History of
Opioid Use
& Abuse
We know that 3400 years ago the Sumerians of Mesopotamia were growing poppies, which they called Hul Gil or "joy plant" (see Opioids and the Treatment of Chronic Pain by Rosenblum et al., in the History of Opiods). Gradually its use spread throughout Asia and Europe to treat many problems. Morphine was first extracted from opium in Germany in 1803. Alexander Wood, a Scottish physician, invented the first hypodermic syringe used exclusively to administer morphia and opium preparations to treat neuralgia. He published his method in 1855. Sadly, Dr. Wood's wife was the first known intravenous morphine addict and she died of an overdose using her husband's invention.
The first useful description of morphine addiction and withdrawal symptoms was produced by Dr. Eduard Livenstein in Germany, who claimed morphine craving was a physiological response. Elixirs, cough suppressants and even beverages containing opium were marketed freely, and they were the best pain treatment option on the battle field during the Civil War. By the late 1800's two-thirds of opioid addicts (including morphine, laudanum and opium) were middle and upper class women, due to over-prescribing the drugs for “female troubles.” Attempts to treat the addictions that arose led to the development of sanatoriums across the country. Heroin, a synthetic form of opium, was introduced as a cough suppressant in 1898, and attracted many new abusers. By the early 20th century the user stereotype had shifted from the housewife or veteran, to the criminal classes coinciding with the increase in European immigrants who were populating the tenements and ghettos.
During WWII there was a decline in opioid addiction as port security increased, clamping down on trafficking the product to the US. Demographic shifts marked by the people of European extraction moving from cities to the suburbs, while Blacks and Hispanics moved into places where rampant abuse was already established. Class and ethnic prejudices were attached to opioid use which are still held, even though the problem is growing most among middle class, white people at present. American youths discovered they could induce an intense euphoria when the pills are crushed and then inhaled or injected, so abuse/addiction was rising among the middle class during the 1960s. During the 1970s during the Viet Nam era, estimates ranged from 1/4 to 1/2 of enlisted Americans using or becoming addicted to heroin. Interestingly, the epidemic of heroin addiction feared to follow returning Vets never occurred, suggesting an psycho-social environmental component to addiction, as the worse of the drug use epidemic stayed in Viet Nam.
An estimated half million American were using heroin and other illicit opioids in the 1980s. This grew to almost 890,000 estimated to being using/abusing heroin by the end of the 1990s. About 200,000 sought treatment. With admissions and emergency room visits for opioid related issues doubling between 1992 and 2001, notice was being given. This author recalls the seminal article The Tragedy of Needless Pain in Scientific American (R. Melzack, 1990 previously described) after which there was an increase in opioid use to treat chronic non-malignant pain (CNMP). The debate rages today, but the key is "how" you do pain management with drug therapy. There are risks with every treatment, and the goal is to control the risk to the extent that it is still reasonable to provide treatment. And, there are people in need of opioid therapies for their pain.
Read on for information about opioid addiction treatment in the next section.
The first useful description of morphine addiction and withdrawal symptoms was produced by Dr. Eduard Livenstein in Germany, who claimed morphine craving was a physiological response. Elixirs, cough suppressants and even beverages containing opium were marketed freely, and they were the best pain treatment option on the battle field during the Civil War. By the late 1800's two-thirds of opioid addicts (including morphine, laudanum and opium) were middle and upper class women, due to over-prescribing the drugs for “female troubles.” Attempts to treat the addictions that arose led to the development of sanatoriums across the country. Heroin, a synthetic form of opium, was introduced as a cough suppressant in 1898, and attracted many new abusers. By the early 20th century the user stereotype had shifted from the housewife or veteran, to the criminal classes coinciding with the increase in European immigrants who were populating the tenements and ghettos.
During WWII there was a decline in opioid addiction as port security increased, clamping down on trafficking the product to the US. Demographic shifts marked by the people of European extraction moving from cities to the suburbs, while Blacks and Hispanics moved into places where rampant abuse was already established. Class and ethnic prejudices were attached to opioid use which are still held, even though the problem is growing most among middle class, white people at present. American youths discovered they could induce an intense euphoria when the pills are crushed and then inhaled or injected, so abuse/addiction was rising among the middle class during the 1960s. During the 1970s during the Viet Nam era, estimates ranged from 1/4 to 1/2 of enlisted Americans using or becoming addicted to heroin. Interestingly, the epidemic of heroin addiction feared to follow returning Vets never occurred, suggesting an psycho-social environmental component to addiction, as the worse of the drug use epidemic stayed in Viet Nam.
An estimated half million American were using heroin and other illicit opioids in the 1980s. This grew to almost 890,000 estimated to being using/abusing heroin by the end of the 1990s. About 200,000 sought treatment. With admissions and emergency room visits for opioid related issues doubling between 1992 and 2001, notice was being given. This author recalls the seminal article The Tragedy of Needless Pain in Scientific American (R. Melzack, 1990 previously described) after which there was an increase in opioid use to treat chronic non-malignant pain (CNMP). The debate rages today, but the key is "how" you do pain management with drug therapy. There are risks with every treatment, and the goal is to control the risk to the extent that it is still reasonable to provide treatment. And, there are people in need of opioid therapies for their pain.
Read on for information about opioid addiction treatment in the next section.
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