I was watching CNN on Sunday night, a program about babies in Florida being born to mothers misusing/abusing oxycodone.  Yes the new “crack babies.” In fact the program was showing a graph of the number of “crack babies” decreasing as “oxy babies” increased, when they interrupted the program to announce a resolution to the “debt ceiling.”

The story was attempting to expose both the problems with the “pill mills” in Florida as well as the impact on these innocent victims of  “Drug dependency syndrome” (a.k.a, addiction).  One comment that struck me forced me back to my pharmacology texts.

“Oxycodone is almost identical to heroin.” (or words to that effect).

This struck me as somewhat strange. It is close to oxycodone but fact Heroin is closer to morphine than it is to oxycodone! While these structures may seem complicated, heroin is a prodrug that in fact the body breaks down to morphine.  Heroin is very commonly used in palliative care settings in the United Kingdom under the proper chemical name, diacetylmorphine.

Why don’t we hear the reporter telling us the similarities of heroin to morphine.  They are in fact all opioids and therefore very similar in structure, if that is in fact important. Heroin is in fact more similar to morphine than it is to oxycodone.

So our perception of these differences is very important.

Would people perceive the story differently if told that oxycodone is very similar to morphine?

Is there such a stigma with morphine that viewers would not perceive “abusers” in the same way?

Is morphine an important part of the current problem of opioid overdoses and deaths?

This final question is particularly important to me, as the work of PPSG started when the question of using heroin for the treatment of cancer pain was raised in Wisconsin.  Rather than heroin, the focus moved to the use of oral morphine. So the discussion of balance was initially being considered in the context of morphine, a context we continue to encourage in low and middle income countries.

As we all evidence, lets be clear and use all of the evidence before us.

jfclearywisc.