Nonaddictive Morphine?

Jacob Sullum | January 31, 2008

University of California at San Francisco researchers say they've genetically engineered mice that can receive morphine on a regular basis without developing tolerance or physical dependence. They believe the success of their genetic manipulation may point the way to developing a strong painkiller that patients can take over an extended period without increasing the dose to maintain effectiveness or worrying about withdrawal symptoms. Those certainly would be welcome improvements for patients in pain, but it would not, contrary to the UCSF press release about the research, "block dependency" or eliminate the possibility of addiction.

Both the university press office and the researchers themselves seem to be equating addiction with tolerance (the need for escalating doses to achieve the same effect) and physical dependence (the adaptation that results in withdrawal symptoms when a drug is suddenly withdrawn). Anyone who takes narcotics long enough and regularly enough will develop tolerance and physical dependence, but addiction requires a persistent desire to use the drug for its psychoactive effects. According to the American Psychiatric Association, tolerance and withdrawal are neither necessary nor sufficient for a diagnosis of drug dependence, and this is one of the rare occasions when I agree with the APA.

Otherwise, we'd have to say that everyone who regularly uses narcotics for pain becomes addicted to them, even though only a small percentage end up using such drugs for nonmedical reasons. We'd also have to go back to saying that drugs such as nicotine and cocaine (use of which does not lead to the clear, predictable tolerance and withdrawal associated with narcotics) are not truly addictive but merely habit-forming, a distinction without a difference. And if addiction were defined as tolerance plus withdrawal, it would not be meaningful to speak of addiction to things other than drugs that provide pleasure or relieve stress, such as gambling, sex, or shopping. Addiction is a pattern of behavior, not a chemical reaction; in the case of drugs, it resides in the person's relationship with the substance, not the substance itself.

Still, it's true that you don't often hear of addiction to aspirin or ibuprofen. If a drug company could produce a painkiller as strong as morphine that had no psychoactive effects, it would not be attractive to people seeking to get high or soothe their unhappiness. Then it would make sense to call the drug nonaddictive.

[Thanks to CK for the tip.]

Comments

|1.31.08 @ 1:25PM|#

San Francisco tiger update, pls, Mr. Sullum.

|1.31.08 @ 1:25PM|#

An opiate that could get you high without being addictive would be the perfect drug.

Episiarch|1.31.08 @ 1:35PM|#

An opiate that could get you high without being addictive would be the perfect drug.

Ab-so-fucking-lutely.

If a drug company could produce a painkiller as strong as morphine that had no psychoactive effects

But then what fun would it be?

Mike Laursen|1.31.08 @ 1:36PM|#

Hmm, San Francisco Tigers would be a great name for a new sports team.

Mike Laursen|1.31.08 @ 1:39PM|#

Wait. There's already a minor league hockey team named the San Francisco Tigers. Now the question is how to buy one of their jerseys.

|1.31.08 @ 1:40PM|#

Unfortunately, along with benzodiazepines and alcohol, opiates are the only drugs with severe physical addictive properties. Given the wide variety of other stuff people get hooked on, the psychological addiction factor must be at least if not more significant. That's not to say this isn't an improvement--my uncle died of an oxy OD after acquiring the habit while rehabbing from back surgery--but as long as it still works, it will still have its chronic nontherapeutic users.

|1.31.08 @ 1:42PM|#

If a drug company could produce a painkiller as strong as morphine that had no psychoactive effects,

I don't believe that is possible. Now or ever.
I have no evidence or expertise to back this up disclaimer goes here.

|1.31.08 @ 1:44PM|#

say they've genetically engineered mice that can receive morphine on a regular basis without developing tolerance or physical dependence. They believe the success of their genetic manipulation may point the way to developing a strong painkiller that patients can take over an extended period without increasing the dose to maintain effectiveness or worrying about withdrawal symptoms.

Some folks think it would be nice if they would just concentrate on a way to keep it from severely constipating one.

|1.31.08 @ 1:44PM|#

Speaking of drugs, no post on how Obama apparently favors decriminalization of pot?

|1.31.08 @ 1:46PM|#

If a drug company could produce a painkiller as strong as morphine that had no psychoactive effects

Serious question here:

Pain is a subjective experience. Isn't being a painkiller in and of itself a psychoactive effect?

sv|1.31.08 @ 1:57PM|#

i was wondering why mr. sullum "rare[ly]... agrees with the APA", and came up with this:

http://www.reason.com/news/show/32186.html

which seemed worthy of a repost.

|1.31.08 @ 1:59PM|#

Funny, I thought addiction was a disease marked by a change in the brain chemistry which renders a person incapable of stopping their usage. The mainstream medical treatment for this condition is, of course, asking god for help and making amends for all the obnoxious things you've done. I'm not sure what these have to do with a medical condition but they've been using this method for decades without the slightest change so it must be foolproof.

|1.31.08 @ 2:02PM|#

RC Dean-

Good point.

|1.31.08 @ 2:13PM|#

FEELS GREAT!

LESS ADDICTIVE!

FEELS GREAT!

LESS ADDICTIVE!

|1.31.08 @ 3:54PM|#

goddammit

I'd composed a great response to R C Dean and Cesar... and the intertubes ate it.

I'm already having a shitty day, I guess this was just garnish.

Shannon Love|1.31.08 @ 4:30PM|#

I would argue that the confusion between tolerance and addiction is what caused the "War on Drugs" in the first place.

Most people and policy makers in the 60's and 70's clearly believed that "addiction" was caused by tolerance and by the drugs altering an individuals physiology and subverting their will. (Indeed, when powered cocaine started becoming a big thing in the late 70's, a lot of experts said that it was a least a safer drug because it wasn't "addictive" because it did not create dependency like heroin. Funny to think of that now).

Working from that model, the only way to prevent drug addiction was to prevent exposure to the drug. Otherwise, anyone could become an addict if exposed enough.

If we had understood addiction to be a psychological problem merely aggravated with some drugs by tolerance we might have chosen a strategy of addiction proofing people by fostering character and emotional stability.

Ventifact|1.31.08 @ 4:32PM|#

Pain is a subjective experience. Isn't being a painkiller in and of itself a psychoactive effect?

Hypothetically a drug could eliminate the sensation of pain without affecting any other conscious (or subconscious) experiences. Such drugs actually exist, e.g. Novocaine. But this is used in local anesthesia and blocks nerve's pain signals before they arrive in the brain. Hypothetically a "non-psychoactive" painkiller could kill those pain signals in the brain itself while having no other effects. I have no idea how practical or feasible this might be.

And anyway, it's kinda a matter of semantics too. I'm not so keen on the traditional mind-body dichotomy, so I am actually with you on this: altering the pain experience is necessarily psychoactive.

.|1.31.08 @ 5:29PM|#

Hypothetically a "non-psychoactive" painkiller could kill those pain signals in the brain itself while having no other effects. I have no idea how practical or feasible this might be.

I don't have a doctorate in this stuff -- but using my understanding of how the brain works, it would be incredibly difficult make a drug that only effects pain recognition in the brain. Its likely that similar chemical processes that happen in other parts of the brain for different purposes would be effected. And that's ignoring the evidence we have that a certain amount of pain processing can happen in the spinal cord.

Layman evidence:
We are pretty good at the chemistry thing & it hasn't happened yet. So obviously, its hard.

SIV|1.31.08 @ 5:47PM|#

An opiate that could get you high without being addictive would be the perfect drug.

They already work that way.Unless you try to stay high 24/7.Even then, they are easier to quit than cigarettes.

SIV|1.31.08 @ 5:52PM|#

Unfortunately, along with benzodiazepines and alcohol, opiates are the only drugs with severe physical addictive properties.

Sudden withdrawal of barbiturates or alchohol can induce seizures and death. Opiate withdrawal is more like the flu. Opiates are not "physically addictive" in the same way as some other cns depressants.

R Mutt|1.31.08 @ 5:56PM|#

Heroin was originally developed as a non-addictive morphine and was originally marketed by Bayer towards children because it was so much safer than morphine.

When people still really don't understand the nature of addiction, I am skeptical of each new drug that will miraculously cure addiction or is deemed non-addictive.

There's a lot of interesting research about the gene clusters involved in addiction and risk-taking behavior, but the idea that scientists can authoritatively state the boundaries of addiction and the government can enforce these boundaries is farcical.

|1.31.08 @ 6:39PM|#

Next I hope they apply this "nonaddictive" thing to Doritos.

The Wine Commonsewer|1.31.08 @ 9:39PM|#

Doritos were the first chip that actually tasted good with beer.

The Wine Commonsewer|1.31.08 @ 9:42PM|#

receive morphine on a regular basis without developing tolerance or physical dependence.

What if you like it? It would seem that you could become addicted to this quite nicely and the upside is that you wouldn't need ever increasing quantities.

My buddy Frank is first generation Italian. He says:

What good Italian can't drink a bottle of wine in an evening. It's only four glasses.

It seems to me that a non-addictive version of morphine might fall into the same category.

You never need more, always the same high.

Whooo-Hooo!

stress|2.1.08 @ 12:38AM|#

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The Wine Commonsewer|2.1.08 @ 1:38AM|#

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|2.1.08 @ 2:26AM|#

A few things:

1)over the past few years, there have been multiple paradigms developed to administer opiates without inducing significant tolerance. This is one of them. The most developed one, that I know of, has already undergone Phase III clinical trials. See here for details and links.

2)Sullum claims, "addiction requires a persistent desire to use the drug for its psychoactive effects" despite negative consequences. Millions of people have many persistent desires - to socialise, watch TV, have sex - all presumably for some psychoactive payoff. So the key criteria for addiction is, or ought to be, whether a person can control their habits if they want to. Of course, there's also the third-person social diagnosis, which I find controversial, i.e. if a person has some habit which they don't mind, but you do, and you wish them to stop, but they don't, and so you deem them addicted to that activity.

3)In terms of opiates, negative reinforcement is a greater driver of use than positive reinforcement, i.e. avoiding withdrawal.

|2.1.08 @ 6:01AM|#

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