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A Balancing Act – Opioid Use Throughout History

Nothing creates controversy in the migraine community quite like the topic of using opioid medications.  It doesn’t matter what the position or facts presented, someone will disagree. It is an emotionally-charged issue. So why take one more crack at it?

It is such an important issue. We can’t afford to stop talking about it just because it’s controversial. For some, the use of opioids can mean regaining a good quality of life. For others, it becomes a dark pit of addiction where the treatment is so much worse than the disease.

When I started reviewing all the information, it quickly became apparent that to cover the topic in any substantial way, more than one article would be required. So today, let’s examine some of the historical highlights regarding opioids. In future installments, we will explore the Risks of long-term use, Migraine-specific use, and end the series with the current Prescribing Guidelines from headache experts.

Ancient History

Opioids are derived from the poppy plant, Papava somniferum. This plant has been used throughout human history as both a medical treatment for pain and recreationally for its ability to create a sense of calm, euphoria, and relaxation. Poppy cultivation and use date back as far as 3400 B.C. Over the centuries, both rulers and healers have vacillated between encouraging its liberal use and trying to restrict its trade1,2.

Let’s take a look at some of the more recent highlights:

  • In the 1800s, laudanum was a common treatment for migraine. It was a combination of opium, sherry, and herbs first created by Thomas Seydneham in 16801.
  • German scientist, Friedrich Serturner, is credited with the development of morphine in 1803 when he dissolves opium in acid and neutralizes it with ammonia. Morphine received broad approval within the medical community. It was lauded as reliable, long-lasting, and safer than opium1.
  • The United States passed its first anti-drug legislation in 1890 by imposing a tax on morphine and opium1.
  • In 1895, a chemist working for what is now the pharmaceutical company, Bayer, developed heroin by diluting morphine with acetyls. It was lauded as an improvement on morphine, with fewer side effects. It became available to the public a few years later1.
  • By the turn of the century, heroin is promoted as a “step-down” treatment for morphine addiction. There are even attempts to mail heroin samples to morphine addicts1.
  • In 1923 the United States bans the sale or purchase of narcotics. A booming black market emerges1.
  • By 1970, the number of heroin addicts skyrockets as soldiers return home from Vietnam. In response, Nixon established the Drug Enforcement Agency (DEA) in 1973 to combat drug use, addiction, and trafficking1.
  • It wasn’t until the 1980s when physicians and researchers began to address the needs of patients with chronic, debilitating pain. As with other attempts throughout history, this one swung too far. Opioid abuse and fatalties rose1.
  • Since the early 1990s there has been an increase in the treatment of non-cancer pain with opioids. There has been a push to treat pain as “the fifth vital sign”. The idea that invisible pain is something to be treated was new. Hospitals and doctor’s offices started including “appropriate pain management” in their Patient Rights documents3.

A new era of pain management

If you’ve had any interactions with healthcare professionals, then you’ve noticed the new questions.

  • “Are you in any pain?”
  • “Rate your pain on a scale from one to ten.”
  • “What is an acceptable level of pain for you to feel comfortable with discharge?”

We have this new perspective on pain management to thank for our pain interviews. While it could get annoying, this change was refreshing. Finally doctors started taking our pain seriously! As a result, prescriptions for oxycodone quadrupled from 1997 to 20023.

The darker side

Unfortunately, during that same time opioid addiction and deaths from accidental overdose increased. Between 1985 and 2005, deaths from accidental overdose increased by 600%. More and more patients faced serious, life-threatening side effects while their pain increased. Liberal use of opioids in the treatment of chronic pain didn’t work out quite as well as hoped3.

By December 2014, opioids cause more deaths than any other drug category and hydrocodone became the most prescribed drug in the United States, making its citizens consumers of 99% of the hydrocodone in the world2. Yet there are still millions of chronic pain patients who are forced to face the day with excruciating pain because they are denied the very medicines that could help. Clearly, something is very wrong with how our healthcare system utilizes this effective, but risky class of medications.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Booth, Martin, (1996). A brief history of opium, Simon & Schuster, Ltd., retrieved 2/26/2015 at http://www.opioids.com/timeline/
  2. Frakt, Austin (12/24/2014). Opioid use and policy in the US, a history, The Incidental Economist, retrieved 2/26/2015 at http://theincidentaleconomist.com/wordpress/opioid-use-and-policy-in-the-us-a-history/
  3. Levin, Morris MD (2014). Opioids in Headache, Headache, 54(1): 1221, retrieved 2/15/2014 at http://www.medscape.com/viewarticle/819417_1.

Comments

  • Cheryl
    4 years ago

    After all else failed, I reluctantly started on Oxycontin 18 years ago and am still taking it. I started at 20 mg 3 times a day and progressed to 40 mg 3 times a day about 10 years ago. Yes, I am dependent on it as my body goes into excruciating withdrawals without it. My MD will not increase the dose so I take Motrin and Tylenol numerous times a day which creates a vicious cycle of rebound headaches I’m told but I wouldn’t know when one headache starts and the other one ends…I go to sleep with it and wake up with it. Peaks and valleys and triggers results in fluctuation in intensity. I’m at a point where the narcotic no longer helps with the pain so I take it just to prevent withdrawal symptoms. I’ve been looking into detox facilities and am told that “cold turkey” is the treatment for Oxycontin users. That is harsh and extremely difficult to do as I’ve done cold turkey before at the local ER when they gave me Seroquel and tramadol. I was not only in W/D and horrific pain, my speech was so slurred that I couldn’t communicate with the MD when he made rounds. After going 3 days in the hospital, I had no improvement so I lied to the nurse and told her I was better. I took myself off the Oxycontin only to be put back on 2 weeks later. As time has gone by I have developed aches in my bones and joints that are as constant as the headaches. There has got to be another option out there. I believe the death rate of oxycodone users is increased by people like me that would rather die than go through the withdrawals again. Anyone else in the same boat or know of a facility that will be gentle with me.

  • Candi
    4 years ago

    I suffer from migraine but am so lucky to be able to keep them under control with imitrex. My daughter suffers from chronic migraine and has yet to find anything that works for her. She’s lost 3 jobs, tried many, many drugs, botox, chiropractor, sinus surgery, neck surgery, still no relief. None of her doctors will prescribe opioid pain killers. It makes me feel like a terrible mother to push my daughter to find a dr. that will let her try some of these drugs to see if they will help her but I want her to get some of her life back. She has also been made to feel like a drug seeker when going to the ER and also when she picks up her prescriptions for her anti-anxiety medications. Opioids are not for everyone, but when they are used properly and they do work, I have no problem with anyone taking them.

  • mo
    4 years ago

    My experience has been very similar to your daughter’s. After 25 years of chronic migraine pain, the only thing that provides relief is opioids. I haven’t developed any kind of addiction to the morphine I am on. During my last ER visit the doctor refused to give me any opiod pain medication. I was offered nausea medication and a muscle relaxer, both of which I had at home. I rarely go to the ER, as it’s like playing roulette with what the doctor thinks will be effective. In a previous visit they had quickly treated my back muscle spasm with Dilauded. The hospital’s policy, I was told by the ER doctor, no longer treats migraines with opiod medications. If you can’t find relief from overwhelming pain in the ER, where do you go? Why was my back pain readily treated while my even more intense migraine pain was disregarded? Next time I will choose a different hospital. I didn’t like being treated like a drug-seeking addict!

  • Paulaff
    4 years ago

    Thanks for addressing this subject. As of now I have no preventive med, since we’ve tried everything according to my Dr (including Botox, acupuncture, & many drugs) & nothing really works. But, my Dr will allow me to have narcotic pain killers which are the only thing I’ve found that truly relieve pain. I cut the tablet in half & often that is enough. I’ve never abused or become addicted. I’m thankful that I finally found a Dr that will prescribe this.

  • PaulaJan
    4 years ago

    My pain Dr was sued for over-prescribing narcotics, was ACQUITTED of all charges after two years of legal wrangling and yet the ability to get pain meds in our state is virtually non existent. All docs are scared to death. I have had migraines for most of my life (I’m 60 yrs old) and opiods have been very helpful in pain management in the past. I get quarterly Botox now but have nothing effective to use for breakthrough pain. It is so very frustrating.

  • Motley
    4 years ago

    Thank you for this article. I have had migraines since I was 13. I am now 51. My pain is chronic although there have been wonderful reprieves. Like others, I have had many neurologists throughout the years. I avoid triggers as best I can and try to function without complaining. I have a high stress job which is very rewarding. Sometimes the triptans work but mostly they do not. I am on botox trials and they help somewhat. The only drug where I can get reprieve and can function is Fiornal. I am terrified about addiction and asked to limit the frequency and number I get. I have discussed it at length with my current Neurologist and he is the best one yet. I also have discussed my fears with my GP. However, Fiornal is for episodic pain not almost daily pain. I must take it almost daily – one a day. Addiction is in my family so periodically, I will try to manage the pain without it for a day or two to test whether withdrawal occurs. It hasn’t thank Goodness. During an episode where pain ramps to 8 or higher, I won’t take any more than 3 plus a gravol to try and knock me out and made a promise to myself that I would go to Emerg it is not working after 3 over a 6 -9 hour period. I faithfully fill my prescription and have asked only twice for it early b/c I was out of town. I live in a small community but have always dealt with the same pharmacy so any drug history is in one place. Like others, because it is an opiate – I feel like a criminal or judged when I pick it up. As well, I will avoid emerg, It was humiliating. – the time before last I was treated as drug seeking despite a very limited number of times in the ER. I actually said to the Nurse – ‘Do you have a problem or disbelieve why I am here? Check my charts or history’ I am not a frequent flyer. (My Neuro told me to vomit on their shoes the next time I get embarrassed.) The last time they were more compassionate but the treatment protocol (5 years between visits) says they can give only give me oxygen (which helps), an anti-nauseant and hydration which delays the treatment of the actual pain. As well, it had been so long since I had been in, I didn’t realize they would give morphine which makes my skin crawl and vomit (worked on the pain though) as does Demerol and Oxycodone. My pain is real and indeed it is in my head but the humiliation is as unbearable as the migraines. Has anyone had success with other drugs in an ER setting?

  • PaulaJan
    4 years ago

    Forget going to the ER. Unless you are having a stroke, ER personnel do not consider migraine an emergency. All I get at the ER is Toradal and Phenergan. No real pain relief, but sleep after shots. I have always been regarded as a drug seeker at ER, even though I SELDOM go there. Don’t go at all now as we have urgent care clinics where shots are given… I go in when Botox has worn off, every few months.

  • rebecca
    4 years ago

    I’ve been using opiates for my migraines since I developed chronic migraine, and this was long enough ago opiates were still considered viable treatment options for migraine. I have yet to find a triptan that works reliabily without side effects, and steroids don’t help at all. I can’t take Depakote or Topamax anymore, so opiates are pretty much all I’ve got to manage the pain.

    It took years, but I finally found a pain specialist who will work with me and give me the meds. The pain contract I had to sign has all kinds of hoops I have to jump through, and you don’t want to get me started on the inherently demeaning aspects of a pain contract. But at least I have the oxycodone for when I need it.

  • Herrenfam
    4 years ago

    I have suffered migraines for more than 25 years – since I was a young teenager. Starting about 10 years ago, triptans no longer worked at ALL for my migraine pain. I have worked with 7 neurologists since that time frame (including my latest neuro for the past 5 years) and while I’m on 1500 mg of Depakote and 75 mg of topamax, I still get 15-18 days of migraine pain a month. It wasn’t until about 18 months ago when my neuro prescribed me butorphanol (stadol) nasal spray that I finally got my life back. I went from spending days and weeks at a time on the couch, not being able to think or talk over the pain, to do nothing but listen to the tv and sleep t being able to live my life again with pin relief within 15 minutes. But I face such shame and misunderstanding by other medical professionals when I inform them I take it or every time I get it filled at the pharmacy. I’m tired of the pharmacy acting like the DEA has me on their top 10 list of opioid addicts lists (I have no addiction problems because I use the medication responsibly) just because I fill my script every 30 days for a 30 day script.

  • jess0410
    4 years ago

    It’s funny how much Judgment is made with this topic. I have had spinal Intractable migraine that started with a bad epidural over 2 years ago and unfortunately opiate therapy is about all that will touch them. But the judgements. … we all live in the same painful world. What works for some doesn’t work for others. Opiates are to treat pain. Give me a antibipolor med and watch me turn into Dr. Jeckel. No joke.

  • Jill M.
    4 years ago

    Tammy,

    Very interesting! I can’t wait to read the other three articles in the series. Great job! 🙂

  • Brian in TN
    4 years ago

    Hope I’m not stealing your thunder, but when discussing opioid use and abuse this study becomes very important: Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010
    Marcus A. Bachhuber, MD1,2,3; Brendan Saloner, PhD3,4; Chinazo O. Cunningham, MD, MS5; Colleen L. Barry, PhD, MPP3,6
    Conclusions and Relevance Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
    http://archinte.jamanetwork.com/article.aspx?articleid=1898878
    One must consider that making cannabis available to patients and doctors treating chronic pain conditions has been the singularly most successful program, for reducing problems associated with opioids, in the history of pain management in the US. It should also serve to reduce the pressure on physicians to withhold opioids from patients who can safely use them for pain management.

  • Jules2dl
    4 years ago

    This is a touchy subject with me as well. I’ve used various opioids since I was 14. I’ve never abused them, never become addicted to them. They help my migraines…and I can’t get a prescription even for Vicodin/oxycodone now. My docs don’t approve of opioid use, so when I have a migraine now, if Migranal doesn’t work, I have nothing to fall back on to help the pain. I used to have dexamethasone (a steroid), but have experienced some jawbone necrosis which the docs think was caused by this drug, so I can’t take it any more. I feel as though I’m walking a tightrope without a safety net! The only other drug I can use now is Haldol, which doesn’t help the pain at all, it just knocks me out. I have to stay in bed when using Haldol, and it kills me to know that if I had some oxycodone, I could take that and still function well while obtaining pain relief. It makes me angry to be seen as a drug-seeking junkie by my docs, when all I want is some pain relief and the ability to get through my day. HARRRUMPH!!!

  • jess0410
    4 years ago

    I feel you. I went through the same thing except I wasn’t going to suffer. You have the right to find a new doctor one who won’t treat you based on what the believe is right but by what works for you.

  • Nancy Harris Bonk moderator
    4 years ago

    Tammy,

    Fabulous! Thank you so much for this article. I’m looking forward to the rest of this series.

    Nancy

  • edivon
    4 years ago

    I did like you article, wish it would go farther and help us handle this wide-spread problem. I’ve been on almost all drugs used for migraines in my 50 years of experience, but the opioids are dependable and you know how to use them for greatest effectiveness. Nothing works like this for a rescue drug. After safely using for 30 years, doctors won’t prescribe anymore. It’s not me, they say, just being careful.

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