Friday, October 27, 2017

Supplanting one Plant for Another

I am fascinated that our government has awakened another crisis in America. The opiate crisis.
I turned on the news this morning to see our Attorney General, my former class mate, speaking on this subject. I am intrigued with the concept.

The poppy is as old as mankind. You remember it had a starring role in the movie The Wizard of Oz. It was the beautiful field full of them that put Dorothy, and her traveling companions, out like the proverbial light. That way the wicked witch and her flying monkeys could harvest them all and carry them back to her evil castle where they were to meet their end.

The substance that mankind became so enamored with early on was opium extracted from the seed of the poppy plant ( Papaveraceous ). In the 18th century laudanum opium was mixed with alcohol and a lot of citizens sat on the front porches in America sipping their little lives away. Early in the 19th century Laudanum's little brother was born, Morphine. It came along just in a nick of time to address the numerous incidents of pain associated with cannon and rifle ball injuries associated with the Civil War. Make that the War between the States. My wife always corrects me and tells me that there is nothing "civil" about war.

Nonetheless morphine, named after the Greek god of dreams, Morpheus, eased the pain of many confederate and union soldiers. Unfortunately, just as welcome as they had been to taking it they found that quitting it was more troublesome. Thus addiction to narcotics was born. It was thought during that period that perhaps if physicians injected it into the patient the addiction would be less if it bypassed the GI tract. The hypodermic needle invented for that purpose only served to get recipients blood levels and relief much quicker and the addiction was to become more intense than ever.

Codeine was isolated in 1830 and was quite useful for relieving cough as well as pain. The Brits, early adapters in most all things, drove usage to alarming levels. Their government sent ships to the coast of China in 1839 in an attempt to curtail the exporting of opium and thus incurred the first "opium war." In 1874 chemists tried to make a less addicting form of morphine and came up with a product named heroin. We all know where that led us.

My interest in this subject decries the fact that I was involved in the distribution of many of these products. I worked for a pharmaceutical company by the name of Endo Laboratories. Our flagship products were, at the time I went to work for them in 1972,  Hycodan ( hydrocodone ), Percodan
 ( oxycodone ), Numorphan ( oxymorphan ). Endo was purchased by the DuPont company and I retired with them in 2002. So that is 30 years that I went about and promoted the usage of these products. Percocet came along in the early 1980's. I carried samples around in the trunk of my car during that time of the hydrocodone products. Nowadays, I would be shot in the head and dumped in the river if certain people knew I had that stuff in the trunk of my car.

So what is my point? Here it is, simply stated. I remember discussing these products with the prescribing physicians I called on. " Dr. I would like to discuss the relative merits of using Percodan in your patients with severe pain." The response of the physician was usually, "I am afraid of using that product for fear of causing addiction in my patient." The company line was " Dr., we respect your position. However, you have a greater responsibility to treat your patient for pain. Nothing does it better than Percodan." Continuing, " When your patient is in severe pain they trust you to relieve it. This product does that better that anything else out there, excepting the needle. Treat the pain. Get your patient well and wean them off the product. They will love you for it." When I got out of the business Percodan, Percocet, Oxycontin, Codeine, Hydrocodone was a multi-billion  dollar market.

Now we come to an Opiate crisis. Whose fault is it? Is it the prescriber? Is it the dispensing personnel, ie: pharmacist? Is it the manufacturing science, pharmaceutical companies? Is it the drug dealer who shoots somebody in the head to get supplies and then sells them on the black market? Is there ever a point at which the patient, end user is responsible?

Is it a crisis because America has turned to something else to help us escape our depressing world? The God of dreams has stolen our dreams. We seek the euphoria that comes with the next fix. This situation is a mess. There will be billions of dollars in TV ads with snappy slogans. Ad companies and grassroots, advocacy professionals will pocket a huge portion of those billions. We will lose the battle. People will become more addicted as we move along.

Think of the juxtapositional cross roads we find our selves at today. It used to be that the plant we most feared was one that produced TCH, Marijuana. Nowadays, state by state, we have accepted the role of that plant to cure our pain, our depression, our glaucoma, etc. The innocent little poppy plant will now take a back seat to the more promising marijauna plant. And round and round we go.

Was it the prophet Isaiah who lived roughly 2000 years ago that foretold that one day "good would be bad and bad would be good." ? I tell you from my vantage point we are there.