The history of Analgesics can illustrate their current use in the world today. From ancient remedies, to the rise of opioids and non-opioid options, tracking the history of pain relievers shows the progress of modern medical science, and how it is not always linear. This series will serve as a brief history of Analgesics, starting with pain relievers prior to the synthesis of morphine in the early 19th century, up to the present day. This article will focus on the Age of Opioids.
The progress of pain medication has taken some complicated detours. Ancient cure-alls such as mandrake root and cinchona bark were once seen as safe and reliable remedies, an opinion modern medicine has rebuked due to the identification of the dangers of their active ingredients. In evaluating these ancient methods, it is important to understand that their perceived effectiveness played a major role in their prolonged popularity, and how a better understanding of medical science resulted in their diminished use. These remedies were not wholly devoid of analgesic properties, but their dangers largely outweighed their effectiveness.
Today, when powerful opioids are prescribed for everything from broken bones to tooth aches, it is important to view our current Age of Opioids through a similar lens. Prescription opioids have a remarkable track-record of pain alleviation, but they have also led to a rise in opioid dependency, which has impacted countless lives. In tracking the rise of prescription opioids from morphine onward, it can be seen both why opioids were so widely prescribed, and why this has contributed to the current opioid crisis happening today.
The Invention of Morphine
The story begins in the early 19th century, when Friedrich Sertürner, a German pharmacist, successfully isolated morphine from opium poppies in 1803.[1] A watershed moment in medical history, morphine quickly became widely used amongst the general public, cementing itself as the gold standard for pain management. Easier to dose and administer than raw opium, Doctors were quick to prescribe it to patients for a variety of ailments. Beyond its commercial use, morphine also found tremendous success on the battlefield, where war medics from the Crimean War in Europe to the American Civil War administered morphine as a potent pain reliever to maimed and injured soldiers.[2] Morphine’s efficacy continues to this day, as two centuries later it is administered in hospitals across the world.
Still, the dangers of morphine were present from the beginning. Sertürner himself lamented his discovery, as he soon became addicted to the drug and was able to observe how its overuse amongst the public created cycles of dependency. Sertürner’s observations from two centuries ago proved to be prescient, as the ensuing years saw the synthesis of newer, more potent opioids, drugs that both alleviated pain and created new instances of addiction.
The Rise of Semi-Synthetics
Sertürner’s work opened the floodgates for opioid research, as the 19th and 20th centuries saw the development of semi-synthetic opioids – opioids that were lab-synthetized from natural opioids. These opioids were much stronger than morphine, yet were initially marketed as being safer and less addictive. Perhaps the most infamous example of this is diamorphine, better known as Heroin. Synthesized by Charles Romley Alder Wright in 1874, heroin was introduced to the world as the first non-addictive opioid in 1898, and was initially administered as a cough suppressant.[3] So confident were its manufacturers in this claim that the name heroin was chosen for its similarities to the German work for ‘strong,’ denoting a drug that would alleviate pain but keep the user in good physical condition. Of course, this was not the case. Today, heroin is an illicit substance that earns billions of dollars for illegal drug markets, and has become one of the poster drugs for the ongoing opioid crisis.
Opioids in the 21st century, from OxyContin to Fentanyl
From the late 20th century to present day, the number of semi-synthetic and synthetic opioids increased, as did incidences of addiction. Oxycodone, better known as OxyContin, could be considered another poster drug for the opioid crisis. Like heroin, it was aggressively marketed as a safe, effective analgesic when it debuted in the 1990s, with its several side effects (including addiction, respiratory depression, and death) being heavily downplayed by its manufacturers.[4] This would become even more dire in recent years with the introduction of the synthetic opioid fentanyl. Exponentially stronger than previous opioids, and only meant to be administered in the most controlled and serious of environments, fentanyl has contributed to thousands of deaths in recent years, primarily in its illegal production and distribution.[5]
When discussing opioids today, it is important to include two caveats: they are highly effective at dealing with pain, and – when administered correctly – they can be taken with relative safety. Over the past two hundred years, opioids have helped millions of people manage their pain, with most not falling prey to the perils of addiction. Problems arise from lack of knowledge surrounding proper use, overprescribing of these drugs for trivial ailments, and a perceived lack of non-opioid pain medications as viable alternatives. For the foreseeable future, opioids will have a singular position in the world of analgesics. There is hope that this hegemony may soon be lessened by opioid alternatives that allow patients to manage their pain in safer ways.
In the next article in this series, we will discuss a brief history of non-opioid analgesics.
[1] Boysen, P. G., Patel, J. H., & King, A. N. (2022). Brief history of opioids in perioperative and Periprocedural Medicine to inform the future. Ochsner Journal, 23(1), 43–49. https://doi.org/10.31486/toj.22.0065
[2] Stefano, G. B., Pilonis, N., Ptacek, R., & Kream, R. M. (2017). Reciprocal evolution of opiate science from medical and Cultural Perspectives. Medical Science Monitor, 23, 2890–2896. https://doi.org/10.12659/msm.905167
[3] Fairbanks, C. A., & Peterson, C. D. (2023). The opioid receptor: Emergence through millennia of Pharmaceutical Sciences. Frontiers in Pain Research, 4. https://doi.org/10.3389/fpain.2023.960389
[4] Van Zee, A. (2009). The promotion and marketing of Oxycontin: Commercial Triumph, public health tragedy. American Journal of Public Health, 99(2), 221–227. https://doi.org/10.2105/ajph.2007.131714
[5] Stanley, T. H. (2014). The fentanyl story. The Journal of Pain, 15(12), 1215–1226. https://doi.org/10.1016/j.jpain.2014.08.010
