Opioids were languishing from the legacy of an earlier epidemic that prompted President Theodore Roosevelt to appoint the US’s first opium commissioner, Dr Hamilton Wright in 1908.
Portenoy wanted to liberate them from this taint.
Wright described Americans as ‘the greatest drug fiends in the world’ and opium and morphine as a ‘national curse’.
After that the medical profession treated opioid pain relief with what Portenoy and his colleagues regarded as unwarranted fear – stigmatising a valuable medicine.
These new evangelists painted a picture of a nation awash in chronic pain that could be relieved if only the medical profession would overcome its prejudices.
They constructed a web of claims they said were rooted in science to back their case – including an assertion that the risk of addiction from narcotic painkillers was ‘less than 1%’ and that dosages could be increased without limit until the pain was overcome.
But the evidence was at best thin and in time would not stand up to detailed scrutiny.
One theory – promoted by Dr David Haddox – was that patients genuinely experiencing pain could not become addicted to opioids because the pain neutralised the euphoria caused by the narcotic.
He said that what looked to prescribing doctors like a patient hooked on the drug was ‘pseudo-addiction’.
Portenoy toured the country – describing opioids as a gift from nature and promoting access to narcotics as a moral argument.
Being pain-free was a human right he said.
In 1993 he told the New York Times of a ‘growing literature showing that these drugs can be used for a long time with few side-effects and that addiction and abuse are not a problem’.
Long after the epidemic took hold and the death toll rose into the hundreds of thousands in the US – Portenoy admitted that there was little basis for this claim and that he had been more interested in changing attitudes to opioids among doctors than in scientific rigour.