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re Opioid Use Disorder: Is history repeating itself?
Recently Patkar (Patkar AA, Lee JC and Burgess DM. BMJ Opioid use disorder 28-2-23) updated this serious medical condition, although their comments did not extend to prevention.
Unfortunately we are quietly witnessing a possible extension to potential risk factors associated with this condition. History shows that morphia lends itself well to chemical manipulation to products which are much more potent therapeutically than the parent compound.
In 1874 a chemist at St Mary's Hospital in London synthesized heroin from morphia. Nothing significant happened to this novel compound until 23 years later heroin was again independently synthesized in Germany. This time, however, heroin was commercially developed and promoted as a treatment for chronic cough in tuberculosis and as a drug which provided effective pain relief, without the addictive properties of morphia. This latter claim was found to be inaccurate. The drug soon "escaped" from controlled medical use and its widespread use over subsequent years led to many deaths worldwide from overuse of heroin.
In 1959 chemists in Belgium synthesized another opioid from morphia, and this was called fentanyl. Development was slow and it was only licensed in 1968. It was a potent analgesic, however, and was widely used by medical practitioners as patches for the relief of chronic pain. However, fentanyl had euphoric properties and this led to its industrial production and distribution well outside medical supervision. In turn, this led to widespread deaths, especially in the USA.
Exactly 100 years after heroin was first synthesized yet another synthetic opioid was synthesized, again by a Belgian drug development drug company. This drug is called sufentanil and again the drug lay "on the shelf" for about 40 years. In recent years the current owners of sufentanil have promoted its use, again as a drug to effectively relieve pain.
Sufentanil is available as a convenient sublingual tablet which is relatively inexpensive. It is very potent and is said to be five times more potent than fentanyl, its parent, which is itself much more potent than morphia. It is unclear whether sufentanil produces the same euphoria or "high" that heroin does, which probably leads to heroin's continuing popularity as a recreational drug.
A recent two page advert, featuring a winsome young collie dog, advertising sufentanil was carried by a medical journal (The Bulletin of The Royal College of Surgeons of England, volume 105, issue May 2023). This advert suggests that sufentanil is suitable for the management of severe pain. As such it is "Efficient, fast, simple and empatethic". While these claims are probably accurate, it does not touch on the possible leakage of sufentanil into the wider world. Were this to occur, it could lead to potentially serious social use, as yet another synthetic opioid drug, following in the footsteps of heroin and of fentanyl.
Does the medical profession need yet another synthetic opioid and what, if any, are the medical profession's moral obligations, to reduce the potential risk of its spread into society, well away from any medical supervision?
Opioid use disorder: Is History repeating itself?
Dear Editor
re Opioid Use Disorder: Is history repeating itself?
Recently Patkar (Patkar AA, Lee JC and Burgess DM. BMJ Opioid use disorder 28-2-23) updated this serious medical condition, although their comments did not extend to prevention.
Unfortunately we are quietly witnessing a possible extension to potential risk factors associated with this condition. History shows that morphia lends itself well to chemical manipulation to products which are much more potent therapeutically than the parent compound.
In 1874 a chemist at St Mary's Hospital in London synthesized heroin from morphia. Nothing significant happened to this novel compound until 23 years later heroin was again independently synthesized in Germany. This time, however, heroin was commercially developed and promoted as a treatment for chronic cough in tuberculosis and as a drug which provided effective pain relief, without the addictive properties of morphia. This latter claim was found to be inaccurate. The drug soon "escaped" from controlled medical use and its widespread use over subsequent years led to many deaths worldwide from overuse of heroin.
In 1959 chemists in Belgium synthesized another opioid from morphia, and this was called fentanyl. Development was slow and it was only licensed in 1968. It was a potent analgesic, however, and was widely used by medical practitioners as patches for the relief of chronic pain. However, fentanyl had euphoric properties and this led to its industrial production and distribution well outside medical supervision. In turn, this led to widespread deaths, especially in the USA.
Exactly 100 years after heroin was first synthesized yet another synthetic opioid was synthesized, again by a Belgian drug development drug company. This drug is called sufentanil and again the drug lay "on the shelf" for about 40 years. In recent years the current owners of sufentanil have promoted its use, again as a drug to effectively relieve pain.
Sufentanil is available as a convenient sublingual tablet which is relatively inexpensive. It is very potent and is said to be five times more potent than fentanyl, its parent, which is itself much more potent than morphia. It is unclear whether sufentanil produces the same euphoria or "high" that heroin does, which probably leads to heroin's continuing popularity as a recreational drug.
A recent two page advert, featuring a winsome young collie dog, advertising sufentanil was carried by a medical journal (The Bulletin of The Royal College of Surgeons of England, volume 105, issue May 2023). This advert suggests that sufentanil is suitable for the management of severe pain. As such it is "Efficient, fast, simple and empatethic". While these claims are probably accurate, it does not touch on the possible leakage of sufentanil into the wider world. Were this to occur, it could lead to potentially serious social use, as yet another synthetic opioid drug, following in the footsteps of heroin and of fentanyl.
Does the medical profession need yet another synthetic opioid and what, if any, are the medical profession's moral obligations, to reduce the potential risk of its spread into society, well away from any medical supervision?
Competing interests: No competing interests