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.
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