The Most Feared Legal Drug on the Market
There are more than a hundred modern prescription drugs derived from plants. On Monday I spoke of herbs and plant-derived products, and their medicinal properties. Today, I want to continue the conversation and talk about a highly popular, yet highly addictive drug –morphine.
Most people seem unaware that morphine was extracted from a plant source more than 200 years ago and is still our best defense against severe pain.
The plant is the poppy flower, Papaver somniferum. Morphine was extracted from it by a German assistant pharmacist — Friedrich Sertürner — in 1804. By 1817, he was selling it in his apothecary shop, and in 1827, when Merck established a manufacturing center in Darmstadt, it began production of morphine in quantity. Morphine is an alkaloid, and Sertürner separated it from the poppy’s milky sap that can be refined into opium.
The use of opium goes well back into antiquity. It is the most commonly mentioned medicinal plant in The Iliad, and an ancient tomb in Crete shows a goddess with opium poppies growing from her head. As old as the use of opium is, Sertürner did something with it that had never been done before and is worthy of historic note: He created the first active ingredient derived from a plant source. Well, not exactly — it was the first recorded by nonindigenous people. He named it morphine after the Greek god Morpheus, who is said to appear in dreams. People given morphine often fall sleep.
Opium poppy flowers morph into pods and are drained to make morphine.
After the hypodermic syringe was invented in the 1850s, morphine use became even more widespread because a shot of it could relieve extraordinary pain within seconds. Ever since, it has been the only buffer against unbearable pain that Westerners have, and it is so important that it is sold under more than a hundred brands around the world.
In 1977, the World Health Organization placed morphine on its first list of 200 or so essential medicines. The only other painkillers that make the list are aspirin, ibuprofen, acetaminophen and the opiate codeine. None of them can provide the kind of relief from intense pain, such as postoperative pain or battlefield wounds, that is provided by morphine. Unbearable pain is thus a condition most people in developed countries rarely experience.
There are two key factors to know about morphine. First, one of the reasons it works so well is that it interacts with the central nervous system. Second, it can be highly addictive, among other significant side effects. Morphine is the chemical cousin of heroin, both derived from the poppy plant.
Morphine, like heroin, has what is called a euphorogenic effect. It makes you feel happy, which helps create addiction. (The human body can make its own opiates, such as endorphins, which is why runners keep running until their knees collapse.) Morphine also can depress breathing. The initial dose of morphine taken after an operation is 5–30 mg. Overdoses of as little as 200 mg can cause death. Withdrawal symptoms for patients who have been receiving morphine for extended periods can be ugly and difficult.
The addiction problem has led more than one pharmaceutical company to seek an alternative to morphine that could be given more freely. Yet the only alternatives that work well, such as oxycodone, hydromorphone, fentanyl, pethedine, and meperidine, are themselves opiates and addictive.
One of the complications of bringing an alternative drug to market is that it may eventually be classified by the Drug Enforcement Agency into one of five categories, or schedules, from I to V, that determine “potential for abuse.” The classification system is the result of a drug law passed by Congress in 1970 and signed by President Richard Nixon.
The most feared drugs are in Schedule I. As the schedule number increases, fear about the drug lessens and access and sales are likely to increase. Any drug listed on a schedule becomes a “controlled substance” subject to restrictions. Schedule I is for drugs for which there is no accepted medical use and drugs that cannot be used safely under medical supervision, such as heroin, LSD and ecstasy. Both the DEA and FDA add and remove drugs from the list. The DEA tends to be quite conservative about such matters, and to this day, marijuana remains on Schedule I, despite changing state laws.
Morphine is a Schedule II drug. Valium, for the sake of an example, is a Schedule IV drug and cough medications containing codeine are Schedule V drugs.
Patients who are properly administered a controlled-release form of morphine should not develop a tolerance to the drug, but there is quite a mythology surrounding morphine, including reports of patients requiring doses above 2,000 mg. The tolerance controversy has tended to limit the amount of opiate pain relievers given in hospitals and spurred a further controversy about terminal patients not being given adequate pain relief.
Several innovative small biotech companies are actively pursuing less-addictive or even non-addictive drugs for serious pain by creating molecules that work on the pain/pleasure areas of the brain. For everyone’s sake, let’s hope they are successful.
To your health and wealth,
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