Fighting the Opioid Epidemic

The Role of Providers and the Clinical Laboratory in Understanding Who is Vulnerable

Amitava Dasgupta

• Publisher: Elsevier
• Year: 2020
• ISBN:
  9780128223901
• Topic: Ciencias biológicas
• Subtopic: Biología

Fighting the Opioid Epidemic: The Role of Providers and the Clinical Laboratory in Understanding Who Is Vulnerable covers the important aspects that are essential in fighting the opioid epidemic. This succinct reference highlights how the toxicology laboratory can play a vital role in fighting the opioid epidemic by implementing a robust system for drugs of abuse testing as well as drug testing in pain management patients. It targets health care professionals in a technical manner, discussing polymorphisms of important genes that may be associated with increased vulnerability of alcohol and drug addiction to an individual.

• Covers all important aspects of opioid abuse, including genetic and environmental factors
• Discusses pharmacology, toxicology and the pharmacogenomics related to opioid metabolism
• Presents genetic and environmental factors associated with those vulnerable to opioid addiction, as well as the pitfalls of drug testing in pain management

Chapter 1: Crude Opium, Morphine, Codeine, and Heroin: Past and Present

Abstract

Opium use was known to ancient cultures as early as 3500 BCE by Sumerians who called it “Hul Gil,” which means “joy plant.” The Sumerians passed the knowledge of poppy cultivation to the Assyrians, the Babylonians, and ultimately, the Egyptians. The description found on the Ebers Papyrus (1500 BC) from Egypt indicated use of poppy seeds as a remedy for pain relief as well to prevent excessive crying in children. The major active ingredient of opium “morphine” was characterized in 1817. Morphine is probably the most potent alkaloid present in opium because it is responsible for analgesic, euphoric, sedative, and also addictive behavior. However, morphine is also responsible for many adverse effects of opium. During 1830s, morphine became a very common analgesic, and after American Civil War, many wounded veterans were addicted to morphine. Heroin, the first designer drug, was synthesized from morphine in 1874. Heroin was first marketed as an antitussive for patient with asthma and tuberculosis in 1898, but later its abuse potential was discovered. Today, heroin is a schedule I drug with no known medical use but has high abuse potential. Heroin overdose is a serious public health issue due to high fatality rate from overdose. Detection of 6-monoacetylmorphine, the first deacetylated metabolite of morphine in blood, indicates that death may have occurred within 20–30 min of heroin overdose.

Keywords

6-Monoacetylmorphine; Heroin; Morphine; Naloxone; Opium; Overdose

Introduction

Poppy plants (Papaver somniferum, Papaver paeoniflorum, and Papaver giganteum) are herbaceous annual plants that can grow almost anywhere. Of all the different species, P. somniferum is the most popular plant due to its beautiful flowers as well as its seeds, which are used for making muffins, baking breads, and other purpose. This plant is one of the oldest medicinal plants known to mankind. The plant's seedpod contains a latex solution that exudes if scored with a sharp instrument. The latex is raw opium that contains both alkaloids and nonalkaloids [1]. Crude opium was used for various purposes since ancient time. Most likely, opium was the first narcotic substance discovered at the dawn of mankind [2].

Opium Use: From Ancient Time to Modern Time

Opium use was known to ancient cultures as early as 3500 BC by Sumerians who called it “Hul Gil,” which means “joy plant.” The Sumerians passed the knowledge of poppy cultivation to the Assyrians, the Babylonians, and ultimately, the Egyptians. The description found on the Ebers Papyrus (1500 BC) from Egypt indicated use of poppy seeds as a remedy for pain relief as well to prevent excessive crying in children. Interestingly, artifactual remains related to opium usage were also found in the Egyptian tomb from 15th century BC. A goddess from about 1500 BC showed her hair adorned probably with poppy capsules and her closed eyes were indication of sedation, thus speculating opium use in ancient time. In addition, juglets probably imitating the poppy capsules were found in that period in both Cyprus and Egypt. By 1300 B.C., the Egyptians were cultivating opium and probably traded opium all over the Middle East and into Europe [3]. Around 850 BCE, the great Greek author Homer considered opium as an intoxicating substance with pain-relieving and sleep-inducing properties [4].

Hippocrates (460–375 BC), the father of medicine, recognized analgesic effects of opium and probably prescribed poppy juice as a purgative, a narcotic, and possibly a cure for leucorrhea. Around 330 B.C., Alexander the Great introduced opium to the people of Persia and India, where the poppies later came to be grown in vast quantities. The first recorded reference of utilizing juice from poppy as a therapeutic agent was made by Theophrastus, the Greek scholar in the third century BC. In the second century, AD Roman physician Galen introduced use of opium for medical use. However, he was also aware of abuse potential of opium [4]. The antidiarrheal property of opium was mentioned by Persian physician Avicenna (980–1037 AD). He also reported that use of opium common in Khorasan (northeast of Iran) and Bokhara (southwest of Uzbekistan). Arab traders introduced opium to India and China during later part of Tang dynasty (618–907 AD). Probably between 10th and 13th century, opium was introduced in the Asia Minor and then to Europe [4].

Ingestion of opium as an oral preparation has undergone many modifications over the Centuries. Thomas Dover (1660–742), an English physician, developed a powdered form of edible opium that was also known to contain saltpeter (mostly potassium nitrate), tartar, licorice, and ipecacuanha. Laudanum, an alcoholic tincture of opium, was created by the 17th century English physician, Thomas Sydenham, and was commonly paired with whiskey or rum. As a means for preparing patients for surgery, Laudanum became widely used in Europe and North America into early 20th century. Moreover, one of the first books dedicated to the uses and effects of opium, Mysteries of Opium Reveal'd, written by the Welsh physician, John Jones, was published in 1701. However, he also listed many side effects of using opium [5].

Opium was used for baby sedation from the ancient time. As a free rider of gum lancing, opiates joined the treatment of difficult teething in the 17th century. During Industrial Revolution, opium was used by working class. With industrialization, private use was rampant among the working class. In German-speaking countries, poppy extracts were administered in soups and pacifiers. In English-speaking countries, proprietary drugs containing opium were marketed under names such as soothers, nostrums, anodynes, cordials, preservatives, and specifics and sold at the doorstep or in grocery stores. Opium's toxicity for infants was common knowledge; thousands of cases of lethal intoxication had been reported from antiquity, but physicians continued to prescribe it for babies. Unregulated trade led to greatly increased private use of opiates during the 19th century. Intoxication became a significant factor in infant mortality. As late as 1912, the International Hague Convention forced governments to implement legislation that effectively curtailed access to opium and to discontinue the dangerous habit of sedating infants [6].

Before the development of general anesthesia, surgery was performed only in extreme necessity. It is probable that an analgesic such as opium would have been given during or following surgery. The first description of opium usage for postoperative analgesia is dated to 1784, when the Glasgow-born London surgeon, James Moore, described use of opium. The Scottish surgeon, Benjamin Bell, also noted that opium was useful in controlling postsurgical pain [5].

According to historical evidence, the abuse of opium has been reported all over the globe—specifically throughout Eastern nations since the 16th century. Before that, opium was mostly used as medicine. Reference has been made in traditional Persian medical literature to the method of cultivation, properties, side effects, and toxicity. In 16th century Iran, opium use began during the reign of the Safavids. Then famous scholar Imad al-Din Mahmud ibn Mas'ud Shirazi composed a book concerning addiction, Afyunieh, a comprehensive book on the topic of opium and all issues of opium abuse. Furthermore, he recommended methods for reducing opium dose as well as substitution with other medications that had a narrower range of side effects, in order to eradicate dependency upon opium and opium-derived materials. This is most likely the first book that comprehensively addressed opium and discussed drug rehabilitation methodology, in traditional Persian medical literature [7].

Along with opium use, opium addictions also become a significant health hazard. Opium addiction was widespread in China, and following a 1799 ban on opium in China, smuggling of opium became a common industry that lead to the opium war between the British and China in 1839. During the 19th century, opium was grown in the United States as well as imported. Besides indiscriminate medical use, opiates were available in the United States in myriad tonics and patented medicines. In addition, smoking in opium dens was unhindered, resulting in an epidemic of opiate addiction by the late 1800s. The developme...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Preface
• Chapter 1. Crude Opium, Morphine, Codeine, and Heroin: Past and Present
• Chapter 2. Prescription Opioids: An Overview
• Chapter 3. Opioid Abuse and Opioid Epidemic
• Chapter 4. Genetic Factors Associated With Opioid Therapy and Opioid Addiction
• Chapter 5. Environmental Factors Linked to Opioids, Drugs, and Alcohol Abuse
• Chapter 6. Poppy Seed Defense and Workplace Drug Testing: Does It Work in the Court?
• Chapter 7. Drug Testing in Pain Management
• Index