over the next four weeks we're gonna be
looking at opioids a class of drugs
originally derived from the opium poppy
we're gonna talk about the history these
drugs the science of how they work their
potential for abuse and how we help
people recover from addiction opioid
drugs can be very very dangerous but
they can also be extremely useful
according to one researcher and I'm
quoting to understand the popularity of
a medicine that eased even if only
temporarily
coughing diarrhea and pain one only
asked to consider the living conditions
at the time until the 20th century
cholera and dysentery regularly ripped
through communities its victims often
dying from debilitating diarrhea
diseases like dropsy consumption oq' and
rheumatism were very common opioids
could be used to treat all of these
things but the line between useful
treatment and harm is very blurry when
it comes to opioids and while they can
be very effective in some respects they
can easily become deadly the history of
opioids are the topic of this week's
healthcare triage
this episode is brought to you in part
with generous support from the National
Institute of Healthcare Management
humans have known about opioids and
their pain relieving and euphoria
inducing properties for a long long time
we've known about them pretty much as
long as we've been writing stuff down
and maybe even longer than that as far
back as 3400 BC records indicate the
poppy was grown in lower Mesopotamia
Sumerians called it Huell Gill or the
joy plant by 1300 BC Egyptians were
growing fields of it and the opium trade
was in full force all over the
Mediterranean world the Greek physician
Hippocrates who you might know from his
Hippocratic oath used opioids to treat a
number of diseases Alexander the great
but opium to Persia and India the 1300s
though opium sort of disappeared for a
couple centuries in Europe evidently the
Holy Inquisition didn't care too much
for its use opioids had some undesirable
social outcomes like addiction and
withdrawal and besides it came from
foreign lands and during the Inquisition
anything foreign was pretty much the
work of the devil by the 1500s though
smoking opium was picking up again in
Portugal laudanum was invented by swiss
polymath physician Paracelsus in the
late 16th century Paracelsus made his
laudanum with a bunch of weird
ingredients like crushed pearls and musk
but the real power of it was the potent
combination of opium and alcohol by the
1600s England started importing opium
from colonies in India by the 1700s the
Dutch in the English were shipping it to
China the Chinese ching dynasty emperors
tried to outlaw opium use but it was
unbelievably popular and it was
extremely profitable for the European
merchants who were importing the stuff
to China in fact it was so profitable
that the English were willing to go to
war with China not once but twice to
keep the opium trade in business not
only did these Wars allow the English to
keep the opium trade open in China they
set the stage for European powers to
force the Chinese to sign all kinds of
unfavorable trade deals the British got
an indefinite lease on Hong Kong for
example which they would hold on to for
over a hundred years not
the island of Chinese control until 1997
the 19th century saw a lot of advances
in the science of opioids in 1803
Friedrich sir Turner in Germany
discovered the active ingredient in
opium morphine he managed to extract
this active alkaloid which allowed for
much more potent opioids to enter the
market in 1827 a merkin company began
manufacturing morphine commercially and
in 1843 Alexander wood figured out that
you can inject morphine with a syringe
it was three times stronger when
administered that way these new opioid
drugs had even more analgesic power but
they also had more powerful side effects
including euphoria and the addiction
that could result from it in 1895
Heinrich Jesse of the Bayer company
discovered the diluting morphine with
the siedel's produced a drug with fewer
side-effects they coined the term heroin
and started producing it commercially a
few years later in the early 1900s free
samples of heroin were sent to morphine
addicts by mail to help them quit as you
can imagine this didn't work out so well
heroin addiction grew rapidly in a 1905
Congress banned opium use in the United
States in 1910 the Chinese convinced the
British to take down the India China
opium trade in the United States the
Harrison narcotics Act of 1914 took aim
at doctors to slow the use of narcotics
about ten years later the Treasury
Department's Narcotics Division banned
all legal narcotic sales this didn't
stop its use though an underground
economy and drugs arose to meet the
demand for illegal opium and heroin
throughout the United States these drugs
have become a growing source of profit
for organized crime during the 20th
century 1973 President Nixon had the
Justice Department create the Drug
Enforcement Administration to bring all
the power of Drug Enforcement into one
agency the war on drugs kicked into high
gear in the 80s and 90s the United
States tried to strangle the drug trade
wherever it was flourishing with
arguably little effect around this time
the most recent wave of opioid misuse
began in the medical community the
belief that use of opioids to control
pain might be safe and effective was
gaining traction in 1980 dr. Jane Porter
argued in the New England Journal of
Medicine that only four out of 12,000
patients
use narcotics became addicted another
study published in the journal pain in
1986 said there are only two of 24
patients who had used narcotics for
years that had any difficulties this
coupled with a growing recognition that
doctors were under treating pain led to
increased use by 1996 the American Pain
Society labeled pain the fifth vital
sign and any doctor will tell you that
pain measurement became an integral part
of any clinical visit the pharmaceutical
industry brought their weight to bear as
well they created and marketed new drugs
and funded lobbying organizations like
the American Academy of pain management
and the American Pain Society in an
attempt to ease the regulation of opioid
drugs but concerns began to arise that
pharmaceutical companies and researchers
were overstating the safety of these
medications in 2007 the maker of
oxycontin pled guilty to misleading
regulators doctors and patients about
the risk of addiction and potential for
misuse of the drug they were forced to
pay about 600 million dollars as a
result other narcotic manufacturers paid
huge fines for questionable marketing
and misleading claims about safety in
2003 the New York Times reported that
more than 20% of young adults abused
prescription pain medications in the
United States even so the drumbeat
continued for more and more treatment of
pain ironically we've been here before
in the United States this is actually
the third wave of opioid abuse in the US
the first occurred in the late 1800s
when Bayer started making heroin it was
being used more and more often for a
wide variety of health problems huge
amounts of money were being made and
misuse was rampant policy responded by
taxing the drugs regulating their use
and treating addiction more widely
following World War two the United
States saw a second wave of abuse
veterans of that war the Korean War and
the Vietnam War were addicted in large
numbers in response the government
passed laws allowing addicts to be
hospitalized involuntarily methadone
clinics were set up and the DEA began to
respond to the drug trade today we face
similar problems opioids now caused more
deaths than any other drugs people in
the United States consumed 99 percent of
the world's hydrocodone 80% of the
world's oxycodone and 65% of the world's
hydromorphone here's the problem pain is
real
it's undertreated far too often but
opioids are dangerous and it's becoming
clear that they don't work that well for
chronic pain we need to help people who
are addicted curb their overuse and also
find alternatives for people who are
suffering healthcare triage is supported
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donation we'd especially like to thank
our Research Associates Joe sevenths and
MT and our surgeon Admiral Sam thanks
Joe MT and Sam more information can be
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