Opiates history

Opiates have been available for 4,000 years or more - describe the changing pattern of use and misuse throughout history. 

Accurate assessment and history of reported opiate allergies are important. A differentiation between allergy, sensitivity, and side effect needs to be made. 

Brownstein MJ, A brief history of opiates, opioid peptides, opioid receptors, Proc... 

For centuries opium was used for both medicinal and recreational purposes. Derived from the poppy Papaver somniferum, it contains numerous opiates, the primary one of which is morphine. The term opiate has largely been replaced by opioid, which represents all compounds with morphinelike activity and includes morphine, morphine derivatives, and peptides. Opiate is used to refer to morphinelike drugs derived from the plant and structurally similar analogues. These drugs are frequently referred to as narcotics, a Greek term for stupor, which is scientifically obsolete. Even in its early history, opium presented a problem when it was smoked or taken orally. The introduction of the hypodermic needle and syringe, however, drastically enhanced the euphoric properties of opioids and thereby altered their abuse liability. In addition, the synthesis of heroin resulted in an opioid that was more potent than morphine and ideally suited for intravenous administration. 

Opium has been used as a medicine for hundreds of years, inevitably creating countless addicts. Scientists have conducted a never-ending search for effective cures for opium addiction, morphine addiction (morphinism), and heroin addiction. For most of its history, opium addiction was treated as a disease with no cure, and doctors concerned themseives with treating the symptoms of addiction rather than the root cause. As a result, other opiates were used to lessen the effects of withdrawal. The addict is placed on a regimen of opiates that slowly decrease over time, weaning the addict from his or her addiction. This process of treatment is still used today. 

Michael is a 30-year-old man who has been a patient in our methadone clinic for three years. He has a ten-year history of opiate use in all, but previous treatment had been elsewhere on a detoxification basis. At one time he had strongly wished to come off drugs completely and went into a residential rehabilitation centre, but although he completed the stay satisfactorily he relapsed into heroin use soon afterwards. It is now agreed between us that his methadone treatment will need to continue long-term. 

It is known, however, that drugs are readily available in many prisons, and the rate of adverse incidents and the time and effort spent in detecting smuggling of drugs in has been enough to persuade some authorities that at least the basics of treatment should be available. The most routine option has become to provide a detoxification for opiate misusers, with for instance lofexidine or dihydrocodeine, and also benzodiazepines will often be issued if there is a history of abuse of these and it is intended to avoid the possibility of fits with a short withdrawal course. The adverse incidents in custody and prisons have included some deaths in users of crack cocaine, with physical explanations postulated but no very satisfactory treatment for cocaine withdrawal indicated. Prison services have typically been wary of methadone, and in favouring lofexidine use it was encouraging that a randomized double-blind trial carried out by prison specialists found lofexidine to be as effective as methadone in relief of withdrawal symptoms (Howells et al. 2002). 

Attitudes Toward Opiates in the US from 1890 to 1940. In Drugs and Narcotics in History, edited by Roy Porter and Mikulas Teich. Cambridge Cambridge University Press. 

Brownstein, M.J. A brief history of opiates, opioid peptides, and opioid receptors, Proc. Natl. Acad. Sci. USA. 1993, 15, 5391-5393. 

Eight healthy male subjects with a mean age of 34.1 years volunteered for this study. During their participation in the study, they resided on a clinical research unit. The subjects had extensive histories of illicit drug use that included recent ingestion (within the past 2 years) of opiates, marijuana, stimulants, alcohol, and sedative-hypnotics, although they were not dependent on any drug (except nicotine). 

Hydromorphone and its natural opioid relatives have been used to relieve pain, treat a variety of ailments, and create euphoric feelings at least as far back as the time of the ancient Greeks. In early Greek history, the priests controlled the use of opium and ascribed to it supernatural powers. In the fifth century bc, Hippocrates, the father of medicine, dismissed the supernatural attributes of opium. Hippocrates believed opium had cathartic, narcotic, hypnotic, and styptic properties. He believed that all diseases had a natural origin and could be cured by natural therapies. All of the natural opiates historically were derived from opium poppy plants. The liquid extracted from the poppy seeds was typically dried to create a concentrated powder. These extracts were then smoked, eaten, or drank. 

Methadone generally lasts about one day in the body, meaning that a person in a maintenance program has to take methadone at least once a day. Federal regulations require that to be eligible for enrollment in a methadone maintenance program, potential patients must be at least 18 years of age and demonstrate that they have had at least a one-year history of heroin (or other opiate) addiction. An exception is made for patients between the ages of 16 and 18 who can document a history of at least two unsuccessful detoxification trials. 

Courtwright, David T. Dark Paradise A History of Opiate Addiction in America. Cambridge, MA Harvard University Press, 2001. 

The legal history of marijuana laws is unusual. The Marijuana Tax Act of 1937 established the federal prohibition of marijuana. The drug was placed in Schedule I, which defines a substance as having a high potential for abuse, a lack of accepted safety for use under supervision, and no currently accepted medical use in treatment in the United States. Doctors are banned from writing prescriptions for marijuana. Opiate-based medications, which are stronger than marijuana, are in Schedule II and were never banned.,—... 

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