We are in a blessed time now that the medical profession is more likely to heal us than to kill us by its ministrations. In the ancient world, to go to a physician was a gamble, often subjecting patients to such hair-raising horrors as bloodletting. And snake oil remedies were common. The ancients did the best they could, and we moderns don’t give them the credit they deserve. The general attitude towards physicians was summed up by the Roman poet Martial: “Until recently, Diaulus was a doctor; now he is an undertaker. He is still doing as an undertaker, what he used to do as a doctor.” Arguably, not until the 20th century were we more likely to be healed than hurt by our doctors.
A physician of earlier centuries had precious few effective medicines to offer. Willow-tree extract contained salicylates and has been used since antiquity for pain relief; it is the basis for aspirin (acetylsalicylic acid).
Perhaps the most powerful physician’s ally was opium. Also very ancient, and derived from the seed-head of the opium poppy (Papaver somniferum), opium had pain-relief properties without peer in the physician’s pharmacopeia, able to relieve pain that aspirin or willow-tree remedies couldn’t touch. It was a double-edged sword: because physicians knew it was effective, they prescribed it for all kinds of ailments, and, as a result, many patients became addicted. Even William Wilberforce, the great British abolitionist, was addicted to opium, which had been prescribed for intestinal ailments.
Opium contains many bioactive and psychotropic molecules, the most important of which may be morphine, first purified from the opium poppy exudate in 1805. Since then other derivatives or variants of morphine have been synthesized for their analgesic (pain killing) properties. For the purposes of this article, I will refer to morphine and its variants as “opioids,” referring to any molecule that binds to the opioid receptor in the brain. Opioids alter one’s state of consciousness and can give one a sense of euphoria—one reason for their illicit, recreational use. Opioids are also addictive and their withdrawal symptoms are often severe.
Opioid addiction kills most of the 70,000 Americans who die each year of drug overdose. That number is staggering and exceeds the number of Americans killed during the entirety of the Vietnam War. Such an enormity cries out for a response. We might attack this problem by stigmatizing or prosecuting physicians who prescribe opioids for pain alleviation or going after the patients who need them. If we act by quick reflexes and simply ban opioids or restrict them from proper medical use, we will remove one of our greatest resources. Opioids allow those afflicted by extreme, chronic pain to function reasonably well and perhaps enjoy their lives.
In reality, the opioid crisis is not one crisis but several. According to an article on the American Council on Science and Health (ACSH) website, opioid prescriptions in the United States doubled from 2003-2013, but this increase does not appear to be responsible for the majority of deaths due to addiction and drug overdosing. For example, in recent years the number of deaths per capita due to opioid overdose does not appear to be correlated with the number of opioid prescriptions written by physicians per capita.
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