receivable balances. Inventory Inventory is stated at the lower of cost or estimated net realizable value on a first-in, first-out, or FIFO, basis. We periodically analyze our inventory levels and write down inventory that has become obsolete, inventory that has a cost basis in excess of its estimated realizable value and inventory quantities that are in excess of expected sales requirements as cost of product sales. The determination of whether inventory costs will be realizable requires estimates by management. If actual market conditions are less favorable than projected by management, additional write-downs of inventory may be required, which would be recorded as cost of product sales. Property and Equipment Property and equipment is stated at cost less accumulated depreciation and amortization. Depreciation is calculated on a straight-line basis over the estimated useful lives of the assets (generally 5 years ). Leasehold improvements are stated at cost and amortized on a straight-line basis over the shorter of the estimated useful life of the asset or the lease term. Impairment of Long-Lived Assets If indicators of impairment exist, we assess the recoverability of the affected long-lived assets by determining whether the carrying value of such assets can be recovered through undiscounted future operating cash flows. If impairment is indicated, we measure the amount of such impairment by comparing the carrying value of the asset to the fair value of the asset and record the impairment as a reduction in the carrying value of the related asset with a corresponding charge to operating expenses. Estimating the undiscounted future operating cash flows associated with long-lived assets requires judgment and assumptions that could differ materially from actual results. Leases We determine if an arrangement is a lease or contains lease components at inception. Operating leases with an initial term greater than 12 months are recorded as lease liabilities with corresponding right-of-use (“ROU”) lease assets on the consolidated balance sheets. ROU lease assets represent our right to use the underlying assets over the lease term, and lease liabilities represent the present value of our obligation to make lease payments arising from the lease. Lease liabilities are recognized at the lease commencement based on the present value of lease payments over the lease term. As most of our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at the commencement date in determining the present value of lease payments. We use the implicit rate when readily determinable. The ROU lease assets equal the lease liabilities, less unamortized lease incentives, unamortized initial direct costs and the cumulative difference between rent expense and amounts paid under the lease. The lease term includes any option to extend or terminate the lease when it is reasonably certain that we will exercise that option. Lease expense is recognized on a straight-line basis over the lease term. We have elected the practical expedient to not separate lease and non-lease components. Revenue Recognition Revenue is recognized in accordance with the Financial Accounting Standards Board (the “FASB”) Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers (“Topic 606”). Topic 606 is based on the principle that revenue should be recognized to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. Product Sales Our Products are distributed in the U.S. through a limited number of Customers that resell to healthcare providers and hospitals, the end users of our Products. Revenue is recognized in an amount that reflects the consideration we expect to receive in exchange for our Products. To determine revenue recognition for contracts with customers within the scope of Topic 606, we perform the following 5 steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations of the contract(s); (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract(s); and (v) recognize revenue when (or as) we satisfy the performance obligations. We recognize revenue from product sales when there is a transfer of control of the product to our Customers. We typically determine transfer of control based on when the product is delivered, and title passes to our Customers. Product Sales Allowances We recognize product sales allowances as a reduction of product sales in the same period the related revenue is recognized. Product sales allowances are based on amounts owed or to be claimed on the related sales. Such variable consideration includes estimates that take into consideration the terms of our agreements with Customers, historical product returns, rebates or discounts taken, the shelf life of the product and specific known market events, such as competitive pricing and new product introductions. If actual future results vary from our estimates, we may need to adjust these estimates, which could have an effect on product sales and earnings in the period of adjustment. Our product sales allowances include: • Product Returns—We allow our Customers to return product for credit beginning three months prior to the product expiration date and up to 12 months after the product expiration date. As such, there may be a significant period of time between the time the product is shipped and the time the credit is issued on returned product. • Distributor Fees—We pay distribution service fees to our Customers based on a contractually fixed percentage of the wholesale acquisition cost and fees for data. These fees are paid no later than two months after the quarter in which product was shipped. • Group Purchasing Organization (“GPO”) Discounts and Rebates—We offer cash discounts to GPO members. These discounts are taken when the GPO members purchase product from our Customers, who then charge back to us the discount amount. Additionally, we offer volume and contract-tier rebates to GPO members. Rebates are based on actual purchase levels during the quarterly rebate purchase period. • GPO Administrative Fees—We pay administrative fees to GPOs for services and access to data. These fees are based on contracted terms and are paid after the quarter in which the product was purchased by the GPOs’ members. • Medicaid Rebates—We participate in Medicaid rebate programs, which provide assistance to certain low-income patients based on each individual state’s guidelines regarding eligibility and services. Under the Medicaid rebate programs, we pay a rebate to each participating state, generally within six months after the quarter in which the product was sold. • Prompt Pay Discounts—We may provide discounts on product sales to our Customers for prompt payment based on contractual terms. We believe our estimated allowance for product returns and GPO discounts requires a high degree of judgment and is subject to change based on our experience and certain quantitative and qualitative factors. We believe our estimated allowances for distributor fees, GPO rebates and administrative fees, Medicaid rebates and prompt pay discounts do not require a high degree of judgment because the amounts are settled within a relatively short period of time. Our product sales allowances and related accruals are evaluated each reporting period and adjusted when trends or significant events indicate that a change in estimate is appropriate. Changes in product sales allowance estimates could materially affect our results of operations and financial position. Accrued Clinical Liabilities We accrue clinical costs based on work performed, which relies on estimates of the progress of the trials and the related expenses incurred. Clinical trial related contracts vary significantly in duration, and may be for a fixed amount, based on the achievement of certain contingent events or deliverables, a variable amount based on actual costs incurred, capped at a certain limit or contain a combination of these elements. Revisions are recorded to research and development expense in the period in which the facts that give rise to the revision become known. Historically, revisions have not resulted in material changes to research and development expense; however, a modification in the protocol of a clinical trial or cancellation of a clinical trial could result in a material charge to our results of operations. Research and Development Expense All costs of research and development are expensed in the period incurred. Research and development expense primarily consists of personnel and related costs, stock-based compensation expense, fees paid to outside service providers and consultants, facilities costs and materials used in clinical and preclinical trials and research and development. Patent Costs We incur outside legal fees in connection with filing and maintaining our various patent applications. All patent costs are expensed as incurred and are included in general and administrative expense in the consolidated statements of operations and comprehensive loss. Stock-Based Compensation Expense We estimate the fair value of each option grant using the Black-Scholes option pricing model and for market-based stock option grants using the Monte Carlo simulation model. This fair value is then amortized using the straight-line single-option method of attributing the value of stock-based compensation to expense over the requisite service periods of the awards. Forfeitures are accounted for, as incurred, as a reversal of stock-based compensation expense related to awards that will not vest. The Black-Scholes option pricing model and the Monte Carlo simulation model both require inputs of complex and subjective assumptions, including each option’s expected life and price volatility of the underlying stock. Warrants We have issued warrants to purchase shares of our common stock in conjunction with certain equity and debt financings or in exchange for services. The terms of the warrants were evaluated to determine the appropriate classification as equity or a liability. Income Taxes We recognize the impact of a tax position in our consolidated financial statements if the position is more likely than not to be sustained on examination and on the technical merits of the position. The total amount of unrecognized tax benefits, if recognized, would affect other tax accounts, primarily deferred taxes in future periods, and would not affect our effective tax rate, since we maintain a full valuation allowance against our deferred tax assets (see Note 12). We recognize interest and penalties related to income tax matters in income tax expense. Comprehensive Loss Comprehensive loss is defined as the change in equity during a period from transactions and other events and circumstances from non-owner sources. Net changes in unrealized gains and losses on available-for-sale securities are included in other comprehensive income (loss) and represent the difference between our net loss and comprehensive loss for both periods presented. Net Loss per Share Basic net loss per share is calculated by dividing the net loss by the weighted-average number of common shares outstanding for the period, including pre-funded warrants to purchase shares of common stock. Diluted net loss per share is computed by dividing the net loss by the weighted-average number of common shares and common stock equivalents outstanding for the period determined using the treasury stock method. For purposes of this calculation, stock options, restricted stock units, warrants and shares of common stock underlying convertible notes are considered to be common stock equivalents and are included in the calculation of diluted net loss per share only when their effect is dilutive. Because we have incurred a net loss for both periods presented in the consolidated statements of operations and comprehensive loss, the following common stock equivalents were not included in the computation of net loss per share because their effect would be anti-dilutive (in thousands): December 31, 2023 2022 Stock options outstanding 24,575 20,749 Restricted stock units outstanding 1,405 3,167 Warrants outstanding 298 8,548 Shares of common stock underlying convertible notes outstanding 9,819 9,819 Segment Reporting Management has determined that we operate in one business segment which is the development and commercialization of therapeutic innovations. All revenues for the years ended December 31, 2023 and 2022 were generated from customers in the U.S. Recent Accounting Pronouncements Not Yet Adopted In December 2023, FASB issued Accounting Standards Update No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”), to enhance income tax reporting disclosures and require disclosure of specific categories in the tabular rate reconciliation. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024, on a prospective basis. Early adoption and retrospective application are permitted. We are currently evaluating the impact on our disclosures.

Fair Value Measurements

Fair Value Measurements	12 Months Ended
	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	3. Fair Value Measurements Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value must maximize the use of observable inputs and minimize the use of unobservable inputs. The FASB ASC Topic 820, Fair Value Measurements & Disclosures , establishes a fair value hierarchy which prioritizes the inputs used in measuring fair value as follows: • Level 1—Observable inputs such as quoted prices in active markets for identical assets or liabilities. • Level 2—Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. • Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. We measure cash, cash equivalents and short-term investments at fair value on a recurring basis. The fair values of such assets were as follows (in thousands): Fair Value Measurements at Reporting Date Using Balance at Quoted Significant Significant Cash and money market funds $ 23,441 $ 23,441 $ — $ — U.S. treasury bills and government agency obligations 31,636 31,636 — — U.S. corporate debt securities 16,889 — 16,889 — Foreign corporate debt securities 5,460 — 5,460 — U.S. commercial paper 1,990 — 1,990 — Foreign commercial paper 993 — 993 — Total $ 80,409 $ 55,077 $ 25,332 $ — Fair Value Measurements at Reporting Date Using Balance at Quoted Significant Significant Cash and money market funds $ 13,867 $ 13,867 $ — $ — U.S. treasury bills and agency obligations 35,715 35,715 — — U.S. corporate debt securities 1,497 — 1,497 — U.S. commercial paper 5,481 — 5,481 — Foreign commercial paper 28,292 — 28,292 — Total $ 84,852 $ 49,582 $ 35,270 $ — We have no t transferred any investment securities between the three levels of the fair value hierarchy. As of December 31, 2023, cash equivalents included $ 5.3 million of available-for-sale securities with contractual maturities of three months or less and short-term investments included $ 51.7 million of available-for-sale securities with contractual maturities of three months to one year. As of December 31, 2022, cash equivalents included $ 1.5 million of available-for-sale securities with contractual maturities of three months or less and short-term investments included $ 69.5 million of available-for-sale securities with contractual maturities of three months to one year. The money market funds as of December 31, 2023 and 2022 are included in cash and cash equivalents on the consolidated balance sheets.

Balance Sheet Details

Balance Sheet Details	12 Months Ended
	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Balance Sheet Details	4. Balance Sheet Details Short-Term Investments The following is a summary of our short-term investments (in thousands): December 31, 2023 Amortized Gross Gross Estimated U.S. treasury bills and government agency obligations $ 31,625 $ 11 $ — $ 31,636 U.S. corporate debt securities 11,652 1 — 11,653 Foreign corporate debt securities 5,459 1 — 5,460 U.S. commercial paper 1,991 — ( 1 ) 1,990 Foreign commercial paper 993 — — 993 Total $ 51,720 $ 13 $ ( 1 ) $ 51,732 December 31, 2022 Amortized Gross Gross Estimated U.S. treasury bills and agency obligations $ 35,734 $ — $ ( 19 ) $ 35,715 U.S. commercial paper 5,481 — — 5,481 Foreign commercial paper 28,292 — — 28,292 Total $ 69,507 $ — $ ( 19 ) $ 69,488 The amortized cost of debt securities is adjusted for amortization of premiums and accretion of discounts to maturity. We regularly monitor and evaluate the realizable value of our marketable securities. We did no t recognize any impairment losses for the years ended December 31, 2023 and 2022. Unrealized gains and losses associated with our investments are reported in accumulated other comprehensive income (loss). For the year ended December 31, 2023, we recorded $ 32,000 in net unrealized gains associated with our short-term investments. For the year ended December 31, 2022, we recorded $ 13,000 in net unrealized losses associated with our short-term investments. Realized gains and losses associated with our investments, if any, are reported in the statements of operations and comprehensive loss. We recognized $ 1,000 in realized losses during the year ended December 31, 2023. We did no t recognize any realized gains or losses during the year ended December 31, 2022. Inventory Inventory consists of the following (in thousands): December 31, 2023 2022 Raw materials $ 17,643 $ 15,137 Work in process 14,550 20,723 Finished goods 9,917 18,713 Total inventory $ 42,110 $ 54,573 As of December 31, 2023, total inventory included $ 11.2 million related to ZYNRELEF, $ 26.4 million related to CINVANTI, $ 4.1 million related to SUSTOL and $ 0.4 million related to APONVIE. As of December 31, 2022, total inventory included $ 30.9 million related to ZYNRELEF, $ 19.9 million related to CINVANTI, $ 2.6 million related to SUSTOL and $ 1.2 million related to APONVIE. Cost of product sales for the years ended December 31, 2023 and 2022 included charges of $ 20.3 million and $ 8.9 million, respectively, resulting primarily from the write-off of ZYNRELEF inventory. Prepaid Expenses and Other Assets Prepaid expenses and other assets consist of the following (in thousands): December 31, 2023 2022 Prepaid expenses $ 11,731 $ 21,120 Prepaid insurance 1,910 1,947 Interest receivables 310 154 Deposits 274 254 Other receivables 21 6,197 Total prepaid expenses and other assets $ 14,246 $ 29,672 Property and Equipment Property and equipment, net consists of the following (in thousands): December 31, 2023 2022 Scientific equipment $ 34,027 $ 33,318 Leasehold improvements 647 647 Computer equipment and software 1,506 1,506 Furniture, fixtures and office equipment 1,014 982 Property and equipment, gross 37,194 36,453 Less: accumulated depreciation and amortization ( 17,028 ) ( 14,293 ) Property and equipment, net $ 20,166 $ 22,160 Depreciation and amortization expense for the years ended December 31, 2023 and 2022 was $ 2.9 million for both periods. As of December 31, 2023 and 2022, $ 6.3 million and $ 5.4 million of property and equipment, respectively, was in process and not depreciated during the respective years. Accrued Payroll and Employee Liabilities and Other Accrued Liabilities Accrued payroll and employee liabilities consist of the following (in thousands): December 31, 2023 2022 Accrued employee salaries and benefits $ 1,371 $ 2,134 Accrued bonuses 5,499 7,783 Accrued vacation 2,354 3,499 Total accrued payroll and employee liabilities $ 9,224 $ 13,416 Other accrued liabilities consist of the following (in thousands): December 31, 2023 2022 Accrued product sales allowances $ 36,529 $ 33,317 Accrued consulting and professional fees 3,940 4,236 Accrued accounts payable 559 363 Accrued interest 412 94 Other accrued liabilities 415 542 Total other accrued liabilities $ 41,855 $ 38,552

Revenue Recognition

Revenue Recognition	12 Months Ended
	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Revenue Recognition	5. Revenue Recognition The following provides disaggregated net product sales (in thousands): For the Years Ended December 31, 2023 2022 CINVANTI net product sales $ 94,869 $ 87,245 SUSTOL net product sales 13,057 10,231 ZYNRELEF net product sales 17,727 10,196 APONVIE net product sales 1,391 — Total net product sales $ 127,044 $ 107,672 The following provides a summary of activity with respect to our product returns, distributor fees and discounts, rebates, administrative and other fees, which are included in other accrued liabilities on the consolidated balance sheets (in thousands): Discounts, Rebates, Product Distributor Administrative and Returns Fees Other Fees Total Balance at December 31, 2022 $ 3,336 $ 4,180 $ 25,801 $ 33,317 Provision 2,638 23,722 169,651 196,011 Payments/credits ( 1,198 ) ( 23,483 ) ( 168,118 ) ( 192,799 ) Balance at December 31, 2023 $ 4,776 $ 4,419 $ 27,334 $ 36,529

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	6. Commitments and Contingencies Leases As of December 31, 2023, we had an operating lease for 52,148 square feet of laboratory and office space in San Diego, California, with a lease term that expires on December 31, 2025 . In October 2021, we entered into a sublease agreement to sublet 23,873 square feet of laboratory and office space. The space was delivered to the subtenant in March 2022. As a result of the sublease agreement, our one 5 -year option to renew the lease on expiration applies only with respect to our remaining 28,275 square feet of laboratory and office space. In September 2023, we also entered into a sublease agreement to sublet 5,840 square feet of office space in Cary, North Carolina, with a lease term that expires on April 30, 2025 . Annual future minimum lease payments as of December 31, 2023 are as follows (in thousands): Year ended December 31: 2024 $ 3,153 2025 3,138 2026 — 2027 — 2028 — Thereafter — Total future minimum lease payments 6,291 Less: discount ( 416 ) Total lease liabilities $ 5,875 Rent expense under all operating leases totaled $ 2.9 million and $ 2.8 million for the years ended December 31, 2023 and 2022, respectively. During the years ended December 31, 2023 and 2022, we paid $ 3.0 million and $ 2.9 million, respectively, for our operating leases. Development Agreements We enter into agreements with clinical sites and clinical research organizations for the conduct of our clinical trials and contract manufacturing organizations for the manufacture and supply of preclinical, clinical and commercial materials and drug product. We make payments to these clinical sites and clinical research organizations based in part on the number of eligible patients enrolled and the length of their participation in the clinical trials. In some of our agreements with contract manufacturing organizations, we are required to meet minimum purchase obligations. Under certain of these agreements, we may be subject to penalties in the event that we prematurely terminate these agreements. At this time, due to the variability associated with clinical site agreements, contract research organization agreements and contract manufacturing agreements, we are unable to estimate with certainty the future costs we will incur. We intend to use our current financial resources to fund our obligations under these commitments. Purchase Obligations At December 31, 2023, purchase obligations primarily consisted of non-cancellable commitments with third-party manufacturers in connection with the manufacturing of our commercial products. Total purchase obligations of $ 60.2 million were not included in our consolidated financial statements for the year ended December 31, 2023, with $ 39.0 million due in one year and $ 21.2 million due within two to three years .

Reorganization

Reorganization	12 Months Ended
	Dec. 31, 2023
Reorganizations [Abstract]
Reorganization	7. Reorganization June 2023 Reorganization In June 2023, we implemented a restructuring plan under which we provided or will provide employees with one-time severance payments upon termination, continuation of benefits for a specific period of time, outplacement services and certain stock award modifications. The total amount expected to be incurred for these activities is $ 4.2 million, which primarily consists of severance payments to terminated employees. During the year ended December 31, 2023, we recognized $ 4.2 million of the total expense, $ 2.4 million of which was included in sales and marketing expense, $ 1.7 million of which was included in research and development expense and $ 0.1 million of which was included in general and administrative expense. As of December 31, 2023, we have paid $ 3.7 million of the total cash severance charges. We anticipate that the cash payments due to terminated employees will be substantially complete in the first quarter of 2024. Executive Officer Departures During the second and third quarters of 2023, we also implemented changes to our executive leadership structure. In connection with these changes, we provided five executive officers with one-time severance payments upon termination, continued benefits for a specified period of time, and certain stock award modifications. The total expense for these activities was $ 13.4 million, $ 4.7 million of which was primarily for severance and $ 8.7 million of which was for non-cash, stock-based compensation expense. During the year ended December 31, 2023, we recognized $ 13.4 million of the total expense, $ 7.2 million of which was included in general and administrative expense, $ 3.9 million of which was included in sales and marketing expense, and $ 2.3 million of which was included in research and development expense. As of December 31, 2023, we have paid substantially all of the cash severance charges. June 2022 Reorganization In June 2022, we implemented a restructuring plan under which we provided employees one-time severance payments upon termination, continuation of benefits for a specific period of time, outplacement services and certain stock award modifications. The total amount incurred for these activities was $ 5.4 million, $ 5.0 million of which was primarily for severance and $ 0.4 million of which was for non-cash, stock-based compensation expense related to stock award modifications. For the year ended December 31, 2022, we recognized $ 5.4 million of the total expense, $ 4.2 million of which was included in research and development expense, $ 1.0 million of which was included in sales and marketing expense, and $ 0.2 million of which was included in general and administrative expense. As of December 31, 2023, we have paid all of the total cash severance charges. We have accounted for these expenses in accordance with the FASB ASC Topic 420, Exit or Disposal Cost Obligations .

Convertible Notes

Convertible Notes	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Convertible Notes	8. Convertible Notes Working Capital Facility Agreement On August 9, 2023, we entered into a working capital facility agreement (the “Loan Agreement”) with Hercules Capital, Inc., as administrative agent and collateral agent, and the lenders party thereto (the “Lenders”). The Loan Agreement provides an aggregate principal amount of up to $ 50.0 million with tranched availability as follows: $ 25.0 million at closing (“tranche 1A”), $ 5.0 million available through December 15, 2024 (“tranche 1B”), and $ 20.0 million available from the earlier of: (1) the full draw of tranche 1B and (2) the expiration of tranche 1B, and available through December 15, 2025 (“tranche 1C”), and in the case of tranches 1B and 1C, subject to certain customary conditions to draw down. The Loan Agreement has a term of four years , with a springing maturity date that is 91 days prior to the stated maturity of our existing senior unsecured convertible notes (if still outstanding at such time). The loans thereunder do not have any scheduled amortization payments and accrue interest at a floating rate equal to, as of closing, 9.95 % per annum, payable in cash on a monthly basis and upon maturity or payoff. In addition, under the terms of the Loan Agreement, the loans also accrue paid-in-kind interest monthly at a fixed-rate of 1.5 % per annum which is due upon maturity or payoff. In addition, in connection with the tranche 1A funding, we issued warrants to the Lenders to purchase up to 297,619 shares of our common stock at an exercise price of $ 1.68 per share. The warrants are equal to 2.00 % of the principal amount of loans funded by the Lenders (the “Warrant Coverage”). The Loan Agreement also requires that we issue additional warrants to the Lenders at the time of each draw down of tranches 1B and 1C with the same Warrant Coverage. Each warrant is exercisable for seven years from the date of issuance. The Loan Agreement contains a minimum cash covenant, beginning on the closing date, requiring us to hold cash of no less than $ 8.5 million, if our market capitalization is less than $ 400 million. The Loan Agreement also contains customary representations and warranties and customary affirmative and negative covenants, including, among other things, restrictions on indebtedness, liens, investments, mergers, dispositions, prepayment of other indebtedness, and dividends and other distributions, subject to certain exceptions. We were in compliance with all covenants of the Loan Agreement as of December 31, 2023. The Loan Agreement was accounted for in accordance with ASC Topic 470, Debt , ASC Topic 480, Distinguishing Liabilities from Equity and ASC Topic 815, Derivatives and Hedging . The initial tranche 1A funding of $ 25.0 million and the warrants issued upon closing to purchase 297,619 shares of our common stock are accounted for as freestanding debt and equity financial instruments, respectively, as they are legally detachable and separately exercisable. The additional borrowings available under the Loan Agreement plus the additional warrants to purchase shares of our common stock, which would be issued concurrently, are accounted for as a single freestanding financial instrument that are not assets or obligations of ours; this financial instrument meets the loan commitment derivative scope exception and will be accounted for when and if we borrow additional tranches in the future. The initial funding of $ 25.0 million was recorded as a liability on the condensed consolidated balance sheets. In connection with the Loan Agreement, we recognized the initial 297,619 issued warrants at their relative fair value of $ 0.4 million, and we incurred debt issuance costs of $ 0.6 million, both of which were recorded as debt discounts. The debt discounts and the end of term fee, of $ 0.8 million, are being amortized and accreted into interest expense using the effective interest rate method over the term of the Loan Agreement, resulting in an effective interest rate of 14.5 %. For the year ended December 31, 2023, interest expense related to the Loan Agreement was $ 1.3 million, which included $ 1.0 million related to the stated interest rate, $ 0.2 million related to paid-in-kind interest, and $ 0.1 million related to the amortization of the debt discounts. As of December 31, 2023, the carrying value of tranche 1A was $ 24.3 million, which is comprised of the $ 25.2 million principal amount outstanding, less debt discounts of $ 0.9 million. Senior Unsecured Convertible Notes In May 2021, we entered into a note purchase agreement with funds affiliated with Baker Bros. Advisors LP for a private placement of $ 150.0 million in Senior Unsecured Convertible Notes (“Notes”). We received a total of $ 149.0 million, net of issuance costs, from the issuance of these Notes. The Notes were issued at par. The Notes bear interest at a rate of 1.5 % per annum, payable in cash semi-annually in arrears on June 15 th and December 15 th of each year, beginning on December 15, 2021 . The Notes mature on May 26, 2026 , unless earlier converted, redeemed or repurchased. The Notes will be subject to redemption at our option, between May 24, 2024 and May 24, 2025, but only if the last reported sale price per share of our common stock exceeds 250 % of the conversion price for a specified period of time, or on or after May 24, 2025 if the last reported sale price per share of our common stock exceeds 200 % of the conversion price for a specified period of time. The redemption price will be equal to the principal amount of the Notes to be redeemed, plus accrued and unpaid interest. Upon conversion, we will settle the Notes in shares of our common stock. The initial conversion rate for the Notes is 65.4620 shares per $ 1,000 principal amount of the Notes (equivalent to an initial conversion price of $ 15.276 per share of common stock). If a holder of the Notes converts upon a make-whole fundamental change or company redemption, the holder may be eligible to receive a make-whole premium through an increase to the conversion rate. In May 2021, we filed a registration statement with the SEC to register for resale 12.4 million shares of our common stock underlying the Notes, including the maximum number of shares of common stock issuable under the make-whole premium. The Notes were accounted for in accordance with ASC Subtopic 470-20, Debt with Conversion and Other Options (“ASC 470-20”) and ASC Subtopic 815-40, Contracts in Entity’s Own Equity (“ASC 815-40”). Under ASC 815-40, to qualify for equity classification (or non-bifurcation, if embedded), the instrument (or embedded feature) must be both (1) indexed to the issuer’s stock and (2) meet the requirements of the equity classification guidance. Based upon our analysis, it was determined that the Notes do contain embedded features indexed to our own stock, but do not meet the requirements for bifurcation, and therefore do not need to be separately accounted for as an equity component. Since the embedded conversion feature meets the equity scope exception from derivative accounting, and, also since the embedded conversion option does not need to be separately accounted for as an equity component under ASC 470-20, the proceeds received from the issuance of the Notes were recorded as a liability on the consolidated balance sheets. We incurred issuance costs related to the Notes of $ 1.0 million, which we recorded as debt issuance costs and are included as a reduction to the Notes on the consolidated balance sheets. The debt issuance costs are being amortized to interest expense using the effective interest rate method over the term of the Notes, resulting in an effective interest rate of 1.6 %. For the year ended December 31, 2023, interest expense related to the Notes was $ 2.5 million, which included $ 2.3 million related to the stated interest rate and $ 0.2 million related to the amortization of debt issuance costs. As of December 31, 2023, the carrying value of the Notes was $ 149.5 million, which is comprised of the $ 150.0 million principal amount of the Notes outstanding, less debt issuance costs of $ 0.5 million.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Stockholders' Equity	9. Stockholders’ Equity 2023 Private Placement On July 21, 2023, we entered into a Securities Purchase Agreement (the “July 2023 Private Placement”) with Rubric Capital Management L.P., Velan Capital, Clearline Capital and Hercules Capital, Inc. (collectively, the “Purchasers”) whereby we sold 20.7 million shares of our common stock in a private placement at a purchase price of $ 1.37 per share. In addition, as a component of the July 2023 Private Placement, we sold 1.2 million pre-funded warrants to purchase shares of our common stock at a purchase price of $ 1.3699 per share. The pre-funded warrants have an exercise price of $ 0.0001 per share. The total net proceeds from the sale of the common stock and pre-funded warrants is $ 29.8 million (net of $ 0.2 million in issuance costs). The July 2023 Private Placement closed on July 25, 2023. In August 2023, we filed a registration statement with the SEC to register for resale 21.9 million shares of our common stock. The registration statement was declared effective on August 31, 2023. 2022 Private Placement On August 8, 2022, we entered into an agreement to sell 16.1 million shares of our common stock in a private placement at a purchase price of $ 3.10 per share (“2022 Private Placement”). In addition, as a component of the 2022 Private Placement, we agreed to sell 8.5 million pre-funded warrants to purchase shares of our common stock at a purchase price of $ 3.0999 per share. The pre-funded warrants have an exercise price of $ 0.0001 per share. The total net proceeds from the sale of the common stock and pre-funded warrants was $ 75.1 million (net of $ 1.4 million in issuance costs). The 2022 Private Placement closed on August 10, 2022. In October 2022, we filed a registration statement with the SEC to register for resale 24.6 million shares of our common stock. The registration statement was declared effective on October 18, 2022. Common Stock Reserved for Future Issuance Shares of our common stock reserved for future issuance as of December 31, 2023 were as follows (in thousands): Number of Shares Stock options outstanding 24,575 Restricted stock units outstanding 1,405 Stock options available for grant 8,605 Shares of common stock reserved under the Employee Stock Purchase Plan 328 Shares of common stock underlying warrants 1,461 Shares of common stock underlying convertible notes outstanding (see Note 8) 9,819 Total shares reserved for future issuance 46,193

Equity Incentive Plans

Equity Incentive Plans	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Equity Incentive Plans	10. Equity Incentive Plans Employee Stock Purchase Plan In 1997, our stockholders approved our Employee Stock Purchase Plan (“ESPP”) at which time a maximum of 10,000 shares of common stock were available for issuance. In December 2007, May 2009, June 2011, May 2014, May 2015, June 2016, June 2017, June 2019, June 2021, May 2022 and June 2023, our stockholders authorized increases in the number of shares reserved for issuance under the ESPP by 5,000 , 10,000 , 25,000 , 25,000 , 100,000 , 100,000 , 200,000 , 300,000 , 200,000, 850,000 and 400,000 shares, respectively, for a total of 2,225,000 shares reserved at December 31, 2023. Under the terms of the ESPP, employees can elect to have up to a maximum of 10 % of their base earnings withheld to purchase shares of our common stock. The purchase price of the stock is 85 % of the lower of the closing prices for our common stock on either: (i) the first trading day in the enrollment period, as defined in the ESPP, in which the purchase is made, or (ii) the purchase date. The length of the enrollment period is 6 months. Enrollment dates are the first business day of May and November. Under the ESPP, we issued 717,046 and 406,421 shares in 2023 and 2022, respectively. The weighted-average exercise price per share of the purchase rights exercised during 2023 and 2022 was $ 1.26 and $ 3.55 , respectively. As of December 31, 2023, 1,897,445 shares of common stock have been issued under the ESPP and 327,555 shares of common stock are available for future issuance. Stock Option Plans We currently have one stock option plan from which we can grant options and restricted stock awards to employees, officers, directors and consultants. In December 2007, the stockholders approved our 2007 Amended and Restated Equity Incentive Plan (“2007 Plan”) at which time a maximum of 150,000 shares of common stock were available for grant. In May 2010, June 2011, May 2014, May 2015, June 2016, June 2017, June 2019, June 2021, May 2022 and June 2023, our stockholders approved amendments to our 2007 Plan to increase the maximum number of shares of common stock available for grant by 100,000 , 4,500,000 , 1,750,000 , 4,300,000 , 3,000,000 , 5,000,000 , 7,000,000 , 2,000,000, 2,900,000 and 8,490,000 shares of common stock, respectively, resulting in an aggregate of 39,190,000 shares of common stock authorized for issuance as of December 31, 2023. At December 31, 2023, there were 8,605,026 shares available for future grant under the 2007 Plan. Any shares that are issuable on exercise of options granted that expire, are cancelled or that we receive pursuant to a net exercise of options are available for future grant and issuance. In 2023, we granted options to certain employees outside of our stockholder approved stock option plan. All options to purchase our common stock were granted with an exercise price that equals fair market value of the underlying common stock on the grant dates and expire no later than 10 years from the date of grant. The options are exercisable in accordance with vesting schedules that generally provide for them to be fully vested and exercisable 4 years after the date of grant, provided, however, that we have also issued stock options awards that are subject to market-based vesting requirements. All stock option grants issued outside of our stockholder approved plans were approved by our Board of Directors and have been registered on Form S-8 with the SEC. In 2020, we began granting restricted stock units (“RSUs”) to employees and non-employee directors pursuant to the 2007 Plan. We satisfy such grants through the issuance of new shares upon vesting. The following summarizes the stock option plan activity: Outstanding Options Weighted- Average Number of Exercise Shares Price Balance at December 31, 2022 20,749,349 $ 14.61 Granted 16,210,379 $ 1.69 Exercised ( 26,570 ) $ 1.32 Cancelled ( 12,358,296 ) $ 12.72 Balance at December 31, 2023 24,574,862 $ 7.06 Outstanding RSUs Weighted- Average Number of Grant Date Shares Fair Value Balance at December 31, 2022 3,167,397 $ 6.46 Granted 1,757,506 $ 2.39 Released ( 1,627,619 ) $ 6.34 Forfeited ( 1,892,355 ) $ 4.27 Balance at December 31, 2023 1,404,929 $ 4.43 For the year ended December 31, 2023, options cancelled (included in options outstanding) consisted of 11,508,070 options forfeited with a weighted-average exercise price of $ 13.10 and 850,226 options expired with a weighted-average exercise price of $ 7.47 . As of December 31, 2023, options exercisable have a weighted-average remaining contractual term of 5.6 years. The total intrinsic value of stock option exercises, which is the difference between the exercise price and closing price of our common stock on the date of exercise, during the year ended December 31, 2023 was $ 10,000 . There were no option exercises during the year ended December 31, 2022. As of December 31, 2023, the total intrinsic value of options outstanding and exercisable was $ 137,000 . As of December 31, 2022, there were no options outstanding and exercisable that were in-the-money. Years Ended December 31, 2023 2022 Weighted- Weighted- Average Average Exercise Exercise Options Price Options Price Exercisable at end of year 11,390,275 $ 12.87 13,650,210 $ 17.86 Options vested or expected to 24,574,862 $ 7.06 20,183,769 $ 14.82 Exercise prices and weighted-average remaining contractual lives for the options outstanding as of December 31, 2023 were: Weighted- Weighted- Average Average Weighted- Exercise Remaining Average Price of Outstanding Range of Contractual Exercise Options Options Options Exercise Prices Life (in years) Price Exercisable Exercisable 6,179,628 $ 0.97 –$ 1.51 9.51 $ 1.25 344,006 $ 1.30 7,660,800 $ 1.52 –$ 2.28 9.28 1.77 2,001,281 1.78 3,406,724 $ 2.32 –$ 3.48 7.68 2.99 2,182,510 3.05 83,323 $ 3.61 –$ 5.42 8.61 4.08 34,239 4.09 21,459 $ 5.50 –$ 8.25 7.65 5.84 10,059 5.81 1,100,494 $ 8.80 –$ 13.20 3.57 11.18 996,018 11.20 3,116,010 $ 13.50 –$ 20.25 4.13 16.10 2,817,050 16.16 2,828,424 $ 20.93 –$ 31.40 4.26 25.72 2,827,112 25.72 178,000 $ 31.45 –$ 41.18 3.17 35.45 178,000 35.45 24,574,862 7.58 7.06 11,390,275 12.87 On December 31, 2023, we had reserved 25,979,791 shares of common stock for future issuance on exercise of outstanding options and vesting of outstanding restricted stock units granted under the 2007 Plan, as well as the non-plan grants. Stock-Based Compensation The following summarizes stock-based compensation expense related to stock-based payment awards pursuant to our equity compensation arrangements (in thousands): December 31, 2023 2022 Research and development $ 10,880 $ 17,909 General and administrative 12,471 11,688 Sales and marketing 9,503 13,383 Total stock-based compensation expense $ 32,854 $ 42,980 As of December 31, 2023, there was $ 23.2 million of total unrecognized compensation cost related to non-vested, stock-based payment awards granted under all of our equity compensation plans and all non-plan option grants. Total unrecognized compensation cost will be adjusted for future changes in estimated forfeitures. We expect to recognize this compensation cost over a weighted-average period of three years . The fair value of RSUs is estimated based on the closing market price of our common stock on the date of the grant. RSUs generally vest quarterly over a four-year period. We estimated the fair value of each option grant and ESPP purchase right on the date of grant using the Black-Scholes option pricing model with the following weighted-average assumptions: Options: December 31, 2023 2022 Risk-free interest rate 3.7 % 3.3 % Dividend yield — % — % Volatility 68.1 % 62.0 % Expected life (years) 6 to 10 6 ESPP: December 31, 2023 2022 Risk-free interest rate 5.3 % 3.2 % Dividend yield — % — % Volatility 99.6 % 83.8 % Expected life (months) 6 6 The weighted-average fair value of options granted was $ 1.13 and $ 1.71 for the years ended December 31, 2023 and 2022, respectively. The weighted-average fair value of shares purchased through the ESPP was $ 0.64 and $ 1.65 for the years ended December 31, 2023 and 2022, respectively. The risk-free interest rate assumption is based on observed interest rates on U.S. Treasury debt securities with maturities close to the expected term of our employee and director stock options and ESPP purchases. The dividend yield assumption is based on our history and expectation of dividend payouts. We have never paid dividends on our common stock, and we do not anticipate paying dividends in the foreseeable future. We used our historical stock price to estimate volatility. The expected life of employee and director stock options represents the average of the contractual term of the options and the weighted-average vesting period, as permitted under the simplified method. We have elected to use the simplified method, as we do not have enough historical exercise experience to provide a reasonable basis on which to estimate the expected term. The expected life for the ESPP purchase rights is 6 months, which represents the length of each purchase period.

Employee Benefit Plan

Employee Benefit Plan	12 Months Ended
	Dec. 31, 2023
Retirement Benefits [Abstract]
Employee Benefit Plan	11. Employee Benefit Plan We have a defined contribution 401(k) plan (“Plan”) covering substantially all of our employees. We make matching cash contributions equal to 50 % of each participant’s contribution during the Plan year up to a maximum amount equal to the lesser of 3 % of each participant’s annual compensation or $ 9,900 and $ 9,150 for the years ended December 31, 2023 and 2022, respectively. Such amounts were recorded as expense in the corresponding years. We may also contribute additional discretionary amounts to the Plan as we determine. For the years ended December 31, 2023 and 2022, we contributed $ 1.0 million and $ 1.4 million, respectively, to the Plan. No discretionary contributions have been made to the Plan since its inception.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	12. Income Taxes For the years ended December 31, 2023 and 2022, we did not record a provision for income taxes due to a full valuation allowance against our deferred tax assets. The difference between the provision for income taxes and income taxes computed using the effective U.S. federal statutory rate is as follows (in thousands): December 31, 2023 2022 Tax at statutory federal rate $ ( 23,210 ) $ ( 38,225 ) State tax, net of federal benefit ( 1,460 ) ( 13,898 ) Research and development credits — ( 3,531 ) Stock-based compensation expense 19,022 5,857 Non-deductible compensation ( 4,682 ) 2,104 Employee retention credit adjustment — ( 1,265 ) Change in valuation allowance 7,556 46,452 Provision to return adjustment 3,008 — Other ( 234 ) 2,506 Provision for income taxes $ — $ — Deferred income tax assets and liabilities arising from differences between accounting for financial statement purposes and tax purposes, less valuation allowance at year-end are as follows (in thousands): December 31, 2023 2022 Deferred tax assets: Net operating loss carryforward $ 320,998 $ 313,834 Research and development credits 59,417 60,245 Section 174 capitalized research and development 28,822 20,903 Stock-based compensation 15,413 23,991 Lease liabilities 1,471 2,052 Other 5,005 3,693 Total gross deferred tax assets 431,126 424,718 Deferred tax liabilities: Right-of-use lease assets ( 1,362 ) ( 1,914 ) Total gross deferred tax liabilities ( 1,362 ) ( 1,914 ) Valuation allowance ( 429,764 ) ( 422,804 ) Net deferred tax assets $ — $ — We have established a valuation allowance to offset net deferred tax assets as of December 31, 2023 and 2022 due to the uncertainty of realizing future tax benefits from such assets. As of December 31, 2023, we had federal and state net operating loss (“NOL”) carryforwards of $ 1.3 billion and $ 879.1 million, respectively. The federal NOL carryforwards consist of $ 542.3 million generated before January 1, 2018, which will begin to expire in 2024 , and $ 755.7 million that can be carried forward indefinitely, but are subject to the 80 % taxable income limitation. The state NOL carryforwards will begin to expire in 2028 . As of December 31, 2023, we had federal and state research and development credit carryforwards of $ 44.6 million and $ 21.7 million, respectively. The federal research and development credit carryforwards will begin to expire in 2024 . The state research and development credit carryforwards will be carried forward indefinitely. Internal Revenue Code (“IRC”) Sections 382 and 383 place a limitation on the amount of taxable income that can be offset by NOL and credit carryforwards after a change in control (generally greater than 50% change in ownership within a three-year period) of a loss corporation. Generally, after a change in control, a loss corporation cannot deduct NOL and credit carryforwards in excess of the IRC Sections 382 and 383 limitation. State jurisdictions have similar rules. We have performed an analysis of IRC Sections 382 and 383 through July 31, 2023 and determined there were ownership changes in 2007, 2011 and 2013. The limitation in the federal and state NOL and research and development credit carryforwards that expire unused would reduce the deferred tax assets, which are fully offset by a valuation allowance. We file U.S. and state income tax returns with varying statutes of limitations. The tax years from 2003 to 2023 remain open to examination due to the carryover of unused NOL carryforwards and tax credits. A reconciliation of our unrecognized tax benefits is as follows (in thousands): Year Ended December 31, 2023 2022 Balance at beginning of year $ 11,235 $ 9,631 Decrease for tax positions of prior years ( 332 ) ( 200 ) Increase based on tax positions related to current year — 1,804 Balance at end of year $ 10,903 $ 11,235 Due to our valuation allowance, the $ 10.9 million of unrecognized tax benefits would not affect the effective tax rate, if recognized. It is the Company’s practice to recognize interest and penalties related to income tax matters in income tax expense. As of December 31, 2023, we had no accrued interest and penalties related to uncertain tax positions. We do not expect any material changes to the estimated amount of liability associated with our uncertain tax positions within the next 12 months. On March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act (“CARES Act”) was enacted and signed into law in response to the COVID-19 pandemic. The CARES Act includes changes to the tax provisions that benefits business such as the Employee Retention Credit (“ERC”). The ERC provides an eligible employer with a tax credit that is allowed against certain employment taxes. We qualified for federal government assistance through the ERC provisions for the period between January 1, 2021 and September 30, 2021. We recognize government grants when there is reasonable assurance of compliance with grant conditions and receipt of the credits. For the year ended December 31, 2022, we recorded a one-time refund totaling $ 6.0 million, which was included in the consolidated balance sheets as prepaid expenses and other current assets, as well as in the consolidated statements of operations and comprehensive loss as an offset to the related employee expenses within research and development, general and administrative, and sales and marketing expenses. The one-time $ 6.0 million refund was received in the second quarter of 2023. Beginning January 1, 2022, the Tax Cuts and Jobs Act (the “Tax Act”) eliminated the option to deduct research and development expenditures in the current year and requires taxpayers to capitalize such expenses pursuant to IRC Section 174. The capitalized expenses are amortized over a 5-year period for domestic expenses and over a 15-year period for foreign expenses. As a result of this provision of the Tax Act, deferred tax assets related to capitalized research expenses increased by $ 21 million during the year ended December 31, 2022.

Subsequent Event

Subsequent Event	12 Months Ended
	Dec. 31, 2023
Subsequent Events [Abstract]
Subsequent Event	13. Subsequent Event In January 2024, we entered into a five-year distributor partnership with CrossLink Life Sciences, LLC (“Crosslink ” ) to expand the sales network supporting ZYNRELEF. Crosslink will be the lead partner in the U.S. to expand ZYNRELEF promotion for orthopedic indications. The partnership will launch in several phases, initially at a regional level, followed by an expanded national rollout. In total, approximately 650 representatives will be added to Heron ’ s sales network over the year. At this time, we cannot estimate the impact of the Crosslink agreement on our future financial results.

Summary of Significant Account

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation The accompanying consolidated financial statements include the accounts of Heron Therapeutics, Inc. and its wholly-owned subsidiary, Heron Therapeutics B.V., which was organized in the Netherlands in March 2015. Heron Therapeutics B.V. has no operations and no material assets or liabilities, and there have been no significant transactions related to Heron Therapeutics B.V. since its inception.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with generally accepted accounting principles in the U.S. (“GAAP”) requires management to make estimates and assumptions that affect the amounts reported in the financial statements and disclosures made in the accompanying notes to the financial statements. Our significant accounting policies that involve significant judgment and estimates include revenue recognition, investments, inventory and the related reserves, accrued clinical and manufacturing liabilities, income taxes and stock-based compensation. Actual results could differ materially from those estimates.
Cash, Cash Equivalents and Short-term Investments	Cash, Cash Equivalents and Short-term Investments Cash and cash equivalents consist of cash and highly liquid investments with contractual maturities of three months or less from the original purchase date. Short-term investments consist of securities with contractual maturities of greater than three months from the original purchase date. Securities with contractual maturities greater than one year are classified as short-term investments on the consolidated balance sheets, as we have the ability, if necessary, to liquidate these securities to meet our liquidity needs in the next 12 months. We have classified our short-term investments as available-for-sale securities in the accompanying consolidated financial statements. Available-for-sale securities are stated at fair market value, with net changes in unrealized gains and losses reported in other comprehensive loss and realized gains and losses included in other income (expense), net. The cost of securities sold is based on the specific identification method. Interest and dividends on securities classified as available-for-sale are included in interest income within other income (expense), net. Our bank and investment accounts have been placed under a control agreement in accordance with our working capital line of credit (see Note 8).
Fair Value of Financial Instruments	Fair Value of Financial Instruments A company may elect to use fair value to measure accounts receivable, available-for-sale securities, accounts payable, guarantees and issued debt, among others. If the use of fair value is elected, any upfront costs and fees related to the item such as debt issuance costs must be recognized in earnings and cannot be deferred. The fair value election is irrevocable and generally made on an instrument-by-instrument basis, even if a company has similar instruments that it elects not to measure based on fair value. Unrealized gains and losses on existing items for which fair value has been elected are reported as a cumulative adjustment to beginning retained earnings and any changes in fair value are recognized in earnings. We have elected to not apply the fair value option to our financial assets and liabilities. Financial instruments, including cash and cash equivalents, receivables, inventory, prepaid expenses, other current assets, accounts payable and accrued expenses, are carried at cost, which is considered to be representative of their respective fair values because of the short-term maturity of these instruments. Short-term available-for-sale investments are carried at fair value. Our convertible notes and non-current notes payable outstanding at December 31, 2023 and 2022 do not have a readily available ascertainable market value, however, their carrying value, which is measured at carrying value less unamortized debt issuance costs or debt discounts, is considered to approximate their fair value.
Concentration of Credit Risk	Concentration of Credit Risk Cash, cash equivalents and short-term investments are financial instruments that potentially subject us to concentrations of credit risk. We deposit our cash in financial institutions. At times, such deposits may be in excess of insured limits. We have not experienced any losses in such accounts and believe we are not exposed to significant risk on our cash, cash equivalents and short-term investments. Any loss incurred or a lack of access to such funds could have a significant adverse impact on our financial condition, results of operations, and cash flows. We may also invest our excess cash in money market funds, U.S. government and agencies, corporate debt securities and commercial paper. We have established guidelines relative to our diversification of our cash investments and their maturities in an effort to maintain safety and liquidity. These guidelines are periodically reviewed and modified to take advantage of trends in yields and interest rates. ZYNRELEF, APONVIE, CINVANTI and SUSTOL (collectively, our “Products”) are distributed in the U.S. through a limited number of specialty distributors and full line wholesalers (collectively, “Customers”) that resell to healthcare providers and hospitals, the end users of our Products. The following includes the percentage of net product sales and accounts receivable balances for our three major Customers, each of which comprised 10% or more of our net product sales: Net Product Accounts Year Ended As of Customer A 43.3 % 42.1 % Customer B 36.8 % 36.1 % Customer C 19.0 % 21.5 % Total 99.1 % 99.7 %
Accounts Receivable, Net	Accounts Receivable, Net Accounts receivable are recorded at the invoice amount, net of an allowance for credit losses. The allowance for credit losses reflects accounts receivable balances that are believed to be uncollectible. In estimating the allowance for credit losses, we consider: (1) our historical experience with collections and write-offs; (2) the credit quality of our Customers and any recent or anticipated changes thereto; (3) the outstanding balances and past due amounts from our Customers; and (4) reasonable and supportable forecast of economic conditions expected to exist throughout the contractual term of the receivable. As of December 31, 2023 and 2022, we determined that an allowance for credit losses was not required. For the years ended December 31, 2023 and 2022, we did not have any material write-offs of accounts receivable balances.
Inventory	Inventory Inventory is stated at the lower of cost or estimated net realizable value on a first-in, first-out, or FIFO, basis. We periodically analyze our inventory levels and write down inventory that has become obsolete, inventory that has a cost basis in excess of its estimated realizable value and inventory quantities that are in excess of expected sales requirements as cost of product sales. The determination of whether inventory costs will be realizable requires estimates by management. If actual market conditions are less favorable than projected by management, additional write-downs of inventory may be required, which would be recorded as cost of product sales.
Property and Equipment	Property and Equipment Property and equipment is stated at cost less accumulated depreciation and amortization. Depreciation is calculated on a straight-line basis over the estimated useful lives of the assets (generally 5 years ). Leasehold improvements are stated at cost and amortized on a straight-line basis over the shorter of the estimated useful life of the asset or the lease term.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets If indicators of impairment exist, we assess the recoverability of the affected long-lived assets by determining whether the carrying value of such assets can be recovered through undiscounted future operating cash flows. If impairment is indicated, we measure the amount of such impairment by comparing the carrying value of the asset to the fair value of the asset and record the impairment as a reduction in the carrying value of the related asset with a corresponding charge to operating expenses. Estimating the undiscounted future operating cash flows associated with long-lived assets requires judgment and assumptions that could differ materially from actual results.
Leases	Leases We determine if an arrangement is a lease or contains lease components at inception. Operating leases with an initial term greater than 12 months are recorded as lease liabilities with corresponding right-of-use (“ROU”) lease assets on the consolidated balance sheets. ROU lease assets represent our right to use the underlying assets over the lease term, and lease liabilities represent the present value of our obligation to make lease payments arising from the lease. Lease liabilities are recognized at the lease commencement based on the present value of lease payments over the lease term. As most of our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at the commencement date in determining the present value of lease payments. We use the implicit rate when readily determinable. The ROU lease assets equal the lease liabilities, less unamortized lease incentives, unamortized initial direct costs and the cumulative difference between rent expense and amounts paid under the lease. The lease term includes any option to extend or terminate the lease when it is reasonably certain that we will exercise that option. Lease expense is recognized on a straight-line basis over the lease term. We have elected the practical expedient to not separate lease and non-lease components.
Revenue Recognition	Revenue Recognition Revenue is recognized in accordance with the Financial Accounting Standards Board (the “FASB”) Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers (“Topic 606”). Topic 606 is based on the principle that revenue should be recognized to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. Product Sales Our Products are distributed in the U.S. through a limited number of Customers that resell to healthcare providers and hospitals, the end users of our Products. Revenue is recognized in an amount that reflects the consideration we expect to receive in exchange for our Products. To determine revenue recognition for contracts with customers within the scope of Topic 606, we perform the following 5 steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations of the contract(s); (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract(s); and (v) recognize revenue when (or as) we satisfy the performance obligations. We recognize revenue from product sales when there is a transfer of control of the product to our Customers. We typically determine transfer of control based on when the product is delivered, and title passes to our Customers. Product Sales Allowances We recognize product sales allowances as a reduction of product sales in the same period the related revenue is recognized. Product sales allowances are based on amounts owed or to be claimed on the related sales. Such variable consideration includes estimates that take into consideration the terms of our agreements with Customers, historical product returns, rebates or discounts taken, the shelf life of the product and specific known market events, such as competitive pricing and new product introductions. If actual future results vary from our estimates, we may need to adjust these estimates, which could have an effect on product sales and earnings in the period of adjustment. Our product sales allowances include: • Product Returns—We allow our Customers to return product for credit beginning three months prior to the product expiration date and up to 12 months after the product expiration date. As such, there may be a significant period of time between the time the product is shipped and the time the credit is issued on returned product. • Distributor Fees—We pay distribution service fees to our Customers based on a contractually fixed percentage of the wholesale acquisition cost and fees for data. These fees are paid no later than two months after the quarter in which product was shipped. • Group Purchasing Organization (“GPO”) Discounts and Rebates—We offer cash discounts to GPO members. These discounts are taken when the GPO members purchase product from our Customers, who then charge back to us the discount amount. Additionally, we offer volume and contract-tier rebates to GPO members. Rebates are based on actual purchase levels during the quarterly rebate purchase period. • GPO Administrative Fees—We pay administrative fees to GPOs for services and access to data. These fees are based on contracted terms and are paid after the quarter in which the product was purchased by the GPOs’ members. • Medicaid Rebates—We participate in Medicaid rebate programs, which provide assistance to certain low-income patients based on each individual state’s guidelines regarding eligibility and services. Under the Medicaid rebate programs, we pay a rebate to each participating state, generally within six months after the quarter in which the product was sold. • Prompt Pay Discounts—We may provide discounts on product sales to our Customers for prompt payment based on contractual terms. We believe our estimated allowance for product returns and GPO discounts requires a high degree of judgment and is subject to change based on our experience and certain quantitative and qualitative factors. We believe our estimated allowances for distributor fees, GPO rebates and administrative fees, Medicaid rebates and prompt pay discounts do not require a high degree of judgment because the amounts are settled within a relatively short period of time. Our product sales allowances and related accruals are evaluated each reporting period and adjusted when trends or significant events indicate that a change in estimate is appropriate. Changes in product sales allowance estimates could materially affect our results of operations and financial position.
Accrued Clinical Liabilities	Accrued Clinical Liabilities We accrue clinical costs based on work performed, which relies on estimates of the progress of the trials and the related expenses incurred. Clinical trial related contracts vary significantly in duration, and may be for a fixed amount, based on the achievement of certain contingent events or deliverables, a variable amount based on actual costs incurred, capped at a certain limit or contain a combination of these elements. Revisions are recorded to research and development expense in the period in which the facts that give rise to the revision become known. Historically, revisions have not resulted in material changes to research and development expense; however, a modification in the protocol of a clinical trial or cancellation of a clinical trial could result in a material charge to our results of operations.
Research and Development Expense	Research and Development Expense All costs of research and development are expensed in the period incurred. Research and development expense primarily consists of personnel and related costs, stock-based compensation expense, fees paid to outside service providers and consultants, facilities costs and materials used in clinical and preclinical trials and research and development.
Patent Costs	Patent Costs We incur outside legal fees in connection with filing and maintaining our various patent applications. All patent costs are expensed as incurred and are included in general and administrative expense in the consolidated statements of operations and comprehensive loss.
Stock-Based Compensation Expense	Stock-Based Compensation Expense We estimate the fair value of each option grant using the Black-Scholes option pricing model and for market-based stock option grants using the Monte Carlo simulation model. This fair value is then amortized using the straight-line single-option method of attributing the value of stock-based compensation to expense over the requisite service periods of the awards. Forfeitures are accounted for, as incurred, as a reversal of stock-based compensation expense related to awards that will not vest. The Black-Scholes option pricing model and the Monte Carlo simulation model both require inputs of complex and subjective assumptions, including each option’s expected life and price volatility of the underlying stock.
Warrants	Warrants We have issued warrants to purchase shares of our common stock in conjunction with certain equity and debt financings or in exchange for services. The terms of the warrants were evaluated to determine the appropriate classification as equity or a liability.
Income Taxes	Income Taxes We recognize the impact of a tax position in our consolidated financial statements if the position is more likely than not to be sustained on examination and on the technical merits of the position. The total amount of unrecognized tax benefits, if recognized, would affect other tax accounts, primarily deferred taxes in future periods, and would not affect our effective tax rate, since we maintain a full valuation allowance against our deferred tax assets (see Note 12). We recognize interest and penalties related to income tax matters in income tax expense.
Comprehensive Loss	Comprehensive Loss Comprehensive loss is defined as the change in equity during a period from transactions and other events and circumstances from non-owner sources. Net changes in unrealized gains and losses on available-for-sale securities are included in other comprehensive income (loss) and represent the difference between our net loss and comprehensive loss for both periods presented.
Net Loss per Share	Net Loss per Share Basic net loss per share is calculated by dividing the net loss by the weighted-average number of common shares outstanding for the period, including pre-funded warrants to purchase shares of common stock. Diluted net loss per share is computed by dividing the net loss by the weighted-average number of common shares and common stock equivalents outstanding for the period determined using the treasury stock method. For purposes of this calculation, stock options, restricted stock units, warrants and shares of common stock underlying convertible notes are considered to be common stock equivalents and are included in the calculation of diluted net loss per share only when their effect is dilutive. Because we have incurred a net loss for both periods presented in the consolidated statements of operations and comprehensive loss, the following common stock equivalents were not included in the computation of net loss per share because their effect would be anti-dilutive (in thousands): December 31, 2023 2022 Stock options outstanding 24,575 20,749 Restricted stock units outstanding 1,405 3,167 Warrants outstanding 298 8,548 Shares of common stock underlying convertible notes outstanding 9,819 9,819
Segment Reporting	Segment Reporting Management has determined that we operate in one business segment which is the development and commercialization of therapeutic innovations. All revenues for the years ended December 31, 2023 and 2022 were generated from customers in the U.S.
Recent Accounting Pronouncements	Recent Accounting Pronouncements Not Yet Adopted In December 2023, FASB issued Accounting Standards Update No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”), to enhance income tax reporting disclosures and require disclosure of specific categories in the tabular rate reconciliation. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024, on a prospective basis. Early adoption and retrospective application are permitted. We are currently evaluating the impact on our disclosures.

Summary of Significant Accou_2

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Percentage of Net Product Sales and Accounts Receivable Balance	The following includes the percentage of net product sales and accounts receivable balances for our three major Customers, each of which comprised 10% or more of our net product sales: Net Product Accounts Year Ended As of Customer A 43.3 % 42.1 % Customer B 36.8 % 36.1 % Customer C 19.0 % 21.5 % Total 99.1 % 99.7 %
Common Stock Equivalents Excluded From Computation of Net Loss Per Share	Because we have incurred a net loss for both periods presented in the consolidated statements of operations and comprehensive loss, the following common stock equivalents were not included in the computation of net loss per share because their effect would be anti-dilutive (in thousands): December 31, 2023 2022 Stock options outstanding 24,575 20,749 Restricted stock units outstanding 1,405 3,167 Warrants outstanding 298 8,548 Shares of common stock underlying convertible notes outstanding 9,819 9,819

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	We measure cash, cash equivalents and short-term investments at fair value on a recurring basis. The fair values of such assets were as follows (in thousands): Fair Value Measurements at Reporting Date Using Balance at Quoted Significant Significant Cash and money market funds $ 23,441 $ 23,441 $ — $ — U.S. treasury bills and government agency obligations 31,636 31,636 — — U.S. corporate debt securities 16,889 — 16,889 — Foreign corporate debt securities 5,460 — 5,460 — U.S. commercial paper 1,990 — 1,990 — Foreign commercial paper 993 — 993 — Total $ 80,409 $ 55,077 $ 25,332 $ — Fair Value Measurements at Reporting Date Using Balance at Quoted Significant Significant Cash and money market funds $ 13,867 $ 13,867 $ — $ — U.S. treasury bills and agency obligations 35,715 35,715 — — U.S. corporate debt securities 1,497 — 1,497 — U.S. commercial paper 5,481 — 5,481 — Foreign commercial paper 28,292 — 28,292 — Total $ 84,852 $ 49,582 $ 35,270 $ —

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	12 Months Ended
	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Summary of Short-Term Investments	The following is a summary of our short-term investments (in thousands): December 31, 2023 Amortized Gross Gross Estimated U.S. treasury bills and government agency obligations $ 31,625 $ 11 $ — $ 31,636 U.S. corporate debt securities 11,652 1 — 11,653 Foreign corporate debt securities 5,459 1 — 5,460 U.S. commercial paper 1,991 — ( 1 ) 1,990 Foreign commercial paper 993 — — 993 Total $ 51,720 $ 13 $ ( 1 ) $ 51,732 December 31, 2022 Amortized Gross Gross Estimated U.S. treasury bills and agency obligations $ 35,734 $ — $ ( 19 ) $ 35,715 U.S. commercial paper 5,481 — — 5,481 Foreign commercial paper 28,292 — — 28,292 Total $ 69,507 $ — $ ( 19 ) $ 69,488
Schedule of Inventory	Inventory consists of the following (in thousands): December 31, 2023 2022 Raw materials $ 17,643 $ 15,137 Work in process 14,550 20,723 Finished goods 9,917 18,713 Total inventory $ 42,110 $ 54,573
Schedule of Prepaid Expenses and Other Assets	Prepaid expenses and other assets consist of the following (in thousands): December 31, 2023 2022 Prepaid expenses $ 11,731 $ 21,120 Prepaid insurance 1,910 1,947 Interest receivables 310 154 Deposits 274 254 Other receivables 21 6,197 Total prepaid expenses and other assets $ 14,246 $ 29,672
Schedule of Property and Equipment, Net	Property and equipment, net consists of the following (in thousands): December 31, 2023 2022 Scientific equipment $ 34,027 $ 33,318 Leasehold improvements 647 647 Computer equipment and software 1,506 1,506 Furniture, fixtures and office equipment 1,014 982 Property and equipment, gross 37,194 36,453 Less: accumulated depreciation and amortization ( 17,028 ) ( 14,293 ) Property and equipment, net $ 20,166 $ 22,160
Schedule of Accrued Liabilities	Accrued payroll and employee liabilities consist of the following (in thousands): December 31, 2023 2022 Accrued employee salaries and benefits $ 1,371 $ 2,134 Accrued bonuses 5,499 7,783 Accrued vacation 2,354 3,499 Total accrued payroll and employee liabilities $ 9,224 $ 13,416 Other accrued liabilities consist of the following (in thousands): December 31, 2023 2022 Accrued product sales allowances $ 36,529 $ 33,317 Accrued consulting and professional fees 3,940 4,236 Accrued accounts payable 559 363 Accrued interest 412 94 Other accrued liabilities 415 542 Total other accrued liabilities $ 41,855 $ 38,552

Revenue Recognition (Tables)

Revenue Recognition (Tables)	12 Months Ended
	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregated Net Product Sales	The following provides disaggregated net product sales (in thousands): For the Years Ended December 31, 2023 2022 CINVANTI net product sales $ 94,869 $ 87,245 SUSTOL net product sales 13,057 10,231 ZYNRELEF net product sales 17,727 10,196 APONVIE net product sales 1,391 — Total net product sales $ 127,044 $ 107,672
Summary of Activity to Product Returns, Distributor Fees and Discounts, Rebates, Administrative and Other Fees	The following provides a summary of activity with respect to our product returns, distributor fees and discounts, rebates, administrative and other fees, which are included in other accrued liabilities on the consolidated balance sheets (in thousands): Discounts, Rebates, Product Distributor Administrative and Returns Fees Other Fees Total Balance at December 31, 2022 $ 3,336 $ 4,180 $ 25,801 $ 33,317 Provision 2,638 23,722 169,651 196,011 Payments/credits ( 1,198 ) ( 23,483 ) ( 168,118 ) ( 192,799 ) Balance at December 31, 2023 $ 4,776 $ 4,419 $ 27,334 $ 36,529

Commitments and Contingencies (

Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Summary of Future Minimum Lease Payments	Annual future minimum lease payments as of December 31, 2023 are as follows (in thousands): Year ended December 31: 2024 $ 3,153 2025 3,138 2026 — 2027 — 2028 — Thereafter — Total future minimum lease payments 6,291 Less: discount ( 416 ) Total lease liabilities $ 5,875

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Summary of Common Stock Reserved for Future Issuance	Shares of our common stock reserved for future issuance as of December 31, 2023 were as follows (in thousands): Number of Shares Stock options outstanding 24,575 Restricted stock units outstanding 1,405 Stock options available for grant 8,605 Shares of common stock reserved under the Employee Stock Purchase Plan 328 Shares of common stock underlying warrants 1,461 Shares of common stock underlying convertible notes outstanding (see Note 8) 9,819 Total shares reserved for future issuance 46,193

Equity Incentive Plans (Tables)

Equity Incentive Plans (Tables)	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Summary of Stock Option Plan Activity	The following summarizes the stock option plan activity: Outstanding Options Weighted- Average Number of Exercise Shares Price Balance at December 31, 2022 20,749,349 $ 14.61 Granted 16,210,379 $ 1.69 Exercised ( 26,570 ) $ 1.32 Cancelled ( 12,358,296 ) $ 12.72 Balance at December 31, 2023 24,574,862 $ 7.06 Outstanding RSUs Weighted- Average Number of Grant Date Shares Fair Value Balance at December 31, 2022 3,167,397 $ 6.46 Granted 1,757,506 $ 2.39 Released ( 1,627,619 ) $ 6.34 Forfeited ( 1,892,355 ) $ 4.27 Balance at December 31, 2023 1,404,929 $ 4.43
Schedule of Options Exercisable, Vested or Expected to Vest	Years Ended December 31, 2023 2022 Weighted- Weighted- Average Average Exercise Exercise Options Price Options Price Exercisable at end of year 11,390,275 $ 12.87 13,650,210 $ 17.86 Options vested or expected to 24,574,862 $ 7.06 20,183,769 $ 14.82
Schedule of Exercise Prices and Weighted-average Remaining Contractual Lives for Options Outstanding	Exercise prices and weighted-average remaining contractual lives for the options outstanding as of December 31, 2023 were: Weighted- Weighted- Average Average Weighted- Exercise Remaining Average Price of Outstanding Range of Contractual Exercise Options Options Options Exercise Prices Life (in years) Price Exercisable Exercisable 6,179,628 $ 0.97 –$ 1.51 9.51 $ 1.25 344,006 $ 1.30 7,660,800 $ 1.52 –$ 2.28 9.28 1.77 2,001,281 1.78 3,406,724 $ 2.32 –$ 3.48 7.68 2.99 2,182,510 3.05 83,323 $ 3.61 –$ 5.42 8.61 4.08 34,239 4.09 21,459 $ 5.50 –$ 8.25 7.65 5.84 10,059 5.81 1,100,494 $ 8.80 –$ 13.20 3.57 11.18 996,018 11.20 3,116,010 $ 13.50 –$ 20.25 4.13 16.10 2,817,050 16.16 2,828,424 $ 20.93 –$ 31.40 4.26 25.72 2,827,112 25.72 178,000 $ 31.45 –$ 41.18 3.17 35.45 178,000 35.45 24,574,862 7.58 7.06 11,390,275 12.87
Summary of Stock-Based Compensation Expense related to Stock-Based Payment Awards	The following summarizes stock-based compensation expense related to stock-based payment awards pursuant to our equity compensation arrangements (in thousands): December 31, 2023 2022 Research and development $ 10,880 $ 17,909 General and administrative 12,471 11,688 Sales and marketing 9,503 13,383 Total stock-based compensation expense $ 32,854 $ 42,980
Summary of Fair Value of Option Grant and ESPP Purchase Right on Grant Date Using Black-Scholes Option Pricing Model	We estimated the fair value of each option grant and ESPP purchase right on the date of grant using the Black-Scholes option pricing model with the following weighted-average assumptions: Options: December 31, 2023 2022 Risk-free interest rate 3.7 % 3.3 % Dividend yield — % — % Volatility 68.1 % 62.0 % Expected life (years) 6 to 10 6 ESPP: December 31, 2023 2022 Risk-free interest rate 5.3 % 3.2 % Dividend yield — % — % Volatility 99.6 % 83.8 % Expected life (months) 6 6

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Schedule of Components of Income Tax Expense (Benefit)	The difference between the provision for income taxes and income taxes computed using the effective U.S. federal statutory rate is as follows (in thousands): December 31, 2023 2022 Tax at statutory federal rate $ ( 23,210 ) $ ( 38,225 ) State tax, net of federal benefit ( 1,460 ) ( 13,898 ) Research and development credits — ( 3,531 ) Stock-based compensation expense 19,022 5,857 Non-deductible compensation ( 4,682 ) 2,104 Employee retention credit adjustment — ( 1,265 ) Change in valuation allowance 7,556 46,452 Provision to return adjustment 3,008 — Other ( 234 ) 2,506 Provision for income taxes $ — $ —
Schedule of Deferred Tax Assets and Liabilities	Deferred income tax assets and liabilities arising from differences between accounting for financial statement purposes and tax purposes, less valuation allowance at year-end are as follows (in thousands): December 31, 2023 2022 Deferred tax assets: Net operating loss carryforward $ 320,998 $ 313,834 Research and development credits 59,417 60,245 Section 174 capitalized research and development 28,822 20,903 Stock-based compensation 15,413 23,991 Lease liabilities 1,471 2,052 Other 5,005 3,693 Total gross deferred tax assets 431,126 424,718 Deferred tax liabilities: Right-of-use lease assets ( 1,362 ) ( 1,914 ) Total gross deferred tax liabilities ( 1,362 ) ( 1,914 ) Valuation allowance ( 429,764 ) ( 422,804 ) Net deferred tax assets $ — $ —
Summary of Unrecognized Tax Benefits	A reconciliation of our unrecognized tax benefits is as follows (in thousands): Year Ended December 31, 2023 2022 Balance at beginning of year $ 11,235 $ 9,631 Decrease for tax positions of prior years ( 332 ) ( 200 ) Increase based on tax positions related to current year — 1,804 Balance at end of year $ 10,903 $ 11,235

Organization and Business - Add

Organization and Business - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Business [Line Items]
Accumulated deficit	$ (1,906,014)	$ (1,795,455)
Cash, cash equivalents and short-term investments	80,400
Net loss	$ (110,559)	$ (182,024)

Summary of Significant Accoun_2

Summary of Significant Accounting Policies - Percentage of Net Product Sales and Accounts Receivable Balance (Details) - Customer Concentration Risk	12 Months Ended
	Dec. 31, 2023
Revenue Benchmark | Largest Customer
Product Information [Line Items]
Concentration risk percentage	43.30%
Revenue Benchmark | Second Largest Customer
Product Information [Line Items]
Concentration risk percentage	36.80%
Revenue Benchmark | Third Largest Customer
Product Information [Line Items]
Concentration risk percentage	19%
Revenue Benchmark | Total Customer
Product Information [Line Items]
Concentration risk percentage	99.10%
Accounts Receivable | Largest Customer
Product Information [Line Items]
Concentration risk percentage	42.10%
Accounts Receivable | Second Largest Customer
Product Information [Line Items]
Concentration risk percentage	36.10%
Accounts Receivable | Third Largest Customer
Product Information [Line Items]
Concentration risk percentage	21.50%
Accounts Receivable | Total Customer
Product Information [Line Items]
Concentration risk percentage	99.70%

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Additional Information (Details)	12 Months Ended
	Dec. 31, 2023 Segment
Product Information [Line Items]
Property, Plant, and Equipment, Useful Life, Term, Description [Extensible Enumeration]	us-gaap:UsefulLifeTermOfLeaseMember
Number of Operating Segments	1

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Common Stock Equivalents Excluded From Computation of Net Loss Per Share (Details) - shares shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Share-based Payment Arrangement, Option
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Shares excluded (in shares)	24,575	20,749
Restricted Stock Units
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Shares excluded (in shares)	1,405	3,167
Warrant
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Shares excluded (in shares)	298	8,548
Convertible Debt Securities
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Shares excluded (in shares)	9,819	9,819

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Financial Assets Measured on a Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	$ 51,732	$ 69,488
U.S. Treasury Bills and Government Agency Obligations
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	31,636	35,715
U.S. Corporate Debt
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	11,653
Foreign Corporate Debt
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	5,460
U.S. Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	1,990	5,481
Fair Value, Recurring
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Total	80,409	84,852
Fair Value, Recurring | Foreign Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	993	28,292
Fair Value, Recurring | U.S. Treasury Bills and Government Agency Obligations
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	31,636	35,715
Fair Value, Recurring | U.S. Corporate Debt
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	16,889	1,497
Fair Value, Recurring | Foreign Corporate Debt
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	5,460
Fair Value, Recurring | U.S. Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	1,990	5,481
Fair Value, Recurring | Cash and Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash and money market funds	23,441	13,867
Fair Value, Recurring | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Total	55,077	49,582
Fair Value, Recurring | Quoted Prices in Active Markets for Identical Assets (Level 1) | U.S. Treasury Bills and Government Agency Obligations
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	31,636	35,715
Fair Value, Recurring | Quoted Prices in Active Markets for Identical Assets (Level 1) | Cash and Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash and money market funds	23,441	13,867
Fair Value, Recurring | Significant Other Observable Inputs (Level 2)
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Total	25,332	35,270
Fair Value, Recurring | Significant Other Observable Inputs (Level 2) | Foreign Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	993	28,292
Fair Value, Recurring | Significant Other Observable Inputs (Level 2) | U.S. Corporate Debt
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	16,889	1,497
Fair Value, Recurring | Significant Other Observable Inputs (Level 2) | Foreign Corporate Debt
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	5,460
Fair Value, Recurring | Significant Other Observable Inputs (Level 2) | U.S. Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Available-for-sale securities	$ 1,990	$ 5,481

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Financial instruments transferred among fair value hierarchy levels	$ 0
Cash equivalents included of available-for-sale securities	5,300,000	$ 1,500,000
Available for sale securities with contractual maturities of three months to one year.	$ 51,700,000	$ 69,500,000

Balance Sheet Details - Summary

Balance Sheet Details - Summary of Short -Term Investments (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Schedule Of Available For Sale Securities [Line Items]
Available-for-sale securities, amortized cost	$ 51,720	$ 69,507
Available-for-sale securities, gross unrealized gains	13
Available-for-sale securities, gross unrealized losses	(1)	(19)
Available-for-sale securities	51,732	69,488
U.S. Treasury Bills and Government Agency Obligations
Schedule Of Available For Sale Securities [Line Items]
Available-for-sale securities, amortized cost	31,625	35,734
Available-for-sale securities, gross unrealized gains	11
Available-for-sale securities, gross unrealized losses		(19)
Available-for-sale securities	31,636	35,715
U.S. Corporate Debt
Schedule Of Available For Sale Securities [Line Items]
Available-for-sale securities, amortized cost	11,652
Available-for-sale securities, gross unrealized gains	1
Available-for-sale securities	11,653
Foreign Corporate Debt
Schedule Of Available For Sale Securities [Line Items]
Available-for-sale securities, amortized cost	5,459
Available-for-sale securities, gross unrealized gains	1
Available-for-sale securities	5,460
U.S. Commercial Paper
Schedule Of Available For Sale Securities [Line Items]
Available-for-sale securities, amortized cost	1,991	5,481
Available-for-sale securities, gross unrealized losses	(1)
Available-for-sale securities	1,990	5,481
Foreign Commercial Paper
Schedule Of Available For Sale Securities [Line Items]
Available-for-sale securities, amortized cost	993	28,292
Available-for-sale securities	$ 993	$ 28,292

Balance Sheet Details - Additio

Balance Sheet Details - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Debt securities, impairment losses	$ 0	$ 0
Debt securities, available-for-sale, unrealized gain (loss)	32,000	(13,000)
Debt securities, available-for-sale, realized gain (loss)	1,000	0
Total inventory	42,110,000	54,573,000
Depreciation and amortization	2,899,000	2,889,000
Construction in Progress, Gross	6,300,000	5,400,000
ZYNRELEF
Total inventory	11,200,000	30,900,000
Cost of product sales, charges	20,300,000	8,900,000
SUSTOL
Total inventory	4,100,000	2,600,000
CINVANTI
Total inventory	26,400,000	19,900,000
APONVIE
Total inventory	$ 400,000	$ 1,200,000

Balance Sheet Details - Schedul

Balance Sheet Details - Schedule of Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 17,643	$ 15,137
Work in process	14,550	20,723
Finished goods	9,917	18,713
Total inventory	$ 42,110	$ 54,573

Balance Sheet Details - Sched_2

Balance Sheet Details - Schedule of Prepaid Expenses and Other Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Prepaid Expense and Other Assets, Current [Abstract]
Prepaid expenses	$ 11,731	$ 21,120
Prepaid insurance	1,910	1,947
Interest receivable	310	154
Deposits	274	254
Other receivables	21	6,197
Total prepaid expenses and other assets	$ 14,246	$ 29,672

Balance Sheet Details - Sched_3

Balance Sheet Details - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 37,194	$ 36,453
Less: accumulated depreciation and amortization	(17,028)	(14,293)
Property and equipment, net	20,166	22,160
Scientific Equipment
Property Plant And Equipment [Line Items]
Property and equipment, gross	34,027	33,318
Leasehold Improvements
Property Plant And Equipment [Line Items]
Property and equipment, gross	647	647
Computer Equipment and Software
Property Plant And Equipment [Line Items]
Property and equipment, gross	1,506	1,506
Furniture, Fixtures and Office Equipment
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 1,014	$ 982

Balance Sheet Details - Sched_4

Balance Sheet Details - Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Accrued payroll and employee liabilities
Accrued employee salaries and benefits	$ 1,371	$ 2,134
Accrued bonuses	5,499	7,783
Accrued vacation	2,354	3,499
Total accrued payroll and employee liabilities	9,224	13,416
Other accrued liabilities
Accrued product sales allowances	36,529	33,317
Accrued consulting and professional fees	3,940	4,236
Accrued accounts payable	559	363
Accrued interest	412	94
Other accrued liabilities	415	542
Total other accrued liabilities	$ 41,855	$ 38,552

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregated Net Product Sales (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Product Information [Line Items]
Net product sales	$ 127,044	$ 107,672
CINVANTI
Product Information [Line Items]
Net product sales	94,869	87,245
SUSTOL
Product Information [Line Items]
Net product sales	13,057	10,231
ZYNRELEF
Product Information [Line Items]
Net product sales	17,727	$ 10,196
APONVIE
Product Information [Line Items]
Net product sales	$ 1,391

Revenue Recognition - Summary o

Revenue Recognition - Summary of Activity to Product Returns, Distributor Fees and Discounts, Rebates, Administrative and Other Fees (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)
Product Information [Line Items]
Balance	$ 33,317
Provision	196,011
Payments/credits	(192,799)
Balance	36,529
Product Returns
Product Information [Line Items]
Balance	3,336
Provision	2,638
Payments/credits	(1,198)
Balance	4,776
Distributor Fees
Product Information [Line Items]
Balance	4,180
Provision	23,722
Payments/credits	(23,483)
Balance	4,419
Discounts, Rebates, Administrative and Other Fees
Product Information [Line Items]
Balance	25,801
Provision	169,651
Payments/credits	(168,118)
Balance	$ 27,334

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2023 ft²	Dec. 31, 2023 USD ($) ft²	Dec. 31, 2022 USD ($)	Oct. 31, 2021 ft²
Lessee Lease Description [Line Items]
Operating lease cash payments		$ 3	$ 2.9
Purchase obligations due in one year		39
Purchase obligations due in two to three year		21.2
Operating lease, rent expense		2.9	$ 2.8
Total purchase obligations		$ 60.2
Maximum
Lessee Lease Description [Line Items]
Purchase obligations due period		3 years
Minimum
Lessee Lease Description [Line Items]
Purchase obligations due period		2 years
Sublease Agreement
Lessee Lease Description [Line Items]
Area of real estate property | ft²				23,873
San Diego, California
Lessee Lease Description [Line Items]
Area of real estate property | ft²		52,148
Lease expiration date		Dec. 31, 2025
Lessee, operating lease, renewal term		5 years
Remaining area of real estate property | ft²		28,275		28,275
Lessee, operating lease, existence of option to extend		true
Cary, North Carolina | Sublease Agreement
Lessee Lease Description [Line Items]
Area of real estate property | ft²	5,840
Lease expiration date	Apr. 30, 2025

Commitments and Contingencies_2

Commitments and Contingencies - Summary of Future Minimum Lease Payments (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Commitments and Contingencies Disclosure [Abstract]
2024	$ 3,153
2025	3,138
Total future minimum lease payments	6,291
Less: discount	(416)
Total lease liabilities	$ 5,875

Reorganization - Additional Inf

Reorganization - Additional Information (Details) $ in Millions	1 Months Ended		12 Months Ended
	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Dec. 31, 2023 USD ($) Officers	Dec. 31, 2022 USD ($)
Restructuring charges, total		$ 5.4
Number of executive officers terminated | Officers			5
Anticipated restructuring expense			$ 13.4
2023 Restructuring Plan
Payments for restructuring charges			4.2
2023 Restructuring Plan | Research and Development Expense
Restructuring charges, total			1.7
2023 Restructuring Plan | General and Administrative Expense
Restructuring charges, total			0.1
2023 Restructuring Plan | Sales and Marketing Expense
Restructuring charges, total			2.4
2022 Restructuring Plan
Payments for restructuring charges				$ 5.4
2022 Restructuring Plan | Research and Development Expense
Restructuring charges, total				4.2
2022 Restructuring Plan | General and Administrative Expense
Restructuring charges, total				0.2
2022 Restructuring Plan | Sales and Marketing Expense
Restructuring charges, total				$ 1
Executive Officer Departures
Restructuring charges, total			13.4
Executive Officer Departures | Research and Development Expense
Restructuring charges, total			2.3
Executive Officer Departures | General and Administrative Expense
Restructuring charges, total			7.2
Executive Officer Departures | Sales and Marketing Expense
Restructuring charges, total			3.9
Employee Severance
Restructuring charges, total		5
Anticipated restructuring expense			4.7
Employee Severance | 2023 Restructuring Plan
Restructuring charges, total	$ 4.2
Payments for restructuring charges			3.7
Accelerated Non-Cash Stock Option Expense
Restructuring charges, total		$ 0.4
Non-Cash, Stock-based Compensation Expense
Anticipated restructuring expense			$ 8.7

Convertible Notes - Additional

Convertible Notes - Additional Information (Details) - USD ($)			1 Months Ended	12 Months Ended
	Aug. 15, 2023	Aug. 09, 2023	May 31, 2021	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Amortization of debt issuance costs				$ 206,000	$ 202,000
Debt instrument convertible type of equity security		The Loan Agreement has a term of four years, with a springing maturity date that is 91 days prior to the stated maturity of our existing senior unsecured convertible notes (if still outstanding at such time).
Loan agreement, term		4 years
Loan agreement spring maturity date		91 days
Debt instrument, interest rate	9.95%
Accrued paid-in-kind interest	$ 1.5
Amortization of debt discount				133,000
Common Stock
Debt Instrument [Line Items]
Initial conversion price/rate			$ 15.276
Warrant
Debt Instrument [Line Items]
Percentage of principal amount of loan funded to lender		2%
Hercules Capital Inc
Debt Instrument [Line Items]
Convertible debt issuable in connection with private placement	50,000,000
Debt issuance costs incurred		$ 600,000
Effective interest rate		14.50%
Interest expense				1,300,000
Interest expense, debt, excluding amortization				1,000,000
Paid-in-kind interest amount				200,000
Amortization of debt discount		$ 800,000		100,000
Number of shares warrant issued to lender		297,619
Common stock exercise price, per share		$ 1.68
Minimum cash covenant amount, requiring to hold cash		$ 8,500,000
Maximum amount of market capitalization		400,000,000
Warrants related fair value recongnized amount		400,000
Debt instrument, face amount		$ 25,000,000
Hercules Capital Inc | Common Stock
Debt Instrument [Line Items]
Number of shares warrant issued to lender		297,619
Hercules Capital Inc | Maximum | Common Stock
Debt Instrument [Line Items]
Number of shares warrant issued to lender		297,619
Hercules Capital Inc | Tranche 1A
Debt Instrument [Line Items]
Convertible debt issuable in connection with private placement	25,000,000
Carrying value of debt				24,300,000
Debt instrument, face amount		$ 25,000,000		25,200,000
Debt issuance costs				900,000
Hercules Capital Inc | Tranche 1B
Debt Instrument [Line Items]
Convertible debt issuable in connection with private placement	5,000,000
Hercules Capital Inc | Tranche 1C
Debt Instrument [Line Items]
Convertible debt issuable in connection with private placement	$ 20,000,000
Notes
Debt Instrument [Line Items]
Amortization of debt issuance costs				200,000
Debt instrument, interest rate			1.50%
Convertible debt issuable in connection with private placement			$ 150,000,000
Debt issuance costs incurred				$ 1,000,000
Effective interest rate				1.60%
Interest expense				$ 2,500,000
Interest expense, debt, excluding amortization				2,300,000
Net proceeds from convertible notes financing			$ 149,000,000
Debt instrument, maturity date			May 26, 2026
Debt instrument, frequency of periodic payment			semi-annually
Debt instrument, date of first required payment			Dec. 15, 2021
Initial conversion price/rate			$ 65.4620
Debt instrument conversion ratio multiple of principal			$ 1,000
Common shares registered for resale in connection with convertible notes			12,400,000
Carrying value of debt				149,500,000
Debt instrument, face amount				150,000,000
Debt issuance costs				$ 500,000
Notes | Redemption Between May 24, 2024 and May 24, 2025
Debt Instrument [Line Items]
Debt instrument, redemption period, stock price exceeds in percentage of conversion price			250%
Notes | Redemption On or After May 24, 2025
Debt Instrument [Line Items]
Debt instrument, redemption period, stock price exceeds in percentage of conversion price			200%

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands					12 Months Ended
	Aug. 31, 2023	Jul. 21, 2023	Oct. 18, 2022	Aug. 08, 2022	Dec. 31, 2023	Dec. 31, 2022
Class Of Stock [Line Items]
Common shares registered for resale	21,900		24,600
Proceeds from issuance of common stock					$ 29,755	$ 75,145
Private Placement
Class Of Stock [Line Items]
Shares of common stock sold				16,100
Purchase price per share				$ 3.10
Proceeds from issuance of common stock and pre-funded warrants				$ 75,100
Stock issuance cost				$ 1,400
Pre-funded Warrants
Class Of Stock [Line Items]
Purchase price per share		$ 1.3699		$ 3.0999
Class of warrant or right, number of securities called by warrants or rights		1,200		8,500
Class of warrant or right, exercise price of warrants or rights		$ 0.0001		$ 0.0001
2023 Private Placement
Class Of Stock [Line Items]
Shares of common stock sold		20,700
Purchase price per share		$ 1.37
Proceeds from issuance of common stock and pre-funded warrants		$ 29,800
Stock issuance cost		$ 200
Common Stock | Private Placement
Class Of Stock [Line Items]
Shares of common stock sold					20,735	16,129

Stockholders' Equity - Summary

Stockholders' Equity - Summary of Common Stock Reserved for Future Issuance (Details) - shares	Dec. 31, 2023	Dec. 31, 2022
Stockholders' Equity Note [Abstract]
Stock options outstanding	24,574,862	20,749,349
Restricted stock units outstanding	1,405,000
Stock options available for grant	8,605,000
Shares of common stock underlying warrants	1,461,000
Shares of common stock underlying convertible notes outstanding (see Note 8)	9,819,000
Total shares reserved for future issuance	46,193,000

Equity Incentive Plan - Additio

Equity Incentive Plan - Additional Information (Details) - USD ($)	1 Months Ended												12 Months Ended
	Jun. 30, 2023	May 31, 2022	Jun. 30, 2021	Jun. 30, 2019	Jun. 30, 2017	Jun. 30, 2016	May 31, 2015	May 31, 2014	Jun. 30, 2011	May 31, 2010	May 31, 2009	Dec. 31, 2007	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 1997
Class Of Stock [Line Items]
Share-based compensation arrangements by share-based payment award, options, exercises in period, weighted average exercise price													$ 1.32
Common stock, shares, issued, total													150,285,044	119,154,538
Common stock, capital shares reserved for future issuance													46,193,000
Share-based compensation arrangement by share-based payment award, number of shares available for grant													8,605,000
Share-based compensation arrangement by share-based payment award, expiration period													10 years
Share-based compensation arrangement by share-based payment award, award vesting period													4 years
Share-based compensation arrangement by share-based payment award, options, exercisable, weighted average remaining contractual term													5 years 7 months 6 days
Share-based compensation arrangement by share-based payment award, options, exercises in period													26,570	0
Share-based compensation arrangement by share-based payment award, options, exercises in period, intrinsic value													$ 10,000
Share-based compensation arrangement by share-based payment award, options, outstanding, intrinsic value													$ 137,000	$ 0
Common stock future issuance on exercise of outstanding options and vesting of outstanding restricted stock units granted													25,979,791
Total unrecognized compensation cost related to non-vested, stock-based payment awards													$ 23,200,000
Total unrecognized compensation cost, expect to recognize over weighted average period													3 years
Restricted Stock Units
Class Of Stock [Line Items]
Share-based compensation arrangement by share-based payment award, award vesting period													4 years
Share-based Payment Arrangement, Option
Class Of Stock [Line Items]
Share-based compensation arrangement by share-based payment award, options, forfeitures in period													11,508,070
Share-based compensation arrangements by share-based payment award, options, forfeitures in period, weighted average exercise price													$ 13.1
Share-based compensation arrangement by share-based payment award, options, expirations in period													850,226
Share-based compensation arrangements by share-based payment award, options, expirations in period, weighted average exercise price													$ 7.47
Expected life														6 years
Employee Stock Purchase Plan
Class Of Stock [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized															10,000
Share-based compensation arrangement by share-based payment award, number of additional shares authorized	400,000	850,000	200,000	300,000	200,000	100,000	100,000	25,000	25,000		10,000	5,000	2,225,000
Share-based compensation arrangement by share-based payment award maximum employee earnings with held to purchase common stock percent													10%
Share-based compensation arrangement by share-based payment award discount on stock price													85%
Share-based compensation arrangement by share-based payment award, shares issued in period													717,046	406,421
Share-based compensation arrangements by share-based payment award, options, exercises in period, weighted average exercise price													$ 1.26	$ 3.55
Common stock, shares, issued, total													1,897,445
Common stock, capital shares reserved for future issuance													327,555
Share-based compensation arrangement by share-based payment award, options, grants in period, weighted average grant date fair value													$ 1.13	1.71
Share-based compensation arrangement by share-based payment award, per share weighted-average fair value price of shares purchased													$ 0.64	$ 1.65
Expected life													6 months
Equity Incentive Plan 2007
Class Of Stock [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized												150,000
Share-based compensation arrangement by share-based payment award, number of additional shares authorized	8,490,000	2,900,000	2,000,000	7,000,000	5,000,000	3,000,000	4,300,000	1,750,000	4,500,000	100,000			39,190,000
Share-based compensation arrangement by share-based payment award, number of shares available for grant													8,605,026

Equity Incentive Plans - Summar

Equity Incentive Plans - Summary of Stock Option Plan Activity (Details) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares outstanding	20,749,349
Number of shares granted	16,210,379
Number of shares exercised	(26,570)	0
Number of shares cancelled	(12,358,296)
Number of shares outstanding	24,574,862	20,749,349
Number of shares outstanding, weighted average exercise price	$ 14.61
Number of shares granted, weighted average exercise price	1.69
Number of shares exercised, weighted average exercise price	1.32
Number of shares cancelled, weighted average exercise price	12.72
Number of shares outstanding, weighted average exercise price	$ 7.06	$ 14.61
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares outstanding	3,167,397
Number of shares granted	1,757,506
Number of shares released	(1,627,619)
Number of shares forfeited	(1,892,355)
Number of shares outstanding	1,404,929	3,167,397
Number of shares outstanding, weighted average grant date fair value	$ 6.46
Number of shares granted, weighted average grant date fair value	2.39
Number of shares released, weighted average grant date fair value	6.34
Number of shares forfeited, weighted average grant date fair value	4.27
Number of shares outstanding, weighted average grant date fair value	$ 4.43	$ 6.46

Equity Incentive Plan - Schedul

Equity Incentive Plan - Schedule of Options Exercisable, Vested or Expected to Vest (Details) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Equity [Abstract]
Options exercisable at end of year	11,390,275	13,650,210
Options vested or expected to vest	24,574,862	20,183,769
Options exercisable at end of year, weighted average exercise price	$ 12.87	$ 17.86
Options vested or expected to vest, weighted average exercise price	$ 7.06	$ 14.82

Equity Incentive Plan - Sched_2

Equity Incentive Plan - Schedule of Exercise Prices and Weighted-average Remaining Contractual Lives for Options Outstanding (Details)	12 Months Ended
	Dec. 31, 2023 $ / shares shares
Options Outstanding (in shares) | shares	24,574,862
Weighted- Average Remaining Contractual Life (Year)	7 years 6 months 29 days
Weighted- Average Exercise Price (in dollars per share)	$ 7.06
Options Exercisable (in shares) | shares	11,390,275
Weighted- Average Exercise Price of Options Exercisable	$ 12.87
Exercise Price Range 1
Options Outstanding (in shares) | shares	6,179,628
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 0.97
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 1.51
Weighted- Average Remaining Contractual Life (Year)	9 years 6 months 3 days
Weighted- Average Exercise Price (in dollars per share)	$ 1.25
Options Exercisable (in shares) | shares	344,006
Weighted- Average Exercise Price of Options Exercisable	$ 1.3
Exercise Price Range 2
Options Outstanding (in shares) | shares	7,660,800
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 1.52
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 2.28
Weighted- Average Remaining Contractual Life (Year)	9 years 3 months 10 days
Weighted- Average Exercise Price (in dollars per share)	$ 1.77
Options Exercisable (in shares) | shares	2,001,281
Weighted- Average Exercise Price of Options Exercisable	$ 1.78
Exercise Price Range 3
Options Outstanding (in shares) | shares	3,406,724
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 2.32
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 3.48
Weighted- Average Remaining Contractual Life (Year)	7 years 8 months 4 days
Weighted- Average Exercise Price (in dollars per share)	$ 2.99
Options Exercisable (in shares) | shares	2,182,510
Weighted- Average Exercise Price of Options Exercisable	$ 3.05
Exercise Price Range 4
Options Outstanding (in shares) | shares	83,323
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 3.61
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 5.42
Weighted- Average Remaining Contractual Life (Year)	8 years 7 months 9 days
Weighted- Average Exercise Price (in dollars per share)	$ 4.08
Options Exercisable (in shares) | shares	34,239
Weighted- Average Exercise Price of Options Exercisable	$ 4.09
Exercise Price Range 5
Options Outstanding (in shares) | shares	21,459
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 5.5
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 8.25
Weighted- Average Remaining Contractual Life (Year)	7 years 7 months 24 days
Weighted- Average Exercise Price (in dollars per share)	$ 5.84
Options Exercisable (in shares) | shares	10,059
Weighted- Average Exercise Price of Options Exercisable	$ 5.81
Exercise Price Range 6
Options Outstanding (in shares) | shares	1,100,494
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 8.8
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 13.2
Weighted- Average Remaining Contractual Life (Year)	3 years 6 months 25 days
Weighted- Average Exercise Price (in dollars per share)	$ 11.18
Options Exercisable (in shares) | shares	996,018
Weighted- Average Exercise Price of Options Exercisable	$ 11.2
Exercise Price Range 7
Options Outstanding (in shares) | shares	3,116,010
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 13.5
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 20.25
Weighted- Average Remaining Contractual Life (Year)	4 years 1 month 17 days
Weighted- Average Exercise Price (in dollars per share)	$ 16.1
Options Exercisable (in shares) | shares	2,817,050
Weighted- Average Exercise Price of Options Exercisable	$ 16.16
Exercise Price Range 8
Options Outstanding (in shares) | shares	2,828,424
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 20.93
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 31.4
Weighted- Average Remaining Contractual Life (Year)	4 years 3 months 3 days
Weighted- Average Exercise Price (in dollars per share)	$ 25.72
Options Exercisable (in shares) | shares	2,827,112
Weighted- Average Exercise Price of Options Exercisable	$ 25.72
Exercise Price Range 9
Options Outstanding (in shares) | shares	178,000
Range of Exercise Prices, Lower Limit (in dollars per share)	$ 31.45
Range of Exercise Prices, Upper Limit (in dollars per share)	$ 41.18
Weighted- Average Remaining Contractual Life (Year)	3 years 2 months 1 day
Weighted- Average Exercise Price (in dollars per share)	$ 35.45
Options Exercisable (in shares) | shares	178,000
Weighted- Average Exercise Price of Options Exercisable	$ 35.45

Equity Incentive Plan - Summary

Equity Incentive Plan - Summary of Stock-Based Compensation Expense related to Stock-Based Payment Awards (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense	$ 32,854	$ 42,980
Research and Development Expense
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense	10,880	17,909
General and Administrative Expense
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense	12,471	11,688
Sales and Marketing Expense
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense	$ 9,503	$ 13,383

Equity Incentive Plan - Summa_2

Equity Incentive Plan - Summary of Fair Value of Option Grant and ESPP Purchase Right on Grant Date Using Black-Scholes Option Pricing Model (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Share-based Payment Arrangement, Option
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Risk-free interest rate	3.70%	3.30%
Dividend yield	0%	0%
Volatility	68.10%	62%
Expected life		6 years
Share-based Payment Arrangement, Option | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Expected life	6 years
Share-based Payment Arrangement, Option | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Expected life	10 years
Employee Stock Purchase Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Risk-free interest rate	5.30%	3.20%
Dividend yield	0%	0%
Volatility	99.60%	83.80%
Expected life	6 months	6 months

Employee Benefit Plan - Additio

Employee Benefit Plan - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Defined Benefit Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of match	50%
Defined contribution plan, maximum annual contributions by employer per employee, amount	$ 9,900	$ 9,150
Defined contribution plan, cost	$ 1,000,000	$ 1,400,000
Maximum
Defined Benefit Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of employees' gross pay	3%

Income Taxes - Schedule of Comp

Income Taxes - Schedule of Components of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Tax at statutory federal rate	$ (23,210)	$ (38,225)
State tax, net of federal benefit	(1,460)	(13,898)
Research and development credits	0	(3,531)
Stock-based compensation expense	19,022	5,857
Non-deductible compensation	(4,682)	2,104
Employee retention credit adjustment	0	(1,265)
Change in valuation allowance	7,556	46,452
Provision to return adjustment	3,008	0
Other	234	2,506
Provision for income taxes	$ 0	$ 0

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Deferred tax assets:
Net operating loss carryforward	$ 320,998	$ 313,834
Research and development credits	59,417	60,245
Section 174 capitalized research and development	28,822	20,903
Stock-based compensation	15,413	23,991
Lease liabilities	1,471	2,052
Other	5,005	3,693
Total gross deferred tax assets	431,126	424,718
Deferred Tax Liabilities, Net [Abstract]
Right-of-use lease assets	(1,362)	(1,914)
Total gross deferred tax liabilities	(1,362)	(1,914)
Valuation allowance	$ (429,764)	$ (422,804)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($)	3 Months Ended	12 Months Ended
	Jun. 30, 2023	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Operating Loss Carryforwards [Line Items]
Deferred Tax Assets, Tax Credit Carryforwards, Research		$ 59,417,000	$ 60,245,000
Unrecognized Tax Benefits, Ending Balance		10,903,000	11,235,000	$ 9,631,000
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued, Total		$ 0
Tax cuts and jobs act, capitalize expense of amortized period for domestic expenses		5 years
Tax cuts and jobs act, capitalize expense of amortized period for foreign expenses		15 years
Tax cuts and jobs act, increased capitalized research expenses		$ 21,000,000
Employee Retention Credit
Operating Loss Carryforwards [Line Items]
Expected one-time refund amount			$ 6,000,000
One-time refund amount received	$ 6,000,000
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards, Total		1,300,000,000
Expiring Operating Loss Carryforwards		$ 542,300,000
Net operating loss carryforwards expiration year		2024
Indefinite Operating Loss Carryforwards		$ 755,700,000
Taxable income limitation percentage for operating loss carryforward		80%
Deferred Tax Assets, Tax Credit Carryforwards, Research		$ 44,600,000
Research and development credit carryforwards expiration year		2024
State and Local Jurisdiction
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards, Total		$ 879,100,000
Net operating loss carryforwards expiration year		2028
Deferred Tax Assets, Tax Credit Carryforwards, Research		$ 21,700,000

Income Taxes - Summary of Unrec

Income Taxes - Summary of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Balance at beginning of year	$ 11,235	$ 9,631
Increase (decrease) for tax positions of prior years	(332)	(200)
Increase based on tax positions related to current year	0	1,804
Balance at end of year	$ 10,903	$ 11,235

Subsequent Event - Additional I

Subsequent Event - Additional Information (Details) - Subsequent Event - CrossLink Life Sciences, LLC	1 Months Ended
	Jan. 31, 2024 Representative
Subsequent Event [Line Items]
Term of distributor partnership	5 years
Number of representatives added to sales network	650