Combination of buprenorphine and naloxone for Opioid Addiction Treatment
Buprenorphine is effective in drug substitution therapy. Now there are new formulations in combination with naloxone.
Oral drug substitution therapy with buprenorphine is one way to try to remove drug users from dependence. A study published in the journal The Lancet states with drug substitution therapy opiates, buprenorphine, heroin users are able to make the stay “clean” for three times longer compared to people taking placebo. In addition the number of participants who completed the study without relapse four times more on buprenorphine recipients. Read more
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Pronunciation: OH-pi-uhm
Chemical Abstracts Service Registry Number: 8008-60-4
Formal Names: Papaver album, Papaver somniferum, Poppy
Informal Names: Ah-pen-yen, Aunti, Aunti Emma, Big O, Black, Blackjack, Black Pill, Black Stuff, Chandoo, Chandu, Chinese, Chinese Molasses, Chinese Tobacco, Chocolate, Cruz, Dopium, Dover, Dover’s Deck, Dover’s Powder, Dreamer, Dream Gun, Dreams, Dream Stick, Easing Powder, Emma, Fi-Do-Nie, Garden-Poppy, Gee, God’s Medicine, Goma, Gondola, Gong, Goric, Great Tobacco, Gum, Guma, Hard Stuff, Hocus, Hop, Indonesian Bud, Joy, Joy Plant, Mawseed, Midnight Oil, Mira, Mud, O, Oil, OJ, OP, Ope, Pen Yan, Pen Yen, PG, Pin Gon, Pin Yen, Plant, PO, Pox, Skee, Tar, Tongs, Tox, Toxy, Toys, When- Shee, Winshee, Yen Shee Suey, Ze, Zero
Type: Depressant (opiate class).
Federal Schedule Listing: Schedule II (DEA no. 9600)
USA Availability: Prescription
Pregnancy Category: C Read more
Incoming search terms for the article:
opium statistics in america (200),opium statistics (158),PAPAVER SOMNIFERUM ALBUM (60),statistics of opium users (56),papaver album (49),papaver drugs (33),Papaver somniferum var album (27),ben franklin opium (26),statistics on Opium (24),opium users statistics (22),Oxymorphone (Numorphan)
Pronunciation: ox-i-MOR-fohn
Chemical Abstracts Service Registry Number: 76-41-5. (Hydrochloride form 357-07-3)
Formal Names: Numorphan
Type: Depressant (opioid class).
Federal Schedule Listing: Schedule II (DEA no. 9652)
USA Availability: Prescription
Pregnancy Category: C Read more
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oxymorphone antidepressant (3),oxymorphone chemistry (3),oxymorphone classification (2),effects of numorphan on fetus (2),does oxycodone cause birth defects (2),dentist use numorphan for what kind of surgerys (2),pentobarbital schedule (2),oxymorphone sinatra (1),oxymorphone restless leg (1),oxymorphone syrup (1),Peyote (Lophophora williamsii)
Pronunciation: pay-OH-tih (also pronounced peh-YOH-teh)
Chemical Abstracts Service Registry Number: 11006-96-5
Formal Names: Lophophora williamsii
Informal Names: Bad Seed, Big Chief, Black Button, Britton, Buttons, Cactus, Cactus
Head, Challote, Devil’s Root, Dry Whiskey, Dumpling Cactus, Half Moon, Hikori, Hikuli, Hyatari, Mescal, Mescal Beans, Mescal Buttons, Mescalito, Mescy, Nubs, P, Pellote, Peyotl, Seni, Shaman, Tops
Type: Hallucinogen.
Federal Schedule Listing: Schedule I (DEA no. 7415)
USA Availability: Illegal to possess
Pregnancy Category: None
Uses.
Peyote is part of a cactus plant. Native American folk medicine has used peyote cactus root for doctoring scalp afflictions. In folk medicine peyote has also been used against snake bite, influenza, and arthritis. Scientists have determined that peyote contains substances that might fight infections. Some Native Americans are reported to use light doses of peyote as a stimulant to maintain endurance when engaged in relentless activity permitting little nourishment
or water, a practice sounding much like traditional use of coca. Spaniards observed such peyote usage in the Aztec empire.
Peyote’s main active component is the hallucinogen mescaline. Some other varieties of cactus also contain mescaline, although generally in much smaller amounts. Researchers suspect the peyote cactus may additionally contain chemicals similar to those appearing in the brain upon use of alcohol. In addition to causing hallucinations, peyote can change perception of time.
Psychic effects can include feeling more peaceful and connected with life; craziness of the everyday world can recede. People can use the experience to work through their concerns and may be more open to suggestions. Physical senses may seem enhanced, and barriers between them may melt, such as allowing sounds to be seen.
Normally a Schedule I substance is illegal to possess except under special permission to do research with it, but for many years members of the Native American Church were allowed to possess and use peyote (but not the pure drug mescaline) for religious purposes. During the 1990s their legal situation became confused, and the issue was a matter of controversy when this book was written.
The religion of Peyotism (of which the Native American Church is but one variety) is a topic beyond the scope of this book, but drug-induced visions are only one part of the practitioners’ way of life. Observers have noted that Peyotism can be an effective way of dealing with addiction to alcohol and opiates. Traditional peyote use occurs in a group context, a social gathering
of persons sharing and furthering the same beliefs and goals. A solitary user estranged from such a setting is likely to have a far different peyote experience.
For instance, one element of a peyote session can be nervousness and fear, emotions that may have different impacts depending on whether a user is alone or is with a group of reassuring and supportive persons. A researcher with the Indian Health Service of the U.S. Public Health Service estimated that traditional peyote usage produced bad psychological experiences once in
70,000 doses, a safety record that the researcher attributed to the social context of traditional use. Physical damage has not been noted from traditional use.
Drawbacks.
Chills, muscle tension, nausea, and vomiting are typical unwanted peyote effects.
Abuse factors.
A study published in the 1950s concluded that peyote tolerance, dependence, and craving did not occur from traditional usage—a finding supported by other authorities as well. A canine experiment showed that tolerance to the vomiting effect occurred if dogs received daily peyote for a year.
Drug interactions.
Not enough scientific information to report.
Cancer.
Not enough scientific information to report.
Pregnancy.
Peyote has caused birth defects in hamsters. A study comparing peyote users to nonusers from the same Indian group found no increase in chromosome damage among the users.
Additional information.
Peyote is sometimes called “mescal,” which is also the name of an alcoholic beverage. The two substances are different, and the beverage has no connection with peyote. Likewise “mescal beans” are an alternative peyote name and also the name of a nonhallucinogenic food.
Additional scientific information may be found in:
Bergman, R.L. “Navajo Peyote Use: Its Apparent Safety.” American Journal of Psychiatry
128 (1971): 695–99.
Boyer, L.B., R.M. Boyer, and H.W. Basehart. “Shamanism and Peyote Use among the
Apaches of the Mescalero Indian Reservation.” In Hallucinogens and Shamanism,
ed. M.J. Harner, 53–66. New York: Oxford University Press, 1973.
Bruhn, J.G. “Mescaline Use for 5700 Years.” Lancet 359 (2002): 1866.
Ellis, H. “Mescal: A New Artificial Paradise.” The Contemporary Review 71 (1897). Reprinted
in Smithsonian Institution’s Annual Report 1897. Washington, DC: Author,
1898. 537–48.
Huttlinger, K.W., and D. Tanner. “The Peyote Way: Implications for Culture Care Theory.”
Journal of Transcultural Nursing 5, no. 2 (1994): 5–11.
Kapadia, G.J., and M.B.E. Fayez. “Peyote Constituents: Chemistry, Biogenesis, and Biological
Effects.” Journal of Pharmaceutical Sciences 59 (1970): 1699–1727.
La Barre, W. “Peyotl and Mescaline.” Journal of Psychedelic Drugs 11 (1979): 33–39.
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Pentazocine (Fortral, Fortralgesic, Fortralin, Fortwin, Liticon, Pentgin, Sosegon, Sosenyl, Talacen, Talwin, Talwin Nx)
Pronunciation: pen-TAZ-oh-seen
Chemical Abstracts Service Registry Number: 359-83-1. (Hydrochloride form 64024-15-3)
Formal Names: Fortral, Fortralgesic, Fortralin, Fortwin, Liticon, Pentgin, Sosegon, Sosenyl, Talacen, Talwin, Talwin Nx
Informal Names: 4 4s, Teacher, Ts, Yellow Footballs. Combination with methylphenidate:
Crackers, 1s & 1s, Poor Man’s Heroin, Ritz & Ts, Ts & Rits, Ts & Rs, Sets. Combination with tripelennamine: Ts & Blues, Ts & Bs
Type: Depressant.
Federal Schedule Listing: Schedule IV (DEA no. 9709)
USA Availability: Prescription
Pregnancy Category: C
Uses.
Pentazocine became available in the 1960s. Some authorities classify the drug as an opioid; some do not. Rather than having cross-tolerance with opiates and opioids, pentazocine can provoke a withdrawal syndrome from them. Volunteers who receive pentazocine have been uncertain about what sort of drug it is; some say it is a hallucinogen; some think they are receiving
alcohol.
Pentazocine has about the same pain relief strength as codeine. An experiment using oral surgery patients found pentazocine’s pain relief to be the same as aspirin’s. After drug abusers began grinding down Talwin tablets and injecting the powder to get morphine and heroin sensations, the manufacturer introduced Talwin Nx tablets, which include a chemical designed to block those sensations if the substance is injected. Dispute exists about whether the Nx version of Talwin actually prevents effects sought by illicit users.
Research indicates that women surgical patients tend to get better pain relief from pentazocine than male patients. Research also indicates that the drug’s surgical pain control is more effective for older patients and less effective for neurotics and for individuals with outgoing personalities.
The drug has been routinely used to ease cancer pain and has had success in reducing joint pain
caused by various afflictions, including arthritis. After noting that pentazocine does not prolong bleeding times, researchers called it suitable to fight pain from hemophilia, a blood disease that promotes bleeding. The substance has also been given as a treatment for stubborn cases of hiccups.
Investigators have documented that people can briefly experience euphoria after taking the drug. Some users feel more amiable and serene after a dose. Drawbacks. Unwanted pentazocine actions include rapid heartbeat, blood pressure changes (up or down), fainting, sweating, confusion, sleepiness, blurred vision, nausea, vomiting, and constipation. Studies have found that
1% to 10% of persons receiving the drug (especially an injectable pharmaceutical version) have odd psychological reactions such as hallucinations, delusions, or a sense of unreality about the world. The substance can interfere with decision making and physical movement. Research has shown that driving skills decline when a person uses the drug, and users should avoid operating
motor vehicles or other dangerous machinery. Because pentazocine has occasionally been associated with seizures, it should be used cautiously by persons prone to that affliction. The substance should also be used cautiously by people suffering from pancreas malfunction or breathing difficulty. The drug may be particularly hazardous for asthma sufferers who are overly sensitive to aspirin. Pentazocine is associated with skin hardening, which can result in
extensive surgical removal of affected areas, to be replaced with skin grafts.
Case reports tell of the drug provoking not only skin lesions but internal lesions in the digestive tract. Prolonged use of the substance can also cause muscle destruction that cripples a person’s ability to move arms and legs. The compound can dangerously reduce white blood cell levels. Rat experiments indicate the drug may provoke attacks of porphyria, a body chemistry disease
that can make people violent and sensitive to light.
One group of researchers documented that pentazocine increased the heart’s workload by 22% in cardiac disease patients. Another group found that after a heart attack the drug increases blood pressure and the heart’s need for oxygen and concluded that pentazocine is dangerous for heart attack patients.
Not all authorities agree with that conclusion, however; some say that such adverse cardiac effects can be avoided through careful dosage, and other opinion says the drug is preferable to morphine for heart attack patients.
Abuse factors.
Some abusers inject powder from oral pentazocine tablets.
Oral pentazocine tablets contain ingredients not intended for introduction into the bloodstream, and injection can be fatal even though the digestive system can handle the same ingredients without difficulty.
Pentazocine and the antihistamine-anesthetic tripelennamine are a common illicit drug combination called Ts & Blues, sometimes used as a substitute for heroin (“T” standing for Talwin and “Blues” for the antihistamine tablets’ color). The combination can create more euphoria than pentazocine alone produces and reduce the discontent caused by some doses of pentazocine. Users report development of memory trouble. Lung damage is a classic consequence of the combination, promoted by injecting oral formats of the drugs. Users
have been hospitalized with chest pain, anxiety, spasms, sweating, nausea, and lightheadedness. Fainting and seizures are less common problems. Kidney damage has been noted. Other antihistamines can also be dangerous to use with pentazocine.
Pentazocine tolerance and dependence can occur. After daily doses were given to monkeys for six weeks, mild withdrawal symptoms appeared when the animals received nalorphine, a substance that provokes withdrawal signs if someone has been using opioids. That result supports classifying pentazocine as an opioid, but in humans nalorphine does not cause pentazocine withdrawal— a result consistent with pentazocine not being an opioid. Pentazocine
withdrawal is normally likened to a light version of the opiate withdrawal syndrome, although case reports tell of some persons suffering intense physical discomfort for up to two weeks (cramping muscles, painful abdomen and back, nausea, itching, sweating, and general discomposure). Debate exists about whether pentazocine addiction should be treated by substituting other drugs such as methadone or whether treatment should avoid substitution
altogether. Some authorities have wondered if pentazocine addiction occurs in persons who are not polydrug abusers. Some authorities even question whether pentazocine addiction exists, noting cases in which body fluid testing contradicted drug users’ claims to be using the drug (while indicating they were using other substances). German researchers found that addiction reports are at least exaggerated; upon investigation, only 8 of 60 reports turned out to be authentic.
Drug interactions.
Persons who smoke or who live in a polluted air environment may need higher doses of pentazocine than persons who breathe clean air. Morphine and pentazocine boost each other’s pain-relieving action. Alcohol and possibly monoamine oxidase inhibitors (found in some antidepressants) may react badly with pentazocine.
Cancer.
Animal research has not shown pentazocine to cause cancer.
Pregnancy.
Normal production of litters has occurred when pentazocine was given to pregnant rats and rabbits, and no birth defects were apparent.
The drug is absorbed by the fetus if a pregnant woman takes a dose. Examination of one hospital’s records of all pregnant patients who used pentazocine illicitly in a two-year period showed that their infants tended to be premature and undersized, but no malformation was attributed to the drug. Newborns were occasionally dependent. Despite those disadvantages the children seemed to develop normally in their first year of life. When pentazocine was given simply as a pain reliever in childbirth, examination of the infants revealed no difference from children born to women who did not receive a medical dose of the drug during childbirth.
A study found Ts & Blues mothers to have an increased rate of assorted diseases that would not promote healthy fetal development: hepatitis, anemia, gonorrhea, syphilis. Such afflictions indicate a risk-taking lifestyle in which prenatal care is a small concern. A survey of maternity records at one hospital showed that pregnant women who used Ts & Blues tended to produce smaller infants, but no major birth defects were associated with the drug combination.
Another study found behavioral abnormalities in newborns that had fetal exposure to Ts & Blues, although the conduct may simply have been a temporary sign of drug withdrawal. Investigators running a rat experiment, however, noted long-term behavioral differences between a group of rats having fetal exposure to the drug combination and another group that was unexposed.
Additional scientific information may be found in:
Brogden, R.N., T.M. Speight, and G.S. Avery. “Pentazocine: A Review of Its Pharmacological
Properties, Therapeutic Efficacy and Dependence Liability.” Drugs 5
(1973): 6–91.
Debooy, V.D., et al. “Intravenous Pentazocine and Methylphenidate Abuse during
Pregnancy. Maternal Lifestyle and Infant Outcome.” American Journal of Diseases
of Children 147 (1993): 1062–65.
“Pentazocine.” British Medical Journal 2 (1970):409–10.
Saarialho-Kere, U., M.J. Mattila, and T. Seppala. “Parenteral Pentazocine: Effects on
Psychomotor Skills and Respiration, and Interactions with Amitriptyline.” European
Journal of Clinical Pharmacology 35 (1988): 483–89.
Showalter, C.V. “T’s and Blues: Abuse of Pentazocine and Tripelennamine.” Journal of
the American Medical Association 244 (1980): 1224–25.
Zacny, J.P., et al. “Comparing the Subjective, Psychomotor and Physiological Effects of
Intravenous Pentazocine and Morphine in Normal Volunteers.” Journal of Pharmacology
and Experimental Therapeutics 286 (1998): 1197–207.
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Pronunciation: ox-i-KOH-dun
Chemical Abstracts Service Registry Number: 76-42-6 (Hydrochloride form 124-
90-3)
Formal Names: Endocet, Endocodone, Endodan, M-Oxy, Oxycet, Oxycocet, OxyContin, OxyFast, OxyIR, Percocet, Percodan, Percodan-Demi, Percolone, Roxicet, Roxicodone, Roxilox, Roxiprin, Supeudol, Tylox
Informal Names: Oxicotten, Oxy, Oxycotton, Oxy 80s, Percs
Type: Depressant (opiate class).
Federal Schedule Listing: Schedule II (DEA no. 9143)
USA Availability: Prescription
Pregnancy Category: B
Uses.
This drug is considered more addictive than codeine, from which oxycodone is derived. Some authorities say oxycodone comes from thebaine, which is correct also, because thebaine is the parent chemical that yields codeine.
Oxycodone is anywhere from 7 to 12 times stronger than codeine and about 0.3 to 2.2 times the strength of morphine, depending on the way the drugs are used. Body chemistry transforms part of an oxycodone dose into oxymorphone. Patients have found pain relief from oxycodone to be as satisfactory as relief from ketamine and morphine. Oxycodone has been used successfully to reduce pain from dentistry, surgery, cancer, and osteoarthritis (a painful disease of a person’s joints). The drug is also used as a sedative and as a cough suppressant. It is sometimes prescribed for “restless leg syndrome,” an affliction in which persons keep moving their arms and legs around. The drug has also reduced tics associated with Tourette’s syndrome.
Oxycodone can relax people and at times even create euphoria. Some researchers speculate that oxycodone’s euphoric effects may improve patients’ sensation of pain relief, making the substance more effective for that purpose than a drug that lacks euphoric effects. The drug works an antidepressant for some persons.
Blood levels from a given dose of oxycodone tend to be about 25% higher in females than in males. The cause is unknown, but the difference apparently has no impact on medical usage.
Drawbacks.
Unwanted effects include nausea, vomiting, constipation, itching, sweating, sleepiness, reduced sex drive, general weakness, impairment of breathing, and momentary low blood pressure when a person stands up. One study found the drug to impair breathing more than various other opiates do, and in another study, doses of oxycodone had to be stopped lest the volunteers
be harmed by further breathing difficulty. Normally the drug should be avoided if a person suffers from pancreatitis, enlarged prostate, difficulty with urination, or poorly functioning thyroid or adrenal glands. Experimenters have demonstrated that the drug reduces physical and mental abilities needed for driving automobiles.
Abuse factors.
The drug’s potential for abuse is considered the same as morphine’s, and oxycodone is a sought-after product among opiate abusers. A study that reviewed medical records found no evidence of tolerance developing in a medical context. Regardless of whether people use the drug
medically or recreationally, dependence can develop, followed by withdrawal symptoms if dosage stops suddenly. Withdrawal symptoms are described as minor and can be avoided by gradually discontinuing the drug instead of suddenly stopping it or by administering clonidine, a substance normally used to control high blood pressure.
Drug interactions.
People should use oxycodone cautiously if they are also taking antihistamines, various antidepressants, or a monoamine oxidase inhibitor (MAOI, found in some antidepressants and other medicine). Combining those sorts of drugs with oxycodone can produce excessive effects. The same is true of alcohol. Oxycodone also seems to interact with cyclosporine, a substance used to suppress an individual’s immune system (an effect useful in preventing rejection of organs in transplant patients).
Cancer.
Oxycodone’s potential for causing cancer is unknown.
Pregnancy.
Oxycodone is believed to pose a small risk of causing birth defects, but safety for administration during pregnancy has not been determined. An examination of medical records found a slightly higher likelihood of birth defects if pregnant women use oxycodone, but, unlike most drugs associated with malformations, no particular type of birth defect appeared after using oxycodone. That suggests the drug might not be responsible for the observed abnormalities.
Newborns may have dependence on the drug if their mothers have been taking it during pregnancy. Enough of the drug can pass into a woman’s milk to cause dependence in a breast-feeding infant.
Combination products.
Tylox contains sodium metabisulfite, to which asthmatics and other persons may have a serious allergic reaction, and should be used cautiously if the user is sensitive to sulfites.
Additional scientific information may be found in:
Kalso, E., and A. Vainio. “Morphine and Oxycodone Hydrochloride in the Management
of Cancer Pain.” Clinical Pharmacology and Therapeutics 47 (1990): 639–46.
Saarialho-Kere, U., M.J. Mattila, and T. Seppala. “Psychomotor, Respiratory and Neuroendocrinological Effects of a Mu-Opioid Receptor Agonist (Oxycodone) in Healthy Volunteers.” Pharmacology and Toxicology 65 (1989): 252–57.
Schick, B., et al. “Preliminary Analysis of First Trimester Exposure to Oxycodone and
Hydrocodone.” Reproductive Toxicology 10 (1996): 162.Stoll, A.L., and S. Rueter. “Treatment Augmentation with Opiates in Severe and Refractory Major Depression.” American Journal of Psychiatry 156 (1999): 2017.
Walters, A.S., et al. “Successful Treatment of the Idiopathic Restless Legs Syndrome in
a Randomized Double-Blind Trial of Oxycodone versus Placebo.” Sleep 16 (1993): 327–32.
Ytterberg, S.R., M.L. Mahowald, and S.R. Woods. “Codeine and Oxycodone Use in patients with Chronic Rheumatic Disease Pain.” Arthritis and Rheumatism 41 (1998): 1603–12.
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Pronunciation: OH-pi-uhm
Chemical Abstracts Service Registry Number: 8008-60-4
Formal Names: Papaver album, Papaver somniferum, Poppy
Informal Names: Ah-pen-yen, Aunti, Aunti Emma, Big O, Black, Blackjack, Black Pill, Black Stuff, Chandoo, Chandu, Chinese, Chinese Molasses, Chinese Tobacco, Chocolate, Cruz, Dopium, Dover, Dover’s Deck, Dover’s Powder, Dreamer, Dream Gun, Dreams, Dream Stick, Easing Powder, Emma, Fi-Do-Nie, Garden-Poppy, Gee, God’s Medicine, Goma, Gondola, Gong, Goric, Great Tobacco, Gum, Guma, Hard Stuff, Hocus, Hop, Indonesian Bud, Joy, Joy Plant, Mawseed, Midnight Oil, Mira, Mud, O, Oil, OJ, OP, Ope, Pen Yan, Pen Yen, PG, Pin Gon, Pin Yen, Plant, PO, Pox, Skee, Tar, Tongs, Tox, Toxy, Toys, When- Shee, Winshee, Yen Shee Suey, Ze, Zero
Type: Depressant (opiate class).
Federal Schedule Listing: Schedule II (DEA no. 9600)
USA Availability: Prescription
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 seedproducing 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.
Note
1. 64 (February 6, 1915): 477.
