A Road to Destruction—from Opium to OxyContin

For centuries now, opium has been used for pain relief. Its earliest use as a ‘joy plant’ and analgesic (pain relieving drug) is thought to have occurred in 3400 B.C. in the great lands of Mesopotamia. The science of poppy cultivation and culling would pass on from Mesopotamia to Egypt by 1300 B.C. During this time, opium trade flourished on both sides of the Mediterranean. In the footsteps of Alexander the Great, on his fateful trip out East, opium came to India in 330 B.C. Before Cleopatra the Great was born, opium was cultivated and used all across ancient Egypt, Greece, Roman, Persian, Arab and Indian empires. 

In over 5,000 years of its history, opium has been used all along for its analgesic properties despite being addictive by nature. On one hand were the pleasure seekers, hopelessly addicted hedonists, and on the other, the health seekers. And, irrevocably the twain met at addiction. In the ancient world, opium made surgeries possible and was used to treat a variety of health conditions. Amongst other diseases it was used to cure were cholera, dysentery, diarrhoea, insomnia, bronchitis, tuberculosis, and other respiratory illnesses.

Opium flowers. Picture taken from Pinterest.

At the beginning of the 19th century, opium’s story would take a prophetic turn. In 1805, at the age of 21, German pharmacist Friedrich Wilhelm Adam Sertürner succeeded in purifying and isolating the analgesic and sleep-inducing agent of opium—morphium—named after the Greek God of dreams, Morpheus. He experimented on his dogs as well as himself, perfecting the range of safe dosage through trial and error, and did not like what the drug did to his animals. It made them pass out and they later woke up aggressive and agitated suffering from fevers and diarrhoea. The dogs were dope sick, experiencing withdrawal symptoms. 

In 1810, addicted to morphine Sertürner wrote prophetically ‘ I consider it my duty to attract attention to the terrible effects of this new substance in order that calamity may be averted.’ 

It appears not many were paying attention. Though first published in 1805, the study did not get much traction until the following decade. Sertürner’s warning seems to be ignored, and 22 years after morphine was isolated, it was first sold commercially by another German apothecary—Heinrich Emanuel Merck of Darmstadt.

In the mid-nineteenth century, in the wake of the American Civil War, hundreds and thousands of soldiers were addicted to morphine. No prescription was necessary and it was standard practice for doctors to leave behind morphine and hypodermic needles (invented in 1853) for the convalescing soldiers. In fact, dope-sickness caused by morphine addiction had a name i.e. “soldier’s disease.” The desperation of the times was manifested as the scourge of morphine addiction spread, striding from ailing soldiers to their near and dear ones ravaging communities. 

There was a pressing need to identify non-addictive alternatives to morphine.

Morphine was the first ever plant alkaloid to be isolated and its purification and discovery led to a burst in pharmacology research into opium alkaloids. By the late 1880’s diacetylmorphine was one amongst many identified opium alkaloids. At Bayer’s pharmacology lab, Heinrich Dreser played an important role is characterising its properties and pitching it as an improved alternative to morphine. Research, at the time, claimed diacetylmorphine to be inferior to morphine in its addictive and pain-relieving powers though it was uniquely able to both slow and deepen respiration thus bringing relief from an irritable cough. Thus desirable over morphine, there was a push to make it commercially available.

We all know of diacetylmorphine as heroin—a molecule twice as potent as morphine and has 20 times the strength of opium.

Bayer , in 1898, became the first company to release heroin as a pill. It was marketed as a family drug; safe for treating myriad disorders ranging from asthma to joint pains. And curiously, it came with an assertion, that it would cure morphine dependency!

Picture credit: NYT, April 21, 2018

Early claims by researches as to heroin’s “weakness” when compared with morphine were fallacious. Errors in scientific judgement and misguided enthusiastic marketing together with the unregulated availability of opium derivatives led to America’s first opioid crisis. A recent NYT editorial gives us some numbers: at the turn of the 20th century approximately 300,000 people were addicted to opium and derivates. 

Elsewhere in the eastern hemisphere, China was losing the opium wars to the East India Company. The shrewd British used opium as a war weapon. An addicted population could not protect its own interests and the ruling Qing dynasty weakened. At the turn of the 20th century, nearly 16.2 million Chinese people were addicted to opium. 

In the first decade of the 20th century, the United States led the world in per capita consumption of habit-forming drugs, i.e. opium, morphine, heroin and cocaine from the coca plant. The gravity of the situation prompted the then President Roosevelt to appoint Hamilton Wright as the first Opium Commissioner of the United States in 1908. In the ensuing years, America would pass two legislations aimed at arresting the epidemic; the 1914 Harrison Narcotics Tax Act , that regulated and taxed the production and distribution of opiates, and the more severe Anti- Heroin Act of 1924 , which banned the importation and possession of opium for the synthesis of heroin.

The laws were effective to curb the scourge of addiction but elimination was not to be. One aftermath of the legislation was the creation of ba lack market for drugs; sale was outlawed but people still needed their fix. In the US, the ebb and flow of painkiller mediated addiction has been a constant over the last century and a half but never was it as severe as in the late 1800’s and early 1900’s. 

But, the future is history. 

In late October 2017, the United States of America declared its current opioid addiction crisis a national public health emergency. In 2016 alone 64000 people died from a drug overdose. In 2017, the number of lives lost climbed to 72,000. This epidemic is yet to peak. 

The seed of the current crisis was sowed in 1996 when Purdue Pharma, a Connecticut based pharmaceutical company, got the green light to release the painkiller OxyContin into the US market. 

OxyContin is nothing but oxycodon, an opium alkaloid derivate, first synthesised in Germany in 1916. More sinister than either morphine or heroine, its usage was restricted to end of life care and extremely painful cancer treatments. This distinction is critical as it was never meant to be prescribed for chronic (day to day) pain management due to its addictive prowess. That is until Purdue Pharma came along, reformulated and repackaged it as OxyContin, and claimed that in its new form, the drug was less than one per cent addictive and provided smooth and sustained pain control all day. This was a blatant lie but it allowed Purdue Pharma to push the drug as safe for consumption. FDA oversight, faulty aggressive marketing, greedy doctors and sales personnel came together to target vulnerable people precipitating this man-made disaster.

In the United State, since 1999, at least 200,000 people have died from an overdose caused by prescription pain-killers. Despite the phenomenal loss of life, oxycontin production and sale, amongst other equally vile drugs, marches on. As America course corrects, the owners of Purdue Pharma—driven by greed—are all set to spread oxycontin’s poisonous tentacles to other countries. 

It is imperative that countries across the world learn from America’s grave missteps and protect their people. To write a new clean future is up to us.