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Thanks, in part, to the generous support of the NIHCM, this month we are releasing four special episodes on Opioids. We hope you enjoy them. This week's episode:

The History of Opioids - We will give a historical overview of people and opioids. We will look at when people first started using opioids, how they've changed over the years, and ways that they've been both amazingly positive as really effective painkillers and devastating to individuals and social orders. We will explore the early accounts of opiate use, addiction, and treatment, and touch on the Opium Wars in China. The evolution from raw opium latex to the powerful drugs derived from opium today traces a clear history of increasing addiction as opioids were available in more and more powerful preparations.


Those of you who want to read more can go here: http://theincidentaleconomist.com/wordpress/?p=70453

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

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Over the next four weeks, we're gonna be looking at opioids, a class of drugs originally derived from the opium poppy.  We're gonna talk about the history of these drugs, the science of how they work, their potential for abuse, and how we help people recover from addiction.  Opioid drugs can be very, very dangerous, but they can also be extremely useful.  According to one researcher, and I'm quoting, "To understand the popularity of a medicine that eased, only if temporarily, coughing, diarrhea, and pain, one only has to consider the living conditions at the time."  Until the 20th century, cholera and dysentery regularly ripped through communities, its victims often dying from debilitating diarrhea.  Diseases like dropsy, consumption, ague, and rheumatism were very common.  Opiods could be used to treat all of these things.  But the line between useful treatment and harm is very blurry when it comes to opioids, and while they can be very effective in some respects, they can easily become deadly.  The history of opiods are the topic of this week's Healthcare Triage.  

(Intro)

This episode is brought to you in part with generous support from the National Institute of Healthcare Management.  

Humans have known about opioids and their pain relieving and euphoria-inducing properties for a long, long time.  We've known about them pretty much as long as we've been writing stuff down, and maybe even longer than that.  As far as back 3400 BC, records indicate the poppy was grown in lower Mesopotamia.  Sumerians called it "Hul Gil", or "the joy plant".  By 1300 BC, Egyptians were growing fields of it, and the opium trade was in full force all over the Mediterranean world.

The Greek physician Hippocrates, who you might know from his Hippocratic Oath, used opioids to treat a number of diseases.  Alexander the Great brought opium to Persia and India.  In the 1300s, though, opium sorta disappeared for a couple centuries in Europe.  Evidently, the holy inquisition didn't care too much for its use.  Opioids had some undesirable social outcomes like addiction and withdrawal, and besides, it came from foreign lands, and during the inquisition, anything foreign was pretty much the work of the devil.

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By the 1500s though, smoking opium was picking up again in Portugal. Laudanum was invented by Swiss Polymath physician Paracelsus in the late 16th century. Paracelsus made his laudanum with a bunch of weird ingredients like crushed pearls and musk, but the real power of it was the potent combination of opium and alcohol.

By the 1600s, England started importing opium from colonies in India. By the 1700s, the Dutch and the English were shipping it to China. The Chinese Ching dynasty emperors tried to outlaw opium use, but it was unbelievably popular, and it was extremely profitable for the European merchants who were importing the stuff to China. In fact, it was so profitable that the English were willing to go to war with China, not once, but twice, to keep the opium trade in business. Not only did these wars allow the English to keep the opium trade open in China, they set the stage for European powers to force the Chinese to sign all kinds of unfavorable trade deals. The British got an indefinite lease on Hong Kong, for example, which they would hold on to for over a hundred years, not returning the island to Chinese control until 1997.

The 19th century saw a lot of advances in the science of opioids. In 1803, Friedrich Serturner, in Germany, discovered the active ingredient in opium: morphine. He managed to extract this active alkaloid, which allowed for much more potent opioids to enter the market. In 1827, E. Merkin company (?~3:37) began manufacturing morphine commercially, and in 1843, Alexander Wood figured out that you can inject morphine with a syringe. It was three times stronger when administered that way. These new opioid drugs had even more analgesic power, but they also had more powerful side effects, including euphoria and the addiction that could result from it. In 1895, Heinrich Dressi (?~3:58) of the Bayer company discovered that diluting morphine with acetyls produced a drug with fewer side-effects.

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