In this article, you’ll learn and discover about Opioids and the 3 treatments for chronic pain.
Opium. Heroin. Morphine. Methadone. Oxycodone. Hydrocodone. What all of these have in common is they’re derived from a plant—the poppy plant. Written references to the use of this plant, native to Southeast Asia, for pain and other ailments, date back to 3400 B.C.
In more recent times, opium and even heroin were commonly used in pharmaceutical preparations for pain relief until the early 1900s. Concern about their addictive potential led the U.S. Congress to eventually ban these substances in pharmaceutical preparations.
That didn’t stop the pharmaceutical companies from searching for ways to find patentable substances derived from the poppy plant to meet a real need: relief from suffering for those in pain. In 1916, Oxycodone, a synthetic drug derived from the poppy plant, was developed and was approved for use in the U.S. in 1939. Hydrocodone, also derived from the poppy plant, was synthesized in 1920 and approved for use in the United States in 1943. These synthetic derivatives became known as opioids.
For decades, physicians were very cautious about prescribing pharmaceuticals containing oxycodone and hydrocodone because they were known to be addictive. But for the pharmaceutical companies, the marketing incentives were great. Tens of millions of patients were in chronic pain and if they could peddle these drugs to those long-term sufferers, a lot of money could be made.
Purdue Pharma developed a long-acting version of oxycodone, which they named OxyContin, and in 1996 began aggressively marketing the drug to physicians. Although they knew from their clinical trials that OxyContin was very addictive, they lied and assured physicians that even with long-term use, addiction to the drug was extremely rare. Their marketing campaign emphasized that pain was vastly undertreated and that the answer was their powerful painkiller. Other pharmaceutical companies followed suit and soon many doctors were liberally prescribing opioids to every pain patient who appeared in their offices. Opioids became blockbuster drugs.
In 2007, the FDA fined Purdue Pharma $634 million for criminal consumer fraud for knowingly lying about the addictive potential of OxyContin. But the damage was already done. Millions were addicted to opioids and tens of thousands had already died of overdoses.
The fines and the negative press didn’t stop the pharmaceutical companies from looking for other ways to profit from these powerful, addictive drugs. Recently, in a scathing investigative report, TV new magazine 60 Minutes revealed that the pharmaceutical companies and their distributors have been knowingly supplying pill mills, who sell drugs to nonmedical users, with vast amounts of opioids and that they used their political influence to get Congress to block the Drug Enforcement Administration (DEA) from prosecuting them.
Today there are 100 million Americans in chronic pain, more than ever before. The number of addicts and overdose deaths continues to escalate. Despite this, many doctors and patients insist these opioids are needed because, due to decades of aggressive marketing, they believe they are the most powerful weapon we have against devastating pain. But the truth is that about 50% of pain patients find they cannot tolerate the side effects of the opioids or don’t find them effective and those who continue to use them get only an average of 39% pain relief.
What has been lost in this discussion is that opioids are derived from a plant and that there are other plants with similar properties that are safer and possibly even more effective than the poppy plant. Here are just three:
- Cannabis (Marijuana)
- Wild Lettuce
It’s no surprise to many people that marijuana is a plant that has medicinal properties, including the ability to relieve pain. References to using marijuana as an analgesic date back to 2700 BC. Marijuana grows wild everywhere in the world except in the coldest climates. It was commonly used for medicinal purposes in the United States and was in many pharmaceutical products until 1941 when it was banned against the advice of the American Medical Association. The ban was the result of the combined efforts of anti-drug crusader Henry Anslinger and the Rockefeller family, whose industrial and chemical interests were threatened by the competition from hemp.
The federal government subsequently classified cannabis as a Schedule 1 drug, a drug with high abuse potential and no known medical use. This has made it very difficult for researchers to obtain the plant or get permission to study it.
Despite the barriers to research and the continuing controversies around it, one thing is perfectly clear: in the thousands of years that marijuana has been used, there has not been even one overdose death from marijuana ever reported.
The science of marijuana is now known, too. Marijuana is the only known plant that contains compounds called cannabinoids. The human body manufactures these same compounds, called endocannabinoids when manufactured internally. These compounds are used by the body to relieve pain, reduce inflammation, and restore the body to a balanced state after stress or injury. When marijuana is introduced into the body through inhalation, ingestion or other means, its natural compounds bind easily to cell receptors, creating few side effects and facilitating healing on many levels.
The average amount of pain relief reported by pain patients who use medical marijuana is 64% according to some studies. Marijuana is not considered physically addictive because withdrawal symptoms after chronic use are minimal. Marijuana can also reduce opioid withdrawal symptoms, and prevent the development of tolerance in opioid users. Some people find the psychological effects of marijuana compelling and have difficulty stopping use for that reason.
Marijuana is currently legal in 29 U.S. states and the District of Columbia for patients with qualifying medical conditions who are certified by a medical provider. It remains illegal at the federal level.
Kratom (Mitragyna speciose)
Kratom is an herb that grows in Southeast Asia. While far less well known than Cannabis, and far less researched, Kratom appears to have similar effects. A literature review published in Frontiers in Psychiatry in April 2017 reported that kratom has the following beneficial effects: analgesic (pain relieving), helps with opiate withdrawal, lowers blood pressure, is antidiabetic and antidiarrheal, and enhances immunity and tissue repair. It also appears to help with weight loss.
The same literature review cites a handful of case reports of deaths associated with kratom, but in every case, there was the presence of other drugs that could have been the cause. Animal studies, primarily in rats, showed some serious adverse effects, but these studies were at ridiculously high doses of 100 to 1000 mg per kilogram (2.2 pounds). Equivalent doses would not be consumed by humans.
Small doses of kratom appear to have stimulant effects, with larger doses having sedating effects. This is similar to CBD, an extract of cannabis.
Like cannabis, kratom has different strains, generally classified into red, green and white veins. Red veins are calming and work better for pain and sedation. Green veins are a little more stimulating than reds and also tend to last the longest. White veins are the most stimulating and are good for an energy boost and mood elevation. Some kratom users use different strains at different times of the day, using more stimulating strains in the morning and more calming strains at night.
In late 2016, the U.S. Drug Enforcement Agency (DEA) tried to schedule Kratom as a Schedule 1 drug(a drug with high abuse potential and no known medical benefits), citing the above-noted fatalities as the reason. The public outcry was significant, and the DEA backed off its decision.
Wild Lettuce (Lactuca virosa)
Wild lettuce, like cannabis, grows wild in many parts of the world, including parts of Europe, Asia, Australia, and North America. It was widely used in the U.S. in the 19th century as an opium substitute. Wild lettuce contains two active compounds, lactucopicrin and lactucin, which bind to opioid receptors and produce pain relief. These compounds are used by drug manufacturers to produce medications to treat asthma, urinary tract disorders, painful menstruation, and joint pain.
Wild lettuce has been reported to provide relief from a migraine and tension headaches, menstrual cramps and joint and muscle pain. Its also has sedative and anti-anxiety effects.
Wild lettuce appears to be safe for most people in small amounts. Wild lettuce may cause an allergic reaction in people who have allergies to ragweed and related plants. If you have narrow-angle glaucoma, it is advised to avoid wild lettuce because it contains a chemical that could worsen this condition.
Wild lettuce can be taken as an extract or as an herbal supplement. It’s unregulated by the FDA and legal everywhere.
The Bottom Line
The poppy plant and its pharmaceutical derivatives do not have a monopoly on pain relief, despite marketing efforts to convince us otherwise. Other plants are safer and have equal or better pain relief effects.
Cindy Perlin is a chronic pain expert, licensed clinical social worker, certified biofeedback practitioner, and chronic pain survivor. She is the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain-Free and the creator of the Alternative Pain Treatment Directory.