RESUMO
There is documentation of the use of opium derived products in the ancient history of the Assyrians: the Egyptians; in the sixth century AD by the Roman Dioscorides; and by Avicenna (980-1037). Reference to opium like products is made by Paracelsus and by Shakespeare. Charles Louis Derosne and Fredrich Wilhelm Adam Serturner isolated morphine from raw opium in 1802 and 1806 respectively, and it was Sertürner who named the substance morphine, after Morpheus, the Greek God of dreams. By the middle 1800s, Opium and related opioid derived products were the source of a major addiction in USA, and to some extent in the United Kingdom. Opioid products are of major therapeutic value in the treatment of pain from injury, post surgery, intractable pain conditions, and some forms of terminal cancer.
Assuntos
Analgésicos Opioides , Entorpecentes , Humanos , Analgésicos Opioides/história , Morfina/história , Entorpecentes/história , Ópio/históriaAssuntos
Aprovação de Drogas , Saúde Pública , United States Food and Drug Administration , Analgésicos Opioides/história , Animais , Qualidade de Produtos para o Consumidor , Aprovação de Drogas/história , Aprovação de Drogas/legislação & jurisprudência , Regulamentação Governamental , História do Século XXI , Humanos , Estados UnidosRESUMO
This special issue is a tribute to our mentor, colleague and friend, Gavril W. Pasternak, MD, PhD. Homage to the breadth and depth of his work (~ 450 publications) over a 40 career in pharmacology and medicine cannot be captured fully in one special issue, but the 22 papers collected herein represent seven of the topics near and dear to Gav's heart, and the colleagues, friends and mentees who held him near to theirs. The seven themes include: (1) sites and mechanisms of opioid actions in vivo; (2) development of novel analgesic agents; (3) opioid tolerance, withdrawal and addiction: mechanisms and treatment; (4) opioid receptor splice variants; (5) novel research tools and approaches; (6) receptor signaling and crosstalk in vitro; and (7) mentorship. This introduction to the issue summarizes contributions and includes formal and personal remembrances of Gav that illustrate his personality, warmth, and dedication to making a difference in patient care and people's lives.
Assuntos
Analgesia/história , Analgésicos Opioides/história , Pessoal de Laboratório/história , Manejo da Dor/história , Dor/história , Médicos/história , História do Século XX , História do Século XXI , Humanos , Receptores Opioides/históriaRESUMO
The American Civil War resulted in massive numbers of injured and ill soldiers. Throughout the conflict, medical doctors relied on opium to treat these conditions, giving rise to claims that the injudicious use of the narcotic caused America's post-bellum opium crisis. Similar claims of medical misuse of opioids are now made as America confronts the modern narcotic crisis. A more nuanced thesis based on a broader base of Civil War era research suggests a more complex set of interacting factors that collectively contributed to America's post-war opium crisis.
Assuntos
Guerra Civil Norte-Americana , Analgésicos Opioides/história , Medicamentos sem Prescrição/história , Dependência de Ópio/história , Analgésicos Opioides/uso terapêutico , História do Século XIX , Humanos , Masculino , Militares/históriaRESUMO
For millennia, mankind has sought a means of altering consciousness, often aided by naturally occurring elements. Psychotropic substances have been an integral part of spiritual, medicinal, and recreational aspects of life. The origin of anesthesiology stems directly from the use of recreational drugs; early inhaled anesthetics were first used as a means of entertainment. Hence, it is no surprise that many medications in the anesthesiologist's armamentarium are diverted for recreational use. In the 172 years following the first successful public demonstration of ether anesthesia, many drugs with abuse potential have been introduced to the practice of anesthesia. Although anesthesiologists are aware of the abuse potential of these drugs, how these drugs are obtained and used for recreational purposes is worthy of discussion. There are articles describing the historical and recreational use of specific drug classes. However, to the best of our knowledge, this is the first comprehensive review focusing on the breadth of drugs used by anesthesiologists.
Assuntos
Analgésicos Opioides/história , Analgésicos/história , Anestesiologia/história , Anestésicos Inalatórios/história , Anestésicos Intravenosos/história , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , História Medieval , HumanosRESUMO
Most pediatric clinicians aspire to promote the physical, emotional, and developmental well-being of children, hoping to bestow a long and healthy life. Yet, some infants, children, and adolescents confront life-threatening illnesses and life-shortening conditions. Over the past 70 years, the clinician's response to the suffering of these children has evolved from veritable neglect to the development of pediatric palliative care as a subspecialty devoted to their care. In this article, we review the history of how clinicians have understood and responded to the suffering of children with serious illnesses, highlighting how an initially narrow focus on anxiety eventually transformed into a holistic, multidimensional awareness of suffering. Through this transition, and influenced by the adult hospice movement, pediatric palliative care emerged as a new discipline. Becoming a discipline, however, has not been a panacea. We conclude by highlighting challenges remaining for the next generation of pediatric palliative care professionals to address.
Assuntos
Cuidados Paliativos/história , Assistência Terminal/história , Adolescente , Analgésicos Opioides/história , Analgésicos Opioides/uso terapêutico , Criança , História do Século XX , História do Século XXI , Humanos , Lactente , Mães/psicologia , Relações Médico-Paciente , Doente Terminal/história , Doente Terminal/psicologiaRESUMO
Women are being disproportionately affected by the opioid crisis, including during pregnancy. Pain and other vulnerabilities to addiction differ between men and women. Management of opioid use disorder should be gender informed and accessible across the lifespan. During pregnancy, care teams should be multidisciplinary to include obstetrics, addiction, social work, anesthesia, pediatrics, and behavioral health. Pain management for women with opioid use disorder requires tailored approaches, including integration of trauma-informed care and addressing psychosocial needs. Thus, coordinated continued care by obstetric and addiction providers through pregnancy into postpartum is key to supporting women in recovery.
Assuntos
Analgésicos Opioides/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/terapia , Dor/tratamento farmacológico , Complicações na Gravidez/terapia , Analgésicos Opioides/história , Dor Crônica/tratamento farmacológico , Overdose de Drogas/etiologia , Overdose de Drogas/prevenção & controle , Feminino , Redução do Dano , História do Século XX , História do Século XXI , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/história , Transtornos Relacionados ao Uso de Opioides/psicologia , Manejo da Dor , Planejamento de Assistência ao Paciente , Participação do Paciente , Cuidado Pós-Natal , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/psicologia , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Trauma Psicológico/psicologia , Fatores SexuaisAssuntos
Indústria Farmacêutica/história , Marketing/história , Preparações Farmacêuticas/história , Analgésicos Opioides/história , Analgésicos Opioides/uso terapêutico , Antibacterianos/história , História do Século XX , Humanos , Uso Excessivo dos Serviços de Saúde/tendências , Oxicodona/história , Oxicodona/uso terapêutico , Oxitetraciclina/históriaAssuntos
Analgésicos Opioides/história , Indústria Farmacêutica/história , Marketing/história , Epidemia de Opioides , Publicidade/história , Publicidade/legislação & jurisprudência , Indústria Farmacêutica/legislação & jurisprudência , História do Século XX , História do Século XXI , Humanos , Marketing/legislação & jurisprudência , Uso Off-Label/história , Uso Off-Label/legislação & jurisprudência , Estados Unidos , United States Food and Drug AdministrationRESUMO
Substance use disorders (SUDs), defined as a collection of symptoms including tolerance and withdrawal, are chronic illnesses characterized by relapse and remission. In the United States, billions of dollars have been lost due to SUDs. In the past 30 years, effective medications and behavioral interventions have played a major role in preventing relapse and facilitating longer periods of abstinence. From the late 1990s to the present, the opioid epidemic or opioid crisis in the United States has raised public awareness of SUDs. Methadone, buprenorphine, and naloxone have proven their effectiveness in treating addicted individuals, and each of them has different effects on different opioid receptors. Methadone and buprenorphine target mu opioid receptors (MORs) in the brain to treat opioid dependence by reducing withdrawal and craving, whereas naloxone is an opioid antagonist used to treat opioid overdose. Mu, kappa, and delta are opioid receptor subtypes with common analgesic effects, and each also has unique effects and distribution in the brain. MORs in distinct brain regions, such as the nucleus accumbens and basolateral amygdala, trigger the euphoria and incentive properties of rewarding stimuli. Kappa opioid receptors can trigger anti-reward effects and produce dysphoric effects. Delta opioid receptors can induce anxiolytic effects. Though effective medications are available, relapse is still common due to neurobiological changes in brain pathways and tolerance of opioid receptors with repeated abuse of substances. In this article, I summarize the biological mechanisms of opioid dependence and opioid receptors and review previous articles about medications used to treat SUDs and their clinical effects.
Assuntos
Analgésicos Opioides/efeitos adversos , Complexo Nuclear Basolateral da Amígdala/metabolismo , Núcleo Accumbens/metabolismo , Transtornos Relacionados ao Uso de Opioides/metabolismo , Receptores Opioides/metabolismo , Analgésicos Opioides/história , Analgésicos Opioides/uso terapêutico , História do Século XX , História do Século XXI , Humanos , Antagonistas de Entorpecentes/história , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/história , Estados Unidos/epidemiologiaAssuntos
Analgésicos Opioides/história , Transtornos Relacionados ao Uso de Opioides/história , Ópio/história , Analgésicos Opioides/uso terapêutico , História do Século XIX , História do Século XX , História Antiga , História Medieval , Humanos , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Ópio/efeitos adversosAssuntos
Drogas Ilícitas/farmacologia , Transtornos Relacionados ao Uso de Substâncias , Analgésicos Opioides/química , Analgésicos Opioides/história , Analgésicos Opioides/farmacologia , Estimulantes do Sistema Nervoso Central/química , Estimulantes do Sistema Nervoso Central/farmacologia , Alucinógenos/química , Alucinógenos/história , Alucinógenos/farmacologia , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Drogas Ilícitas/química , Drogas Ilícitas/históriaRESUMO
As the major psychoactive agent in opium and direct precursor for heroin, morphine is a historically critical molecule in chemical neuroscience. A structurally complex phenanthrene alkaloid produced by Papaver somniferum, morphine has fascinated chemists seeking to disentangle pharmacologically beneficial analgesic effects from addiction, tolerance, and dependence liabilities. In this review, we will detail the history of morphine, from the first extraction and isolation by Sertürner in 1804 to the illicit use of morphine and proliferation of opioid use and abuse disorders currently ravaging the United States. Morphine is a molecule of great cultural relevance, as the agent that single-handedly transformed our understanding of pharmacognosy, receptor dynamics, and substance abuse and dependence disorders.
Assuntos
Analgésicos Opioides/história , Morfina/história , Transtornos Relacionados ao Uso de Opioides/história , Analgésicos Opioides/química , Analgésicos Opioides/uso terapêutico , Tolerância a Medicamentos , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , Morfina/química , Morfina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/metabolismo , Dor/tratamento farmacológico , Papaver , Receptores Opioides/metabolismo , Estados UnidosAssuntos
Idoso , Idoso de 80 Anos ou mais , Ópio/história , Analgésicos Opioides/história , Transtornos Relacionados ao Uso de Opioides/história , Ópio/efeitos adversos , História Antiga , História Medieval , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/prevenção & controleRESUMO
Evidence of human use of opium dates back as far as the sixth millennium BCE. Ancient societies through the Renaissance period created a variety of opium products, proliferating its common use and subsequent addiction. Because the active moiety was not known at this time, the potency of these opium concoctions could neither be predicted nor controlled. The first step in identifying opium's active ingredient, morphine, was its chemical isolation in the early 1800s by Wilhelm Sertürner. The subsequent elucidation of morphine's chemical formula and Sir Robert Robinson's derivation of morphine's structural formula, which won him the 1947 Nobel Prize in Chemistry, round out 150 years of the incremental advances in our chemical understanding of morphine. Nevertheless, our attempts to synthesize morphine, despite our advanced knowledge in synthetic chemistry, are still no match for the plant-based extraction of morphine from the poppy plant. The status quo remains problematic socially, economically, and politically; the relationships between the countries laboriously growing poppy plants to extract morphine and those countries importing these painkillers are unstable at best. In this study, we contrast the cumulative scientific discoveries that have led to our current chemical knowledge of morphine with the centuries-old natural method of morphine production that still dominates the opioid market today.
Assuntos
Analgésicos Opioides/história , Morfina/história , Papaver/química , Analgésicos Opioides/síntese química , Analgésicos Opioides/química , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , História Medieval , Morfina/síntese química , Morfina/química , Extratos Vegetais/história , Resinas Vegetais/históriaRESUMO
BACKGROUND: Over 100 million Americans are living with chronic pain, and pain is the most common reason that patients seek medical attention. Despite the prevalence of pain, the practice of pain management and the scientific discipline of pain research are relatively new fields compared to the rest of medicine - contributing to a twenty-first century dilemma for health care providers asked to relieve suffering in the "Fifth Vital Sign" era. METHODS: This manuscript provides a narrative review of the basic mechanisms of chronic pain and history of chronic pain management in the United States - including the various regulatory, health system and provider factors that contributed to the decline of multidisciplinary pain treatment in favor of the predominant opioid treatment strategy seen today. Multiple non-opioid pain treatment strategies are then outlined. The manuscript concludes with three key questions to help guide future research at the intersection of pain and addiction. CONCLUSIONS: The assessment and treatment of chronic pain will continue to be one of the most common functions of a health care provider. To move beyond an over reliance on opioid medications, the addiction and pain research communities must unite with chronic pain patients to increase the evidence base supporting non-opioid analgesic strategies.