A complex history
Reprinted from "Opioids" issue of Visions Journal, 2018, 13 (3), p. 8
One hundred and ten years after opium was made illegal in Canada, we find ourselves in the midst of the worst opioid overdose crisis in our history. How did we get here?
How has our historical relationship with opioids shaped the current situation? Why are some opioids illegal? What role do governments and drug companies play?
One might be excused for thinking that opioids were made illegal because we discovered they were dangerous. We might also believe that this class of drugs is so powerful that its users become immediately dependent and will do anything to acquire the drug. But neither is true, and the truth is not quite that simple.
The early days of opioids
Opioids have been used throughout the world for thousands of years—as medication and for other reasons. The earliest clear reference to opium poppy cultivation is more than 5000 years old. The ancient Sumerians of lower Mesopotamia referred to the opium poppy as Hul Gil—the “Joy Plant.”1,2 Since then, opium has been used in many cultures and praised for its healing effects. It has also been used for sacred and recreational purposes, though the boundaries between different types of use were never clear.
Laudanum (a mixture of opium and alcohol) was used as a common remedy for a variety of ailments in the 17th and 18th centuries.3 Then, in 1804, German chemist Friedrich Wilhelm Adam Sertürner isolated morphine from opium.4 Morphine became the preferred medical treatment for pain, anxiety and many other health issues, particularly after the invention of the hypodermic needle in 1853, which made the drug easier to administer. In 1874, heroin was derived from morphine and used primarily to treat pain.5
Since then, an almost limitless number of related drugs (known collectively as opioids) have been derived from opium or synthesized in laboratories. These opioids have been promoted by their makers, prescribed by medical professionals and used by the general public. One famous opioid-containing product was Mrs. Winslow’s Soothing Syrup, a morphine and alcohol mixture that was marketed at the end of the 19th century as a concoction to help fussy children sleep.6
What is Morphine?
Morphine is one of many different chemicals present in raw opium. Heroin is morphine that has been even further refined via chemical reaction (it is simply morphine with an acetyl molecule attached). Heroin is roughly two to three times as potent as morphine.
The era of prohibition
As the opium trade between China and British India took off during the 16th and 17th centuries, the Chinese government banned importation of the drug in order to reduce opium consumption among its citizens. Not only was the Chinese Empire unsuccessful in regulating opium use among its citizens but its attempt to suppress the opium trade led to violent military retaliation by the British Empire.7
Throughout this period, trade and use of opium (and, later, heroin) increased in Europe and North America as well. In the West, the 20th century was characterized by prohibition. But these sorts of government policy changes were driven by trade and immigration concerns rather than a widescale perception of harm. In fact, it was only when the West’s opium trade with China began to decline, around 1906, that the Chinese government was able to regulate importation and consumption of the drug.8
Canada was one of the first countries to ban opium for personal, non-medicinal use, starting with the Opium Act of 1908, which made it an offence to import, manufacture, possess or sell opium for non-medical reasons.9 This legislation was passed in response to the public campaign for Chinese exclusion and the moral panic about drug use and its impact on race relations and gender roles. Anti-Asian sentiment led to labour riots against Chinese and Japanese workers in Vancouver in 1907.10 The ban on opium was seen domestically as a response to the “Chinese problem” and internationally as leading the way on the “opium problem.”11
After World War I, a string of amendments to existing legislation led to the Opium and Narcotic Drug Act of 1929. This would become Canada’s main drug policy until the late 1960s, when other countries began to introduce similar legislation and we entered an era of international prohibition of non-regulated trade and consumption of narcotics.
The pharmaceutical promotion of opioids—and the court’s response
At the same time that Western governments were prohibiting the non-medicinal trade and use of opioids, pharmaceutical companies and medical authorities were promoting and selling opioids for a range of medical and health purposes. For example, at the end of the 19th century, the German drug company Bayer began advertising heroin as a cough remedy that was more effective and less addictive than either morphine or codeine, setting the stage for other pharmaceutical companies to promote new opioids as both effective and non-addictive.
Synthetic opioids (such as oxycodone) were introduced in the 1950s; doctors quickly embraced them as a treatment for pain.12 During the 1980s, physicians explored the use of prescription opioids to treat cases of chronic pain. The prescription opioid landscape changed again in the 1990s, as new, slow-release opioids entered the market, offering pain-treatment options that were supposed to be safer.
Pharmaceutical companies increased marketing efforts to health care providers, holding information symposia and offering coupons for some of their opioid medications. The market for those medications grew. In 1996, Purdue Pharma began to aggressively market and promote OxyContin, its synthesized opioid remedy, following the pattern originally set by Bayer: it exaggerated the drug’s effectiveness and downplayed its addictive potential.13
In the late 2000s, the courts began to recognize the dangers inherent in the pharmaceutical promotion of opioids. In 2007, Purdue pleaded guilty to misleading regulators, doctors and patients about the risk of dependence associated with OxyContin and agreed to pay $600 million in fines.14 More recently, Purdue Pharma (Canada) agreed to pay $20 million—including $2 million to provincial health plans to help compensate for how the company had marketed and sold OxyContin.15
The way forward
Substances derived from the opium poppy (and similar, synthetic opioid concoctions) have been used throughout human history—for medicinal and sacred purposes, and for pleasure. Physical and ideological wars have been fought over the drugs—both in an effort to protect the opioid trade and in an effort to stamp it out. Many individuals and corporations have become rich because of opioids, but countless others have lost fortunes—even their lives and the lives of their loved ones.
Opioids have been praised, demonized, prohibited and promoted, all at the same time. They are certainly not going away; maybe it’s time we learned, as individuals and as communities, to manage these substances in our midst. This will mean we need to change the way we talk about drugs. Rather than using a simple binary of good and bad, we will need to acknowledge the complex reasons people use drugs and the different impacts drug use can have in different contexts. Then we will need to help people develop the skills they need to make informed and positive choices.
About the author
Gaëlle is a research assistant for the Canadian Institute for Substance Use Research at the University of Victoria
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The fines were distributed to different agencies (including law enforcement and Medicaid programs), the federal government and individuals who had sued the company.
“OxyContin maker agrees to $20M settlement in Canadian class-action case.” (2017). CBC News, May 1. www.cbc.ca/news/health/oxycontin-class-action-1.4093781.