Morphine Relief Without Addiction?

Roland Piquepaille writes "Morphine has been used as a painkiller for decades, if not centuries. Unfortunately for patients, morphine is also an addictive substance. Now, Brigham Young University (BYU) chemists are using a vine plant that grows in Australia to develop a new painkilling molecule, but with fewer side effects. The Deseret Morning News reports that the BYU chemists hope to ease pain with hasubanonine, the synthetic compound they created and which has a similar molecular structure as morphine. Still, more tests need to be done before this natural drug can replace morphine."

Comments

I know what should be used

[daniil]

Dr. Freud recommends cocaine as morphine relief.

Heroin

[snowgirl]

If I recall correctly, Heroin was originally designed the same way, or at least to help people get off of a morphine addiction.

Oops! It turned out to be even more addictive, oh well, let's try again. hehe

Re:Heroin

[mspohr]

From the Wikipedia:

From 1898 through to 1910 it was marketed as a non-addictive morphine substitute and cough medicine for children. Bayer marketed heroin as a "cure" for morphine addiction before it was discovered that heroin is converted to morphine in the liver.

One problem with this new drug is that anything that is analgesic will have some addictive potential.

Re:Heroin

[hackstraw]

If I recall correctly, Heroin was originally designed the same way, or at least to help people get off of a morphine addiction.

Oops! It turned out to be even more addictive, oh well, let's try again. hehe

Rinse and repeat with methadone.

Re:Heroin

[Ungrounded Lightning]

If I recall correctly, Heroin was originally designed the same way, or at least to help people get off of a morphine addiction.

you might be thinking of methadone to treat a heroin addiction.

No, he WAS thinking of Herion.

The drug chemists were trying minor modifications on the morphine molecule, trying to find something with the pain relief but without the addition. This new one had all the pain killing power, so they tried it on a number of the lab personnel and it didn't give any of them withdrawal symptoms.

So they marketed it as the "Heroine" that would rescue the world from addiction by killing pain without hooking. Only to discover that it hooked at least as well as it cured pain.

Turns out:
  a) The body jut converts it back to morphine.
  b) There is a small fraction of the population that doesn't get hooked on morphine and its derivatives. And it happened that all the people in the lab they tried it on were members of that subset - a statistically unlikely occurrence.

(There was a theory that such people also gravitate toward research science fields, such as chemistry and medicine, for unknown reasons, though I haven't heard whether this was ever checked out.)

= = = =

One of the most tragic parts of the whole additction / drug war / underprescription of painkillers by doctors for fear of prosecution is that morphine and derivatives, given in appropriate doses for relief from actual severe or chronic pain, apparently DON'T addict. It's a dose spike far above the pain-relief level that sets the hook. (Not that it's easy to tell in chronic pain cases, since the return of the underlying pain is a fine substitute for withdrawal symptoms. But for acute pain tapering the dose - even (especially) by self-administration, also tends to avoid the hook.

But DEA scrutinizes doctor dosing habits and sporadicly prosecutes doctors who prescribe "too much" narcotics. And they don't adequately take into account whether the doctor is a specialist in pain treatment or treatment of illnesses with a lot of associated pain, and thus have an atypical patient mix biased toward need for pain medication and high doses.

So doctors underprescribe. And that leaves many chronic pain sufferers with no alternatives but ongoing excruciating pain, suicide, or recourse to illegal drugs (with their uncertain strengths, and high cost requiring IV administration with its sudden onset, leading to dose spikes and addiction).

Re:Heroin

[sjames]

So doctors underprescribe. And that leaves many chronic pain sufferers with no alternatives but ongoing excruciating pain, suicide, or recourse to illegal drugs (with their uncertain strengths, and high cost requiring IV administration with its sudden onset, leading to dose spikes and addiction).

The really sad thing is that for those in chronic pain, addiction isn't really much of a risk considering that the pain itself will make sure that they NEED to take whatever painkiller they have regularly anyway. Reluctance (on the government's part anyway) to give terminal patients all they want is also baffling to me.

Re:Heroin

[Thangodin]

The reason is that suffering is supposed to build character, which makes these drugs evil. God wants you to suffer for your own good. Now do you understand? Of course not, it doesn't make sense, but there it is. Someone once said that a Puritan is a person who lies awake at night terrified that somebody, somewhere, is enjoying themselves.

I wish it were only Puritans, but this kind of lunacy seems to permeate most of Christianity. Christoper Hitchens wrote a book entitled The Missionary Position which included eyewitness accounts of people who worked with Mother Theresa. Apparently, Mother Theresa refused to use pain killers stronger than aspirin, even for terminal patients who were writhing with pain from cancer. It's not like she couldn't afford them; her order had fifty million in the bank, and she wasn't far from Afghanistan--morphine would have been dirt cheap. Her rationale was that suffering brought you closer to Christ who suffered on the cross. So hey, pain is good, painkillers are evil, got it?

At some point, a religious consolation which was supposed to make people feel better about their pain (I'm sorry we can't help your pain, but something good may come of it) became twisted into a message that pain was good for the soul (which is why the Inquisitor needs all these implements of torture.) But don't try to understand it, it's a mystery...

Re:Heroin

[Thangodin]

Well, how else do you explain the irrational resistance to alleviating pain? What, an old man that's going to be dead in a month will get addicted to morphine? The reason for this isn't medical, moral, financial, or at all rational. So, what's left? What irrational belief would encourage otherwise normal people to allow someone to suffer when it would be so easy to prevent it? The same forces which pushed for the prohibition of drugs also pushed for the prohibition of alcohol. Look them up and find out who they were. Our reluctance to give people in pain the drugs they need is a continuation of this same policy. When you're doing something stupid, it's helpful to know why you're doing it, so that maybe you can stop doing it.

I'd always known that this tendency to regard suffering as a positive boon to others ran through the stricter Protestant sects, and some Victorian writers, including Charlotte Bronte and Charles Dickens, go into some length describing how this idea suited the purposes of ministers with a streak of cruelty. The Catholics also have a long tradition of "mortification of the flesh", and Pope John Paul II wrote an entire Apostolic Letter on suffering and the need for suffering. The wording is quite similar to quotes from Mother Teresa. Still, this was always presented as being voluntary, and those who tolerated or contributed to the suffering of others were usually regarded as aberrations--in polite company, anyway. But the argument was still making the rounds in Catholic schools when I was young.

But finding it in Mother Teresa's case, where it was policy in an order of 40,000 nuns and volunteers charged with caring for the sick, and realizing how many people saw this and never said a word publicly, and you realize that this is not an isolated aberration. And the pursuance of this same policy, albeit in a milder form, in public medicine should tell you just how far it reaches.

Still, maybe the Eastern Orthodox churches aren't into this, but it certainly seems to run through the Protestant and Catholic churches. That is most of Christianity.

Re:Heroin

[grandgator]

That's not exactly right, but it's close. All opiates (and opiOIDS) work primarily by binding the mu receptor in both the peripheral and central nervous systems. After that point, there is still a lot of unknown in what actually happens with respect to specific signaling cascades, etc. But that's not a result of lack of understanding regarding the pharmacology of opiates/opioids, but rather a lack of understanding what actual biochemical signals/processes/cascades are responsible for producing "pain."

The actual addiction part is not just from what happens to various levels of chemicals when you apply and then remove the drug, but to a larger extent is caused by what actually happens to the number/density of receptors themselves. A difficult problem to combat.

The problem, as many other posts here about heroin and morphine allude to, is that any compound that works via these receptors will cause similar addictive effects. The only way to avoid that it to change the way that the drug targets receptors. But, if you do that, then it's not really fair to have this article. i.e., it would then make about as much sense to say "Pepto Bismol relieves stomach pain without the addictive effects of heroin!" In other words - duh! They're not the same thing.

The reason the mu receptor is a common pain medicine target is because it is SO effective at block pain signals. But, as with so many other things posted here, there is no free lunch. You want big time pain relief? Mu receptors are the way to go. But that means issues with addiction/withdrawal/etc.

Next up: Fire that doesn't burn you!

[user9918277462]

Painkillers (opioid painkillers, specifically) are addictive precisely because of their analgesic effects. Addiction and analgesia are not separate traits, but rather two aspects of the same action. Anything that provides strong central pain relief (as opposed to peripheral analgesia as in NSAIDs) has at least some risk of causing psychological or physical dependence.

Re:Next up: Fire that doesn't burn you!

[Pedrito]

Painkillers (opioid painkillers, specifically) are addictive precisely because of their analgesic effects.

Don't confuse addiction with habit. Addiction is a physical dependency and that aspect doesn't necessarily have any relation to its analgesic effect. Aspirin has analgesic properties, but NO addictive qualities.

What makes opioids addictive is unknown. What makes them analgesic is, to some degree, understood. The two may be linked, but because something is analgesic does not make it addictive. It may be "habit-forming", on the other hand. Marijuana, for example, can be habit-forming, but it is not addictive because one does not develop a physical dependence on the presence of the drug in their system.

Re:Next up: Fire that doesn't burn you!

[Baddas]

Read the grandparent again. Asprin is a drug that acts very similarly to NSAIDs, which he SPECIFICALLY disclaimed

Marijuana is a non sequitur, he's talking about central nervous system analgesics.

Try that one again, this time, with reading comprehension.

For reference:
Asprin: peripheral analgesic
Heroin: central analgesic
Ibuprofen: peripheral analgesic
Oxycodone: central analgesic.

See a pattern here? pethidine, oxycodone, hydrocodone, diamorphine, fentanyl, basically anything that is inhibited by a mu antagonist is going to get you addicted if you take it long enough.

Morphine doesnt stop pain

[Anonymous Coward]

as someone who was recently in hospital and had morphine (and as a person who has done just about every drug there is) i can say it doesnt actually _stop_ the pain it just makes you not care about it, but it was still there even when wasted out of my skull it just makes you not care

now a painkiller that would actually take away pain would iam sure be welcomed

I see addicts.

[Anonymous Coward]

I love how all the low number slashdot users all appear to be addicts/former addicts.

chronic pain

[Anonymous Coward]

When you live with a terminally ill person, the idea of addiction quickly becomes asinine. Yet, they still won't prescribe it for addiction reasons. Lo, let this comment get relegated to the depths of un-moderation. And you Slashdot libertarians can wait until your family member has chronic pain - so you can wonder why republicans don't want them addicted. Ooo, I know, blame it on democrats.

Medical comments:

[olddoc]

I am an Anesthesiologist. I give people morhine and fentanyl on a daily basis.
Morphine is a natural drug, it comes from a plant. Cocaine, digitalis, aspirin and many other drugs are also natural.
If the new drug is related to morphine I take that to mean it will work on the same receptors in the brain.
If it does, it will have a similar side effect profile: constipation, nausea, respiratory depression and probably addictive potential.
To me, this is just a "me too" drug like Tagamet/Zantac/Pepcid that all work the same way on the same receptors.

Interestingly, there is no profit margin in simple morphine. The cost to the hospital for an ampule that would relieve severe pain is on the order of $1.
The DEA paperwork is a bigger cost to a hospital!

The biggest long term problem for people who take morhine (or heroin in the UK or oxycontin or any drug in this class) is constipation.
Cancer patients don't have to worry about addiction.

Relief

[Doc Ruby]

Boy, am I glad that tribal Australians will be reimbursed for all the R&D they invested in breeding that vine for thousands of years. That their prior art will prevent some pharmaco from patenting the vine, that the pharmaco lobbyists won't be able to prevent Australians from using the cheap original plant.

Do editors read? Roland Piquepaill gets a pass?

[lax-goalie]

In the next to last sentence: "the synthetic compound they created".

In the last sentence: "this natural drug".

Ummm, those two phrases are the complete opposite of each other...

From the F'ing article:

We've synthesized a mixture of the two mirror-image compounds, the idea being we can take the mirror image of the natural one

Mirror image of the "natural one". Sounds like a "synthetic compound" to me...

not only that...

[Quadraginta]

If you read TFA instead of the completely misleading summary, you'll note that...

(1) The BYU chemists don't know if the compound has painkilling properties at all. It's the mirror image of another molecule which is known not to be a painkiller. The mirror image is similar to morphine, so they hope it might have the painkilling properties of morphine. But it's painkilling properties are at this point entirely theoretical.

(2) They have no clue whatsoever whether, if it has painkilling properties, it is less addictive than morphine. It just as easily be more addictive. All they know is, while it looks like morphine, it isn't exactly morphine, so it will probably have slightly different properties.

(3) And of course, they have no idea whether the new molecule would have other, less desirable differences from morphine -- like being a deadly poison to the kidneys. Whether the stuff could even be safely taken by humans is still unknown.

In short, the summary on this article wildly exaggerates its content.

Puhleease: seperate blog for Roland Piquepaille

[viking2000]

I would like to suggest that Roland Piquepailles submissions be placed in a seperate blog.

I read /. to get real news and facts, and see discussions from people with insight.
Roland Piquepailles submissions are usually vague quasiscience or fiction.

It seems this last one "Morphine Relief Without Addiction?", is just some graduate students learning to synthsize a compound with no empirical data it is any more useful than sand. I quote: "The *idea* is that we *can* send it to NIH to test to see if it kills pain"

You should mod this up if you agree or mod away as flamebait/offtopic/troll if you dont agree, but at least mod it.

Addiction not a problem for most morphine users

[Shannon Love]

The vast majority of people who must use morphine for medical reasons, even those requiring long term use, don't become morphine "addicts" as we normally use the term. Most users wean themselves off the drug relatively easily when the pain they used the morphine to suppress goes away. Many drugs, with and without neurological effects, are physically addictive in that suddenly stopping the intake of the drug causes illness yet no one speaks of "beta blocker addicts."

Addiction to psychoactive drugs arises from the psychological instead of the physiological effects of the drugs. New drugs that offer the the same psychological effects as traditional drugs will present most of the same addiction issues.

Source with Images

[nmb3000]

Interesting that neither the summary nor the article links to the page at BYU's NewsNet page. It has a few more details, links to other sources, a video, and pictures related to the research.

Actually, Most People Don't Become Addicted

[Anonymous Coward]

There is a small fraction of the population that doesn't get hooked on morphine and its derivatives.

This is misleading. Actually, the vast majority of individuals who use opioids do not develop addiction. Everyone develops physical dependence and it's important to understand the difference. While physical dependence requires that long term opiate users taper thier dose of a long period of time, addiction (psychological dependence) occurs in only a few percent of opiate users.

Opiate addiction is similar to alcoholism. The vast majority of alcohol users will never experience addiction disorder.

For two years I took 60mg of time release morphine (Avinza) for fibromyalgia. Personally, it was much more difficult to quit drinking coffee than it was to taper off morphine (using oxycodone to taper).