There are at least two important ways to answer this question. Unfortunately, the most scientific definition, while straightforward, is so disarmingly simple, that it doesnít tell us nearly all of what we need to know about these medications, because it ignores the important cultural forces that influence our use of these medications: the opioids comprise a class of medications that have been employed to relieve pain for well over one hundred years. Their use is so routine in certain settings (after surgery, in the Emergency Room, for labor and delivery, for cancer and in the laboratory) that they are regarded as the standard against which all other pain-killing drugs (analgesics) are compared. These drugs, previously referred to as ìnarcoticsî are derived from or are chemically related to opium, the main constituent of the poppy plant (papaver somniferum), which has been used as a pain killer since biblical times. Science has only recently demonstrated that the human body makes substances that possess a similar structure and function. These endorphins, enkephalins and other molecules, referred to as ìendogenous opioids,î are thought to be responsible for the so-called ìrunnerís high.î

While the above explanation is accurate, it does not even begin to portray the raging controversy that exists surrounding the contemporary use of opioids. While the term ìopioidî is awkward at first, it is preferred to the term ìnarcotic.î Contemporary authorities including the authors of our most important pharmacology textbook, Goodman and Gillmanís The Pharmacologic Basis of Therapeutics have advised that we abandon the term narcotic. It is so culturally and socially laden with references to drug abuse that its has use a chilling effect on prescribers and patients alike, interfering with appropriate treatment of pain. The lurid images of back alley abuse conjured by the term narcotic eclipse its scientific meaning, and as a result, the term opioid is strongly preferred.

In the midst of the tremendous progress that has been made generally in medicine and specifically in our understanding of pain and its treatment it is practically unthinkable that the individual who has done the most to advance our thinking about this issue is Jack Kevorkian. It has taken, arguably a fanatic, if not a lunatic (this authorís thoughts) to bring to our attention that despite the most sophisticated health care delivery system in the world, many Americans inappropriately are led to seek an early death because their pain is not adequately addressed. Since medical science is by no means perfect, those who suffer are not necessarily entitled to relief of their pain, but they are certainly at least entitled to our best efforts to achieve improvement, and by no means should they be subjected to humiliation or derision for seeking the relief of suffering. Although when ignored, unrelieved pain like any other chronic illness leads to depression, pain is almost always fundamentally a medical problem, so we should no more coerce the sufferer to ìtough it outî than we would encourage a diabetic to withhold taking their insulin as a means to ìbuild their character.î While we donít readily admit it, modern medicine actually cures very little of todayís maladies: diabetes and hypertension are not eradicated, but are managed, and thus the mandate to manage chronic pain over a patientís lifetime should not be a surprise or a dilemma that we, as a culture, should shrink away from. These unfortunate individuals should certainly not be discarded as having ìfailedî our current treatments, rather we should acknowledge the shortcomings of current therapies. It is only recently that pain in patients with life threatening cancer has been treated more effectively, and although legislation exists to protect the rights of those with chronic pain (and the prescribing physician), in reality, one practically needs to be dying in this country in order to be assured of getting adequate pain relief.