Opioids and Analgesics

by

Marcia Meldrum

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0018

Introduction

The opioid drugs—opium and its derivatives, particularly morphine, heroin, codeine, hydrocodone, and oxycodone—have played a unique and problematic role in the history of medicine: on the one hand, as highly effective analgesics for the relief of severe and chronic pain; on the other, as dangerously addictive substances that have led many individuals into lives of dependence and despair, and supported wars, human trafficking, and criminal enterprises around the world. Although opioids have been used and abused in Europe and Asia for centuries, the 1900s and early 2000s have seen an increase in global trade, abuse, and controversy, even as scientists have developed a more accurate and nuanced understanding of the physiology of addiction. In the United States, a long-standing medical dependence on opioid drugs transitioned to avoidance as these came under federal regulation requiring physician reporting with the Harrison Narcotics Act in 1914. Recreational drug use was increasingly marginalized to nonmainstream groups, including musicians, artists, and people of color; and medical use limited in principle to end-stage disease and short-term treatment of acute conditions. With the explosion of new pharmaceuticals and the development of a culture of abundance and permissiveness in the 1950s and 1960s, opioid usage, in particular habitual ingestion of prescription drugs such as Vicodin and Percocet, became more common among middle-class groups. In the 1980s, pain management specialists advocated opioid use for improved relief of severe pain, in chronic as well as terminal disease. These trends intersected in the late 1990s and early 2000s to become an opioid “crisis,” rooted in prescription drug dependence, but often evolving into deadly substance abuse, fueled by new opioid sources and marketing techniques. Non-opioid analgesics, meanwhile, have become essential to modern life, as physical pain, once imbued with philosophical and religious meanings, has been medicalized and become a disease in itself.

Reference Works

Kumar 2022 is a wide-ranging compendium of the history, science, and therapeutics of opioids. For the history of opioid use and addiction from antiquity through the twenty-first century, including essays by rehab specialists and others, see Newton 2018. For documents relating to the opioid epidemic of the 2000s, see the Opioid Industry Documents Archive, cited under The US Opioid Epidemic in the Twenty-First Century.

• Kumar, Vasanth. Handbook on Opium: History and Basis of Opioids in Therapeutics. London: Academic Press, 2022.

  DOI: 10.1016/C2020-0-03480-8

  A thorough review of the biochemistry of opium; the history of its cultivation, trafficking, and clinical and recreational use; and the development and exploitation of its synthetic derivatives, from prehistory through the twenty-first century. Emphasis is on the science and the medicinal applications of opioids, but with much useful historical information provided for context and including tables, illustrations, and extensive references.

• Newton, David E. The Opioid Crisis: A Reference Handbook. Santa Barbara, CA: ABC-CLIO, 2018.

  DOI: 10.5040/9798400693571

  Newton divides this well-organized handbook into five sections: (1) the historical and scientific background of opium, morphine and their derivatives and mechanisms of action; (2) a statistical and narrative analysis of the opioid epidemic of the early twenty-first century, including discussion of legal restrictions, prevention strategies, and treatment approaches; (3) nine essays by individuals with personal experiences of opioid addiction; (4) essential data on major organizations involved in opioid control and education, including several biographical essays on important figures; and (5) crucial laws and court cases, and data tables on opioid use.