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The Birth of Naloxone: An Intellectual History of an Ambivalent Opioid

Published online by Cambridge University Press:  27 October 2021

Laura Kolbe*
Affiliation:
Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, New York, NY10065, USA
Joseph J. Fins
Affiliation:
Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, New York, NY10065, USA
*
*Corresponding author. Email: [email protected]

Abstract

Naloxone, which reverses the effects of opioids, was synthesized in 1960, though the hunt for opioid antagonists began a half-century earlier. The history of this quest reveals how cultural and medical attitudes toward opioids have been marked by a polarization of discourse that belies a keen ambivalence. From 1915 to 1960, researchers were stymied in seeking a “pure” antidote to opioids, discovering instead numerous opioid molecules of mixed or paradoxical properties. At the same time, the quest for a dominant explanatory and therapeutic model for addiction was likewise unsettled. After naloxone’s discovery, new dichotomizing language arose in the “War on Drugs,” in increasingly divergent views between addiction medicine and palliative care, and in public debates about layperson naloxone access. Naloxone, one of the emblematic drugs of our time, highlights the ambivalence latent in public and biomedical discussions of opioids as agents of risk and relief.

Type
Articles
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Notes

1. Fins, JJ. Acts of omission and commission in pain management. Journal of Pain and Symptom Management 1999;17(2):120–4.CrossRefGoogle Scholar

2. Manglik, A. Molecular basis of opioid action: From structures to new leads. Biological Psychiatry 2019;87:614.CrossRefGoogle Scholar

3. Jones, JS. Opium slavery: Civil War veterans and opiate addiction. The Journal of the Civil War Era 2020;10(2):185212.CrossRefGoogle Scholar

4. Courtwright, DT. Dark Paradise: A History of Opiate Addiction in America. Revised ed., Cambridge, MA: Harvard University Press.; 2001.CrossRefGoogle Scholar

5. Nilsson J. America’s first opioid epidemic. Saturday Evening Post; 2019 Aug 29.

6. Boudreau, D, Von Korff, M, Rutter, CM, Saunders, K, Ray, GT, Sullivan, MD, et al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiology and Drug Safety 2009;18:1166–75.CrossRefGoogle Scholar

7. Campbell, N. OD: Naloxone and the Politics of Overdose. Cambridge, MA: MIT Press; 2020.CrossRefGoogle Scholar

8. Acker, CJ. Addiction and the Laboratory: Scientific Definitions of Opiate Addiction in the 1920s and 1930s. San Francisco: University of California Press; 1990.Google Scholar

9. Robinson, S, Adinoff, B. The classification of substance use disorders: Historical, contextual, and conceptual considerations. Behavioral Sciences (Basel) 2016;6(3):18.CrossRefGoogle Scholar

10. Nalorphine, Lasagna L. (N-allylnormorphine); practical and theoretical considerations. AMA Archives of Internal Medicine 1954;94(4):532–58.CrossRefGoogle Scholar

11. Pasternak, G. The Opiate Receptors. New York: Springer Science and Business Media; 2013.Google Scholar

12. See note 10, Lasagna 1954.

13. See note 11, Pasternak 2013.

14. Terry, CE, Pellens, M. The Opium Problem. New York: Bureau of Social Hygiene; 1928.Google Scholar

15. Kassius, P. Social hygiene training for social workers. Presented at the Social Hygiene Meeting held in conjunction with National Conference of Social Work, Minneapolis, June 15, 1931. Journal of Social Hygiene 1931;17(1): 438.Google Scholar

16. See note 8, Acker 1990.

17. See note 8, Acker 1990.

18. “Narcosan.” New York Times 1926 Dec 15; available at https://www.nytimes.com/1926/12/15/archives/narcosan.html?searchResultPosition=1 (last accessed 23 Jan 2021).

19. “‘Narcosan’ and drug addiction.” Science 1927;65(1672):40.

20. See note 19, “‘Narcosan’ and drug addiction,” 1927.

21. “Wide Interest in Narcosan.” New York Times 1926 Dec 26; available at https://www.nytimes.com/1926/12/26/archives/wide-interest-in-narcosan-welfare-island-besieged-by-pleas-from.html?searchResultPosition=4 (last accessed 23 Jan 2021).

22. Lambert, A. Narcosan for drug addiction: Report of the Mayor’s Committee of New York on Drug Addiction. JAMA 1929;92(2):147.CrossRefGoogle Scholar

23. McCawley, EL, Hart, ER, Marsh, DF. The preparation of N-allylnormorphine. Journal of the American Chemical Society 1941;63(1):314.CrossRefGoogle Scholar

24. Strober, M. Treatment of acute heroin intoxication with nalorphine (nalline) hydrochloride. JAMA 1954;154(4):327–8.CrossRefGoogle Scholar

25. Eckenhoff JE, Elder JD, King, BD. N-allylnormorphine in the treatment of morphine or Demerol narcosis. American Journal of Medical Science 1952;223:191–6.CrossRefGoogle Scholar

26. Moreno, J. Beecher reconsidered. The Hastings Center Report 2019;49(3):3.CrossRefGoogle Scholar

27. Lasagna, L, Beecher, HK. The analgesic effectiveness of nalorphine and nalorphine-morphine combinations in man. Journal of Pharmacology and Experimental Therapeutics 1954;112(3):356–63.Google Scholar

28. See note 11, Pasternak 2013.

29. “Rapid diagnosis of addiction to morphine.” JAMA 1954;154(5):414.

30. Fins, JJ. From psychosurgery to neuromodulation and palliation: History’s lessons for the ethical conduct and regulation of neuropsychiatric research. Neurosurgery Clinics of North America 2003;14(2):303.CrossRefGoogle Scholar

31. Delgado, JM. Physical Control of the Mind: Toward a Psychocivilized Society. New York: Harper and Row; 1986.Google Scholar

32. Adams, EB. Voluntary sterilization of inmate for reduced prison sentences. Duke Journal of Gender Law & Policy 2018;26:2344.Google Scholar

33. Breggin, PR. Psychosurgery for political purposes. Duquesne Law Review 1975;13(4):841–62.Google Scholar

34. Campbell, N. Discovering Addiction: The Science and Politics of Substance Use Research. Ann Arbor, MI: University of Michigan Press; 2007.CrossRefGoogle Scholar

35. Beecher, HK. Ethics and clinical research. Bulletin of the World Health Organization, 1966;79(4), 367–72.Google Scholar

36. See note 34, Campbell 2007.

37. See note 34, Campbell 2007.

38. Swartz, J. Porter Narcotic Farm Act. In: Marion, NE, Oliver, WM, eds. Drugs in American Society: An Encyclopedia of History, Politics, Culture, and the Law. Santa Barbara, CA: ABC-CLIO; 2014 pp 741744.Google Scholar

39. See note 38, Swartz 2014.

40. Yardley W. Jack Fishman dies at 83; saved many from overdose. New York Times 2013 Dec 15; available at https://www.nytimes.com/2013/12/15/business/jack-fishman-who-helped-develop-a-drug-to-treat-overdoses-dies-at-83.html?searchResultPosition=1 (last accessed 23 Jan 2021).

41. Sadove, MS, Balagot, RC, Hatano, S, Jobgen, EA. Study of a narcotic antagonist—N-allyl-noroxymorphone. JAMA 1963;183(8):666–8.CrossRefGoogle Scholar

42. Zaks, A, Jones, T, Fink, M, Freedman, AM. Naloxone treatment of opiate dependence: A progress report. JAMA 1971;215(13):2108–10.CrossRefGoogle Scholar

43. See note 42, Zaks et al. 1971.

44. Dole, VP, Nyswander, ME, Kreek, MJ. Narcotic blockade. Archives of Internal Medicine 1966;118(4):304–9.CrossRefGoogle Scholar

45. Barber C. Public enemy number one: A pragmatic approach to America’s drug problem. Richard Nixon Foundation 2016 June 29; available at https://www.nixonfoundation.org/2016/06/26404/ (last accessed 13 Aug 2020).

46. Schmidt DA. Chemical warfare drugs called possible aid to heroin addicts. New York Times 1971 Nov 23; available at https://www.nytimes.com/1971/11/23/archives/chemical-warfare-drugs-called-possible-aid-to-heroin-addicts.html?searchResultPosition=1 (last accessed 23 Jan 2021).

47. Sibley J. Six projects started to develop nonaddictive heroin substitute. New York Times 1971 Sept 20; available at https://www.nytimes.com/1971/09/20/archives/six-projects-started-to-develop-nonaddictive-heroin-substitute.html?searchResultPosition=1 (last accessed 23 Jan 2021).

48. Woods, JH, Downs, DA, Carney, J. Behavioral functions of narcotic antagonists: Response-drug contingencies. Federation Proceedings 1975;34(9):1777–84.CrossRefGoogle Scholar

49. Blachly, PH. Naloxone for diagnosis in methadone programs. JAMA 1973;224(3):334–5.CrossRefGoogle Scholar

50. Vrecko, S. Birth of a brain disease: Science, the state, and addiction neuropolitics. History of the Human Sciences 2010;23(4):5267.CrossRefGoogle Scholar

51. Moreno, J. Undue Risk: Secret State Experiments on Humans. Abingdon, United Kingdom: Routledge; 2001.Google Scholar

52. See note 51, Moreno 2001.

53. Fins, JJ. Mind wars: Brain research and national defense. JAMA 2007;297(12):1379–83.CrossRefGoogle Scholar

54. WHO Expert Committee on Cancer Pain Relief and Active Supportive Care & World Health Organization. Cancer Pain Relief and Palliative Care: Report of a WHO Expert Committee. Geneva: World Health Organization; 1990.

55. Field, MJ, Cassel, CK, eds., Institute of Medicine (US) Committee on Care at the End of Life. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academies Press; 1997. 1 Google Scholar, Introduction; available at https://www.ncbi.nlm.nih.gov/books/NBK233600/ (last accessed 23 Jan 2021).

56. See note 1, Fins 1999.

57. See note 1, Fins 1999.

58. Manfredi, , Ribeiro S, Chandler SW, Payne R. Inappropriate use of naloxone in cancer patients with pain. Journal of Pain and Symptom Management 1996;11(2):131–4.CrossRefGoogle Scholar

59. Peters, WP, Johnson, MW, Friedman, PA, Mitch, WE. Pressor effect of naloxone in septic shock. Lancet 1981;1(8219):529–32.CrossRefGoogle Scholar

60. Hardy, PAJ. Naloxone, arousal, and the patient’s best interests. Lancet 1981;318(8254):1052.CrossRefGoogle Scholar

61. Green, WG. What’s wrong with trying to make the patient comfortable? Canadian Medical Association Journal 1988;138(10):959.Google Scholar

62. Yeston, NS, Grasberger RC, McIntosh TK. Naloxone in reversal of hypotension in septic shock. JAMA 1983;250(17):2287.CrossRefGoogle Scholar

63. Siram, S, Park, SY. Naloxone in septic shock: Report of two cases. Journal of the National Medical Association 1984;76(7):713–16.Google Scholar

64. Hensel, M, Volk, T, Knox, WJ. [Forced opioid detoxification under general anesthesia: A new challenge for anesthetists and intensive care physicians]. Anästhesiol Intensivmed Notfallmed Schmerzther 1999;34(5):261–8.CrossRefGoogle Scholar

65. National Institute on Drug Abuse. America’s Addiction to Opioids: Heroin and Prescription Drug Abuse; 2014; available at https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse (last accessed 23 Jan 2021).

66. Campbell J. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. Glenview: American Pain Society; 1999.

67. Faulkner-Gurstein, R. The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy. Social Science & Medicine 2017;180:20–7.CrossRefGoogle Scholar

68. Strang, J, Darke, S, Hall, W, Farrell, M, Ali R. Heroin overdose: The case for take-home naloxone. BMJ 1996;312(7044):1435s–6.CrossRefGoogle Scholar

69. Bigg, D. Data on take home naloxone are unclear but not condemnatory. BMJ 2002;324(7338):678.CrossRefGoogle Scholar

70. Seal, KH, Thawley, R, Gee, L, Bamberger, J, Kral, AH, Ciccarone, D, Downing, M, Edlin, BR. Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study. Journal of Urban Health 2005;82(2):303–11.CrossRefGoogle Scholar

71. Campana, S. Overdose mortality and naloxone distribution in Italy. Paper presented at: Prevention of Heroin Overdose: Pragmatic Approaches; January 1314, 2000 Google Scholar; Seattle, WA.

72. Dettmer, K, Saunders, B, Strang, J. Take home naloxone and the prevention of deaths from opiate overdose: Two pilot schemes. BMJ 2001;322(7291):895–6.CrossRefGoogle Scholar

73. See note 68, Strang et al. 1996.

74. Galea, S, Worthington N, Piper TM, Nandi VV, Curtis M, Rosenthal DM. Provision of naloxone to injection drug users as an overdose prevention strategy: Early evidence from a pilot study in New York City. Addictive Behaviors 2006;31(5):907912.CrossRefGoogle Scholar

75. See note 74, Galea et al. 2006.

76. Campbell, N. Naloxone as a technology of solidarity: History of opioid overdose prevention. Canadian Medical Association Journal 2019;191(34):E945E946.CrossRefGoogle Scholar

77. Irwin, A. Citizen Science: A Study of People, Expertise, and Sustainable Development (Environment and Society). London, New York: Routledge; 1995.Google Scholar

78. Dayton, L, Gicquelais, RE, Tobin, K, Davey, Rothwell M, Falade-Nwulia, O, Kong, X, et al. More than just availability: Who has access and who administers take-home naloxone in Baltimore, MD. PLoS One 2019;14(11):e0224686.CrossRefGoogle Scholar

79. Comiskey, CM. Take-home naloxone: While good, it is far from good enough. The Lancet Public Health 2018;3(5):e205e206.CrossRefGoogle Scholar