Like corn syrup, is the structure of synthetic opioids as much to blame for their consequences as the large-scale promotions behind them?

Over the last three decades, two health crises have simultaneously overwhelmed modern America: obesity and addiction. The rise of both and a driving factor of each – opioids for addiction, and sugar for obesity – can be traced to two similar inventions, the creation and proliferation of synthetic opiates, and the promulgation of high fructose corn syrup. However, these two products are not only similar in how they have been marketed to consumers, but in how their chemical architecture metabolizes in the human body.

Additionally, much of modern medicine is saying the same thing about both, but the message is a bit misleading. Many experts now argue that there are no health differences between corn syrup and table sugar. Similarly, most addiction researchers also claim that there are no health differences between natural and synthetic opiates. The one truth all agree on are that sugar and opium can be dangerous for your health, no matter whether they are found in nature or manufactured in a lab. However, the synthetic substances were both developed to decrease costs and to increase customer satisfaction. The only flaw in both of these goals was that they simply work too well.

As Dr. Richard Galligan, Neuroscience Program Director and Professor of Pharmacology and Toxicology at Michigan State University, explains,

“Opiates are a chemical from the opium poppy. Morphine and codeine are naturally occurring drugs that were discovered centuries ago, but in order for morphine to be effective, you need to use a very large dose in order for it to overwhelm the liver functions for the medicine to pass through. Synthetic opiates – like hydrocodone and oxycodone – were developed with slight modifications of the morphine structure so that they could more easily base through the liver functions. Oxycodone isn’t more addictive than morphine. It’s just that gram for gram, it’s more effective. The addiction liability with both is roughly the same.”

According to a 2009 article published in the American Journal of Public Health by Dr. Art Van Zee, The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,

“One of the most critical issues regarding the use of opioids in the treatment of chronic non – cancer-related pain is the potential of iatrogenic addiction. The lifetime prevalence of addictive disorders has been estimated at 3% to 16% of the general population. However, we lack any large, methodically rigorous prospective study addressing the issue of iatrogenic addiction during long-term opioid use for chronic nonmalignant pain. There are a number of studies, however, that demonstrate that in the treatment of chronic non – cancer-related pain with opioids, there is a high incidence of prescription drug abuse.”

Much like opioids and addiction, the timing of the increase of obesity in America is traditionally linked with the rise of the use of High Fructose Corn Syrup, which became legal in 1976, and replaced sucrose in American soft drinks, starting in 1980. Not surprisingly to some, American obesity began its stark increase in the 1980s. In a 2004 study published in the American Journal of Clinical Nutrition,

“There is a distinct likelihood that the increased consumption of [High Fructose Corn Syrup] in beverages may be linked to the increase in obesity. HFCS was introduced into the food supply just before 1970 and increased rapidly to constitute more than 40% of the sweeteners used by 2000. The increase in HFCS consumption just preceded the rapid increase in the prevalence of obesity that occurred between the National Center for Health Statistics survey in 1976 – 1980 and the next survey in 1988 – 1994.”

Likewise, the rise of opioid addiction has run parallel to the increase of synthetic opioids in the marketplace. OxyContin was introduced on the market in 2001. Since that time, the number of opioid-related deaths has more than quadrupled. Researchers agree, both the propensity towards addictions and obesity lie as much with the consumer as with the ingredients they are consuming, but like corn syrup, is the structure of synthetic opioids as much to blame for their consequences as the large-scale promotions behind them? Though many in the science community argue that corn syrup produces the same effect in humans as sucrose, other researchers don’t agree.

According to a Princeton University Study,

“As a result of the manufacturing process for high-fructose corn syrup, the fructose molecules in the sweetener are free and unbound, ready for absorption and utilization. In contrast, every fructose molecule in sucrose that comes from cane sugar or beet sugar is bound to a corresponding glucose molecule and must go through an extra metabolic step before it can be utilized.”

Much like synthetic opiates, the structure of corn syrup allows it to pass through the liver more freely, allowing the fructose-glucose combination to be more quickly metabolized. According to researcher Shreela Sharma, a registered dietitian and associate professor at the University of Texas School of Public Health in Houston, “In the end, sugar is sugar when it comes to calories, but it’s not the same when your body is metabolizing these different sugars. To me, these small differences ultimately do end up making a big difference.”

In a paper published in the Proceedings of the National Academy of Sciences, Kathleen Page, assistant professor of medicine at the Keck School of Medicine of USC, found that fructose is a weaker suppressor of brain areas which regulate appetite and desire to eat when compared to glucose. According to Page,

“We have found that when compared to glucose, the simple sugar, fructose, is a weaker suppressor of brain areas that help control appetite and the motivation to eat.”

Like corn syrup, synthetic opiates also produce different results in the brain than their natural counterparts. According to Dr. Galligan from Michigan State,

“We have evolved over time to protect our brain from toxic substances. Our cerebral circulation has specialized cells that make it more difficult for substances to enter the brain. For instance, morphine crosses the blood brain barrier very slowly. One of the things that makes heroin different is that it crosses the blood brain barrier very well, because it was modified to do as much. This is also true for oxycodone, which was developed to diffuse more easily across these membranes.”

Another similarity is the gross proliferation of both HFCS and synthetic opiates, and how both have been marketed to the masses. As Dr. Galligan states, “The addiction epidemic is about convenience as much as it is about chemistry.”

In both cases, major agricultural and pharmaceutical industries went all in to market and promote their new and more convenient products. According to a 2010 article in The Atlantic,

“In 2008, the Corn Refiners Association spent at least $13 million and as much as $20 million in a massive public relations campaign about the natural goodness of high fructose corn syrup, including television ads aimed mainly at moms. That’s nine times more than what the Centers for Disease Control and Prevention allocated that year for its entire 5-a-Day fruits and vegetables program.”

As Dr. Van Zee illustrates, the company behind OxyContin Purdue Pharmaceuticals put in an astronomical marketing push at the advent of their new drug,

“The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non – cancer-related pain. Purdue pursued an ‘aggressive’ campaign to promote the use of opioids in general and OxyContin in particular. In 2001 alone, the company spent $200 million in an array of approaches to market and promote OxyContin.”

Though not often discussed, the similarities between High Fructose Corn Syrup, synthetic opiates, and the industries behind them are stark – both are low-cost options to already established products, which produce quicker and more effective results at a higher risk to health and a higher likelihood of addiction. It is not surprising that both were made in labs, created by companies whose primary pursuit was profit. Either the designers were entirely unconcerned about the negative consequences of their product, or they knew all along just how effective they would be.