Pregnancy Category C

Uses. Many opium products are discussed elsewhere in this book, but here we are dealing with the substance from which all those products originate. Opium has long been used to relieve pain, fight coughs, cure diarrhea, and control spasms. Traditionally, opium is dried sap harvested from the seed-producing portion of opium poppy plants. At harvest time fields of poppies can have a strong smell, and children in the fields can be overcome by those airborne chemicals. A modern opium variety is "poppy straw," composed of dry or liquid extracts from the plant. The natural product can be used by itself or can be refined to produce various drugs known as "opiates," valued for their medicinal effects.

Archaeologists have found evidence of opium poppy cultivation dating from 15,000 years ago, but examination of historical records has not proven that ancient peoples understood opium's medicinal benefits; the product may have been used traditionally but without understanding how or even whether it worked. Opium may have been used in Roman Empire religious ceremonies, perhaps exploiting the drug's effects to symbolize a process of death and reincarnation, and even older records imply that ancients may have believed that opium could produce happiness, although evidence of ancient recreational use is nonexistent.

The Opium War from 1840 to 1842 was the first drug war, followed by the second Opium War of 1856 to 1860. These military conflicts were fought against China by England and other European powers in order to force the Chinese government to legalize the opium trade (certainly a goal different from that of the "drug war" familiar to Americans as the twenty-first century began).

Opium and its morphine component were widely used to treat wounded soldiers in the American Civil War, and later historians have routinely said that addiction became so common that it was called "the soldier's disease." Such illness may have existed, but an investigator who diligently examined medical writings from that time found none that attributed postwar addictions to war-related medical use. In that era the opium trade was legal, and someone who analyzed opium import statistics found no evidence that consumption rose due to Civil War addictions; a distinguished authority has noted that people of that era called dysentery "the soldier's disease."

Just before World War I an article in the Journal of the American Medical Association declared, "If the entire materia medica at our disposal were limited to the choice and use of only one drug, I am sure that a great many, if not the majority, of us would choose opium; and I am convinced that if we were to select, say half a dozen of the most important drugs in the Pharmacopeia, we should all place opium in the first rank."1 Although many useful drugs have been discovered since then, opium is still the basis for many standard medications. Because opium is a natural product, its morphine content can vary greatly from batch to batch. Opium commercially processed for medical use is adjusted so that 10% of any given amount of medical opium is composed of morphine.

Although medical opinion about opium has changed little, public opinion has changed a lot. Reasons for that shift go beyond the scope of this book, but in the nineteenth century, use of opium and its derivatives had wide social approval in America. Alcohol was considered more hazardous to health and home. One of the most telling measures of approval came from the life insurance industry in India, which freely granted policies to known opium users, as mortality statistics showed opium having no effect on life span. A life insurance official reported similar experience in China, although older users in China had higher mortality than older nonusers (probably many users took the drug for diseases that nonusers did not have, with the death rate related more to those diseases than to opium). Some of those statistics would change as the twentieth century progressed because drug laws would change the kinds of people who used opium, thereby associating opium with populations having higher mortality for reasons unrelated to opium's drug properties.

Although identified with China, opium has been grown in the United States. In the late eighteenth century Benjamin Franklin used laudanum (typically wine laced with opium) to treat himself for kidney stones. During the nineteenth century Americans used opium mainly as an ingredient in laudanum and paregoric. Paregoric is a liquid including anise, camphor, and opium.

Paregoric was first produced in the eighteenth century as an asthma medicine. The compound is no longer used for that purpose but can reduce lung congestion by helping people to cough up mucus. Paregoric is a standard diarrhea remedy and is used to help infants suffering from drug withdrawal syndromes. In the 1960s the compound had a flurry of popularity among opiate addicts who would process the product in hopes of isolating the opium, then inject the substance they produced. The outcomes were typical of what happens when oral medications are injected, resulting in lung damage and disfiguring injuries to injection sites.

Less familiar modern opium preparations include home remedy mixtures of the substance with caffeine, aspirin, and acetaminophen (Tylenol or other brands). In America opium preparations were once a standard method of quieting noisy infants and children, and that practice is still followed in some parts of the world. One hazard in that custom is the possibility of fatal overdose, as people administering such concoctions do not always understand pediatric dosage.

Drawbacks. Although some opium users have generally unhealthy lifestyles, few ailments have been attributed solely to the drug. Those ailments tend to be in the gastrointestinal tract, such as problems with the small intestine's bile duct. "Cauliflower ear," in which an ear thickens and becomes misshapen, was once associated with opium smoking. The affliction, however, apparently came not from the drug but rather from the habit of lying down for hours in a comatose condition with an ear pressing against a hard surface.

Abuse factors. Recreational use of opium is harder to define than we might think, because even if persons take the drug in a social setting, they can be seeking to reduce mental anxiety or physical pain, which is not the same as using a drug for fun. Some people swallow dry opium or drink tea made with seed or with dried heads of poppy flowers. In the nineteenth century poppy tea was a common medicinal drink, but in the early twenty-first century the habit tends to be limited to opiate addicts. The traditional recreational way to use opium is to inhale its smoke. Heating opium enough to make it smoke can reduce the drug content, and opium is already far weaker than substances refined from it (such as morphine and heroin). One authority estimates that the amount of active drug inhaled by someone who smokes a given weight of opium will typically be 300 to 400 times less than the drug content in the same weight of injected heroin. Moreover, while an entire dose of heroin might be ingested in a few seconds, a pipeful of opium is smoked over a much longer period to slowly savor its effects, further reducing the opium's impact. The English poet Samuel Taylor Coleridge started out using opium for medical purposes, as did Thomas De Quincey, and both men produced classic accounts of hallucinations and creative inspiration occurring under opium's influence. Those accounts and later ones may well be true, but for such results people need to be particularly sensitive to the drug and also be prone to such experiences regardless of pharmaceutical encouragement. Arsenic is sometimes added to opium to increase smokers' interest in sexual activity, a practice generating reports of arsenic poisoning among users.

Drug interactions. Not enough scientific information to report about the natural product, although many studies have examined drug interactions with opiates and opioids.

Cancer. Laboratory tests find that opium smoke may cause cancer, as may opium dross (waste products, such as scrapings from the inside of an opium pipe, which some persons chew or suck). Opium is suspected of causing esophageal and bladder cancer.

Pregnancy. A pregnant woman using paregoric can give birth to an infant having dependence with opium.

Additional information. Seed from opium poppies is a food product commonly used in breads, cakes, and candies. Consumption of amounts found in a normal meal can cause a false opiate positive in drug screens; controversy exists about whether further analysis of results from such testing can show that poppy seed was the cause. Poppy seed oil is a comparatively unfamiliar product, but animal tests indicate it has good potential for human nutrition. In some parts of the world iodized poppy seed oil has been used instead of iodized salt to treat goiter and has been suggested as a means of preventing nervous endemic cretinism caused by iodine deficiency in the diet of pregnant women. Iodized poppy seed oil is taken up by cancerous portions of a liver, giving the substance clinical usefulness if anticancer drugs are blended into it, as the drugs then concentrate exactly where they are needed in the liver. Results from animal research have led investigators to speculate that consuming normal poppy seed oil may help prevent cancer.

Opium lettuce is not related to opium but can produce mild sensations similar to opium. Sedative and pain relief qualities of opium lettuce have been used for centuries. Lung and urinary tract afflictions have been treated with it. Opium lettuce is smoked for recreational purposes, but results have not caused the practice to gain popularity. A case report tells of individuals who received medical care after injecting a preparation made from the plant. It has other names including Acrid Lettuce, Bitter Lettuce, Compass Plant, Great Lettuce, Green Endive, Lactucarium, Lactuca virosa, Poison Lettuce, Prickly Lettuce, Strong-Scented Lettuce, and Wild Lettuce.

Additional scientific information may be found in:

Aurin, M. "Chasing the Dragon: The Cultural Metamorphosis of Opium in the United States, 1825-1935." Medical Anthropology Quarterly 14 (2000): 414-41.

Gharagozlou, H., and M.T. Behin. "Frequency of Psychiatric Symptoms among 150 Opium Addicts in Shiraz, Iran." International Journal of the Addictions 14 (1979): 1145-49.

Goodhand, J. "From Holy War to Opium War? A Case Study of the Opium Economy in North-Eastern Afghanistan." Disasters 24 (2000): 87-102.

Haller, J.S. "Opium Usage in Nineteenth Century Therapeutics." Bulletin of the New York Academy of Medicine 65 (1989): 591-607.

Kalant, H. "Opium Revisited: A Brief Review of Its Nature, Composition, Non-Medical Use and Relative Risks." Addiction 92 (1997): 267-77.

Lerner, A.M., and F.J. Oerther. "Characteristics and Sequelae of Paregoric Abuse." Annals of Internal Medicine 65 (1966): 1019-30.

Quinones, M.A. "Drug Abuse during the Civil War (1861-1865)." International Journal of the Addictions 10 (1975): 1007-20.

Strang, J. "Lessons from an English Opium Eater: Thomas De Quincey Reconsidered." International Journal of the Addictions 25 (1990): 1455-65.


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