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Brief American History of Opioids in Medicine

Written by Melissa Nguyen PharmD'19
Published on October 18, 2017

Heroin, morphine, codeine, and fentanyl are examples of a drug class known as opioids. These are typically prescribed for pain relief. In fact, they are recommended by the World Health Organization (WHO) for mild to moderate cancer pain alongside non-opioid and adjuvant medications.  Opioid use in medicine is not recent; this blog will discuss the history of medical opioid use in America.

Morphine was isolated from opium in 1806 by Friedrich Wilhelm Adam Sertṻrner. In the United States, morphine treated pain, anxiety, tuberculosis, and “female disease” by the mid-1800s.  In the Civil War, it was heavily used as an analgesic, and Civil War veterans became addicted to morphine. To deter the public from becoming addicted, Bayer, a German Chemical Company produced the morphine derivative known as heroin. Heroin was supposed to be a non-addictive morphine substitute, and was used for a variety of indications. It was advertised as a cough suppressant, a more potent pain killer, and morphine addiction detoxification agent. It was considered a “wonder drug.” Despite the creation of heroin to decrease addiction, opioid abuse became more rampant during this time, and by 1924 heroin became illegal.

This was not the only regulation for opioids. In three separate trials, the US. Supreme Court only allowed doctors to prescribe opioids to relieve addiction and, by 1920, they couldn’t prescribe opioids to addicted patients. To decrease abuse, the Drug Abuse Control Amendment was passed in 1965. This act required licenses to sell and distribute depressants, stimulants, and hallucinogens. By 1970, the FDA placed these substances on a schedule via the Controlled Substance Act. These drugs were scheduled by medicinal use, potential for abuse, and harmfulness. Schedule I drugs were declared too dangerous, and they could no longer be prescribed. In 1973, President Richard Nixon declared the War on Drugs and created the Drug Enforcement Agency.

While the United States passed laws discouraging opioid abuse, the FDA still approved opioids for medical use. The FDA approved oxycodone as Percodan® in 1950 and Vicodin ® in 1978. In 1990, opioids’ use  extended from cancer pain to non-cancer pain. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) labeled pain as the “fifth vital sign” as part of their standard for pain management. JCAHO’s standards cited “there is no evidence that addiction is a significant issue when persons are given opioids for pain control.” These standards were sponsored by Purdue Pharma, and they were required in U.S. hospitals, and they described addiction side effects as “inaccurate and exaggerated.” To better manage pain, pharmaceutical companies created extended-release medications such as fentanyl, morphine, oxycodone, and hydromorphone. While these medications are prescribed for pain management, they are still highly abused today. Opioids first started out as a “wonder drug,” however due to misuse and abuse it has led to the opioid epidemic seen today.

Opioids are constantly being evaluated in their use in pain management in order to limit abuse. Physicians have called upon JCAHO to publish new standards for pain management. The public is becoming more aware of the opioid crisis as it affects pop culture. Student physicians are being trained on how to deal with this issue as well. In addition, CVS is playing a part and is limiting opioid prescriptions to week-long quantities. Even with an increased awareness and regulations, there is still much to do to solve the opioid crisis.

Categories:  OpioidsPublic HealthHealth PolicyDepartment of Health Policy and Public HealthSubstance Use Disorders InstituteMayes College of Healthcare and Business PolicyPharmaceutical and Healthcare Business