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God’s Own Medicine

Feature

Paul Offit

Skeptical Inquirer Volume 41.2, March/April 2017

In 2008, overdoses from opium-based painkillers surpassed motor vehicle accidents as the most common cause of accidental death in America. The reason: we’ve failed to learn from history.

About 6,000 years ago, around the time of Abraham, the Sumerians settled between the Tigris and Euphrates Rivers. They invented cuneiform writing. They invented farming. And they discovered a plant called “hul gil,” or “the plant of joy.” Carl Linneaus, an eighteenth-century botanist, called it Papaver somniferum. William Osler, the founder of Johns Hopkins Hospital, called it “God’s own medicine.” Today we call it the opium poppy.

One of the first to embrace opium was Hippocrates, who used it to treat insomnia. But it was a relatively unknown contemporary of Hippocrates named Diagoras of Melos who was the first to notice that many of his fellow Greeks had become addicted to the drug—hopelessly addicted. He warned against its use as opium users became opium addicts.

Two thousand years passed.

In 1803, Frederich Sertürner, a twenty-year-old German chemist, purified opium’s most abundant and most active ingredient. He called it “morphium” after the Greek God of Dreams: Morpheus. Sertürner found that morphium was six times more powerful than opium. He reasoned that with lesser quantities of the drug required to relieve pain, fewer people would become addicted. It didn’t work out that way. When he finished his studies, he was addicted to morphine. Sertürner warned, “I consider it my duty to attract attention to the terrible effects of this new substance I called morphium in order that calamity may be averted.” Again, no one listened. Within thirty years, the German pharmaceutical company Merck began mass-producing the drug, calling it morphine.

Opium addicts became morphine addicts.

In 1874, C.R. Alder Wright took the next step. He boiled morphine with the reactive form of acetic acid, producing a grey-white powder with the chemical name diacetylmorphine. Wright believed that he, too, had created a nonaddictive form of the drug. So he fed it to his dog, who became violently ill and frighteningly hyperactive. Wright threw the powder away—but not before publishing his findings in the Journal of the Chemical Society of London. Twenty years passed before anyone paid attention to Wright’s new compound.

The first to pick up on Wright’s experiment was a young chemistry professor named Heinrich Dreser who worked for a pharmaceutical company in the Rhineland named Bayer Laboratories. Dreser found, as had Wright before him, that diacetylmorphine was five times more potent than morphine and crossed the blood-brain barrier much more efficiently; as a consequence, lesser quantities of the drug were necessary to relieve pain. Dreser believed that he, too, had created a nonaddictive pain reliever. So he fed diacetylmorphine to rats, rabbits, a few workmen in his company, and a handful of local patients. Everyone seemed to love the drug, and no one had become addicted after four weeks of observation. Dreser was certain that he had stumbled upon the Holy Grail of pain relief.

In September 1898, Heinrich Dreser presented his findings to the 70th Congress of German Naturalists and Physicians. Even though he had no evidence to support his claims, Dreser said that diacetylmorphine could treat colds, sore throats, headaches, and severe respiratory infections. Dreser also believed that he had created the perfect drug to treat morphine addiction. Attendees at the meeting gave him a standing ovation.

At first, Bayer couldn’t decide what to name its new blockbuster drug. Some executives wanted to call it wunderlich, meaning miracle. Others wanted to call it heroisch, meaning heroic. The second group won out. In 1898, Bayer executives launched their new drug at the same time that they launched Bayer Aspirin. They called it Bayer Heroin. Because clinicians feared that aspirin might cause gastritis, the drug was available by prescription only. Heroin, which was believed to be safe, was available over the counter. In 1900, Eli Lilly, working in collaboration with Bayer, began distributing heroin in the United States. Clinicians embraced the drug. In 1906, the American Medical Association recommended heroin for the treatment of “bronchitis, pneumonia, consumption [tuberculosis], asthma, whooping cough, laryngitis, and certain forms of hay fever.”

Morphine addicts became heroin addicts.

It was back to the drawing board. Certainly there must be some way to separate pain relief from addiction. Again, scientists turned to opium. This time, however, they turned away from morphine. Although morphine is the most powerful component in opium, it isn’t the only component. Opium also contains codeine (methlymorphine), a mild analgesic and cough suppressant; alpha-narcotine and papaverine, two muscle relaxants; and thebaine, which was named for Thebes, a town in Egypt where the opium poppy was grown. Thebaine formed the basis of the next attempt to separate pain relief from addiction.

The first synthetic version of thebaine was produced in 1916 by two German chemists working at the University of Frankfurt. They called it oxycodone, an opioid. (By definition, an opiate is a drug obtained directly from opium, such as morphine; an opioid is an opiate that has been synthetically modified, such as heroin or oxycodone.)

Oxycodone made its American debut in the early 1950s in combination with aspirin (brand name Percodan), ibuprofen (Combunox), or acetominophen (Percocet). But the most addictive, most abused, and most deadly form of the drug was pure oxycodone offered in a time-released preparation called OxyContin, which was manufactured by Purdue Pharmaceuticals. By chewing the drug, users could bypass the time-release mechanism and ingest as much as 160 milligrams of oxycodone—a lethal dose of the drug. (Ironically, on a weight-by-weight basis, oxycodone is actually more powerful than morphine.)

Heroin addicts became opioid addicts.

In 2002, a survey taken at a high school in rural Michigan found that 98 percent of students had heard of OxyContin and 9.5 percent had tried it.

In 2003, Rush Limbaugh, who had mocked drug abusers on his radio show for being morally bankrupt, admitted that he was addicted to OxyContin.

In 2004, three million people were using OxyContin, the most prevalent prescription painkiller in the United States.

In 2007, 14,000 people in the United States died from prescription painkillers, a problem that cost the health care and criminal justice systems more than $55 billion.

In 2008, 15,000 people died from prescription painkillers, the leading cause of accidental deaths in thirty states.

In 2009, health insurers spent $72 billion in direct healthcare costs related to the treatment of addiction to painkillers.

In 2010, more people died from prescription painkillers than from heroin and cocaine combined.

In 2012, 12 million Americans reported the recreational use of prescription painkillers.

In 2014, retail pharmacies dispensed 245 million prescriptions for painkillers. About 2.5 million adults were addicted to the drug.

In 2015, 19,000 people died from prescription painkillers. More young people died from opioid overdose than from motor vehicle accidents.

Today, the United States, which contains 5 percent of the world’s population, uses 80 percent of the world’s painkillers.

On January 16, 2016, Gina Kolata and Sarah Cohen, in an article for the New York Times, stated, “The rising death rates for young white adults make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.”

On March 15, 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines to physicians in an attempt to control the raging epidemic of opioid abuse. The CDC recommended that doctors should prescribe opioids, 1) only after nonprescription painkillers and physical therapies have failed; 2) in quantities not to exceed a three-day supply for short-term pain; and 3) only when improvement was significant.

In the end, the medical profession’s stubborn belief that it can separate pain relief from addiction has created a problem that will take decades to undo.

Paul Offit

Paul A. Offit, MD, is a professor of pediatrics in the division of infectious diseases at the Children’s Hospital of Philadelphia and the author of Pandora’s Lab: Seven Stories of Science Gone Wrong (National Geographic Press, April 2017). He is a fellow of the Committee for Skeptical Inquiry.