Pain

“Opiophobia!” Film #4 from LIFE Before Death.


Perhaps opiophobia is a real thing. Sandy Ward. one of my colleagues here at the UW School of Nursing was one of the first to document the many barriers that patients and clinicians have towards pain relief, and some were related to patients’ fear of these drugs.

But as Charles von Gunten asks, from where does this fear arise?

It seems that in the early 20th Century, opioids were widely used in the USA.  Some actually attribute the Civil War with creating a huge number of people who were using opium regularly (I am avoiding using the term addict). With all the suffering of that war, nearly 10,000,000 opioid pills were issued to just the Union soldiers, along with 2.8 million ounces of other opioid preparations. Opioids were used for pain, diarrhea, dysentery and malaria.

Many women at the time were on opioids for neuralgia, morning sickness or menstrual pain.  Landanum (tincture of opium) was available without prescription by Mail order from Sears and Roebuck, as was cocaine!!!!

Yes, new formulations of opioids have been discovered, morphine in 1803 and cocaine in 1859.  Freud had recommend cocaine as a means of treating morphine and alcohol “addiction.”  Cocaine was found in the original Coca-cola formulation (according to those who have seen the recipe) and heroin was introduced as an over-the counter cough suppressant in 1898 by Bayer (yes the makers of aspirin!!!)

So what turned the tide?

It is estimated that by 1914, 1 in 400 (0.25%) of the US population were “Addicted” to some form of opium. Crime was being linked to cocaine use with strong racial overtones against African Americans, Chinese and those of Hispanic origin. Prohibition set in and control measures were sought by legislators. In 1914,  most states had laws that regulated cocaine and 29 states had laws controlling opium and morphine.  With USA leadership, the International Opium Commission took place in Shanghai in 1909, and following a second conference, the International Opium Convention of 1912.

The Harrison Act become Federal law in the US in 1914, in order to restrict use of opioids through a special tax. Supply did drop but the most significant action was the clause that was interpreted to mean that doctor could not prescribe opiates to ‘addicts’ as addiction was not considered to be a disease. But many physicians continued to prescribe and thousands were arrested and spent time in prison.  The US Supreme Court confirmed the ability of the government to make these decisions.  The Harrison Act was tightened in 1924 when heroin was included. (Remember that around this time, alcohol was also prohibited in the US). The Supreme Court in 1925 overturned the ban on treating addicts stating that the US government could not interfere with Medical practice.

The League of Nations, formed after World War 1, committed to the 1925 International Convention with the primary goal to ban opium and cocaine. Cannabis was also included. This “banning” approach continued until the 1961 Single Convention for Narcotic Drugs, which stated that opioids were essential for the treatment of pain. However we are all aware of the negative attitude continuing even to this date and supported by the more modern “War on Drugs” that is still ongoing.

So “opiophobia” is not new but appears to be a problem that has been with us for just over 100 years.  It is the widespread distribution of films like this that may begin to break down the barriers to unrealistic attitudes towards these essential drugs for the treatment of pain.

jim

http://www.druglibrary.org/schaffer/History/e1910/worstfiend.htm

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide

Discussion

5 thoughts on ““Opiophobia!” Film #4 from LIFE Before Death.

  1. Although fear of prescribing opioids in palliative care is inappropriate, the use of the term “Opiophobia” is reckless and irresponsible. There are very good reasons to be afraid of opioids!

    It’s amazing that people are still using this term in the face of an epidemic of opioid analgesic overdose deaths and addiction afflicting the United States, Canada and Australia… An epidemic caused in large part by minimization of risks and aggressive marketing for chronic non-cancer pain.

    The message conveyed by the video is not balanced.

    Posted by Andrew Kolodny | July 25, 2011, 11:42 AM

Trackbacks/Pingbacks

  1. Pingback: Torture in Health Care! Torture by Neglect? Short film #7. « painpolicy - July 1, 2011

  2. Pingback: Short film #8. Pain in HIV « painpolicy - July 8, 2011

  3. Pingback: LIFE before Death “Demand and Supply” Film #10 « painpolicy - July 25, 2011

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