Hektoen International

A Journal of Medical Humanities

Opium and its derivatives

Opium poppy (Papaver somniferum). Photo by Louise Joly (AtelierJoly) on Wikimedia. CC BY-SA 1.0

Humans have taken psychotropic drugs since time immemorial, for pleasure and for pain. Opium was used by the Sumerians during the Neolithic era and mentioned in the Egyptian Papyrus Ebers and in ancient Chinese manuscripts. It was prescribed by the Greek and Roman physicians, by Hippocrates, Dioscorides, Pliny, Celsus, and Galen. The Roman emperor Marcus Aurelius may have been addicted to opium. In the Middle Ages, Arab physicians in Baghdad used it widely, even to treat leprosy. At about AD 1000, Avicenna recommended opium for diarrhea and for diseases of the eye.

Paracelsus, a 16th-century Swiss alchemist, experimented with opium, compounding it in alcohol with crushed pearls, musk, and amber as “laudanum.” Thomas Sydenham in London prescribed a tincture of opium made up with sherry wine and herbs and also called it laudanum in his 1676 Medical Observations Concerning the History and Cure of Acute Diseases. In 1732, Thomas Dover invented a patent medicine known as “Dover’s Powder” and consisting of opium, ipecacuanha, and lactose. James Moore in 1784 was first to use opium for postoperative pain.

Around 1690 Jakob Le Mort in Leiden prepared an elixir for asthma that he called “paregoric.” It consisted of “honey, licorice, flowers of Benjamin, and opium, camphor, oil of aniseed, salt of tartar and spirit of wine,” and was listed as “Elixir Asthmaticum” in the London Pharmacopoeia of 1721. Until quite recently, a simpler camphorated solution of opium or paregoric was standard treatment for diarrhea in adults and children. It contained the equivalent 0.4 mg per ml of anhydrous morphine, compared to 10 mg in laudanum or tincture of opium.

Historically, by the time Carl Linnaeus (1753) had named the opium poppy Papaver somniferum, opium had long been extracted from the sticky stuff of its unripe pods. It could be ingested or smoked. After Alexander Wood’s invention of the hypodermic syringe in1853 it could also be injected subcutaneously or intravenously as a recreational drug. During the 17th and 18th centuries, traders working for the British East India Company established a lucrative opium trade by smuggling it from India into China. This led to the Opium Wars of 1839–1842 and 1856–1860, when the Chinese government attempted to prohibit the opium trade but was defeated by the British, forced to pay an indemnity, and yield sovereignty over Hong Kong.

Opium pod cut to demonstrate fluid extraction. Photo by KGM007 (TeunSpaans) on Wikimedia. 

In the West opium was widely available, often smoked in squalid opium dens such as described by Charles Dickens in The Mystery of Edwin Drood. De Quincy wrote about his experience in The Confessions of an Opium Eater (1821). Opium was widely used during the US Civil War, during which many wounded soldiers were given “God’s Own Medicine,” and their ensuing addiction came to be called “Soldier’s Disease.” Samuel Taylor Coleridge’s poem about Kubla Khan in Xanadu was famously interrupted when he woke up prematurely from an opium dream. Mary Todd Lincoln became addicted to opium, as well as Elisabeth Barrett Browning, Charles Dickens, Florence Nightingale, and many others.

In 1789, the sixteen-year-old Friedrich Serturner, a pharmacy assistant in Paderborn, West Germany, experimented on rats and stray dogs and isolated a sleep-inducing substance from poppy seed juice. During Napoleon Bonaparte’s occupation, he was legally able to open a shop and sell it as a powerful pain killer. Later he described the “crystallizable” properties of his new substance and called it morphium. When obtaining tremendous relief from a severe toothache, he realized it was safe for human consumption, and by carrying out tests on himself and on three young volunteers, he determined that 15 mg of the drug was the optimal dose for pain relief. The name was later changed to morphine.

Opium contains about 12% morphine, the related opiates codeine and thebaine, and the non-analgesic alkaloids papaverine and noscapine. Codeine was isolated in 1832 by Pierre Robiquet, a French chemist and was widely used for cough and pain. In 1874, English chemist C.R. Alder Wright synthesized diacetylmorphine (heroin) by heating morphine over a stove. It languished in the labs until 1898 when Bayer Pharmaceuticals decided to market it as a non-addictive cough suppressant. It became popular but was even more addicting than morphine. In the mid twentieth century the synthetic congeners of morphine pethidine (Demerol) and methadone were widely used, replaced later by several more modern agents.

By the early 20th century, the harmful addictive effects of psychotropic drugs opiates led most countries to gradually control their distribution and use. In the United States, the Harrison Narcotics Tax Act of 1914 restricted the sale of opiates. Today, the growing of opium poppies and the production of opium and its derivatives is illegal in most countries. It remains a major cash crop in places like Afghanistan, and illegal trafficking remains a major global issue. Various synthetic opioids, such as oxycodone and fentanyl, have been developed to replace opium, but unfortunately have also led to epidemics of addiction and misuse.

GEORGE DUNEA, MD, Editor-in-Chief

Summer 2023



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