Opioid epidemic in the 19th century

#pain #painrelief #opioid

I read with great interest the paper published by Dr. Warraich (@haiderwarraich). He is very right in his conclusions related to ethical education of doctors, and a more strict attention to the FDA activities. Some observations are necessary:

1. The title of his article is misleading. The reasons for the explosion of opioid crisis over 1 century ago are much more complex than what he says. Just to mention few, the enormous immigration from China to USA in the 19th century brought (and diffused) the use of smoking opium, already very common in China. Bayer promoted its "Heroin" not as a drug against pain but as a syrup to reduce or abolish the cough, especially in children. Hence, the first phrase of the article ("In the 1890s, chronic pain was rampant in America") is historically incorrect. At that time people were suffering and dying in pain, without any medical support. Medicine was focused on survival more than on suffering and pain management. The medical culture to care for pain patients arrived much later, some 80 years later. We should never forget that this was an important step forward for the Medicine, but especially for the patients. More careful attention to pain is increasing the quality of life, and ultimately the life expectancy.

2. The huge (illegal) diffusion of fentanyl and many other drugs from China, India, Colombia etc. to USA and the rest of the world is illegal by definition. As such it should be considered and treated. This has nothing to do with opioid prescription for medical purposes. It seems more linked to social behaviours and the "necessities" of the young generations. In my opinion, any readers may observe the pathological behaviour of many teenagers drinking litres of alcool, and destroying themselves. This is in most of the cases legal, it is made under our eyes, and can kill. Are we going to abolish beer, wine and spirits producers because of that. Maybe it would be much more productive to find the ways to prevent that the teenagers kill their brain abusing of alcool, and other substances.

3. The article does not mention the differences existing between USA and other countries, where the prescription of opioids and the rules established for the control of their use are a bit different. Believed or not, in Europe the rules are much clearer and strict, at least till now. Between other reasons related to marketing and business, this seems a very important point in preventing the crisis described in the article.

So, again I appreciated very much the article of Dr. Warraich and would strongly recommend to implement what he suggests. At the same time, I would defend the rights of the suffering people that need cares, and should not be obliged to live in pain because the society is not able to find solutions to illegal behaviours, both of medicine, regulatory institutions, but especially of the society in general.

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