Category:Opioids: Difference between revisions

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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>

[[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 ==

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== 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 Heroin was withdrawn from ordinary medical use and made illegal in many countries in the early twentieth century.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

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== 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 ==

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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 '''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 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 ==

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