Junk The Term Narcotics—Call Them Opioids
The term “narcotic” no longer has a place in any communication involving pain management or addiction. It is not only demeaning and misleading, but it lets society and the debating parties off the hook.
You say, “What debate?” Simple. Society—not just medical practitioners and their pain patients—has to come to grips with what opioids are all about. Just read your local newspaper or turn on your TV. Hardly a day goes by that we don’t hear about “overprescribing,” overdose deaths, and greedy prescribers, wholesalers, and pharmacists. Calls for restrictions and elimination of opioids are commonplace. Do we want patients to needlessly suffer just because we don’t understand opioids? It’s time that every concerned party get real about the need for natural opioids in the body, as well as for pain and addiction treatment. Opioids aren’t going away.
Semantics and science can, and should, be simple and understandable to help concerned parties find practical solutions. The contention submitted here is that forever junking the term “narcotics” will be a giant step forward. We must encourage every party to use the term “opioid” to make a single, scientific point. The physiologic effects of opioids are fundamentally the same whether we are talking about poppy plants in the Afghanistan fields, heroin in the inner city, a pill for the arthritic, or endorphins in the human body. Blame the Creator if you will, but get used to the fact that our natural, endogenous pain relievers and opium have the same physiologic effects. These compounds are best called “opioids” to make the point that they are in one class. They not only give us pain relief, but also maintain our immune and healing mechanisms, give us feelings of motivation, happiness, self-worth, and provide endurance. Our individual, natural levels of endogenous opioids, like all hormones and neurotransmitters, are genetically determined. And yes, these inborn levels have something to do with the behaviors of addiction and opioid dosages for pain relief.
It should be recalled that the discovery of opioid receptors and endorphins in the early 1970s is relatively new.1 In medical and scientific terms, a discovery that is fewer than 50 years old is a “newbie.” The term “endorphin” (endogenous morphine-like) at first was used to designate a general class of substances postulated to occur in the brain and was subsequently applied to a particular class of compounds related to the enkephalins.2-4 The phrase “endogenous opioid” is now used to describe any peptide (chain of amino acids) with morphine-like activity. Exogenous, opium-derived, or synthetically produced morphine-like compounds are kissing cousins of the endogenous peptides with morphine-like activity; hence, the collective name “opioids,” which include endogenous and exogenous compounds with morphine-like activity. This makes common sense and is understandable.
What’s bad about the term “narcotic”? First, the original definition stems from the Greek word “narkē,” meaning numbness (Table 1). Later, any drug that caused sedation or could be abused was labeled a narcotic. For example, the Harrison Narcotic Act, passed in the early part of the last century, included a panorama of abusable drugs called “narcotics” that included sedatives, hallucinogens, stimulants, as well as some opioids. Scientifically, it is simply archaic to call any drug or group of drugs a “narcotic.” Those who currently use the term “narcotic” do it out of ignorance of drug classes or to paint opioids with a pejorative brush. Neither is acceptable. Sedatives should be called sedatives, stimulants should be called stimulants, and opioids should be called opioids.
The term “opioid” started to appear and be defined in medical dictionaries by 1981. It’s now our job to call it like it is, and educate all parties that opioids are a class of similar compounds with similar physiologic actions. They are found in and out of the body. Consequently, when we prescribe or administer an opioid, we are fundamentally giving the patient something they already have. It’s a little like giving a patient insulin or thyroid hormones. We’re just enhancing an endogenous, natural, and critical hormone. When it comes to serious pain relief, there is no real substitute for opioids, and there never will be. They are part of us.