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Opioids: The Good, the Bad, and the Ugly

HARRIET HALL

Harriet Hall, MD, also known as “The SkepDoc,” is a retired family physician, a CSI fellow, and an editor of the Science-Based Medicine blog. Her website is www.skepdoc.info.

Opium, a dried latex collected from the opium poppy, was the original “wonder drug.” It effectively relieved pain and had other medicinal effects—and incidentally produced both euphoria and addiction. There is archaeological evidence that it was used as early as 5700 BC. It was the active ingredient in laudanum and paregoric. For decades, these opiates were readily available without a prescription, and many famous people became addicted, including the poet Elizabeth Barrett Browning and the surgeon William Halsted, a founder of Johns Hopkins Hospital who was considered the “Father of Modern Surgery.” Products such as Mrs. Winslow’s Soothing Syrup were widely given to infants to get them to stop fussing and to relieve the pain of teething. Parents didn’t realize it contained the opium derivative morphine. It worked. It soothed babies, put them to sleep, and relieved frazzled mothers. Unfortunately, there was a risk that it might put babies to sleep permanently.

Morphine was isolated from opium in 1804, and codeine, another component, was identified in 1832. Codeine is metabolized to morphine in the liver. It doesn’t work for everyone; it is not effective in individuals who are poor metabolizers. Opium derivatives are called opiates; synthetic analogues are called opioids. Both are classified as narcotics.

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