May 19, 2020 in Counseling

Medicine vs Monster

The pros and cons of opioid usage. It's medicinal positive effects and it's illegal abusive negative consequences.

DeShawn Kenner

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Dorothy Effect

In the Wizard of OZ, Dorothy fell asleep in a field of poppies. It is now infamously known that when there are many of these flowers together, their odor is so strong that anyone who breathes it falls asleep, and if the sleeper is not carried away from the scent of the bright red flowers, they will sleep forever. Dorothy did not know this. Nor could she get away from the bright red flowers that surrounded her. Luckily, for her that her companions carried her sleeping body to a spot beside the river, far enough from the Poppy Field to prevent her from breathing anymore of the poison of the flowers, and waited for the fresh air to help wake her up. From the land of OZ to the blocks of Brooklyn, the poppy gas caused much pleasure and pain. Let us examine the medical history and benefits of the Opium Poppy, as well as the destructive capabilities, and history. However, before I start with those investigations, I will define what Opium Poppy is, and why it is so popular.

What is Opium?

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DeShawn Kenner

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The power of the poppy lies in its opium. The Opium Poppy medically called the “Papaver Somniferous,” is a large annual angiosperm in the Poppy family, with each stem topped by a flower of pink, red, white, or purple petals. If the capsule is sliced while it is still green, it leaks milky latex rich in potent psychoactive alkaloids. The dried latex, which turns brown, can be peeled from the capsule, and is known as crude opium. Alkaloids are medically important; others are hallucinogenic, or poisonous. The two naturally occurring alkaloids of opium are morphine, and codeine. These agents act on the opioid r receptors that naturally occur in the membrane of some neurons in the brains of humans. The three main receptors in the human brain are: 1) The Mu Opioid Receptor, 2) The Kappa Opioid Receptor, 3) The Delta Opioid Receptor. (The Mu, and the Kappa Opioid Receptors both play a part in pain perception; The Delta is still not fully understood.) Opium has been semi synthesized into heroin, and diamorphine; also it has been synthesized into “10” other opioid versions which are: 1) Methadone, 2) Meperidine, 3) Oxycodone, 4) Oxymorphone, 5) Hydrocodone, 6) Hydromorphone, 7) Dihydrocodeine, 8) Propoxyphene, 9) Pentazocine, and 10) Fentanyl, which has been in the public eye a lot of recently for its contribution to the opioid epidemic; however, in its beginnings Opium was viewed as a medical marvel.

History of Opioids

The origin of opium stems from the hot dry climate of a Middle Eastern country several thousand years ago, when someone discovered that for seven to ten days of its yearlong life, the Poppy, produced a substance that when eaten, eased pain, and suffering. The importance and extent of opium in early Egyptian, and Greek cultures are still under debate, however in the Ebers Papyrus, (circa 1500BC), a remedy is mentioned, “to prevent the excessive crying of children.” Because a later Egyptian remedy for the same purpose clearly contained opium (as well as fly excrement), many historic writers report the first specific medical use of opium as dating from the Ebers Papyrus. Opium was important in Greek medicine. Galen, the last of the great Greek physicians, emphasized caution in the use of opium; but felt that it was an almost cure all, saying that it resisted poison, and venomous bites, cured headaches, vertigo, deafness, epilepsy, apoplexy, dimness of sight, loss of voice, asthma, coughs of all kinds, spitting of blood, tightness of breath, colic, the iliac poison, jaundice, hardness of the spleen, stone, urinary complaints, fevers dropsies, leprosies, the troubles to which women are subject, melancholy, and all pestilences. Greek and Roman knowledge of opium languished during the Dark Ages, and this had little influence on the world’s use of opium for the next thousand years. However, the Arabic world embraced opium completely, because the Koran forbade the use of alcohol in any form; opium and hashish became the primary social drugs wherever the Islamic culture moved, and it most far and fast. When the Arabian world made contact with India and China, opium was one of the products they traded with the Chinese in exchange for gunpowder and guns. By the tenth century, opium had been referred to in Chinese medical writings. During the reign of the Arabic civilization, two Arabic physicians made substantial contributions to medicine, and to the history of opium. First around 1000 AD Biruni composed a Pharmacology book; second in the same period the most famous Arabic physician Avicenna, used opium preparations effectively, and extensively, in his medical practice. His writings along with those of Galen, formed the basis of medical education in Europe during its renaissance, thus advancing the reputation of opium. In the 19th century, a medical transformation took place in Europe. A clinician named Paracelsus accomplished amazing cures for time. One of his secrets was an opium extract called laudanum. He was a renaissance supporter of opium as a cure for all things; he referred to it as, “the stone of immorality.” Because of him, and his followers, new opium preparations were developed in the 16th, 17th, and 18th centuries. One of those was laudanum, as prepared by Dr. Thomas Sydenham, the father of English Medicine. He spoke more highly of opium than Paracelsus did. He said, “Without opium the healing art would cease to exist.” His laudanum contained two ounces of strained opium, one ounce of saffron, a dram of cinnamon, and a dram of cloves dissolved in one pint of canary wine taken in small quantities. In 1806 chemist, Frederic Serturner showed that he had isolated the primary active ingredient in opium. The active ingredient was ten times as potent as opium. He named it morphium after Morpheus, “the god of dreams.’ In 1831, the implications of his chemical work and medical value of morphine had become so overwhelming that the pharmacist’s assistant was given the French equivalency of the Nobel Peace Prize.

Evolution of Opioids

In 1832, the alkaloid codeine was isolated, the word codeine is Greek for Poppy head. The perfection of the hypodermic syringe in 1853 by Dr. Alexander Wood made it possible to deliver more morphine directly into the blood, or tissue rather than the slower process of eating opium, or morphine, and waiting for absorption to occur from the gastrointestinal system of the body. Political events such as: The Civil War, (1861-1865), the Prussian-Austrian war (1866), and the Franco-Prussian war (1870), helped to accelerate the use of morphine by injection. Military medicine was and to a degree still characterized by the dictum, “First Provide Relief.” Morphine given by injection worked rapidly and well; it was given to many soldiers in large doses to reduce pain, and relief from dysentery. At the end of the 19th century, an important chemical transformation was made to the morphine molecule. In 1874 two acetyl groups were attached to morphine. Creating diacetylmorphine, this was given the brand name, “Heroin,” and placed on the market in 1898 by Bayer laboratories. The chemical change is important because heroin is three times as potent as morphine. The pharmacology of heroin and, morphine is identical except that the two-acetyl groups increase lipid solubility of the heroin molecule, and thus the molecule enters the brain quicker, and acts quicker on the user. Heroin was originally marketed as a non-addictive cough suppressant that would replace morphine, and codeine. In 1900, a review article concluded that tolerance, and dependence on heroin was only a minor problem, which were later disproved. With the medical magic of opium, and its natural, and various synthetic forms well known, I needed to investigate why it was also perceived as a monster.

Opioid Abuse & Treatment

According to the DSM-1V-TR CLASSIFICATION substance-related disorders, namely opioid-related disorders can have an Axis I diagnoses if they show at least three symptoms such as 1) tolerance, 2) withdrawal, and 3) a person is using large amounts of an opioid over a longer period than intended. As a result, it undermines the successful life pursuits of the substance abusers to attempt to satisfy their substance craving at the cost of work and family relationships. Its theoretical perspective is the Biopsychosocial perspective, which means the substance-related disorder can be biologically (genetics) caused; psychologically (mentally) cause; or/and socially (culture) caused. Opioids have a very high dependence potential. If the drug is used habitually for pain relief, it will be necessary to increase the dose to maintain a continuous affect; the same is true for the euphoric feeling sought by recreational users. The number of soldiers returning from the Civil War who were dependent on morphine was high enough that the illness was later called a soldier’s disease, or the army disease. The scenario also played out for many soldiers who returned from the Vietnam War; however, they were addicted to heroin. Birunis’ pharmacology book gave his full description of what some believe to be the first written description of opioid abuse. A person, who uses opioids daily at high doses, will experience certain withdrawal symptoms such as nausea, vomiting, diarrhea, aches, pains, and a general sense of misery.

Physical and psychological dependence are the paramount concerns of opioid use, and abuse. However, a bigger problem than both of the concerns aforementioned is the toxicity potential of opioids; they have the potential to kill someone. Opioid overdose can be diagnosed on the bases of the opium tried: 1) come, 2) depressed respiration, and 3) pinpoint pupils. Cross dependence is seen among the opioids. The prescription opioids have become an issue because in 2012, two percent of Americans age 12 and older reported non-medical use of a prescription pain reliever within the last month. Avicenna the Arabic physician who I mention earlier in this piece, dies because of drinking too much of a mixture of opium, and wine. Emergency medical treatment calls for the use of naloxone (Narcan), which reverses the opioid effect of depressed respiration within a few minutes. The opioid epidemic among US workers, caused entirely by uncontrolled prescription of highly addictive narcotics by private practitioners, and pushed by the profit driven US pharmaceutical industry has led to over 600,000 deaths by overdoes, and millions of lives shortened by the cruel realities of addiction. In the 21st century, deaths from prescription opioid overdoses exceeded deaths from heroin and cocaine combined. Opium in all its forms can, and has been deadly for many. Among treatments used, one that is used to end opioid addiction is Cognitive Behavioral Therapy (CBT), which uses cognitive-therapy techniques with behavioral-skills training. Individuals learn to identify and change behavior that may lead to continued drug use, such as going out to bars, or associating with users. Pharmacotherapy’s include: Methadone, Buprenorphine, and Naltrexone. As far as social factors are concerned milieu therapy in which staff and clients in a treatment setting work as therapeutic community to promote positive functioning in clients.

Summary

In conclusion, Opium and its alkaloids have been beneficial, and abused by humans of all lifestyles for many millennia. The difference between the medicinal and the toxic effects of opium has been in its dosage. The addictive properties of opioids and their ability to kill someone make them dangerous. Yet the allure of their ability to induce pleasure, and suppress pain, and suffering has kept them relevant in many lives, and societies in the past, present, and surely the future. US Healthcare funds would be better spent on education in regards to risky behavior prevention, and healthy lifestyle promotion, starting with elementary school age children all the way up to high school. Delayed gratification aka self-control strategies modeled by Dr. Walter Mischel, (Marshmallow Test), would be an excellent tool used to teach children how to avoid drug misuse, and abuse. In a study done by Dr. Mischel at Stanford University, research found out that the children, who learned to delay gratification by using self-control methods, went on to live longer, healthier successful lives in comparison to those children who had not learned delayed gratification techniques observed in the same study. I would also love to see all opioids legalized completely, and not conveniently, because I view them, and their uses as a healthcare concern, and not as a criminal justice concern, which criminalizes the user, and the opium poppy, which served humanity for thousands of years. As Dr. Thomas Sydenhamm the father of English Clinical Medicine said, “without opium the healing art would cease to exist.”

 

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