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Case Study: God's Own Medicine

Where the “Low Fat Revolution” (reported in my earlier blog) lost steam after three decades, it began  as an attempt to reduce heart disease, which Andreas Eenfeldt suggests is the result of changes in human food consumption over thousands of years. In a similar way, Paul Offit in Pandora's Lab outlines the attempts to produce a non-addictive pain killer as the first of his seven worst inventions.  It is a story filled with good intentions, but disastrous unintended consequences. Following is an outline of that story. 

About 6,000 years ago, around the time of Abraham, the Sumerians invented much of what has become agriculture. One of their discoveries was a plant they call hul gil, “the plant of joy.” Today we know it as the opium poppy. Offit traces the long history of the use of opium, but it is the attempts to retain its pain-relieving qualities while removing the addictiveness that led to a trail of tragic consequences.

• 1803 – Friedrich Sertürner, a 20-year-old chemist’s apprentice, isolated opium’s key ingredient, calling it morphium after the Greek god of dreams. Later called morphine, it was six times more powerful than opium. Sertürner became addicted and tried to prevent its use, but by 1827 Merck began mass producing it and European doctors began prescribing it for a variety of illnesses.
• 1853 – morphine became the first intravenous drug when Scottish doctor Alexander Wood used a syringe to inject it into the bloodstream instead of ingesting it, reasoning that people would not develop an “appetite” for the drug.  By 1880, almost every physician in the U.S. owned a hypodermic needle and began instructing patients on how to inject morphine on their own. Wood’s wife died from a morphine overdose, the first recorded patient to die from an injectable drug. By 1900, more than 300,000 people in the U.S. were addicted to morphine.
• 1874 – C. R. Alder Wright, a London pharmacist, boiled morphine with vinegar (acetic acid), attempting to produce a nonaddictive pain reliever in a process known as acetalization. Wright fed the powder (diacetylmorphine) to his dog, who had a very bad reaction and nearly died. Wright threw away the powder and published his findings. Though he became a Fellow of the Royal Society, nobody paid attention to this report at the time.
• 1895 – Heinrich Dreser, a young chemistry professor working for a struggling pharmaceutical company, discovered Wright’s article and instructed his assistant, Felix Hoffman, to acetylate morphine. Hoffman had already done this with sodium salicylate, an anti-inflammatory drug to treat rheumatism, but that drug damaged the lining of the stomach. The resulting compound, acetyl salicylic acid, virtually eliminated the stomach damage. In 1899, Dreser and Hoffman’s company—named for its founder, Friedrich Bayer—marketed its new drug, calling it Bayer Aspirin.
• 1898 – Dreser presented the findings of work he and Hoffman had using the acetalized version of morphine (diacetylmorphine), which they claimed could treat colds, sore throats, headaches and respiratory infections like pneumonia and tuberculosis—two leading causes of death. It was five times more powerful than morphine (already six times more powerful than opium) and they claimed it was completely non-habit forming, though only a handful of people had been tested over four weeks before presenting the results at a major medical meeting in Germany).  Bayer executives were enthusiastic. Some wanted to call it Wunderlich (miracle), but Dreser preferred heroisch (heroic). Bayer introduced it in 1898 as heroin. Aspirin, introduced a year later, could be obtained by prescription only because of fears of gastritis, while heroin was believed much safer and could be purchased over-the-counter.
• 1900 – Eli Lilly, collaborating with Bayer, began distributing heroin without prescription, and promoted it alongside aspirin as a treatment for colds and the flu.  Heroin became a standard of care. In 1906, the Journal of the American Medical Association stated that heroin was “recommended chiefly for the treatment of diseases of bronchitis, pneumonia, consumption [tuberculosis], asthma, whooping cough, laryngitis, and certain forms of hay fever.”
• 1924 – by now the addictive nature of heroin was clear and the U.S. Congress passed the Heroin Act, making manufacture and sale of the drug illegal. It did stop its use. Heroin went underground, with distribution in the hands of the mob.
• 1960s-90s – despite efforts to limit heroin use, it only escalated. Poppy growing and opium production shifted as efforts increased to abolish it. American troops in Vietnam suffered as production moved to southeast Asia, with about 15 percent addicted to heroin. By 1971 President Nixon declared an “all-out war on drugs.”  By 1995 more than 600,000 Americans were addicted to heroin. The Drug Enforcement Agency had 75 offices in 50 countries, spending more than $13 billion a year to keep heroin out of the country.
• The new millennium – by 2003 the number of Americans addicted to heroin had decreased from 600,000 to a little more than 100,000—not because of lost interest in narcotics, but because a new form of addiction was available, and once again, it came about because of the search for the next wonder drug.  Scientists turned to another component of opium: thebaine (named for Thebes, a town in ancient Egypt where opium poppy was grown). The first synthetic version was produced as early as 1916. It was called oxycodone.  Offit goes into a detailed description of developments that led to the introduction of a timed-release version of uncut oxycodone called OcyContin, which would eventually account for 80% of the sales of Purdue Pharma. (In 2001, Purdue reaped $1.45 billion from the sale of OxyContiin, the highest retail sale of any named pharmaceutical product, including Viagra).  But there was also a huge black market as recreational use of OxyContin exploded. Offit chronicles the story:
  • 2002 – Purdue Pharma was selling more than $30 million worth of OxyContin every week. By April, 1,300 deaths had been reported to the FDA, most in cases where doctors had prescribed the drug.
  • 2003 – radio commentator Rush Limbaugh admitted his own addiction to OxyContin [prescribed for severe back pain].
  • 2004 – three million people were using OxyContin—now the most prevalent prescription painkiller in the U.S.
  • 2007 – 14,000 people died from overdoses of prescription painkillers, at a cost to the health care and justice systems of over $55 billion
  • 2010 – 22 million people had misused prescription painkillers, and more people died from these drugs than from heroin and cocaine combined
  • 2012 – 12 million Americans aged 12 and older reported the recreational use of prescription painkillers; 16,000 died from overdoses.
  • 2014 – U.S. retail pharmacies dispensed 245 million prescriptions for opioid pain killers. About 2.5 million adults were addicted to the drug.
  • March 15, 2016 – the Centers for Disease Control and Prevention (CDC) finally offered guidelines for the sensible use of prescription painkillers.
  • October 2017 – [after the publication of Offit’s book] – President Trump issued an opioid emergency declaration

The story laid out by Offit shows the repeated failure—and the escalation of unintended consequences—of the attempt by numerous researchers to harness the painkilling components of the opium poppy while removing its addictiveness.  Not only have those who desperately need relief from chronic pain been tempted by the next miracle drug, but millions more have been drawn in by the recreational use of these products.

Quoting Offit: “When Friedrich Sertürner feared that in morphine he had opened a Pandora’s box and let loose a monster, his warnings were ignored.” He then cites instances of extremely limited data before concluding, “If you’re going to medicate a nation, at the very least you should base your recommendations on a mountain of evidence, not a molehill.”  

CONTINUE to Part 3: Lessons Learned or GO BACK to Part 1: Introduction