Opium
Opium is a potent substance derived from the opium poppy and has been utilized since ancient times for its medicinal properties, particularly pain relief and anxiety reduction. Historically, opium was primarily viewed as a healing agent, with early physicians documenting its benefits long before it became associated with recreational use. The introduction of opium to China in the 15th century marked a shift in its application, as it began to be smoked for euphoric effects, leading to addiction among some users. In the late 19th century, significant advancements in pharmacology resulted in the isolation of key opium derivatives such as morphine and codeine, which became widely prescribed in the United States.
However, the rise of opioid addiction led to strict regulations, particularly following the Harrison Act of 1914, which aimed to control opiate distribution. The ongoing opioid epidemic, marked by alarming overdose rates, has prompted health organizations to address the crisis, particularly given that a significant proportion of overdose deaths involve opioids. While opiates are essential for pain management, their side effects and potential for addiction necessitate careful monitoring and responsible prescribing practices. The complexities of opioid use highlight the delicate balance between providing relief for those in need and mitigating the risks associated with their abuse.
Subject Terms
Opium
Definition: Opium is a narcotic drug produced from the poppy plant that binds to specific opioid receptors in the central nervous system to relieve pain.
Status: Legal with a prescription; illegal as the street drug heroin
Classification: Schedule I and II controlled substances
Source: Dried latex of the outer skin of the poppy plant (Papaver somniferum)
Transmission route: Oral, intravenous, intramuscular, parenteral, transdermal, rectal, inhalant
History of Use
Opium is processed in a manner that has changed little from fifth-century methods. Ancient peoples too used the plant to alleviate pain and anxiety and to perform minor surgeries. Early civilizations wrote about the healing powers of opium, as did such early physicians as Dioscorides, Galen, and Avicenna. Throughout these times, written records indicate that opium was considered primarily a healing tool and not a recreational drug.
China was the next great civilization to be introduced to the opium plant through trade with the Islamic world around the fifteenth century. The Chinese also used opium for medicinal purposes, but as opium use spread, people began to find a new use for the plant. The gummy rolled-up balls of the poppy plant, which resemble clay, were smoked in special pipes that circulated air under the opium balls. The result was a euphoric and hallucinogenic experience. While smoking opium was by no means epidemic, it was popular and highly addictive.
By 1900, Friedrich Sertürner had isolated morphine from opium, Pierre Jean Robiquet had discovered codeine, and opium and opium derivatives were becoming the most popular medicines in the United States. Produced by Bayer, Heroin (the brand name) was given to children as a cough syrup. Laudanum, a tincture of opium, was one of the most highly prescribed medicines, primarily to middle-class women for menstrual pains, creating countless addicts. Soon, the Harrison Act of 1914 was passed to regulate opiate use in the United States.
Opiates now are integrated into medicine as necessary tools for pain control. However, physicians are facing more and more regulation in prescribing these drugs. Strict regulation of opioid drugs has gained support due to the rising rates of abuse by a small group of physicians and by the alarming rates of prescription medication abuse. This regulation has affected patient care, as physicians, especially those who care for persons with chronic pain and those who provide end-of-life or palliative care, often fear prescribing opiates. However, studies have shown that the first group, people in chronic pain, has little to no risk of becoming addicted to pain medications. For the second group, those needing palliative care, physicians argue that denying dying patients pain medicine for fear they will get addicted goes against the Hippocratic oath. Even physicians who do not treat patients needing such care tend to underprescribe pain medications. Studies show that about 50 percent of patients report that they are not receiving adequate treatment for their pain.
By the second decade of the twenty-first century, opioid abuse had steadily increased to the point where opioid overdose was considered an epidemic by organizations such as the Centers for Disease Control and Prevention (CDC) and the US Department of Health and Human Services (HHS). By 2015, deaths resulting from drug overdose had become the leading cause of death from injury in the United States, and that same year, the HHS launched an initiative targeting this epidemic. Opioid abuse and overdose were of greatest concern because, according to the CDC, more than six out of ten drug overdose deaths involved an opioid as of 2015, with an estimated ninety-one Americans dying each day after overdosing on the drug, including heroin. Health officials had grown particularly concerned over the increased abuse of prescription opioids, especially among younger populations.
Effects and Potential Risks
Opiates work by disrupting the signals of pain sent to the brain from various channels. Some signals move through the nervous system. Other signaling systems are chemical and involve a biochemical cascade. One of the reasons why opiates are so effective is that they can block pain at many of these points.
Opiates are quick acting: A patient in severe pain will feel instant relief through the aid of intravenous morphine, for example. Oral medication takes about twenty to thirty minutes before acting but is extremely effective at controlling pain.
The most common side effects of opiates are constipation, sedation, nausea and vomiting, respiratory distress, tolerance, and addiction. For persons with cardiac or pulmonary disease, careful monitoring is necessary to check the patient’s breathing. This is especially relevant in hospice care, where patients may be receiving high doses of morphine, which can severely impair breathing.
Detoxification from any opiate, whether a street drug like heroin or a legally prescribed medication, is extremely difficult and can, for some people, be life threatening if not performed under medical supervision. Any person taking large doses of an opiate who attempts to detox can suffer seizures, prolonged insomnia, severe depression, suicidal thoughts, anxiety, and panic attacks. Physical symptoms include vomiting, shaking, anorexia, fever, and chills. It is recommended that a person who needs help with any kind of opium addiction seek the help of a physician.
Bibliography
Booth, Martin. Opium: A History. St. Martin’s, 1999.
Harris, Nancy, editor. Opiates. Greenhaven, 2005.
Kenjhan, Refik. “Opioids and Pain.” Clinical and Experimental Pharmacology and Physiology, vol. 22, 1995, pp. 397–403.
Nicholson, Bruce. “Responsible Prescribing of Opioids for the Management of Chronic Pain.” Drugs, vol. 63, 2003, pp. 17–30.
The Opioid Epidemic: By the Numbers. US Department of Health and Human Services, June 2016, www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf. Accessed 17 Feb. 2017.
"Understanding the Epidemic: Drug Overdoses in the United States Continue to Increase in 2015." Centers for Disease Control and Prevention, 16 Dec. 2016, www.cdc.gov/drugoverdose/epidemic/. Accessed 17 Feb. 2017.
Websites of Interest
National Institute on Drug Abuse
http://www.drugabuse.gov
WebMD: Narcotic Abuse
http://www.emedicinehealth.com/narcotic‗abuse