Opiate addiction was America’s first drug crisis. Emerging in the late 1800’s and early 1900’s and culminating in the needle based heroin epidemic that has been with us ever since, the abuse of this class of drugs spawned the “war on drugs.” Absolutely essential to medical care as morphine, oxycodone, and similar molecules, opiates cannot and should not be banished, but need to be thoughtfully studied, regulated, and prescribed by physicians duly qualified and supported by society for this role.
In the past two decades, pharmaceutical industry excess and premature enthusiasm by the health system to relieve escalating pain syndromes led to the “OxyContin” debacle, where a useful pain remedy was overprescribed, shared, diverted, and abused and overtook heroin as the leading cause of drug overdose deaths. In the face of greater scrutiny now for OxyContin and other opiates prescribed for pain, heroin is making a comeback. Since the 1960’s, methadone was the only permitted substitution opiate for physicians to prescribe; for many addicts, it has been compared in necessity to insulin for the diabetic. But methadone, dispensed only in special clinics, itself shared many of the dangers and side effects of heroin and OxyContin, namely euphoria, addictive use, overdose, and perpetual dependence.
The best medication solution now available for opiate addiction and the logical alternative to morphine, OxyContin and related drugs for pain is buprenorphine. Discovered in the late 1960’s at a world class opioid laboratory in Hull, England., its inventors hoped to find the elusive “Holy Grail” of opioid pharmacology, a morphine analog effective for pain, but not associated with addiction or overdose. It is now understood that buprenorphine falls short of Holy Grail status on all of these parameters, but can consistently demonstrate distinct and superior pharmacologic and clinical properties compared to any other opioid drug.
More to come in the future.