Pill of joy, pill of pain

In one of the stranger journalistic tasks I have taken on over the course of my career, I decide to research Vicodin, while I am taking Vicodin.

It’s not the topic that is so strange, just the way I feel as I peck away at the research: fuzzy, sleepy, strangely unmotivated, plugged up, and, oh yes, totally afraid to let those effects run out. What is this stuff that makes my recovery from breast surgery possible? Why does it knock me on my butt? Why does society love it and hate it?

Now, the post-surgical pain is merely annoying, not even “moderately severe,” so I’ve tapered off and I am typing this Vicodin-free. For the first time since I woke up in post-op I may almost be capable of organized thought.

• So what is Vicodin?

It’s a pill that may also go by the name of Lortab, Lorcet, Anexia, Norco and whatever new names pharmaceutical firms can dream up for the same thing. It contains a large quantity of acetaminophen (that’s Tylenol to you), usually 350 mg to 750 mg and a small quantity of hydrocodone, usually 2.5 to 10 mg. It is the drug most commonly prescribed to patients who have just had surgery. That’s the dry definition. Here’s the cooler stuff:

• All euphoric paths lead to opium.

Maybe I’m just unbelievably dense, having grown up in the 1960s and 1970s just a mile from San Francisco’s Haight-Ashbury, but I somehow just figure out that ALL narcotics—and Vicodin is a narcotic—have their roots in opium.

Archeological digs suggest that Neanderthals first cultivate opium some 30,000 years ago. The first written reference is about 4,000 years old. A Sumerian text calls the plant “hul gil,” or “plant of joy.” The Sumerians give it to the Babylonians who give it to the Egyptians, who give it to the Greeks and Romans who give it to everyone else.

Pretty flower, big buzz

Until the 19th century, all opium is crude opium, a tar-like substance obtained from the pods of poppy plant cultivar, “papaver somniferum,” or “sleepy poppy.” The tar contains a complex chemical cocktail: sugars, proteins, fats, water, latex, ammonia, sulfuric and lactic acids and, mostly notably for our purposes, a group of alkaloids: morphine (10-15 percent), codeine (1 to 3 percent), papaverine (1 to 3 percent), noscapine (4 to 8 percent) and thebaine (1 to 2 percent).

The potent stuff is in that latex dripping down the side

All those alkaloids, except thebaine, provide pain relief just as they are, the most familiar of these are the “natural” opiates, morphine and codeine.

But if you combine or boil thebaine with ethylene glycol and an acid, you can produce a “semi-synthetic” narcotic “opioid” called hydrocodone that they process into a Vicodin pill.

If I was better at chemistry, I could really explain this chemical model of Vicodin

Similar processes yield a grab bag of partly-manmade narcotics familiar from tabloid headlines, think Percodan, Dilaudid, Oxycodone, Demerol.

Heroin is also “semi-synthetic.” An English researcher, trying to find a non-addictive alternative to opium, discovers it in 1874 by boiling it on a stove with acetic acid. About 30 years later, the Bayer company begins manufacturing it commercially. Laudanum, an older preparation, is just opium boiled in wine or brandy with a few spices added. Talk about a double whammy.

Do some more chemistry voodoo and you get totally synthetic narcotics, also called “opiods,” Fentanyl, Methadone, Darvon, Dolophine. Immobilon, appropriately named, is 1,000 times stronger than morphine. It’s what they put in elephant darts. In the 1960s, some researchers at McFarlane, Smith & Co. stir their midmorning tea with rods contaminated with that compound, and fell flat almost instantly, nearly dying.

• My pathetic, Vicodin-fueled recovery period connects me to the great sweep of history:

It would be nice to think that intellectual curiosity fuels the human need to explore during the Age of Discovery. That’s certainly part of the truth, but I think the stronger motivation is that we want trade routes for things that give us a buzz: sugar, coffee, tea and opium.

Thomas Jefferson grows opium poppies in his garden. They sell the seeds in the Monticello gift shop until 1991. Then a drug bust at University of Virginia makes them rethink that.

John Jacob Astor traffics in opium, first smuggling it from Turkey to China, then going “respectable,” and selling exclusively to England. During this era, millions in England and America are addicted to opiates, which are freely available at pharmacies and grocery stores.

Vicodin connects me to some history’s great wars: The Opium Wars, of course, but also the Cold War (when France and the US supplied Southeast Asian drug lords with ammunition so that they could fight communism), the Vietnam War (when the CIA transported raw opium from Burma and Laos), and the endless wars in Afghanistan, including the current one.

• We love opium and all its derivatives.

Homer talks about opium in “The Odyssey.” In that era, people serve poppy tea to mourners, no doubt taking the edge off grief. Opium poppy seed cakes and pods show up in Neolithic Swiss village excavations. Apparently, the early Swiss were more swingers than are their modern descendants. Mohammed bans alcohol, but not opium. “Take your opium,” is a standard greeting in some Indian cities even before the British East India Company arrives to create the opium trade that would bring China to its knees. In the 1800s, mothers can choose from dozens of opium-based preparations to keep their kids docile and happy. Who needs attachment parenting or Ferberizing?

• We give opium and its derivatives high flying names:

During the Crusades, opium becomes taboo in Europe because it comes from the tainted East, where all those infidels live. It is reintroduced during the Reformation renamed “laudanum,” that’s the opium-brandy concoction, or “Stones of Immortality” made of “opium thebacium,” citrus juices, crushed pearls and quintessence of gold. Sounds more expensive than universal healthcare.

In 1805, the German chemist who first isolates the most common compound in opium calls it “morphium,” after the Greek god of dreams, Morpheus.

In 1898, when Bayer introduces a new broad-spectrum painkiller, the company calls it “heroin” because the drug makes users feel like they are heros.

• The opium family of drugs does not produce unconsciousness, or dampen sensation, like booze, or barbituates, or ether, so many of us have been attracted to it through the ages. Attraction leads to addiction, alas. So we hate opium. Except we don’t.

At the height of China’s Opium Wars, nearly a quarter of that country’s men become addicted to the drug. In my stupid, devil-may-care 20s I try opium once, in a remote Thai village in the Golden Triangle. (The Thais still put you in jail forever if they catch you, but I am too silly to take that into account. Luckily, I do not get caught.) I must say, I can understand how most of a country might get addicted. Plant of joy, indeed.

From Marcus Aurelius to...

The list of opiate and opioid addicts goes on seemingly forever: Roman emperor Marcus Aurelius (Easy for him to be so stoic when he’s high!), Christmas Carol author Charles Dickens, Victorian poet Elizabeth Barrett Browning, nurse Florence Nightingale, 1960s singer Janis Joplin, Saturday Night Live legend Jim Belushi, grunge singer Kurt Cobain, “Princess Leia” actress and author Carrie Fisher, radio blowhard Rush Limbaugh, King of Pop Michael Jackson, and millions, probably billions over the millennia, more.

...to Michael Jackson

An FDA advisory panel recently suggests taking Vicodin off the market, mostly because of concerns about the possibility of Acetaminophen overdose. (It causes liver failure at doses higher than 4 grams, or 4,000 mg a day). But every “Vicodin information” sheet and web page I read warns about addiction and the need to quit as soon as you can possibly bear the pain. The Partnership for a Drug Free America says nearly 1 in 4 teenagers abuses opioid painkillers. That’s not even counting the really hard stuff. Google “purchase Vicodin” and you’ll pull up dozens upon dozens of pages offering to sell you the stuff semi-legally (People dressed like doctors are prominent in the graphics.) Google “synthesize Vicodin” and you will also pull up dozens and dozens of pages telling you how to make opiates yourself.

• All this and we don’t even know exactly how it works.

Amazingly, after tens of thousands of years, we’re a little fuzzy on the details of how opiates help relieve pain and produce euphoria. In the 1970s, searching for a way to help people like opium just a little less, scientists discovered several kinds of “opiate receptors” on specialized nerve cells in the spine and the brain. Apparently the opium molecules fit like keys into these molecular locks, and block the production of other compounds that help transmit or receive certain nerve signals, like pain. This proves that social scourges like heroin addiction are not just sociological, they are physiological.

These receptors also affect the “smooth muscles” of your internal organs, the involuntary contract and release cycles that keep your lungs expanding and contracting, that keep your gastrointestinal tract percolating yesterday’s dinner. So that’s part of the reason Vicodin has made me out of sorts and “irregular.”

Scientists have discovered quite a lot about these opioid receptors, because the idea is that the cure for addiction may lie in this knowledge. Lock something into the receptors that is NOT opium-based and you cure the addiction. But there’s still a lot to know about the exact chemical pathways that are created by each kind of opium derivative. What cascades of chemicals make these things happen? With which drugs? Lots of fodder remains there for future Ph.D. dissertations.

So there still is a lot research today into opiate receptors. New ones are proposed fairly regularly.

Of course, these chemical keys and locks did not evolve so that we could take opiates. We can make our own opiates, endorphins for instance. Endorphins block pain so that you can keep running from that wild bear; the evolutionary advantage is obvious. But in the modern world, prodding your body to make endorphins usually requires that you do something like run at a full tilt for several miles.

It’s so much easier to take a pill. That’s the joy, and the pain, of it.

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About leftbreast

I have had breast cancer. I was diagnosed at 47, and am now 49. I have finished "active treatment," two surgeries, chemo, radiation, monoclonal antibodies. These days, I only take a drug to suppress my uptake of estrogen, since my tumor was highly reactive to that hormone. I have been married to my husband Pete for 21 years. I have a stepdaughter, Maureen, 30, and a daughter, Erin, 10. I've been a freelance magazine journalist for 20-plus years, covering everything from Chinese foreign policy to Catholic nuns to endangered species. I have had a great life. I have lived in Asia and all over the United States. I have spent nights with tree-sitters in Oregon and with astronomers at the Mauna Kea observatory in Hawaii. I've been to a cocktail party on the poopdeck of a British destroyer docked in Shanghai. I've taken the bus to Tibet, and tramped through the cloud forests of Panama with biologists. A magazine sent me on a raft trip down the Colorado through the Grand Canyon; another sent me to cooking school for a week. I have spent time with celebrities, presidents and heroin dealers. I love my work. I have a loving, supportive family and more friends than I probably deserve. I have had the space and time to camp, ski, cycle, garden, cook and spoil my pets (an Australian shepherd, a German shepherd and a tabby cat). If it all ended tomorrow, I would have to say that it has been a really, really good ride. When I was in thick of treatment, I was simply fighting for more time. Now, I'm trying to connect the experience of cancer with the rest of my life, with the time that's been won. I hope the cancer never comes back, but if it does, I'll be ready. That's what this blog is about.
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6 Responses to Pill of joy, pill of pain

  1. Alex says:

    Brilliant post, Heather!

  2. Sarah Goodyear says:

    Excellent that you managed to work in MJ.

    • leftbreast says:

      Yes, and I figured out how to cut and paste photos from Media Commons. Flickr wasn’t working for some reason. Found this wonderful subscription stock photo website, ShutterStock. Am considering subscribing, because some of the images are so cool…

  3. D.M. says:

    Amazing post, Heather! Great research, brilliant writing. I have probably read more articles on Opium than anyone on else on this planet, and yours is by far one of the most compelling and factual I’ve seen.

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