The history of opiates goes back a long, long time, as long as the invention of writing. The popularity of opiates can be explained very easily if we understand the context in which they began to be used as medicines. Until the 20th century, diseases such as dysentery and cholera decimated entire populations, while others such as dropsy, arthritis, and tuberculosis kept much of the population bedridden, and opiates work for all of them. But as we saw in the previous post, the line between medicine and poison is as thin as it is blurred.
In 1827 morphine began to be marketed as a pain reliever, providing ten times more pain relief than opium, and in 1843 Alexander Wood discovered that it could be injected with a syringe, making it triple effective. These new drugs had great analgesic power, but as we have seen, they also have much more powerful side effects. In 1895 Heinrich Jesse of Bayer discovered that he could dilute morphine with acetyls (a molecule made up of two carbon atoms, three hydrogen atoms, and one oxygen atom), resulting in a drug with fewer side effects: heroin.
Thousands of free samples of heroin were sent out in the early 1900s to help addicts kick morphine. Of course, this only increased the number of heroin addicts to such scandalous numbers that in the early 1920s the United States Department of the Treasury prohibited the sale of all types of opiates within its territory. This put the medical community in a dilemma, which could not agree on the treatment of pain without causing a terrible addiction in patients (“terrible” is not an exaggeration, opiate addiction is a brutal situation). Thereafter, medical colleges restricted the use of opioids — the appropriate term in the US — to patients with cancer and chronic non-cancer pain, always sparingly.
This changed in the 1980s. In a letter published in The New England Journal of Medicine by Dr. Hershel Jick, where he describes in the results of a study on the use of opioids that “the development of an addiction is very rare in patients no prior history. Although it was a really small sample, the pharmaceutical industry used this letter and a lot of lobbying as justification to develop and market new and improved painkillers, the real painkillers, a term that was coined in the mid-s. XX to refer to morphine and heroin.
In 1987, the sale of heroin sulfate was approved, allowing doses every 12 hours instead of every 4 or 6, and in 1990 the first extended-release fentanyl patch went on sale, which releases the anesthetic in the patient’s bloodstream, and is still used today in the treatment of postoperative pain. In December 1995, the sale of Oxycontin, extended-release oxycodone, the true origin of the epidemic in the United States, was approved. Meperidine is another anesthetic analgesic that is widely used in postoperative pain, as well as in neuralgia and fractures.
Far above in the potency scale is hydromorphone, generally reserved for conditions that do not respond to other types of analgesics, since it binds to the μ (mu) receptor of the nervous system, which interrupts the biochemical processes that cause pain . More popular is fentanyl, an anesthetic painkiller that is used both in surgical procedures and in the treatment of chronic pain, and is currently sold so much in the US that there are presentations from dermal patches and nasal sprays, to candy lollipops. It is followed in potency by another μ receptor agonist, sufentanil, one of the most widely used drugs in operative processes, since in addition to the sedative effect it also causes local anesthesia. The most potent opioid currently known is etorphine, literally an elephant tranquilizer, and it is used almost exclusively as a sedative in large mammals as it is about 5,000 times more potent than morphine.
Despite the negative aspect of the impact of these drugs on society, it is really impressive how they have evolved to become a true arsenal in the fight against pain, wherever it comes from. It’s good to know that medical science is so advanced that if you die, at least it won’t be from pain.
An engineer
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He is a Computer Systems Engineer. His areas of knowledge are technologies, science and the environment.