Category:Opioids - Revision history

MDElliottMD: Category taxonomy ship: retag plant categories -> Plants

2026-05-22T00:38:04Z

Category taxonomy ship: retag plant categories -> Plants

← Older revision		Revision as of 00:38, 22 May 2026
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	[[Category:Medicines]]		[[Category:Medicines]]
	[[Category:Pharmaceutical]]		[[Category:Pharmaceutical]]
	[[Category:~~Plant~~]]		[[Category:Plants]]

MDElliottMD: Canonical retrofit, preserve-and-complete: added Opioids indexed, Notes on scope, and About these pages sections; member list upgraded to a curated index; added Medicines tag, Plant and Pharmaceutical origin preserved; removed a stray Wikipedia citation

2026-05-21T07:24:29Z

Canonical retrofit, preserve-and-complete: added Opioids indexed, Notes on scope, and About these pages sections; member list upgraded to a curated index; added Medicines tag, Plant and Pharmaceutical origin preserved; removed a stray Wikipedia citation

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 The '''third wave''', from around 2013, has been driven by illicitly manufactured synthetic opioids, above all [[fentanyl]], which is far more potent by weight than [[morphine]] and is frequently mixed into other illicit drugs, often without the user's knowledge.<ref name="cdc"/> Some analysts describe a '''fourth wave''' marked by combined use of [[fentanyl]] with stimulants such as [[methamphetamine]] or [[cocaine]].<ref name="feinberg">Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine. What is the opioid epidemic? A public health explainer.</ref>
-The progression from [[opium]] to [[heroin]] to [[fentanyl]], each successive material more potent by weight than the last, has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986; and "Iron law of prohibition", Wikipedia.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, [[heroin]] was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>
+The progression from [[opium]] to [[heroin]] to [[fentanyl]], each successive material more potent by weight than the last, has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, [[heroin]] was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>
 == Harm reduction ==
@@ Line 47: / Line 47: @@
 == Mechanisms ==
 Opioids bind opioid receptors, especially the µ-opioid receptor, with additional activity at the κ and δ receptors, found in the nervous system and elsewhere in the body. Binding at the µ-opioid receptor is associated with the analgesic effects of opioids, with their euphoric effects, and with respiratory depression, the mechanism by which opioid overdose causes death.<ref name="chemviews"/> As with medicines generally, that opioids bind these receptors is well established; the fuller relationship between receptor binding and the range of clinical effects, including the development of tolerance and of dependence, is more complex and remains a subject of research, and should not be regarded as a closed question.
 == Safety ==
 The central acute danger of opioids is respiratory depression: at sufficient dose, opioids slow and can stop breathing, and this is the mechanism of fatal overdose. Risk is substantially increased when opioids are combined with other central nervous system depressants, including alcohol and benzodiazepines, and when potency is unknown, the particular hazard of illicitly manufactured [[fentanyl]]. Repeated use is associated with tolerance and with physical dependence, and a withdrawal syndrome on stopping. Figures for these risks in the literature are population estimates that vary between studies, and individual response varies considerably between people.
 == References ==
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 [[Category:MedCategory]]
 [[Category:MedCategoryFull]]
 [[Category:Pharmaceutical]]
 [[Category:Plant]]

MDElliottMD: Phase 2 retag: add Pharmaceutical + Plant root parent (taxonomy restructure 2026-05-20)

2026-05-19T19:22:08Z

Phase 2 retag: add Pharmaceutical + Plant root parent (taxonomy restructure 2026-05-20)

← Older revision		Revision as of 19:22, 19 May 2026
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	[[Category:MedCategory]]		[[Category:MedCategory]]
	[[Category:MedCategoryFull]]		[[Category:MedCategoryFull]]
			[[Category:Pharmaceutical]]
			[[Category:Plant]]

MDElliottMD: Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

2026-05-19T03:16:14Z

Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

← Older revision		Revision as of 03:16, 19 May 2026
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	By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>		By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>

	[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the Opium Wars.<ref name="newsweek"/> The trade was not solely British — prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>		[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the Opium Wars.<ref name="newsweek"/> The trade was not solely British, prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>

	== The isolation of morphine ==		== The isolation of morphine ==
	A turning point came between 1803 and 1804, when the young German pharmacist Friedrich Wilhelm Sertürner isolated a crystalline substance from [[opium]]. He named it after Morpheus, the Greek god of dreams — ''morphium'', later [[morphine]].<ref name="serturner">Schmitz R. Friedrich Wilhelm Sertürner and the discovery of morphine. ''Pharm Hist.'' 1985;27(2):61–74. PMID 11611724.</ref> It is generally regarded as the first alkaloid isolated from a plant, and it allowed, for the first time, pain treatment with a defined compound in measured doses. The firm E. Merck began commercial production in 1827.		A turning point came between 1803 and 1804, when the young German pharmacist Friedrich Wilhelm Sertürner isolated a crystalline substance from [[opium]]. He named it after Morpheus, the Greek god of dreams, ''morphium'', later [[morphine]].<ref name="serturner">Schmitz R. Friedrich Wilhelm Sertürner and the discovery of morphine. ''Pharm Hist.'' 1985;27(2):61–74. PMID 11611724.</ref> It is generally regarded as the first alkaloid isolated from a plant, and it allowed, for the first time, pain treatment with a defined compound in measured doses. The firm E. Merck began commercial production in 1827.

	[[Morphine]]'s use expanded enormously after the mid-nineteenth-century adoption of the hypodermic syringe, which allowed direct injection. Widespread medical and battlefield use — including during the American Civil War — was followed by recognition of how readily [[morphine]] produced dependence.<ref name="chemviews"/>		[[Morphine]]'s use expanded enormously after the mid-nineteenth-century adoption of the hypodermic syringe, which allowed direct injection. Widespread medical and battlefield use, including during the American Civil War, was followed by recognition of how readily [[morphine]] produced dependence.<ref name="chemviews"/>

	== Heroin ==		== Heroin ==
	The pattern then repeated. In 1874 the English chemist C. R. Alder Wright first synthesized [[diacetylmorphine]] from [[morphine]], though the compound attracted little attention at the time. In the 1890s chemists at the Bayer company in Germany developed it further, and Bayer brought it to market in 1898 under the trade name [[Heroin]].<ref name="chemviews"/> It was promoted as a cough remedy and as a non-addictive substitute for [[morphine]] — a claim that proved badly wrong, as [[heroin]] is, if anything, more rapidly habit-forming. [[Heroin]] was withdrawn from ordinary medical use and made illegal in many countries in the early twentieth century.		The pattern then repeated. In 1874 the English chemist C. R. Alder Wright first synthesized [[diacetylmorphine]] from [[morphine]], though the compound attracted little attention at the time. In the 1890s chemists at the Bayer company in Germany developed it further, and Bayer brought it to market in 1898 under the trade name [[Heroin]].<ref name="chemviews"/> It was promoted as a cough remedy and as a non-addictive substitute for [[morphine]], a claim that proved badly wrong, as [[heroin]] is, if anything, more rapidly habit-forming. [[Heroin]] was withdrawn from ordinary medical use and made illegal in many countries in the early twentieth century.

	{{PendellsCorner		{{PendellsCorner
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	== Drug regulation in the early twentieth century ==		== Drug regulation in the early twentieth century ==
	Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking Opium Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates — including prescribing physicians — to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>		Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking Opium Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates, including prescribing physicians, to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>

	== The modern opioid epidemic ==		== The modern opioid epidemic ==
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	The '''second wave''', from around 2010, saw a rise in [[heroin]] overdose deaths, as some people dependent on prescription opioids moved to [[heroin]], which had become cheaper and more available.<ref name="cdc"/>		The '''second wave''', from around 2010, saw a rise in [[heroin]] overdose deaths, as some people dependent on prescription opioids moved to [[heroin]], which had become cheaper and more available.<ref name="cdc"/>

	The '''third wave''', from around 2013, has been driven by illicitly manufactured synthetic opioids — above all [[fentanyl]], which is far more potent by weight than [[morphine]] and is frequently mixed into other illicit drugs, often without the user's knowledge.<ref name="cdc"/> Some analysts describe a '''fourth wave''' marked by combined use of [[fentanyl]] with stimulants such as [[methamphetamine]] or [[cocaine]].<ref name="feinberg">Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine. What is the opioid epidemic? A public health explainer.</ref>		The '''third wave''', from around 2013, has been driven by illicitly manufactured synthetic opioids, above all [[fentanyl]], which is far more potent by weight than [[morphine]] and is frequently mixed into other illicit drugs, often without the user's knowledge.<ref name="cdc"/> Some analysts describe a '''fourth wave''' marked by combined use of [[fentanyl]] with stimulants such as [[methamphetamine]] or [[cocaine]].<ref name="feinberg">Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine. What is the opioid epidemic? A public health explainer.</ref>

	The progression from [[opium]] to [[heroin]] to [[fentanyl]] — each successive material more potent by weight than the last — has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986; and "Iron law of prohibition", Wikipedia.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, [[heroin]] was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>		The progression from [[opium]] to [[heroin]] to [[fentanyl]], each successive material more potent by weight than the last, has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986; and "Iron law of prohibition", Wikipedia.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, [[heroin]] was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>

	== Harm reduction ==		== Harm reduction ==
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	== Mechanisms ==		== Mechanisms ==
	Opioids bind opioid receptors — especially the µ-opioid receptor, with additional activity at the κ and δ receptors — found in the nervous system and elsewhere in the body. Binding at the µ-opioid receptor is associated with the analgesic effects of opioids, with their euphoric effects, and with respiratory depression, the mechanism by which opioid overdose causes death.<ref name="chemviews"/> As with medicines generally, that opioids bind these receptors is well established; the fuller relationship between receptor binding and the range of clinical effects — including the development of tolerance and of dependence — is more complex and remains a subject of research, and should not be regarded as a closed question.		Opioids bind opioid receptors, especially the µ-opioid receptor, with additional activity at the κ and δ receptors, found in the nervous system and elsewhere in the body. Binding at the µ-opioid receptor is associated with the analgesic effects of opioids, with their euphoric effects, and with respiratory depression, the mechanism by which opioid overdose causes death.<ref name="chemviews"/> As with medicines generally, that opioids bind these receptors is well established; the fuller relationship between receptor binding and the range of clinical effects, including the development of tolerance and of dependence, is more complex and remains a subject of research, and should not be regarded as a closed question.

	== Members ==		== Members ==
	The opioids include compounds of natural origin such as [[morphine]] and [[codeine]]; semi-synthetic compounds such as [[heroin]] ([[diacetylmorphine]]), [[oxycodone]], [[hydrocodone]], and [[buprenorphine]]; and synthetic compounds such as [[fentanyl]], [[methadone]], and [[tramadol]]. [[Naloxone]] and [[naltrexone]] are opioid antagonists — they block opioid receptors rather than activating them. The list is not exhaustive.		The opioids include compounds of natural origin such as [[morphine]] and [[codeine]]; semi-synthetic compounds such as [[heroin]] ([[diacetylmorphine]]), [[oxycodone]], [[hydrocodone]], and [[buprenorphine]]; and synthetic compounds such as [[fentanyl]], [[methadone]], and [[tramadol]]. [[Naloxone]] and [[naltrexone]] are opioid antagonists, they block opioid receptors rather than activating them. The list is not exhaustive.

	== Safety ==		== Safety ==
	The central acute danger of opioids is respiratory depression: at sufficient dose, opioids slow and can stop breathing, and this is the mechanism of fatal overdose. Risk is substantially increased when opioids are combined with other central nervous system depressants, including alcohol and benzodiazepines, and when potency is unknown — the particular hazard of illicitly manufactured [[fentanyl]]. Repeated use is associated with tolerance and with physical dependence, and a withdrawal syndrome on stopping. Figures for these risks in the literature are population estimates that vary between studies, and individual response varies considerably between people.		The central acute danger of opioids is respiratory depression: at sufficient dose, opioids slow and can stop breathing, and this is the mechanism of fatal overdose. Risk is substantially increased when opioids are combined with other central nervous system depressants, including alcohol and benzodiazepines, and when potency is unknown, the particular hazard of illicitly manufactured [[fentanyl]]. Repeated use is associated with tolerance and with physical dependence, and a withdrawal syndrome on stopping. Figures for these risks in the literature are population estimates that vary between studies, and individual response varies considerably between people.

	== References ==		== References ==

MDElliottMD: Re-apply proper-noun un-link (Opium Wars, Smoking Opium Exclusion Act) after heroin back-fill re-run wiped it

2026-05-17T20:14:43Z

Re-apply proper-noun un-link (Opium Wars, Smoking Opium Exclusion Act) after heroin back-fill re-run wiped it

← Older revision		Revision as of 20:14, 17 May 2026
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	By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>		By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>

	[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the [[Opium]] Wars.<ref name="newsweek"/> The trade was not solely British — prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>		[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the Opium Wars.<ref name="newsweek"/> The trade was not solely British — prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>

	== The isolation of morphine ==		== The isolation of morphine ==
Line 29:		Line 29:

	== Drug regulation in the early twentieth century ==		== Drug regulation in the early twentieth century ==
	Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking [[Opium]] Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates — including prescribing physicians — to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>		Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking Opium Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates — including prescribing physicians — to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>

	== The modern opioid epidemic ==		== The modern opioid epidemic ==

MDElliottMD: Back-fill heroin -> heroin after adding Category:Medicines to Heroin redirect

2026-05-17T20:13:26Z

Back-fill heroin -> heroin after adding Category:Medicines to Heroin redirect

← Older revision		Revision as of 20:13, 17 May 2026
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	By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>		By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>

	[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the Opium Wars.<ref name="newsweek"/> The trade was not solely British — prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>		[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the [[Opium]] Wars.<ref name="newsweek"/> The trade was not solely British — prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>

	== The isolation of morphine ==		== The isolation of morphine ==
Line 21:		Line 21:

	== Heroin ==		== Heroin ==
	The pattern then repeated. In 1874 the English chemist C. R. Alder Wright first synthesized [[diacetylmorphine]] from [[morphine]], though the compound attracted little attention at the time. In the 1890s chemists at the Bayer company in Germany developed it further, and Bayer brought it to market in 1898 under the trade name Heroin.<ref name="chemviews"/> It was promoted as a cough remedy and as a non-addictive substitute for [[morphine]] — a claim that proved badly wrong, as heroin is, if anything, more rapidly habit-forming. Heroin was withdrawn from ordinary medical use and made illegal in many countries in the early twentieth century.		The pattern then repeated. In 1874 the English chemist C. R. Alder Wright first synthesized [[diacetylmorphine]] from [[morphine]], though the compound attracted little attention at the time. In the 1890s chemists at the Bayer company in Germany developed it further, and Bayer brought it to market in 1898 under the trade name [[Heroin]].<ref name="chemviews"/> It was promoted as a cough remedy and as a non-addictive substitute for [[morphine]] — a claim that proved badly wrong, as [[heroin]] is, if anything, more rapidly habit-forming. [[Heroin]] was withdrawn from ordinary medical use and made illegal in many countries in the early twentieth century.

	{{PendellsCorner		{{PendellsCorner
Line 29:		Line 29:

	== Drug regulation in the early twentieth century ==		== Drug regulation in the early twentieth century ==
	Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking Opium Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates — including prescribing physicians — to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>		Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking [[Opium]] Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates — including prescribing physicians — to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>

	== The modern opioid epidemic ==		== The modern opioid epidemic ==
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	The '''first wave''' began in the 1990s with a sharp rise in the prescribing of opioid medicines for chronic pain. OxyContin, an extended-release [[oxycodone]] product, was approved by the U.S. Food and Drug Administration on December 12, 1995, and marketed from 1996 by Purdue Pharma; the company was later found to have promoted the medicine with misleading claims that understated its addictive potential, and it and members of the Sackler family that owned it became the subject of extensive litigation.<ref name="vanzee">Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. ''Am J Public Health.'' 2009;99(2):221–227. PMID 18799767.</ref><ref name="cfr">Council on Foreign Relations. Fentanyl and the U.S. opioid epidemic. 2025.</ref>		The '''first wave''' began in the 1990s with a sharp rise in the prescribing of opioid medicines for chronic pain. OxyContin, an extended-release [[oxycodone]] product, was approved by the U.S. Food and Drug Administration on December 12, 1995, and marketed from 1996 by Purdue Pharma; the company was later found to have promoted the medicine with misleading claims that understated its addictive potential, and it and members of the Sackler family that owned it became the subject of extensive litigation.<ref name="vanzee">Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. ''Am J Public Health.'' 2009;99(2):221–227. PMID 18799767.</ref><ref name="cfr">Council on Foreign Relations. Fentanyl and the U.S. opioid epidemic. 2025.</ref>

	The '''second wave''', from around 2010, saw a rise in heroin overdose deaths, as some people dependent on prescription opioids moved to heroin, which had become cheaper and more available.<ref name="cdc"/>		The '''second wave''', from around 2010, saw a rise in [[heroin]] overdose deaths, as some people dependent on prescription opioids moved to [[heroin]], which had become cheaper and more available.<ref name="cdc"/>

	The '''third wave''', from around 2013, has been driven by illicitly manufactured synthetic opioids — above all [[fentanyl]], which is far more potent by weight than [[morphine]] and is frequently mixed into other illicit drugs, often without the user's knowledge.<ref name="cdc"/> Some analysts describe a '''fourth wave''' marked by combined use of [[fentanyl]] with stimulants such as [[methamphetamine]] or [[cocaine]].<ref name="feinberg">Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine. What is the opioid epidemic? A public health explainer.</ref>		The '''third wave''', from around 2013, has been driven by illicitly manufactured synthetic opioids — above all [[fentanyl]], which is far more potent by weight than [[morphine]] and is frequently mixed into other illicit drugs, often without the user's knowledge.<ref name="cdc"/> Some analysts describe a '''fourth wave''' marked by combined use of [[fentanyl]] with stimulants such as [[methamphetamine]] or [[cocaine]].<ref name="feinberg">Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine. What is the opioid epidemic? A public health explainer.</ref>

	The progression from [[opium]] to heroin to [[fentanyl]] — each successive material more potent by weight than the last — has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986; and "Iron law of prohibition", Wikipedia.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, heroin was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>		The progression from [[opium]] to [[heroin]] to [[fentanyl]] — each successive material more potent by weight than the last — has been linked not only to medical and market factors but also to drug prohibition itself. The "iron law of prohibition", a term coined by Richard Cowan in 1986 and summarized as "the harder the enforcement, the harder the drugs", holds that when a substance is prohibited, the illicit market tends to favour more concentrated and potent forms, because these are more efficient to conceal, store, and transport for a given value.<ref name="ironlaw">Thornton M. The potency of illegal drugs. ''J Drug Issues.'' 1998;28(3):725–740. DOI 10.1177/002204269802800309. See also Cowan R. How the narcs created crack. ''National Review.'' 1986; and "Iron law of prohibition", Wikipedia.</ref> The economist Mark Thornton has published research describing this effect for illegal drugs, and an analogous shift is commonly noted during alcohol prohibition in the United States, when consumption moved from beer toward more concentrated spirits. Commentators have invoked the same reasoning to explain why, in the 2010s, [[heroin]] was increasingly displaced by [[fentanyl]] and other still more potent synthetic opioids. Those who emphasize this argument present it as a case against prohibition; it remains one explanation among several for the rising potency of the illicit opioid supply.<ref name="ironlaw"/>

	== Harm reduction ==		== Harm reduction ==

MDElliottMD: Un-link Opium inside proper-noun phrases (Opium Wars, Smoking Opium Exclusion Act)

2026-05-17T20:06:05Z

Un-link Opium inside proper-noun phrases (Opium Wars, Smoking Opium Exclusion Act)

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	By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>		By the early nineteenth century, laudanum was widely and legally available, and [[opium]] acquired a notable place in literary culture. In 1821 Thomas De Quincey published ''Confessions of an English Opium-Eater'', an autobiographical account of his laudanum use widely regarded as the first literary memoir of addiction; it linked [[opium]] to the imaginative life of the Romantic era and influenced later writers.<ref name="dequincey">De Quincey T. ''Confessions of an English Opium-Eater.'' London Magazine; 1821.</ref>

	[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the [[Opium]] Wars.<ref name="newsweek"/> The trade was not solely British — prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>		[[Opium]] was also a major article of international trade. Most consequential was the nineteenth-century commerce between British India and China; Chinese attempts to halt the inflow of [[opium]], and the British use of force in response, led to the conflicts known as the Opium Wars.<ref name="newsweek"/> The trade was not solely British — prominent American merchants, including John Jacob Astor and Boston trading firms, also participated in the nineteenth-century [[opium]] commerce with China.<ref name="frontline">Opium throughout history. FRONTLINE, ''The Opium Kings.'' PBS; 1998.</ref>

	== The isolation of morphine ==		== The isolation of morphine ==
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	== Drug regulation in the early twentieth century ==		== Drug regulation in the early twentieth century ==
	Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking [[Opium]] Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates — including prescribing physicians — to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>		Through the nineteenth century, [[opium]] and its derivatives were largely unregulated in the United States and were widely sold in patent medicines. A series of early-twentieth-century laws changed this. The Pure Food and Drug Act of 1906 required medicines to disclose ingredients such as opiates on their labels; this measure alone is reported to have reduced opiate sales substantially.<ref name="psmag">One hundred years ago, prohibition began in earnest. ''Pacific Standard.'' 2015.</ref> The Smoking Opium Exclusion Act of 1909 banned the importation of [[opium]] prepared for smoking. The Harrison Narcotics Act of 1914 required those who produced, imported, or distributed opiates — including prescribing physicians — to register and pay a tax; it was subsequently interpreted by courts and enforcement officials to prohibit the prescribing of opioids to maintain people who were addicted, which moved much opioid use outside legal medicine.<ref name="psmag"/>

	== The modern opioid epidemic ==		== The modern opioid epidemic ==

MDElliottMD: Back-fill wikilinks to Category:Medicines members in running prose

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Back-fill wikilinks to Category:Medicines members in running prose

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MDElliottMD: Add manual Members section (auto-list hidden on MedCategoryFull pages)

2026-05-17T02:35:41Z

Add manual Members section (auto-list hidden on MedCategoryFull pages)

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	== Mechanisms ==		== Mechanisms ==
	Opioids bind opioid receptors — especially the µ-opioid receptor, with additional activity at the κ and δ receptors — found in the nervous system and elsewhere in the body. Binding at the µ-opioid receptor is associated with the analgesic effects of opioids, with their euphoric effects, and with respiratory depression, the mechanism by which opioid overdose causes death.<ref name="chemviews"/> As with medicines generally, that opioids bind these receptors is well established; the fuller relationship between receptor binding and the range of clinical effects — including the development of tolerance and of dependence — is more complex and remains a subject of research, and should not be regarded as a closed question.		Opioids bind opioid receptors — especially the µ-opioid receptor, with additional activity at the κ and δ receptors — found in the nervous system and elsewhere in the body. Binding at the µ-opioid receptor is associated with the analgesic effects of opioids, with their euphoric effects, and with respiratory depression, the mechanism by which opioid overdose causes death.<ref name="chemviews"/> As with medicines generally, that opioids bind these receptors is well established; the fuller relationship between receptor binding and the range of clinical effects — including the development of tolerance and of dependence — is more complex and remains a subject of research, and should not be regarded as a closed question.

			== Members ==
			The opioids include compounds of natural origin such as [[morphine]] and [[codeine]]; semi-synthetic compounds such as [[heroin]] (diacetylmorphine), [[oxycodone]], [[hydrocodone]], and [[buprenorphine]]; and synthetic compounds such as [[fentanyl]], [[methadone]], and [[tramadol]]. [[Naloxone]] and [[naltrexone]] are opioid antagonists — they block opioid receptors rather than activating them. The list is not exhaustive.

	== Safety ==		== Safety ==

MDElliottMD: Add MedCategoryFull marker to enable scoped auto-list hide

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	[[Category:MedCategory]]		[[Category:MedCategory]]
			[[Category:MedCategoryFull]]