The Opioid Epidemic: Failing to Learn from History

Transcription

1 The Opioid Epidemic: Failing to Learn from History Paul A. Offit Division of Infectious Diseases Children s Hospital of Philadelphia University of Pennsylvania School of Medicine

2 The first civilization produced the first medicine

3 Opium About 6,000 years ago, the Sumerians migrated from Persia and settled between the Tigris and Euphrates rivers. They invented cuneiform writing. They invented farming. And they discovered a plant that would cause more pleasure and more suffering than any plant in history.

4 Hul gil : the plant of joy

5 Carl Linneaus: Papaver Somniferum

6 Opium poppy

7 Opium Morphine: a powerful analgesic. Codeine (methylmorphine): mild analgesic and cough suppressant Alpha-narcotine and papaverine: muscle relaxants. Thebain: forms the basis of a drug that is now killing about 19,000 people a year in the US.

8 Hippocrates, 400 B.C.

9 Diagoras of Melos

10 Diagoras of Melos Saw that many of his fellow Greeks had become hopelessly addicted to the drug. He became the first person in history to argue against its use, declaring that it was better to suffer pain than to become addicted to opium. His warnings have been ignored for the last 2,500 years.

11 Opium users became opium addicts

12 Paracelsus, 16 th century

13 Paracelsus Mixed opium with brandy, calling his concoction laudanum. I possess a secret remedy that I call laudanum and that is superior to all other heroic remedies. Swept through Europe and eventually the United States. Louisa May Alcott, George Washington and Mary Todd Lincoln were addicted to the drug.

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15 Mrs. Henry Lafayette Dubose

16 Frederich Sertürner, 1803

17 Friedrich Sertürner In 1803, 20-year-old German chemist s apprentice isolated morphine. When he finished his studies, he was addicted to the drug. I consider it my duty to attract attention to the terrible effects of this new substance I called morphium in order that calamity may be averted.

18 Morphine In 1827, the German pharmaceutical company Merck began mass producing morphine. European and American doctors prescribed it for a variety of illnesses. Morphine was also a staple of the patent medicine craze.

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20 Dr. Alexander Wood, 1853

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22 Alexander Wood In 1853, Wood, a physician in Edinburgh, Scotland invented the hypodermic needle. Wood reasoned that if morphine was injected instead of ingested, people wouldn t develop an appetite for the drug. Wood believed he had separated morphine s analgesic properties from its addictive properties.

23 Alexander Wood By 1880, almost every physician in the US owned a hypodermic needle and began instructing patients on how to use it. Wood s wife would later die from a morphine overdose the first recorded patient to die from an injected drug. By 1900, more than 300,000 morphine addicts lived in the US.

24 Opium addicts became morphine addicts

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27 C. R. Alder Wright, 1874

28 C. R. Alder Wright In 1874, C.R. Alder Wright, a pharmacist in London, diacetylated morphine, convinced that he had finally created a non-addictive painkiller. Published his findings in the Journal of the Chemical Society of London. Twenty one years passed.

29 Felix Hoffman and Heinrich Dreser, 1895

30 Bayer Laboratories Felix Hoffman had recently acetylated another chemical, sodium salicylate, which had been used as an anti-inflammatory drug to treat rheumatism. The problem with sodium salicylate was that it cause gastritis; the new drug, acetyl salicylic acid, lessened the problem.

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32 Hoffman and Dreser In 1895, Felix Hoffman and Heinrich Dreser diacetylated morphine, making diacetylmorphine. Fed their new drug to a few rats and rabbits that loved it. Fed it to four workmen in their company, who also loved it.

33 Hoffman and Dreser Tested the drug on a handful of people for a few weeks, claiming it treated colds, sore throats, headaches, pneumonia, and tuberculosis. Presented their findings to the 70 th Congress of German Naturalists and Physicians. Received a standing ovation.

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36 Heroin In 1900, Eli Lilly began distributing heroin in the United States, promoting it side-by-side with aspirin as a treatment for colds and flu. Claimed it was safe even for pregnant women. In 1906, JAMA stated heroin was recommended chiefly for bronchitis, pneumonia, consumption, asthma, whooping cough, laryngitis, and hay fever.

37 Morphine addicts became heroin addicts

38 Heroin By 1910, doctors were fully aware of heroin s dangers and professional use declined. By 1918, more than 200,000 heroin addicts lived in NYC alone. In 1924, Congress passed the Heroin Act, making manufacture and sale illegal.

39 Arthur Flegenheimer, aka Dutch Schultz

40 Jack Legs Diamond

41 Meyer Lansky

42 Charles Lucky Luciano

43 Heroin Initially, heroin use confined to the urban poor. By the 1940s, use spread to the Harlem jazz scene; by the 1950s, through the writings of Keroac and Burroughs, to the Beat Generation. By the mid-1960s, more than 500,000 Americans were addicted to heroin.

44 Heroin US government took action. Pressured Turkey to stop producing opium and tried to eliminate importation of heroin through France. Efforts were dramatized in a movie.

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46 Richard M. Nixon In 1971, President Nixon declared an all out war on drugs. Nixon: America has the largest number of heroin addicts of any nation in the world. If we cannot destroy the drug menace in America, it will surely destroy us.

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50 Elvis Presley Elvis Presley died in 1977 At the time of his death, Valium, methaqualone, morphine, codeine, and barbiturates were found in his bloodstream.

51 Thebaine In 1916, two German chemists chemically modified another component of opium, thebaine, to make oxycodone. In the early 1950s, oxycodone made its American debut as Combunox (oxycodone plus ibuprofen) and Percocet (oxycodone plus acetominophen). Most powerful preparation uncut.

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53 OxyContin Made by Purdue Pharma. Initially marketed as a first line agent for arthritis. Purdue combined oxycodone with an acrylic to allow for a timed-release of the drug. However, by chewing the drug, people could bypass the timed-release and receive an immediate rush of 160 mg of oxycodone.

54 Russell Portenoy

55 Russell Portenoy In 1986, Russell Portenoy, a NYC pain specialist, published a paper in Pain. Study of 38 patients on opioid painkillers, only 2 had become addicted; and both had a history of addiction. Chastised colleagues for their opiophobia. Argued that it was time to make pain the fifth vital sign, no one should have to suffer.

56 Heroin addicts became opioid addicts

57 OxyContin In 2002, survey at a rural Michigan high school showed that 98% of students had heard of OxyContin and 9.5% had tried it. In 2003, Rush Limbaugh, who had mocked drug abusers for being morally bankrupt, admitted his addiction to OxyContin. In 2004, 3 million people were using OxyContin, the most prevalent prescription painkiller in the US.

58 OxyContin In 2007, about 14,000 people in US died from prescription painkillers, costing the healthcare and criminal justice systems $55 billion. In 2008, about 15,000 people died from prescription painkillers, the leading cause of accidental deaths in 30 states. In 2009, health insurers spent $72 billion in direct healthcare costs related to painkillers.

59 OxyContin In 2010, more people died from prescription painkillers than from heroin and cocaine combined. In 2012, about 12 million Americans aged 12 years and older reported the recreational use of prescription painkillers. In 2014, retail pharmacies dispensed 245 million prescriptions for painkillers. About 2.5 million adults were addicted to the drug.

60 OxyContin In 2015, about 19,000 people died from prescription painkillers. More young people died from opioid overdose than from motor vehicle accidents. The United States, which represents 5% of the world s population, uses 80% of the world s painkillers.

61 Hubris The medical profession s undying belief that it can effectively separate pain relief from addiction remains a lesson unlearned