The medical community has been dealing with addiction to opioid-based pain medication for over 150 years. It is not a new issue. It has only been in recent years that the rate of addiction has reached crisis proportions. In 2016 alone, opioid overdose claimed 42,000 lives – more than the number of those lost to breast cancer. Lawmakers at both the federal and state levels have begun acknowledging the problem, and legal action against opioid manufacturers is moving forward, but this has only slowed the trend. The opioid addiction crisis has been decades in the making, and there are no quick, easy solutions.
The history of opium can be traced back over five millennia. Archaeologists have found evidence of opium cultivation in present-day Iraq, dating back to approximately 3400 B.C.E. The Sumerians who inhabited the region at the time knew of the opium poppy as the “joy plant.” Cultivation of opium spread from Sumer to Egypt and Central Asia and India, eventually finding its way to China as its properties became known and demand for the product grew.
The modern history of opium begins in 17th Century Europe when physicians began administering opium to patients in order to help relieve pain. However, even though pain management has been a medical issue since time immemorial, very little was understood about it. There were also philosophical issues and attitudes that seem odd, and even cruel by modern standards. In a 2003 article, “A Capsule History of Pain Management,” UCLA medical historian Marcia Meldrum writes, “[Physicians] inflicted it when necessary, to relieve evil humors...the physician valued pain as a symptom, a sign of the patient's vitality, of the prescription's effectiveness.”
By the 1830s, morphine, a derivative of opium, was being produced in the U.S. and was becoming a standard treatment for injury as well as chronic pain. The first use of morphine on the battlefield was during the American Civil War, and a significant number of wounded combat soldiers became addicted as a result. It did not help that an abundance of over-the-counter products containing opium derivatives was available at pharmacies throughout the late 19th Century. Then, in 1898, a German pharmaceutical company known as Bayer began the manufacture of a new, more powerful opiate. Hailed as a “wonder drug,” heroin was little understood. Nonetheless, it was easily available as a form of cough medicine as well as a pain reliever.
By 1914, growing concern about opioid abuse led to the passage of the Harrison Narcotics Tax Act, which imposed steep taxes on the manufacture, importation, and sale of opiates. By the early 1920s, the medical profession finally realized the dangers of opiate addiction. By 1924, the manufacture and sale of heroin in the U.S. were outlawed.
For the next seventy years, doctors were reluctant to prescribe opioid-based medications for pain, turning to alternatives as much as possible and prescribing opiates only as a last resort. Things began to change in the 1970s with the introduction of Vicodin and Percocet. In 1980, Dr. Hershel Jick and his graduate assistant, Jane Porter, published a brief letter in the New England Journal of Medicine. The letter described their observations of nearly 12,000 patients who had been given opiate-based medications for pain management, in which they noted that only four of the patients had become addicted. They concluded that “despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”
That letter was a game-changer. Over the next quarter-century, pharmaceutical companies, as well as members of the medical community, cited the “Porter-Jick Letter” as “evidence” that the dangers of opioid addiction were minimal. According to a recent analysis by Canadian researchers, the Porter & Jick letter has been cited well over 600 times since its initial publication as evidence that opioids are non-addictive.
These citations have been made by researchers and marketers who fail to note that: (i) the letter did not constitute clinical research, and (ii) the observations were of hospital patients who were taking opioid prescriptions under close medical supervision. Those who did the analysis of these citations “believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy.”
By the mid-1990s, the damage was done. In 1996, Perdue Pharma won approval for a new, powerful opioid medication known as OxyContin. Over the next several years, an aggressive marketing campaign resulted in an exponential growth in the number of OxyContin prescriptions being written. In 2007, however, the Perdue executives were charged with misbranding the product and minimizing the addiction risk. The company ended up paying a settlement to the U.S. government in the amount of $635 million.
Today, prescription opioids are being recognized as the true “gateway drug.” Various states have enacted legislation to limit the amount of opioid medication a patient can receive, while Purdue – arguably, one of the primary culprits in creating the current crisis – has announced an end to opioid marketing and has cut back its physician sales staff by 50 percent.
Unfortunately, the damage done by nearly four decades of misinformation and corporate greed will not be reversed anytime soon.