The Doctors Who Started the Opioid Epidemic

By refusing to accept their inability to separate pain relief from addiction, physicians have long suffered the sin of hubris—and their patients have paid the price.

On January 16, 2016, Gina Kolata and Sarah Cohen, writing for the New York Times, offered up some grim news: “The rising death rates for young white adults make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.” The reason: opioid addiction. The biggest culprit: doctors. By refusing to accept their inability to separate pain relief from addiction, physicians have long suffered the sin of hubris—and their patients have paid the price.

It started with humankind’s first medicine.

About 6,000 years ago, the Sumerians discovered opium. One of the first clinicians to recommend it was Hippocrates, the Father of Modern Medicine, who used opium to treat nausea. But it was an unknown contemporary of Hippocrates named Diagoras of Melos who first noticed that many of his fellow Greeks had become addicted to the drug. Diagoras’s warnings were ignored.

Opium users became opium addicts.

In 1803, Frederich Sertürner, a 20-year-old German chemist, purified opium’s most active and most abundant ingredient. He called it morphium after the Greek God of Dreams. Sertürner hoped that by purifying opium’s main ingredient, he could separate pain relief from addiction. While conducting his studies, Sertürner became addicted to the drug. Like Diagoras of Melos, he warned against its use. Again, no one listened. In 1827, the German pharmaceutical company Merck began mass-producing Sertürner’s drug.

Opium addicts became morphine addicts.

In 1874, C.R. Alder Wright chemically modified morphine to produce diacetylmorphine. He fed it to his dog, which became violently ill and frighteningly hyperactive. Wright published his findings in an obscure scientific journal. For 20 years, no one noticed the powerful drug that Wright had created.

In 1985, Heinrich Dreser, a chemist working for a pharmaceutical company in the Rhineland named Bayer, discovered Wright’s paper. Dreser found that diacetylmorphine entered the brain five times more efficiently than morphine. He reasoned that because lesser quantities of this drug could relieve pain, it would be less addictive. He tested diacetylmorphine on a few workmen in his company and a handful of local patients. After four weeks of observation, no one appeared to be addicted—at last, a non-addictive, potent painkiller. Bayer named the drug for its heroic properties.

Morphine addicts became heroin addicts.

In the early 1900s, German researchers chemically modified thebaine, another component of opium. They called it oxycodone. In the early 1950s, oxycodone entered the United States. The most potent, most addictive, and most deadly preparation of oxycodone was OxyContin, which was manufactured by Purdue Pharmaceuticals and licensed in 1995. Purdue later hoped to reduce the number of daily doses by offering a time-released preparation. However, by chewing the product, users could bypass the time-released mechanism and ingest as much as 160 milligrams of oxycodone at one time, a potentially lethal dose.

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June 2017
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