Happy Birthday, Morphine

Two hundred years on, 'God's own medicine' still reigns
as king of pain relief

By Edward Lee

In an obscure German laboratory 200 years ago, a young pharmacist's assistant, Friedrich Wilhelm Sert�rner, mixed opium with acid. After neutralizing the solution with ammonia, a potent painkiller emerged to form what some have called "God's own medicine." Sert�rner named it morphine, after Morpheus, the Greek god of dreams.

TAMING THE POPPY
The euphoric effects of the opium poppy had been known for over five thousand years, but physicians soon recognized that morphine eliminated the highly variable analgesic potency and side effects of opium. Since its discovery it has remained the most important drug in pain medicine.

"At our centre, morphine probably comprises up to 90% of the drugs used in pain management," says staff anesthetist Dr Doug Snider of the Royal Alexandra Hospital in Edmonton. "Why? Because we have the most experience with it, it's safe, can be given by all routes, does a great job controlling pain and it's cheap."

A VISIT FROM MORPHEUS
In no other arena was pain control more important than during war. Morphine helped countless numbers of soldiers, be it staving off shock on the way to the field hospital or providing a relatively pain-free death. But as its use became more ubiquitous the mushrooming of addiction followed, particularly with the introduction of the hypodermic needle, placed directly in the hands of the wounded. American Civil War soldiers were particularly affected.

In 1827, E Merck & Company began marketing morphine commercially. By the late 1800s, concoctions laced with morphine found their way into the household under innocuous brand names such as Mrs Winslow's Soothing Syrup, a formula that promised to settle a teething infant. "It soothes the child, softens the gums, allays all pain...is the best remedy for diarrhea," claimed one advertisement. Around the same time, iatrogenically-caused addiction increased as physicians became more liberal in dispensing morphine for pain.

TARNISHED REPUTATION
When curative methods for addiction failed, and the manipulation of morphine's chemical structure to eliminate its addictive potential yielded only dead ends, regulation by government controls remained the only way to curb an increasing number of addicts. In 1914, the United States passed the Harrison Narcotic Act, which served as a template for the regulation of drugs worldwide.

Laws used to control access to morphine, along with prejudices within the medical community against the drug resulted in an almost complete cessation of its use for several decades. It was rediscovered in the 1970s with the hospice movement in palliating pain in cancer patients and the development of modern pain medicine.

"When it came down to dealing with severe pain, there was nothing available as effective as morphine," says Dr Snider. "Doctors started to realize this, that it wasn't dangerous or addictive when used properly, and we have been seeing an increase in usage ever since." In fact, the prescription of morphine has continually increased by about 20% per year since 1980.

"Morphine is the standard of care in pain management. It's the most important drug in anesthesia," adds Dr Snider. "It has side effects, including nausea, vomiting and itchiness, but there are already medications that help settle these symptoms and new ones in research."

Is there any sign that morphine might be dethroned by a better analgesic? Dr Snider answers, "We are starting to see increased usage in fentanyl and dilaudid, but overall, morphine is still the standard and it looks like it will be that way for a long time yet."