Opium: History’s First Wonder Drug
Most readers of this booklet were children when they first saw the film The Wizard of Oz. You may remember the scene where the Wicked Witch of the West conjured a field of poppies to put Dorothy and her fellow travelers to sleep. As a child, I always found that scene puzzling. Why would poppies put them to sleep?
The relationship between sleep and poppies would not have been a mystery to many people when that film was first released in 1939. Many viewers would readily recall a time when sleeping potions and painkillers derived from poppies were unregulated and available without prescription at drugstores. In fact, in the United States the notion of regulating medications is only about 100 years old. Government control of medication in general is tied to the history of our use of opium-derived drugs in this country.
Opium is the dried sap obtained from the opium poppy. It has been used as a medication for thousands of years. It is literally a stone-age medication whose use continues to thrive in the modern era.
Opium poppies were cultivated in the Mediterranean as early as 5000 BCE. The Ebers Papyrus is an Egyptian medical text written on papyrus fiber 3,500 years ago. It correctly describes the role of the heart as the center of the blood supply, the function of the kidneys, and even disorders such as depression and dementia. Importantly, it also describes medical uses of the poppy plant, including using the drug to treat breast abscesses and to calm babies. Poppies were widely cultivated during the times of Akhenaton and Tutankhamon, and were used to help people sleep, to calm anxious feelings, and to relieve pain. For all we know, King Tut may have used opium at some point.
The ancient applications of opium were still in use in the twentieth century. Laudanum, an alcohol and powdered opium preparation, was unregulated and used in home remedies, including sleeping potions, until the passage of the Pure Food and Drug Act of 1906. Until early in the last century, nurses actually spoon-fed laudanum to infants to quiet them down. It is astonishing to think that nurses in ancient Egypt were following the same practice!
There are several types of poppy plant, but one in particular, Papaver somniferum, is the source of opium. Until relatively recently, the extraction process had been unchanged for centuries. The process was labor intensive. The unripe seedpods, which contain a milky fluid or latex, were harvested and dried in the sun. After the pods were gathered, shallow cuts were made in them. The latex within leaked out and dried. The next day, workers returned to scrape off the dried latex. The extract could be used in liquid, solid, or powder form. This basic process is still in use today, though we now use less labor-intensive methods.
Another extraction method—developed in the 1930s—is called the industrial poppy straw process. In this mechanized process, the poppy straw, which includes the seedpod and stems, is harvested after the plant has matured and dried. Ripe poppy seeds are removed, and the remainder is called poppy straw. The straw is pulverized, and then chemicals are used to extract morphine (the most abundant opiate found in poppies) from it. Today, this industrial process is the source of 90 percent of the world’s supply of legal morphine.1
The United Nations Office on Drugs and Crime reports on illegal poppy harvests. According to its World Drug Report 2012, estimated opium production rose from 4,700 tons in 2010 to 7,000 tons in 2011. Afghanistan produced 5,800 tons in 2011, more than 80 percent of the world’s total.2 Other leading producers include the Lao People’s Democratic Republic and Myanmar. Roughly half of the 7,000 tons was trafficked as raw opium, and half was converted into heroin.
The First Medications
Though opium has been used as a treatment for millennia, it was in more modern times that we began to refine and extract other drugs from it. And it has only been in the last half-century or so that we have learned to create synthetic chemicals in the lab using our new understanding of the chemistry of opium.
Europeans introduced opium to North America, and colonists often used laudanum (as noted, an opium extract in alcohol) for a variety of purposes. The plant was grown and harvested for local use, but it was understood by the early 1800s that habitual use of opium caused tremors, “stupidity,” and other problems. Nevertheless, it was used for asthma, treatment of cholera, pain, and other purposes. It was also used recreationally to induce a high or stupor.
Morphine was the first drug refined from opium. It was discovered in 1803 by Friedrich Sertürner, a twenty-year-old pharmacist’s assistant who was exploring the properties of opium. His experiments over time showed that when the morphine component was removed from opium, the opium had no effect—in other words, morphine was a key to opium’s medicinal properties. He named the drug after Morpheus, the Greek god of dreams, and presented his findings to the scientific community. His work had two impacts: it launched the study of alkaloid chemistry (the study of naturally occurring chemical compounds), and it marked the beginnings of the modern drug industry.
Other research on morphine showed how it could be used to relieve pain and bring sleep. By the mid-1820s, morphine was being sold in western Europe. The Merck company was one of the manufacturers. Doctors marveled at morphine’s pain-relief capacity and even hoped that it could be used to cure opium addiction. Both morphine and opium (in mixtures called laudanum, paregoric, and a solution called “black drop”) were used throughout the nineteenth century to treat a variety of ailments, including cough, diarrhea, anemia, diabetes, tetanus, and even “insanity.” A textbook in the late 1800s listed fifty-four diseases that morphine could treat.
Morphine was a frequent painkiller during and after the Civil War. Addiction was so common among Civil War veterans that it became known as “soldier’s disease.” However, addiction also occurred among the “hopeless wives and mothers, made so by the slaughter of those who were dearest to them [who found] temporary relief from their sufferings in opium.”3 The use of morphine was facilitated by the development and refinement of the hypodermic syringe, which was a common instrument by 1870. Late in the nineteenth century, morphine was used to treat alcoholics. Compared to alcohol, morphine was viewed as less expensive and generally the lesser of two evils. The practice of converting alcoholics to morphine addicts continued well into the twentieth century.
In 1874, heroin was first synthesized from morphine in an attempt to remove the addictive properties of opium while keeping the other benefits of the drug. (This same goal—the creation of a potent painkiller that is not addictive—continues to motivate drug companies today.) Developers at Bayer Company tested the new drug and found that it worked more quickly than morphine and was about three times as potent. They named the drug Heroin and began marketing it in Europe and the United States, passing out free samples to doctors to encourage its use.
Heroin could be injected or snorted. Because its high was more intense than that of morphine, it became popular for recreational drug users, who preferred it to morphine. (The drug’s addictive properties soon became evident. By the early 1900s, the American Medical Association issued a warning, and by 1913 Bayer stopped production altogether.)
In the United States at that time, drugs were unregulated. Some medical practices were primitive and decidedly unscientific, including such practices as bleeding and blistering, and based more on superstition than scientific method. There were no laws holding advertisers and manufacturers accountable for their claims or quality. Americans could (and did) obtain drugs such as opium and morphine over the counter or through the mail and use them freely for health and recreational purposes, believing the false claims in the ads and on the packages.
In the early twentieth century, a series of newspaper exposés revealed the manufacturers’ deceptive claims. The outrage resulted in the first federal Food and Drug Act, which was signed into law by President Theodore Roosevelt in 1906. Its primary goal was “truth in labeling” to raise standards in the food and drug industries and to protect honest businesspeople from the bad reputations of the dishonest. It included a list of ingredients that had to be included on labels. Among these were alcohol, morphine, cocaine, cannabis (marijuana), and chloral hydrate (a sedative).
The Relationship Between Opium and Drug Regulation
Until the Food and Drug Act, drugs were unregulated for the most part, and the laws that existed were unenforced. The fact is that physicians of the time had very few truly effective medications, and opium and its derivatives aided a number of symptoms. The per capita rate of opiate addiction was actually greater at the end of the nineteenth century than it is today. Physicians of the time knew about opiate addiction, and some specialized in its treatment, but it took an act of government to slow the spread.4
This history of opioids illuminates our culture’s changing attitudes toward drug use, abuse, and addiction. In the nineteenth century, opium in various forms, morphine, and eventually heroin were readily available, affordable, effective, and legal. To be sure, people of the time observed the addictive nature of these substances. They believed that the drugs weakened personal willpower. In this sense, the drugs were thought of as leading to moral degeneration, which included stealing to get more money for more drugs. But the drugs and their use were not illegal, nor were the drugs themselves viewed as a menace. The people addicted to opium and morphine use were seen as weak, not as criminals. A similar stigma exists today, as many view addiction as a personal weakness rather than a serious disease or national health problem—although this is changing rapidly. The criminalization of drug use, however, has added a new layer of social stigma, converting many addicts into criminals. In fact, the increasingly harsh drug laws during the twentieth century created a new criminal class.
Other historical factors entered into the picture around this time. During the nineteenth century, many Chinese came to the United States to work, bringing with them a tradition of smoking opium. Alongside the emergence of immigrant Chinese smoking opium, the use of injectable morphine was on the rise. As noted, the invention of the syringe and the tremendous number of wounded veterans from the Civil War gave rise to a number of new addicts (400,000 by some estimates). Both inhalation (that is, the tradition of smoking opium) and injection (the American tradition of shooting up morphine) yield stronger, more rapid highs. The rapid high is part of the allure of the drugs, and a key to abuse and addiction.
The rapid growth of morphine addicts gave rise to a gradual shift in opinion about addicts. Initially seen as morally weak, ill people needing help, addicts were now often seen as social outcasts deserving harsh punishment.
After the passage of the first drug regulations, more and more drug control laws and regulations were enacted, with increasingly harsh penalties. For example, the Harrison Narcotic Act of 1914 appeared, at face value, to be a means of regulating the marketing of opium, morphine, heroin, and other drugs. But enforcement practices essentially prohibited doctors from dispensing narcotics to addicts. As a result, doctors who knew that their patients (addicts) needed maintenance doses were arrested and imprisoned. Eventually they ceased prescribing opiates to addicts altogether.
In the 1920s, the Supreme Court determined that prescribing for addictions was not a legitimate medical practice. This decision by justices—not doctors—had the result of making addiction itself a federal crime. Addicts went underground. By 1956, the death penalty became an option for anyone older than age eighteen who gave heroin to a minor. The same law mandated minimum prison sentences of ten years for the sale and possession of opiates.
In just fifty years, opiates had moved from being legal and widely available to becoming a highly controlled class of drugs. One could even be put to death for distributing heroin, a drug that had been named and marketed by the company that today sells Bayer Aspirin.
In 1970, the Controlled Substances Act consolidated a number of laws regulating various drugs, including opiates, and included a classification system labeling drugs by their abuse potential, accepted medical use, risk to public health, and other factors. The law also provided funding for treatment of and research into drug abuse, and it ended the harsh mandatory minimum sentences. During the next three decades, however, Congress returned to an ever-more-punitive system of punishments for possession and sales. By the mid-1980s, mandatory minimum sentences were back in place, and the death penalty could be exacted against major drug traffickers.
This history reveals how public biases and fears shift—and how their codification into law can have devastating consequences. It is truly astonishing to consider that many of the people who have been imprisoned for opiate possession over the past half-century or more would not even have been thought of as criminals 150 years ago. Many would have been considered upstanding citizens with a “certain weakness.” Others were war veterans suffering from chronic pain, weary pioneers dependent on nightly doses of laudanum, or Iowa wheat farmers with bad backs. Though addiction was more prevalent in the mid- to late-nineteenth century, it was viewed largely as a health issue. Today, both the criminal and the social penalties are quite severe and, arguably, sadly misaligned with the civil damage caused. Readers who today think of drug users as criminals would do well to remember this history. The designation of drug users and addicts as a criminal class is a modern phenomenon, rather than a rational public health stance.
Public opinion (often a leading indicator of criminal justice practice) is slowly shifting back to treating addiction as a public health concern rather than a criminal issue. Drug courts have been created in all fifty states to combine judicial and social service systems to help nonviolent drug offenders find the treatment and support they need. And new health care laws, such as the Affordable Care Act and others, are making treatment more accessible, providing incentives for communities to offer treatment options, and forcing insurers to treat addiction and mental health on par with other medical issues.