Hydromorphone - Overview

Overview

Use of the opium poppy for medical purposes dates back more than 6,000 years. The first archeological record of poppy use can be found in the ancient cultures of the Fertile Crescent (now Iraq and Iran). The ancient Egyptians, Greeks, and Romans all sought opium products for relief of many ailments, from diarrhea to headaches. The Greeks and Romans also knew that opium could be used as a poison. The Greek god of dreams, Morpheus, is depicted in artworks holding opium poppies in his hands.

Between 1000 and 300 BCE, users had learned that the best way to experience euphoriaPronounced yu-FOR-ee-yuh; a state of extreme happiness and enhanced well-being; the opposite of dysphoria. from opium was to smoke it. By the Middle Ages (c. 500–c. 1500), opium use was widespread in Asia, the Middle East, and the Far East. The drug was mixed into wine or other stronger liquors and called laudanum, the Latin word for "to be praised."

Completely legal in the nineteenth century, opium was used and abused by poets such as Samuel Taylor Coleridge (1772–1834) and Elizabeth Barrett Browning (1806–1861), as well as wide segments of the general population. The drug was both cheaper and easier to get than alcohol. In fact, some doctors used it to treat alcoholism. In Europe during this era, opium-based medicines were liquids containing small doses of the drug. Taking such medicines orally further limited the drug's power. Thus, it was possible to use "tincturesCombinations of an active drug and a liquid alcohol." and "elixirs" containing opium for many years while maintaining a fairly ordinary lifestyle. However, it was also easy to take higher doses of the "tinctures" than recommended, leading to addiction and changes in behavior.

Morphine Is Introduced

Morphine, one of the active ingredients in the opium poppy, was first isolated in 1803 by German scientist Friedrich Sertürner (1783–1841). He named the substance after the Greek god Morpheus. By 1832 morphine salts could be obtained in most pharmacies without a doctor's order. The invention of the hypodermic needle in 1848 provided a whole new way to deliver morphine. The hypodermic needle is sharp and hollow and used for administering an injection into the skin. Surgeons used needles to deliver morphine to ease pain during the American Civil War (1861–1865), sending many soldiers home with healed wounds—and addiction problems. In the late 1800s, morphine addiction was called the "soldiers' disease."

After the Civil War, the medical profession set out to discover a way to keep morphine's pain-relieving qualities while removing its potential for addiction. In 1874 British chemist Alder Wright boiled morphine with acetic anhydride, a type of acid. The resulting drug, heroin, was at first thought to be that perfect painkiller. But heroin actually proved more habit-forming than morphine. (An entry for heroin is available in this encyclopedia.) Meanwhile, the growth of opium densDarkly lit establishments, often in the Chinatown section of big cities, where people went to smoke opium; many dens had beds, boards, or sofas upon which people could recline while experiencing the effects of the drug. and the abuse of clearly addictive "tonics" raised new alarms about the hazards of morphine, opium, and heroin. The Harrison Narcotics Act of 1914 removed all opiatesAny drug derived from the opium poppy or synthetically produced to mimic the effects of the opium poppy; opiates tend to decrease restlessness, bring on sleep, and relieve pain. from over-the-counter medicines and made them available only by a doctor's prescription. In 1924 heroin was made illegal.

In an effort to keep powerful prescription drugs from falling into drug dealers hands, the FDA announced plans to track such drugs by using radio frequency identification (RFID) tags. According to then-acting FDA commissioner Lester Crawford (p
In an effort to keep powerful prescription drugs from falling into drug dealers' hands, the FDA announced plans to track such drugs by using radio frequency identification (RFID) tags. According to then-acting FDA commissioner Lester Crawford (pictured here), RFID technology allows drugs to be tracked from the manufacturer to the pharmacy to the consumer. AP/Wide World Photos.

Dilaudid Hits the Market

As of 2005, opiates are separated into two categories: completely illegal Schedule I substances, such as heroin, and regulated Schedule II substances, including morphine, codeine, and hydromorphone. Hydromorphone, a slight alteration of the morphine molecule, was first created and patented by Abbott Laboratories as the prescription pain-killer Dilaudid. Stronger than morphine and available in pill, injection, and suppositoryMedicine that is delivered through the anus. form, Dilaudid quickly became popular as a pain reliever for patients in long-lasting, or chronic, pain. It could also be used safely by patients who had allergic reactions to morphine.

With the explosion of drug experimentation in the 1960s and 1970s, Dilaudid began to appear on the streets under a variety of names, including "dillies" and "drug store heroin." Other problems arose with the prescription painkiller. Some people did not use it correctly and became addicted to it. Others gave away their prescriptions, or sold them, or allowed family members to use the pills. Such tactics began occurring in the early twenty-first century with the popular painkillers OxyContin and Vicodin.

In 2005, Purdue Pharma introduced a new, extended-release hydromorphone capsule called Palladone. Stronger and more dangerous than OxyContin, Palladone was regulated by the most sophisticated tracking devices in an effort to keep it from falling into illegal use. Palladone is a Schedule II controlled substance.

In July 2005 Purdue Pharma voluntarily recalled Palladone after reports surfaced that the drug could prove fatal if combined with alcohol. Although the company warned people not to use the drug with alcohol, it withdrew Palladone pending further investigation. Alcohol can affect the extended-release mechanism in the drug, causing the contents of the pill to be released rapidly rather than slowly. This dose dumping could prove fatal, hence the recall.