THE CURSE OF THE POPPY BLOSSOM

Opium, the congealed sap of the poppy plant, has been both a blessing and a
curse to mankind since its discovery some four millennia ago. The ancient
Sumerians called it Hul Gil (the joy plant) and taught its harvesting
methods to the Assyrians who in turn shared it with the Babylonians and
Egyptians. For countless centuries opium has lessened pain, induced sleep
and soothed the troubled spirits of those in emotional turmoil. But for
those who used it more than briefly it might also result in a tenacious
state of dependency. And despite claims otherwise, it numbed the creative
talents of those addicted to its euphoric effects. On a larger scale, opium
prompted a series of wars in 19th-century Asia. Top Opinion stories:

In 1803, the German chemist Friedrich Sertuerner isolated one of the active
ingredients of opium sap, calling it Principium somniferum, and later,
morphine, named after Morpheus, the Roman god of dreams and the son of
Hypnos. Morphine represented a major advance as a therapeutic agent for two
reasons: First, as a pure alkaloid it could now be administered in precise
amounts (opium sap, on the other hand, varied in narcotic strength from
batch to batch). And second, in contrast to opium, morphine was soluble in
water and hence could be injected into the body, thus achieving virtually
instantaneous pharmacological effects such as pain suppression.

The great promise of morphine had been fulfilled: It was cheap, produced
its effects rapidly and was much safer than opium. By 1827, E. Merck of
Darmstadt, Germany, began the commercial manufacture of morphine. But it
did not take long for physicians to appreciate that morphine also generated
habituation, dependency and finally addiction.

An appeal was made to the many creative organic chemists of 19th- century
Germany: Can an opiate alkaloid be isolated -- or synthesized from raw
opium while still retaining its analgesic (pain-killing) and narcotic
powers, preserving its rapid and short-acting attributes, causing no
troublesome side-effects and, most important, provoking no chemical dependency?

In 1895, the German chemist Heinrich Dreser, working for the Bayer Company,
modified the chemical structure of morphine, producing a highly potent
narcotic which was initially thought to produce little addiction. The
product went into production and was first known as diacetylmorphine but
later called heroin. The British initially used heroin, in decreasing
doses, to treat opium addiction. But by 1903, heroin addiction had risen to
alarming proportions, particularly in the United States and the dream of a
nonaddicting opiate had vanished.

The search continued for a potent opiate that was essentially free of
addictive tendencies and avoided the nightmare of withdrawal symptoms.
During World War II, Germany had a shortage of medicinal morphine. And in
response to this, I.G. Farben developed a synthetic alternative originally
called adolfine (allegedly named to honor Adolf Hitler) but then named
dolofine. It is more likely that the name was coined from the Latin, dolor
(pain) and finis (end). The German pharmacologists were especially
impressed with the ability of this compound to reduce pathological spasms
of internal organs.

U.S. public health officials were seeking an opiate that might lessen the
intolerable discomfort of deliberate heroin withdrawal; and in 1950, they
included dolofine in their clinical trials. The chemical name for dolofine
was methaminodiphenylone; and following the American penchancy for
acronyms, they shortened the name to methadone.

In the early 1950s, Dr. Vincent Dole and his colleagues found that a single
daily oral dose of methadone, in heroin addicts, was sufficient to prevent
both the craving for narcotics and the withdrawal symptomatology.

Admittedly, these clinic patients were now irreversibly addicted to
methadone, but at least they were able to maintain jobs and avoid the
roller-coaster phenomenon of heroin dependency. Those who condemned the
methadone clinics claimed that they achieved little more than substitute
one addiction for another. But the advocates of methadone replacement
therapy declared that this therapy is inexpensive, has few significant
side-effects and permits its users to lead crime-free, productive lives
with little motivation to seek heroin. Currently there are, in this nation,
more than 100,000 individuals on oral methadone replacement therapy.

Yet another recently developed opiate-like narcotic is oxycondone that,
when, properly administered, is a powerful agent capable of suppressing
pains generated by cancer or injury.

In January 2001, newspaper reports described a crime-wave ascribed to the
stealing and trafficking of oxycondone supplies both from pharmacies,
nursing homes and even from the medicine chests of individuals legally in
possession of these agents. One of the most popular of the oxycondones is a
medication called OxyContin. Each tablet of this drug is covered by a
substance which regulates the measured release of the underlying narcotic
during a 12-hour interval. Many patients can thus obtain uninterrupted pain
relief with only two oral tablets each day. And many are convinced that
OxyContin suppresses pain more effectively than any of the other opiates.

Addicts quickly learned that when the outer coating of OxyContin is
removed, they are left with an very powerful narcotic that can be easily
administered intravenously, achieving a rapid and somewhat sustained high.
OxyContin became the street drug of choice in smaller Appalachian and
Midwest communities particularly where heroin was not readily available.

A number of deaths have been associated with the illegal use of OxyContin;
but in most of these cases there was concurrent abuse of alcohol and other
illicit substances.

A recent analysis of drug-related emergency room visits shows a clear
increase in visits occasioned by adverse effects of OxyContin abuse. Last
year, there were an estimated 10,400 such visits nationwide. But to keep
this is the context of overall drug abuse, there were, during that same
interval, 187,000 emergency room visits prompted by cocaine usage. A 1999
National Household Survey on Drug Abuse showed that about 9 percent of the
American public (19.9 million people), on one or more occasions, had used
illegally obtained pain-killers.

The search for new opiates continues. But given the uncritical enthusiasm
that greeted prior opiate candidates, it would be prudent to regard each
newly arrived drug with a substantial measure of caution.