The Opium Cycle

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Recently, Purdue Pharma filed for bankruptcy as part of a tentative multi-billion dollar settlement with state and local governments over lawsuits alleging that the company misled doctors and the public about the addictive nature of their well-known painkiller, Oxycontin.

But Purdue Pharma's story is part of a pattern that has repeated itself throughout the history of the opium trade. It's a pattern documented by the book Opium: How An Ancient Flower Shaped And Poisoned Our World by Dr. John H. Halpern and David Blistein. The cycle begins when an opium product proves devastating to users. Innovators come along, promising a safer alternative, and virtually every time, they downplay the risks of addiction. Addiction ensues. Then come new innovators, promising something better and less addictive, and the cycle continues.

This cycle, Halpern and Blistein recount, goes all the way back to Ancient Greece. Aulus Cornelius Celsus was a doctor famous for writing one of the world's first medical encyclopedias, which included a recipe for opium pills. He recommended it for insomnia, bad headaches, and joint pain. It didn't turn out so well. Opium addiction spread, and its victims included Roman emperor Marcus Aurelius.

Around 1000 AD, Persian physician Avicenna developed standard opium doses the size of chickpeas. Dose standardization helped prevent overdoses but opium addiction rose in Persia over the following centuries. Avicenna himself died of an opium overdose.

European opioid addiction started with the invention of Laudanum in the 1500s by a doctor, Paracelsus, who was an inspiration for Dr. Frankenstein. A concoction mixed with citrus juice, Laudanum allowed the body to metabolize its opioids more efficiently. Paracelsus swore that it was safe and effective, and people used it for all sorts of ills. It was sold without a prescription until the until the early 20th Century.

Around 1800, Austrian Friedrich Sterürner isolated morphine from opium for the first time. He sampled it on himself after a toothache. Friends followed. A few years later he realized just how addictive it was. Yet the scientific establishment lauded him with honorary degrees and awards. He died a morphine addict.

In the Victorian era, Charles Gabriel Pravaz and Alexander Wood invented the precision syringe. They assumed opium's addictive nature was due to the method of ingestion, not the poppy itself. If they could bypass the stomach — and its 'hunger' for opioids — then they would bypass addiction. Doctors also thought that morphine was local. They imagined that if they injected morphine, its effects wouldn't pass beyond the injection point. These assumptions, of course, proved to be exactly wrong. Pravaz tested the syringe with morphine on his wife. The exact facts are in dispute, but Blistein and Halpern write that she "developed a lethal fondness for morphine," and might have died of an overdose.

And perhaps the most shocking of all: In 1898, the pharmaceutical company Bayer marketed a cough suppressant with an active ingredient that supposedly lacked the addictive qualities of morphine, which by then was known to be wildly addictive. Those claims were wrong; that ingredient was... heroin.

And, now, here we are today. Manufacturers continue to develop new opioid painkillers and claim they're less addictive. But as we reckon with the ongoing opioid crisis, and as innovations in medicine advance, Blistein and Dr. Halpern's book Opium offers a warning. In the words of Aulus Cornelius Celsus: "The sweeter the dreams, the rougher the awakening."

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