Opioids as a Pharmakon

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Opioids can be thought of as the prime example of a pharmakon, or a substance that exists simultaneously as a remedy and a disease; a cure and a malady. Opium has been used since ancient times for its remarkable ability to relieve pain, primarily in the form of laudanum. The development of synthetic and semi-synthetic opioids in the twentieth century made opioids even more useful in the treatment of pain caused by cancers, terminal illnesses, broken bones, burns, and child birth. By attaching directly to receptors responsible for the perception of pain in the peripheral and central nervous systems, opioids provide effective pain relief for even severe injuries. Opioids can also be utilized in the treatment of conditions such as diarrhea and to relieve coughs and chest pain.

However, precisely because of their mechanism of action in the human nervous system, opioids present themselves as a significant malady when misused. The same receptors responsible for detection of pain are also involved in regulating stimulation and arousal, mood, and muscle constriction. Persistent exposure to opioids can lead to opioid use disorder, in which the nervous system becomes dependent on the presence of extraneous opioids to function properly. When an opioid user misses their usual dose, a new disease entirely appears: opioid withdrawal. This includes a profound sense of dysphoria and anxiety as the mood-boosting effects of the opioids wane, the return of the pain the opioids were intended to treat and the appearance of new phantom pains, insomnia, nausea, diarrhea, and ultimately severe psychological cravings. Withdrawal from opioids, as well as their psychological addictiveness, leads to relapse in up to 91% of opioid addicts (Kadam et. al.). Opioid use disorder presents a severe risk of interfering with one’s daily life.