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    Why do we keep prescribing heroin to patients?

    In order to fully understand the issues surrounding opioid prescribing practices, it is important to review a brief history of how these drugs came to market.


    RELATED READING: A former opioid addict's story


    Opium was the first opioid, derived from the sap of opium poppies whose growth and cultivation dates back to 3400 BC. In the 18th century, physicians in the U.S. used opium for multiple ailments. Toward the end of the 18th century, the addictive qualities of opium became apparent, as well as the need for an alternative.

    In 1805, morphine and codeine were isolated from opium, and morphine was subsequently touted as a cure for opium addiction. Morphine’s use increased in popularity as it has about 10 times more euphoric effects than the equivalent amount of opium. As with opium, morphine’s addictive nature became obvious as well as the need for continued research for alternative medications.

    Are you starting to see a pattern yet?

    Heroin was first synthesized from morphine in 1874 and then made commercially available in 1898 by the Bayer Pharmaceutical Company. Considered a miracle drug, it was used to treat headaches, colds and other common ailments. Heroin, ironically, was given to active morphine and codeine addicts as an alternative to—and as a solution for—their addiction. The unrestricted distribution of heroin led to an astronomical number of addicts and a resulting rising crime rate.


    FURTHER READING: What can physicians do to help curb the opioid crisis?


    As legal and mental health concerns began to grow throughout the United States, authorities took note and ultimately banned its manufacture and distribution in 1924, just three decades after its introduction.

    Next: Patients need to be warned

    Myles Gart MD
    Myles Gart, MD, MMM, is a member of the ASA Committee on Professional Liability, president and CEO of gartmd.com and a practicing ...


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    • [email protected]
      We continue to use it because up till now, nothing has been found that is as effective without organ toxicity. Is it dangerous? Yes. Is it overused? No doubt. Is it, as with so many other societal ills, largely caused by government? Yes. But the calls to arbitrarily ban its use are just absurd.
    • UBM User
      This year I am retiring from medicine as a Board Certified Family Practitioner who has NEVER written an outpatient prescription for OxyContin(OC). When the Purdue Pharma rep came to detail me on OC in the early 90's, he wanted 2 minutes of my time and I stood him in front of a clock and gave him 2 minutes precisely. I laughed when he attempted to convince me his product was non-addicting due to a patented slow delivery formulation. How many times through history have we been lied into believing a "new" opioid is non-addicting? The owners of Purdue were three brothers who understood addiction well. They made their first substantial profit from Valium. I fully believe they counted on utilizing the captive audience of addicts to ensure their profits. Yes, let's face it, this whole epidemic is driven by profit!! The US Department of Justice settled for $600 million plus in 2005 with Purdue Pharma and was bought off, so let's not expect any CEO to be held accountable for pushing the US into opioid hell. A well publicized law suit in California in about 1990, where under-treated pain in an elderly man with a hip fracture, led to a multi-million dollar settlement. Subsequently, doctors were driven by fear of a lawsuit to begin using addicting opioids on a greater population span. That was a mighty convenient lawsuit. In 2003, I left Family Practice to become a Hospitalist. Admitting 4 to 5 overdoses a day was not unusual. Throughout my career, I have tried to get across to younger physicians trained to be opioid lenient( because pain is the great enemy), that they could destroy a patient who once experiences opioids and then begs, steals, and lies to get their opioids until they die from overuse. Some patient's cannot ever use opioids without self destruction. Others will become the same with enough exposure. This lesson has been learned throughout history. In 1907, the Empress of China was notified that 30% of the males in China under 40 years old were addicts of opium thanks to the US and British opium traders. This is a demographic that rots the soul of any nation. In 2012, I ran into a former patient in the grocery store. I asked her about her 2 boys whom I delivered. Both dead of overdoses and her husband dead from cancer, she was ready to die too despite her youth. This is the price we are paying, our youth. I would love to see prosecution for the opioid carnage. I hope we can reign in this monster without ever impacting those patient's who require opioids for terminal pain or those older patient's with severe pain who deserve relief and understand the consequences. Am I the only one who finds putting a 20 year old girl on Opana for fibromyalgia insane? Primun non noceri
    • Anonymous
      I am a physician who benefits greatly from hydrocodone, NSAIDs and methocarbamol for severe chronic whiplash injury. I as well as millions of others, the large majority of patients prescribed narcotics for severe pain never become addicts or turn to heroin or illegal use of prescription products. Do not punish those of us (the large majority) who are responsible and benefit greatly from these medicines when properly utilized. I have no doubt that some patients are genetically predisposed to abuse. That is not the fault of those of us who are not; And we should not be the made to suffer because of our good fortune.
    • [email protected]
      Good article. Makes countries like Egypt who ban all opioid pain medications, even in post-op or trauma cases look a lot better in the light of the findings.

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