Opioid-related issues "popping" up again.

For centuries the world has appreciated the potent analgesic qualities and adverse effects/addictive qualities of opioids. Evidence of potential poppy plant use (preserved remains of cultivated poppy seeds and pods) may date back to the fourth millennium BC (2). Opium was proposed as a remedy for multiple ailments in 1552 BC in the Ebers papyrus. Drug use in ancient central Asia is evidenced by Herodotus’ fifth century BC mention of the Massagets’ (a people who inhabited the northern coast of the Caspian Sea) custom of inhaling smoke from burnt poppy heads for the purpose of inducing euphoria (3). Although there have been amazing advances in pain medicine, the age-old controversy surrounding opioids continues. Currently, opioids are accepted analgesics for cancer pain and non-cancer pain alike and the concept of “balance” best describes the optimal approach to opioid prescribing. Balance refers to assuring opioids are able to be prescribed freely when appropriate in efforts to ameliorate suffering, while at the same time spending efforts to avoid or minimize opioid diversion/misuse. In the 1600s and 1700s, in the section on gout in The Ancient Physician’s Legacy, the formula of Thomas Dover’s famous, Dover’s Powder was revealed. “Take Opium one ounce, Salt-Petre and Tartar vitriolated each four ounces, Ipocacuana one ounce. Put the Salt-Petre and Tartar into a red hot mortar, stirring them with a spoon until they have done flaming. Then powder them very fine; after that slice in your opium, grind them to a powder, and then mix the other powders with these” (1). Opium use continued to grow both for medicinal uses, and pseudo-medicinal uses (including via smoking). The publication of Thomas de Quincey’s Confessions of an English Opium-Eater (1821–1822) brought the addictive potential of opioids (which was already known) into the main arena of international attention. “Sine papaveribus, sine opiates et medicamentis, ex lis confectic, manca et clausa, esset medicina.” “Without opium, without hypnotics and the medicines made from these, medicine would be helpless and crippled.” (1).