Opioids

History of Opioid Use

One of the first references to the medical use of opium was by the Greek, Theophrastus, who, at the beginning of the third century B.C., spoke of meconium, which was composed of the extracts of the stems, leaves, and fruit of Papaver somniferum. Parcelus (1490–1540 A.D.), a famous physician from the Middle Ages, used opium often, and his followers were equally enthusiastic. Thomas Sydenham, a well-known physician of the 17th century, described the treatment of a series of dysentery epidemics that occurred in 1669–1672:

“And here I cannot but break out in praise of the great God, the giver of all good things, who hath granted to the human race, as a comfort in their affliction, no medicine of the value of opium, either in regard to the number of diseases it can control, or its efficiency in extirpating them.”

(Latham RG, The Works of Thomas Sydenham, Syndenham Society, London, 1848.)

However, just as early as the description of the beneficial medical effects of opioids, the phenomenon of opioid withdrawal was described. Dr. John Jones was very candid in his account from 1700: “A return of all diseases, pains and disasters, must happen generally, because the opium takes them off by a bare diversion of the sense thereof by pleasure.” Such a description presaged the ultimate dilemma with opioids. They have tremendous beneficial medical effects accompanied by significant side effects, the most devastating of which are opioid addiction and chronic uncontrolled use.

FIGURE 5.1 Papaver somniferum L. [From: Bentley R, Trimen H. Medicinal plants: being descriptions with original figures of the principal plants employed in medicine and an account of the characters, properties and uses of their parts and products of medicinal value. Churchill, London, 1880.]

The history of opioid abuse in the Western world began with the spread of opium from the Middle East to Europe and the Orient. Europeans traded opium for tea from China through the British East India Company. British merchants smuggled opium into China to balance their purchases of tea for export to Britain. The Chinese realized the marked addictive properties of opium and attempted to stop the trade practice, ultimately resulting in the Opium Wars of the 1840s, the outcome of which was a British victory. The British were ceded Hong Kong from the Chinese, and the Chinese ports were opened to the opium trade. As a result, the importation of opium to China was legalized. Opium use then spread to the United States and elsewhere with the immigration of Chinese laborers. Unlimited opium use in the United States contributed to the passage of the Harrison Narcotics Act in 1914 and, the social marginalization of opioid use and development of heroin addiction.

Heroin addiction remains a substantial medical problem in the United States, and prescription opioids present a growing medical problem. The 2011 United States National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration estimated that 4.2 million people aged 12 and older had ever engaged in heroin use (1.7%), and 34.6 million people aged 12 and older had ever engaged in the use of analgesics (13.5%). Additionally, 0.62 million people aged 12 and older were last-year users of heroin (0.2%), and 11.1 million people aged 12 and older were last-year users of analgesics (4.3%). Notable statistics from the survey included the following. In 2011, of those people aged 12 or older who ever used in the last year, 0.43 million (65.5%) showed heroin abuse or dependence, and 1.8 million (16.5%) showed analgesic abuse or dependence (Substance Use Disorder based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM-5], criteria). Of those who ever used in the last year, 0.37 million (57%) showed heroin dependence, and 1.4 million (12.7%) showed analgesic dependence (DSM-IV criteria).

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