Opium 200c

- VERMEULEN Frans,


opium

 Op.
Opium teaches only one thing, which is that aside from physical suffering, there is nothing real.
[André Malraux]
Signs
Papaver somniferum. Opium Poppy. N.O. Papaveraceae.
CLASSIFICATION The opium poppy belongs to the Papaveraceae, a plant family that is mainly native to the north temperate zone. The family consists chiefly of herbaceous annuals or perennials, and some shrubs. There are 23 genera [some taxonomic systems recognize 41 genera], of which Papaver is the largest - containing about 100 species - and Chelidonium and Sanguinaria the smallest - both containing 1 species only. Members of the Poppy family which are employed in homoeopathy include Sanguinaria, Chelidonium, Papaver, Argemone, Eschscholzia, Adlumia, Corydalis, and Fumaria. The latter two are in some taxonomic systems included in the separate family Fumariaceae.
FEATURES All members of the Papaveraceae have stems and leaves that contain a well-developed system of secretory canals which produce yellow, milky or watery latex. The large and often showy flowers are bisexual and possess two free sepals, which fall off before the flowers open. The four petals are rolled or crumpled when in bud. The flowers are short-lived, dropping very quickly when picked. The seeds of various species yield drying oils or oils important in the manufacture of soaps. Many species are cultivated as garden ornamental plants.
GENUS The name Papaver is of uncertain origin. The name opium comes from Gr opion, the diminutive of opos, juice. The genus contains about 100 species of annual, biennial, and perennial herbs with erect stems, pinnately divided leaves and regular, short-lived flowers that bear two sepals, four delicate petals, and numerous stamens. Although the flowers are much visited by bees and other insects foraging for pollen, they do not in fact contain any honey. The fruit is a many-seeded capsule - Linnaeus counted 32,000 seeds in a single capsule of P. somniferum - that releases its seeds through a ring of pores in a pepper-pot action. Most species are native to temperate and subtropical regions in Asia, North Africa and Europe, with several in North America, one in South Africa and one in Australia. Of all the Papaver species, only P. somniferum, P. setigetum, and P. bracteatum produce opium.
OPIUM POPPY Although the origins of the opium poppy are uncertain, the general assumption is that it is a native of Asia Minor. An annual species, the plant grows to 80 cm high, with white to purple flowers and urn-shaped seedpods. As in all poppies, the buds are pendulous until they are ready to open, the stems bending over near the apex. As the buds open, the stem straightens and becomes erect. Initially the size of a large pea, the pods grow rapidly to become the size of a small hen's egg. The bluish-green pods have a slightly waxy appearance, producing thousands of 'moonseeds' and opening in dry weather. The plant has a growth cycle of approximately 120 days. It thrives best in recently dug or plowed ground. [The first plants to appear spontaneously on recently disturbed soils are usually chamomile and poppy!] Excessive rain is likely to reduce the opium-producing capabilities and direct sunlight, at least twelve hours daily, is esp. important for growth. Short days inhibit alkaloid formation. Burma is the largest producer of opium, followed by Afghanistan, Colombia, Pakistan, and Mexico. Since the plant cannot prosper in tropical climates, it is grown at cooler mountainous regions in excess of 1,000 metres above sea level. It prefers cool nights and warm days and will stand slight frost.
HISTORY Seldom has a single plant affected so many or resulted in such hostility. The opium poppy was cultivated in the ancient civilisations of Persia and Mesopotamia. Controversial archaeological evidence suggests that its use may date back to thirty thousands years ago. The first known written reference to the plant appears in a Sumerian text dated around 4,000 BC, which describes it as the 'plant of joy' and mentions that it brings sleep and an end to pain. In Egypt opium preparations were called 'thebacium' after the highly potent poppies grown near the capital city of Thebes. Pharaohs are entombed with opium artefacts by their sides. The ancient Greeks and Romans used opium as a sedative and soporific. Homer conveys its effects in the Odyssey, relating how Helen helped the depressed Telemachus by slipping in his wine a drug "that had the power of robbing grief and anger of their sting and banishing all painful memories. No one who swallowed this dissolved in their wine could shed a single tear that day, even for the death of his mother or father, or if they put his brother or his own son to the sword and he were there to see it done." Representations of the Greek and Roman gods of sleep, Hypnos and Somnos, both show them wearing or carrying poppies. The twin brothers Hypnos and Thanatos [Sleep and Death] were depicted as crowned with poppies, demonstrating the Greek awareness that sleep induced by opium could lead to death. "How wonderful is Death, Death and his brother Sleep!" wrote Shelley. After the decline of the Roman Empire, the use of the plant spreads through the Islamic Empire and reaches India and Southeast Asia. It is thought that opium was unknown in eastern Asia in ancient times, being first introduced to China by Arab traders in the 5th century AD. By the 7th century, the Turkish and Islamic cultures have discovered that more powerful effects could be obtained by smoking the poppy's congealed juices. In early 14th-century Europe opium use declines, or even disappears, under the strong influence of the Holy Inquisition, for anything from the East was linked to the Devil. Persians and Indians begin eating and drinking opium mixtures for recreational use in the 1600s. Portuguese merchants direct the trade flow of Indian opium into China. In 1606 Elizabeth I sends ships to India to purchase opium and transport it back to England. Circa 1700 the smoking of madak [a mixture of opium and tobacco] in pipes is introduced in China by the Dutch from Java. [Today this is a special pipe that facilitates vaporisation of the tarry goo without burning it.] The smoking of opium becomes a widespread practice, but in 1729 the sale of opium, except under license for medicinal use, and the operation of smoking houses are prohibited by emperor Yung Chen. The emperor could not turn the tables, for large quantities were still being smuggled into the country. Seventy years later, emperor Kia King bans opium completely, making trade and poppy cultivation illegal. By 1800, the British East India Company has a virtual monopoly on opium, controlling supply and setting prices. When, in 1839, a Chinese petition for help [in eradicating opium use] is ignored by Queen Victoria, the Chinese emperor confiscates 20,000 barrels of opium. The British retaliate by attacking the port-city of Canton, launching the First Opium War. After three years of war, the defeated Chinese are forced to pay a large settlement, cede Hong Kong to Britain, and open five new ports for the opium trade to continue. The Second Opium War, in 1858, ends again with a Chinese defeat, resulting in the formal legislation of opium importation to China. In 1878, Britain passes the Opium Act, restricting the selling of opium to registered Chinese opium smokers and Indian opium eaters. In 1910 the Chinese are finally successful in convincing the British to dismantle the India-China opium trade. In the following years the opium epidemic subsides. By then a new epidemic is full-blown: heroin. 1-3
CONSTITUENTS Crude opium is derived from the maturing seed pods induced to yield their sap by incising the capsules. This is done around sunset, the resultant coagulated drops of exudation being scraped off next day, dried and then kneaded into brownish balls. Opium contains sugars, proteins, fats, water, meconic acid, plant wax, latex, gums, ammonia, various acids, and numerous alkaloids, most notably morphine [10-15%], codeine [1-3%], noscapine [4-8%], papaverine [1-3%], and thebaine [1-2%]. Opium alkaloids are of two types, depending on chemical structure and action. Morphine, codeine, and thebaine, which represent the morphian type, act upon the nervous system. Papaverine, noscapine [formerly called narcotine], narceine, nor-laudanosine, and reticuline act to relax smooth muscle. The alkaloids are present in the drug in part as salts of various acids [meconic acid, lactic acid, fumaric acid, sulphuric acid]. First synthesized in 1898 from morphine, heroin was thought to be a safe means of curtailing or curing morphine addiction. Several of the alkaloids present in opium have opposing effects, and the combined effect is distinct from the effect of, for instance, morphine alone. The presence in opium of thebaine, a strychnine-like convulsant stimulating smooth muscle, helps to counteract one of the most dangerous actions of morphine, respiratory depression. Thebaine is a precursor to the chemical synthesis of codeine.
MEDICINE Hippocrates acknowledged the usefulness of the opium poppy as a narcotic and styptic in treating internal diseases, women's diseases, and epidemics. Physicians commonly believed that the opium poppy was of divine origin, which gave rise to such names as sacred anchor of life, milk of paradise, hand of god, and destroyer of grief. After the ban on opium use by the Holy Inquisition, which lasted for nearly two hundred years, opium was reintroduced by Paracelsus [1490-1541] who created a concoction by extracting opium into brandy. He claimed to "possess a secret remedy which I call laudanum and which is superior to all other heroic remedies." The preparation soon became popular in medieval Europe. The English physician Thomas Sydenham [1624-1689] later standardised laudanum in the now classical formulation known as Laudanum liquidum Sydenhami: 2 ounces of opium, 1 ounce of saffron, a dram of cinnamon and cloves, all dissolved in a pint of Canary wine. Paregoric was laudanum mixed with camphor, benzoic acid, and oil of anise, a soothing medicine commonly given to children. By the 19th century, vials of laudanum and raw opium were so freely available that people used it as people today use alcohol or nicotine. It produced thousands of opium addicts in Europe and North America, many of whom were prominent and wealthy. Therapeutically, opium was prescribed in numerous preparations not only as an analgesic and narcotic, but also as a diaphoretic, as a remedy against diarrhoea, vomiting, and cough, and in the treatment of various nervous and mental disorders. An American medical textbook [1868] extolled the virtues of opium thus: "[Opioids] cause a feeling of delicious ease and comfort, with an elevation of the whole moral and intellectual nature...There is not the same uncontrollable excitement as from alcohol, but an exaltation of our better mental qualities, a warmer glow of benevolence, a disposition to do great things, but nobly and beneficently, a higher devotional spirit, and withal a stronger self-reliance, and consciousness of power. Nor is this consciousness altogether mistaken. For the intellectual and imaginative faculties are raised to the highest point compatible with individual capacity...Opium seems to make the individual, for a time, a better and greater man...."
19th CENTURY "[In 19th-century America] there were countless patent medicines on the market containing opium or morphine. They were sold under such names as Ayer's Cherry Pectoral, Mrs. Winslow's Soothing Syrup, Darby's Carminative, Godfrey's Cordial, McMunn's Elixir of Opium, Dover's Powder, and so on. Some were teething syrups for young children, some were soothing syrups, some were recommended for diarrhoea and dysentery or for women's trouble. They were widely advertised in newspapers and magazines and on billboards as painkillers, cough mixtures, women's friends, consumption cures, and so on. One wholesale drug house, it is said, distributed more than 600 proprietary medicines and other products containing opiates. ... A survey of 10,000 prescriptions filled by thirty-five Boston drugstores in 1888 revealed that 1,481 of them contained opiates. Among prescriptions refilled three or more times, 78 percent contained opiates. ... Though called opium eaters in the medical literature, most 19th-century opium users were in fact opium drinkers; they drank laudanum or other opiate liquids. Similarly morphine eaters included many who took morphine by injection or in other ways. Opium smokers, however, were considered to be in a separate category. ... The nineteenth-century use of opiates was more or less the same in Britain. Opium in the form of laudanum was the balm of the Industrial Revolution. It enabled women to work crippling long hours in the mills [Painlessness of complaints usually painful. Indifference to joy and suffering.] whilst simultaneously quieting their babies and children who were by their sides. [Content, forgets all ailments and pain.] "Whether the infant were put out to nurse with professional baby farmers or kept at home while the mother worked, they were frequently doses with opiates to keep them quiet, the most popular of these being 'Godfrey's Cordial'. This was made of laudanum dissolved in treacle. The standard London form of the cordial contained two teaspoonful of laudanum to the quart, but in the provinces it was frequently made much stronger. It was the custom to begin ... within a few days of the birth and to increase the dose until a dose of two teaspoonful three times a day was reached, when the child was put on neat laudanum. The increasing dose was dictated not only by the growth of the child but by the fact that laudanum, a derivative of opium, is highly addictive, so that larger quantities were constantly needed to produce an effect. 'In the majority of cases the children die before they are two. They generally go off as in a consumption, 'in a waste'. They become pale and wan with sharpness of features.'"4. In 1873 an English physician reported: Amongst the three millions and three-quarters [people in London] there are to be found some persons here and there who take [opium] as a luxury, though by far the greater number of those who take it in anything like quantity do so for some old neuralgia or rheumatic malady, and began under medical advice. Neither is it to be found over the agricultural or manufacturing districts, save in the most scattered and casual way. The genuine opium-eating districts are the ague and fen districts of Norfolk and Lincolnshire. There it is not casual, accidental, or rare, but popular, habitual, and common. Anyone who visits such a town as Louth or Wisbeach, and strolls about the streets on a Saturday evening, watching the country people as they do their marketing, may soon satisfy himself that the crowds in the chemists' shops come for opium; and they have a peculiar way of getting it. They go in, lay down their money, and receive the opium pills in exchange without saying a word. For instance, I was at Wisbeach one evening in August 1871; went into a chemist's shop; laid a penny on the counter. The chemist said - "The best?" I nodded. He gave me a pillbox and took up the penny; and so the purchase was completed without my having uttered a syllable. You offer money, and get opium as a matter of course. This may show how familiar the custom is. ... Several characteristics of opiate use under 19th-century conditions of low cost and ready legal availability will strike contemporary readers as strange. Most users of narcotics in those days were women. An 1878 survey of 1,313 opiate users in Michigan, for example, found that 803 of them [61.2 percent] were females. An 1880 Chicago study similarly reported: Among the 235 habitual opium eaters, 169 were found to be females, a proportion of about 3 to 1. An Iowa survey in 1885 showed 63.8 percent females. The use of opiates by prostitutes did not fully account for this excess of women in the user population. Thus the Chicago report noted: Of the 169 females, about one-third belong to that class known as prostitutes. Deducting these, we still have among those taking the different kinds of opiates, 2 females to 1 male. The widespread medical custom of prescribing opiates for menstrual and menopausal discomforts, and the many proprietary opiates advertised for female troubles, no doubt contributed to this excess of female opiate users. A 1914 Tennessee survey, which found that two-thirds of the users were women, noted also that two-thirds of the women were between twenty-five and fifty-five. The first twenty years of this period, the survey report commented, is about the age when the stresses of life begin to make themselves felt with women, and includes the beginning of the menopause period. [19th-century women, on the average, reached menopause somewhat earlier than 20th-century women do.] It appears reasonable, therefore, to ascribe to this part of female life, no small portion of the addiction among women. The extent to which alcohol drinking by women was frowned upon may also have contributed to the excess of women among opiate users. Husbands drank alcohol in the saloon; wives took opium at home. ... A 1881 Catholic World article said: Opium-eating, unlike the use of alcoholic stimulants, is an aristocratic vice and prevails more extensively among the wealthy and educated classes than among those of inferior social position; but no class is exempt from its blighting influence. The merchant, lawyer, and physician are to be found among the host who sacrifice the choicest treasures of life at the shrine of Opium. The slaves of Alcohol may be clothed in rags, but vassals of the monarch who sits enthroned on the poppy are generally found dressed in purple and fine linen. The 1885 Iowa survey similarly noted that the majority of opiate users are to be found among the educated and most honoured and useful members of society."5 US opiate addicts increased from low levels in the 1840s to a historic high of 313,000 by 1896. Average American consumption of opium increased four-fold from 12 grains per person in the 1840s to 52 grains in the 1890s.
PHARMACOLOGY The discovery of opioid receptors in the brain during the 1970s has established that opiate addiction is both physiological and psychological. Morphine, opium, heroin, and other opiates activate the opioid receptors to produce their effects. The first concentration of opioid receptors is formed by a nerve cell system which plays an important role in transmitting pain stimuli. Morphine is effective in pain associated with tissue injury, inflammation or tumour growth, though opiates in general are less useful in neuropathic pain syndromes [such as phantom limb pain, trigeminal neuralgia]. Morphine also reduces the affective component of pain; it causes a powerful sense of contentment and well-being. This is an important component of its analgesic effect, since the agitation and anxiety associated with a painful illness or injury are thereby reduced. [In distressed patients the euphoria produced by morphine is pronounced, but in patients who become accustomed to chronic pain, it causes analgesia with little or no euphoria.] The most striking quality of the analgesic effect of opiates is that it has virtually no effect whatever on the other sensory perceptions, consciousness or the motor functions. All other substances with an analgesic effect, such as laughing gas, alcohol, ether and barbiturates also have, in an effective dose, a definite effect on consciousness, motor coordination, the intellect and emotional control. The drowsiness which can be caused by opiates is experienced only at high dosage. A concentration of opioid receptors are also located in the respiratory centre. Opiates have an inhibiting effect on these cells: both the frequency and the depth of breathing is reduced under the influence of opiates. In the case of an overdose, respiration can come to a complete halt, which is the commonest cause of death in acute opiate poisoning. The third concentration is in the vomiting centre. These cells are stimulated into activity by opiates: opiate use causes nausea and vomiting [e.g. in up to 40% of patients to whom morphine is given]. However, tolerance for this effect is built up very quickly, although some users continue to vomit after each 'shot' for years. This effect is strongest with the opiate apomorphine, which is used medically specifically for this purpose and was at one time used as a conditioned 'aversion therapy' for treating various kinds of unwanted behaviour. The effect of opiates on the digestive system, which also contains large numbers of opioid receptors, has been known about for the longest period of time. Long before opiates were used as painkillers, opium was used for diarrhoea: opiates reduce intestinal motility. [Most heroin addicts are constipated.] Opiates also affect the endocrinal system. By influencing the hypothalamus, body temperature is slightly lowered, although it goes up with chronic use of high doses. Via the hypophysis, opiates lower the amounts of cortisol and testosterone in the blood, although these effects disappear again with chronic use as a result of tolerance. Opiates contract the pupils to pinpoint size. This is an extremely reliable signal of opiate use. Morphine widens the veins in the skin, often giving the face, throat and upper part of the chest a flushed appearance and a warm sensation. This is due to the fact that morphine releases histamine. It is also the reason for the itching, urticaria, and perspiration often seen in opiate users. Systemic effects of histamine release include bronchoconstriction and hypotension. Effects on smooth muscle other than that of the gastrointestinal tract and bronchi are slight, though spasm of the ureters, bladder and uterus sometimes occur. Chronic use of opiates often is associated with skin abscesses, cellulitis, endocarditis, myoglobinuria, arrhythmias, tetanus, and thrombophlebitis. Physical dependence is characterised by a clear-cut abstinence syndrome. Addicts show an abstinence syndrome that somewhat resembles severe influenza, with yawning, pupillary dilatation, fever, sweating, goose pimples, nausea, diarrhoea, and insomnia. In addition, there are extreme restlessness and distress. The symptoms are maximal in about 2 days and largely disappear in 8-10 days, though some residual symptoms persist for several weeks. Psychological dependence usually lasts for months or years. 6,7
OPIOID RECEPTORS "Research first reported in 1989 showed that the brains of clinically depressed or suicidal individuals harbour abnormal levels of the brain chemicals serotonin and norepinephrine. Two teams of researchers, one in Philadelphia and the other in Maryland, published articles in the same issue of the Archives of General Psychiatry showing that flaws in the brain's serotonin levels are linked to violent suicide attempts and aggression. In 1991, additional findings by a US-Israeli research team supported the theory that suicidal behaviour is associated with specific biochemical abnormalities in the brain. The team showed that the brain cells that regulate the perception of pleasure and pain in suicide victims differ markedly from the same cells in people who die of natural causes. The US-Israeli team was the first to look at opioid receptors in the brains of suicide victims. Opioid receptors absorb tiny amounts of an opium-like chemical produced by the brain and play a critical role in pleasure/pain sensations. The research team measured opioid-receptor concentrations in 12 drug-free and disease-free suicide victims presumed to have been depressed before they died. It was discovered that there was a massive 100 to 800 percent increase in the concentration of Mu receptors [an opioid receptor] and a 50 percent decrease in the concentration of Delta receptors [another opioid receptor] compared with the concentrations of those in 12 other individuals who died of other causes. ... A member of the US-Israeli team, Dr Anat Biegon says that, 'We know people suffering from depression have a very high incidence of chronic pain. This may indicate a defect in the opioid system ... the essence of depression is anhedonia - an inability to experience pleasure. And opioid receptors are the primary targets of the brain's reward system'."8
ENDORPHINS Human [and animal] brains produce their own morphine-like substances named endorphins [from endogenous morphins]. These substances are produced in response to stimulation and play a role in the organism's reaction to pain and stress. The system can be activated by drugs, electrical stimulation, stress, pain, and treatments such as acupuncture. Endorphins limit the amount of chemical transmitters released by incoming, sensory, nerve fibres, allowing the organism to take action without being completely distracted by pain or stress. Pain stimuli usually get direct access into consciousness, and can dominate behaviour, but the endorphinic pain relief system provides a way for appropriate action, that is either fight or flight. There are numerous accounts of people during battle, accidents, or sporting events who don't even notice the pain from injuries. During labour endorphins are released to help the mother and foetus withstand the pain and stress. It has been speculated that chronic underproduction of endorphins may lead to a craving for narcotic drugs. Endorphins have proven to be just as addictive as morphine and heroin. "Hunger's Heroin High. According to one theory, patients with anorexia nervosa or bulimia are actually addicted to the release of their own endorphins. Put at its baldest, this amounts to the claim that anorexia is 'perpetuated by an addiction to starvation ... Anorexics are compulsive, often centring their lives on fasting and other anorexic behaviours just as drug addicts centre their lives on getting their next fix. They typically deny they have a problem, or ... report feeling driven by an almost demonic force beyound their control.' What motivates this hypothesis is the well-established fact that fasting induces the release of endogenous opioids. ... The pattern is suggestively like the feast-or-famine, binge-or-bust characteristics of many people with eating disorders or addictions. In fact, in a human study comparing binge eaters with normal controls, the opioid antagonist naloxone significantly reduced total caloric intake from snacks on the part of binge eaters, but not in controls, and the reduction was particularly pronounced for sweet high-fat foods like cookies or chocolates. ... The problem could be that bulimics do not produce adequate amounts of endorphins and are fasting in order to trigger their release: two studies showed that bulimics with normal weight had significantly lower levels of beta-endorphin than non-bulimics of normal weight. In what may be a related phenomenon, several studies have shown that the terminally ill are much more comfortable and die in greater peace if they are not given any more food or water than they ask for, which is often little or nothing. 'Starving', the researchers report, 'seems to ease the death of such patients because dehydration lessens consciousness, promotes sleepiness and diminishes pain' - all typical effects of the endogenous opioids. ... Jogging Junkies - That 'Natural' High. The males in our culture would probably get just as hooked on their endorphins if they had any motivation for a really determined diet, but they are all too busy taking steroids and pumping iron - or jogging. There have been conflicting results from studies attempting to show that endorphins play some role in the dedication of the jogging, iron-pumping, or otherwise aerobic types. Endorphins almost certainly are involved; the problem has been to detect them, since they are produced in small quantities and rapidly metabolised. The best evidence for the origins of the sense of well-being gained by 'sweataholics' after they do their thing was a double-blind, placebo-randomised crossover study in which participants in an aerobic class were given either a placebo or the opioid blocker naloxone before exercising, then evaluated for mood afterwards by several standardized questionnaires. There was indeed a significant tendency for the nonblocked exercisers - those who had taken placebo - to experience a calm, pleasant, relaxed mood while the naloxone-treated subjects were still relatively fretful."9 Endorphins have been held at least partly responsible for the favourable mood - at its extreme the 'runner's high' - which vigorous physical exercise, such as running and jogging, can produce in ordinary people and in mildly depressed or anxious psychiatric patients. Extremes of exercise and endurance may lead to a distinct state of euphoria, as is explained by the famous ultrarunner Yiannis Kouros in an article published by Ultrarunning magazine [March 1990]: "Some may ask why I am running such long distances. There are reasons. During the ultras I come to a point where my body is almost dead. My mind has to take leadership. When it is very hard there is a war going on between the body and the mind. If my body wins, I will have to give up; if my mind wins, I will continue. At that time I feel that I stay outside of my body. It is as if I see my body in front of me; my mind commands and my body follows. This is a very special feeling, which I like very much. It is a very beautiful feeling and the only time I experience my personality separate from my body, as two different things." How remarkably close this comes to a delusion listed for Opium: 'Delusion being double, as if there were another self and he is not sure which will conquer the other.' There are documented cases of withdrawal symptoms such as irritability and minor attention span deficit brought on by a lowering of the body's endorphin levels due to a drop in overall physical activity. Endorphins are even thought to play a role in near-death experiences, producing visual hallucinations, such as bright lights, and a feeling of extreme well-being.
DERIVATIVES After heroin, morphine has the greatest dependence liability of the narcotic analgesics in common use. Morphine is isolated from crude opium. Its main medical use is symptomatic relief of moderately severe to severe pain. Effects include: suppression of the sensation of and the emotional response to pain; euphoria; drowsiness, lethargy, relaxation; difficulty in concentrating; pupillary constriction; blurred vision, impaired night vision; suppression of cough reflex; nausea and vomiting; loss of appetite; constipation; reduced libido. Codeine is found in small concentrations in opium. Most codeine in medical products is synthesized from morphine. Medically used in the treatment of diarrhoea, as a cough suppressant, and to relieve pain. Effects are similar to those of morphine, except sedation and euphoria are less intense. Doses higher than 250 mg may result in intense itching, flushed skin, dizziness, sedation, nausea and vomiting. Hydromorphone is synthetically produced from morphine and one of the most used opioids in the relief of pain for the terminally ill. It has effects similar to morphine, except euphoria is similar to codeine. Nausea and vomiting may occur. Hydromorphone is allegedly less sedative than morphine. 10
INSPIRATION Over the last centuries, but in particular during Victorian times, opium [laudanum] has been popular to lend wings to artistic inspirations. Following the dreamer's way, the 19th century Romantics used laudanum either recreationally or on a full-time basis. Laudanum brought pleasurable, relaxing effects, although these sometimes came at the cost of long, dry spells in their creativity and occasional loss of ambition. Writers and poets who used opium include Byron, Shelley, Coleridge, Dickens, Baudelaire, Gautier, Dumas, Poe, Novalis, Hoffmann, and Thomas de Quincey. Novalis [1772-1801] praises opium in his Hymnen an die Nacht [Hymns to the Night], in which he celebrates night, or death, as an entry into a higher life. The German writer, composer, and painter E.T. A. Hoffmann [1776-1822], known for his Strange Stories, knew and used opium. Samuel Taylor Coleridge [1772-1834] wrote the poem Kubla Khan while under the spell of opium. Coleridge accused De Quincey of taking opium for pleasure, while stating that he himself only took it for medicinal purposes. De Quincey, however, was quite able to control his habit, whereas Coleridge drank about two pints of laudanum a day for most of his life. Edgar Allan Poe [1809-1849] had a weakness for alcohol, opium, and absinthe. The heroes of his tales are often addicted to opium, seek an elusive love in vain, and do everything to destroy themselves. Charles Baudelaire [1821-1867] was a great admirer of Poe's work. Baudelaire incorporated his experiences with opium and cannabis in Les Fleurs du Mal [The Flowers of Evil], a collection of poetry published in 1857. Cannabis and opium are also part of his Les Paradis artificiels, in which he additionally included sections of De Quincey's famous essay on opium. De Quincey [1785-1859] published in 1821 his Confessions of an English Opium-Eater. He states that not he himself, but opium, should be regarded as the true hero of his essay. Theophile Gautier [1811-1872], one of the leading French literary figures at the time and founder of 'Le Club des Haschischins', experimented extensively with cannabis and opium and published his experiences. "Alethea Hayter in Opium and the Romantic Imagination refers to John Keats as a writer who used opium only occasionally. Recently, however, a test was made of a lock of the poet's hair, and the test results indicated chronic use of opioids. George Crabbe, the poet and clergyman, used laudanum regularly without deleterious effect on his poetry, day job, or family life. Elizabeth Barrett Browning took morphine in ether for her nerves, and became addicted. She kicked off when she married Robert Browning, and was drug-free when she birthed their daughter, but probably relapsed after that. Some, like Walter Scott, who used opium as a medicine for digestive problems, were able to quit whenever their physical ailments permitted. Southey, Shelley, and Byron used laudanum whenever they felt they needed it, and were able to put it down when the need passed. Wilkie Collins was a laudanum addict, as was Baudelaire."11 Wilkie Collins [1824-1889] is best known for his two detective novels, The Woman in White and The Moonstone, but, in addition to frequently reprinted horror stories like 'The Dream-Woman' and 'A Terribly Strange Bed', he also wrote The Haunted Hotel [1879].
NOSTALGIA The French poet, actor, film director, and painter Jean Cocteau [1889-1963] wrote Opium: The Diary of a Cure based on his notes when treated, in 1929, for opium addiction. He writes: "I am describing a cure: a wound in slow motion. The drawings which follow are cries of pain in slow motion, and the notes are the stages in passing from a state considered as abnormal to a state considered as normal. ... Opium leads the organism towards death in euphoric mood. The tortures arise from the process of returning to life against one's wish. ... A person undergoing a cure experiences brief periods of sleep, and awakenings which remove the taste for sleep. The organism seems to emerge from hibernation, that strange economy of tortoises, marmots and crocodiles. ... Do not expect me to be a traitor. Of course opium remains unique and the euphoria it induces superior to that of health. I owe it my perfect hours. ... It seems to me that on an earth so old, so wrinkled, so painted, where so many compromises and laughable conventions are rife, opium [if its harmful effects could be eliminated] would soften people's manners and would cause more good than the fever of activity causes harm. ... The reawakening of one's senses [the first clear symptom of recovery] is accompanied by sneezes, yawns, sniffling and tears. ... I am writing these notes between six and seven in the morning. With opium nothing exists before eleven o'clock. ... The effectiveness of opium is the result of a pact. If we fall under its spell, we shall never be able to give it up. Opium cannot bear impatient addicts, bunglers. It moves away, leaving them morphine, heroin, suicide and death. ... One must make an end to the myth of opium - visions. Opium nourishes a state of half-dream. It puts the emotions to sleep, exalts the heart and lightens the spirit. ... All children possess the magic power of being able to change themselves into what they wish. Poets, in whom childhood is prolonged, suffer a great deal when they lose this power. This undoubtedly one of the reasons which drive the poet to use opium. ... Opium enables one to give form to the unformed; it prevents, alas, the communication of this privilege to anyone else. ... The return journey will take place at his [the smoker's] own risk. The smoker first pays his ransom. Opium releases him, but the return is unattractive. However, having returned to this planet, a nostalgia remains."12
THEMES In Eleusinian symbolism, the poppy offered to Demeter symbolized the Earth, but also stood for the power of sleep and forgetfulness which possesses humans after death and before rebirth. The poppy was an attribute of Demeter and identified with her symbolically. A Corinthian myth tells that Demeter presented the poppy to the people of the city of Mekona. Another myth tells that Demeter found comfort with the young Athenian Mecon when mourning the loss of her daughter Persephone. After Mecon's death Demeter changed him into the poppy because of the plant's property to alleviate misery and to relieve pain. A third version has it that Demeter created the poppy for the express purpose of getting some sleep after the loss of her daughter. Goddess of Grain, Nurturer and Mother, Demeter's name comes from Gr meter, mother. The maternal archetype, she represents maternal instinct fulfilled through pregnancy or through providing physical [as Goddess of Grain], psychological [important role as mother of Persephone], or spiritual nourishment [the Eleusinian Mysteries] to others. Reminding of this is a custom in Russia, where to remain an old maid is said to 'remain a poppy.' The presence of milk in poppies without doubt strengthens the symbolic link with the nurturing mother figure. Giving various 'correspondences' for the opium poppy, Pendell regards the plant as related to the 'activity of contemplation', to the 'archetype of the mama's boy or the junkie', with the ibis and the swan as the correlated animals. He says that opium's specific form of ignorance is 'egoism', whilst 'fear of infinity' is its weakness. It should be noted here that opium is more a narcotic than a psychedelic drug, providing sensations of warmth, calmness, drowsiness and a loss of concern for outside events [the consolation of rest and warmth]. Opium makes happy through sedation, but its effects wear off, and inactivity and dullness accompany the happiness it induces. Pendell says that the opium smoker is sought out by "domesticated cats, seekers of a warm body upon which they can walk about, stretch out as they please, and nap: purring and secure."13 The ancient Greeks drank an infusion of chopped-up poppy capsules in water, straight or mixed with wine. This beverage was called mekonium, after mekon, a Greek word for the poppy. Accordingly, an acid present in the opium poppy is named meconic acid, and Meconopsis, a genus of largely Asiatic poppies, received its name because its members resemble [Gr opsis, appearance] the opium poppy [mekon]. Interestingly, meconium is also the term used for both the first faeces of a newborn child and a newly emerged insect imago. Earth is the place on which the transmutations of birth, death and oblivion, and resurrection occur, but the process of [re]emergence nevertheless may be a shocking experience. The homoeopathic drug picture provides plenty of evidence supporting this idea, such as: "Homoeopathic doctors suggest Opium for countering the risk of sudden death to which certain newborns are prone. During pregnancy, the mother had a very frightening experience, and to counteract it, her body fabricated a large quantity of opioids which passed through the placenta and penetrated the child's brain. These babies are born asleep, drowsy; they do not suck with enough strength, fall asleep while nursing, and are slow to recover their birth weight. Umbilical hernias and constipation may be present."14 Overall, one may feel inclined to rename this plant genus into 'Mamaver'. The failure to thrive and listlessness of the newborn will also result when the mother stops functioning. The mythological Demeter stopped functioning when she grieved over the disappearance of her daughter Persephone. Wandering upon the earth in search for Persephone, Demeter refused to eat, sleep, or bathe, and consequently nothing in nature would grow and famine threatened to destroy humankind. Similarly, the destructive aspect of Demeter is expressed when a mother withholds emotional and physical contact from her infant, as well as needed nutrition. During the birth process the consolation of rest and warmth is disturbed, a situation befitting the Opium delusion 'is away from home, must get there'. The reverse is also true: problems in women after their children have left home, leaving them in a state called 'empty nest depression'. An American study of over 500 women who were hospitalized for the first time between the ages of forty and fifty-nine, showed that extremely nurturant, overly involved mothers who lost their maternal role were the most depressed. "Prior to their illnesses, these women were 'super-mother' types with a history of making sacrifices. Quotes from these depressed women revealed their emotional investment in providing for others and the emptiness they felt when their children left. When they lost their maternal roles, life lost its meaning. This reaction is a severe apathetic depression."15 Another element associated with the poppy is that of sacrifice. This is particularly symbolized by the red poppy, Papaver rhoeas, which by Christianity was made an emblem of Christ's sacrifice and 'sleep of death'. In later centuries the plant became associated with those who have died in battle. "The red poppies which followed the ploughing of the field of Waterloo after the Duke of Wellington's victory were said to have sprung from the blood of the troops who fell during the engagement." [Note here the typical tendency of poppies to emerge on freshly dug - that is: disturbed - ground.] In the 20th century the poppy became a symbol of remembrance of those who died in the First World War and subsequent wars. Wearing a poppy to 'keep faith in those who died' resulted in the British Legion organizing its first Poppy Day in 1921. This annual event later became Remembrance Sunday, when artificial poppies are sold for war charity. White poppies have also been worn during the Remembrance Day period. They were used sporadically until 1980, when they were adopted by the Peace Pledge Union. The Union organizes an alternative wreath-laying ceremony at the Cenotaph in Whitehall, London, at which a wreath of white poppies is used. 16
PROVINGS •• [1] Hahnemann - 5 provers; method: unknown.
•• [2] Jörg - 10 provers [9 males, 1 female], 1825; method: repeated and increasing doses of tincture [8 provers] or crude opium [1 prover].
•• [3] Eidherr - 10 provers, c. 1861; method: increasing doses of tincture [7 trials]; increasing doses of 1st dil. [4 trials]; 12th and 30th dils. [gave 'few and unimportant symptoms']; three provers reported no effect from the dilutions from 30th to 6th, 5th or 1st.
[1] Booth, Opium: A History. [2] Erowid Vault; website. [3] Heroin. co. uk; website. [4] David Wardle, English Popular Education 1780-1970; Cambridge University Press 1970. [5] Brecher et al, The Consumers Union Report on Licit and Illicit Drugs, 1972. [6] The Opiates History; Drugtext website. [7] Rang, Dale and Ritter, Pharmacology. [8] Juan, The Odd Brain. [9] Perrine, The Chemistry of Mind-Altering Drugs. [10] Hamilton, Opioid FAQ; alt. drugs website. [11] Pendell, Pharmako/Poeia. [12] Cocteau, Opium: The Diary of a Cure; cited in Schleiffer, Narcotic Plants of the Old World. [13] Pendell, ibid. [14] Grandgeorge, The Spirit of Hom. Medicines. [15] Bolen, Goddesses in Everywoman. [16] Vickery, Dictionary of Plant-lore.
Affinity
MIND. SENSES. NERVES [brain; cerebro-spinal; sympathetic]. Lungs. Respiration. Digestive tract. * Left side. Right side.
Modalities
Worse: EMOTIONS. FEAR. Fright. Joy. ALCOHOL. Sleep. Suppressed discharges. Receding eruptions. If heated. HEAT. Hot bath. During and after sleep. Stimulants. Cold. Uncovering. While perspiring.
Better: Cold. Constant walking. Open air.
Main symptoms
M Ailments from:
Disappointment;
Embarrassment;
Fear, fright, FRIGHT from SIGHT of an ACCIDENT;
Grief;
Mortification, REPROACHES;
SHAME.
[Sense of shame around animal functions such as eating, excreting, sweating, body smells, breast-feeding, etc.]
Mental shock.
• "Strong tendency to be alarmed, TIMOROUS character." [Kent]
The reaction almost invariably is FLIGHT [rather than fight] leading to WITHDRAWAL into an inner world.
[In some parts of the contemporary Middle East, chilled glasses of poppy tea are served to mourners at funerals to ease their grief.]
M Near-death / pregnancy.
• "My experience has shown Opium to be the most important and most frequently indicated remedy for the treatment of harmful influences and their consequences from this period of life [pregnancy]. ... An Opium state is the well known state of coma or of 'having almost died.' Body and soul are almost separated from each other, life is hanging by a thin thread. If such a person comes back into life, everything seems to him as if in a dream. The connection between body and soul remains loose as during sleep. Feelings are numb and dominated by fear. The body feels as if it doesn't belong to him. ... What circumstances and influences have such an impact upon the pregnant woman and her unborn child to be able to produce a functional and later on physical sickness. ... The following gives a provisional synopsis of the important causes of intrauterine and perinatal mortification: Fear and fright: Undesired pregnancy, thoughts or attempts of abortion, miscarriage, death of a newborn, fright of the pregnant mother for something endangering her life [war, accident, catastrophe, rape], complications during birth [clasp of umbilical cord, malposition of foetus, placenta praevia, twins, etc.], premature birth, operations during confinement [caesarean, forceps, vacuum extraction], deformities. Grief and sadness: Death of a close relative, etc. Allopathic medication: Especially narcotics, analgesics, opiates, hormones, antibiotics."1
Themes of marked lack of love, denial [being denied], lack of genuine animal warmth.
M Fear of the fright REMAINS [cannot cut loose].
M WITHDRAWAL into an inner world.
• "Even the loud laugh and the hootings which accompany them home produce no effect; they are wrapped in an elysium, from which they are only to be awakened by the miserable reaction which must, sooner or later, recall them to existence." [Allen]
• According to Galen, the Roman emperor Marcus Aurelius adjusted his daily dose of opium according to whether he wanted to sleep or to feel good about dealing with the day-to-day duties of being an emperor. 2
Delusion he himself was dead; he is a criminal to be executed.
Delusion is about to receive injury.
Attempts to escape.
Delusion he is away from home, and must get there.
Asks for nothing. Doesn't complain.
Compare on physical level: RECEDING eruptions, and spasms from approach of strangers.
M RESTING IN [PLEASANT] NOTHINGNESS.
• "Constant quiet contentment of mind, as if in heaven." [Allen]
UNAFFECTED by external impressions.
Indifference and apathy.
• "She had severe family afflictions, but was not at all distressed by them while under the influence of Opium, though she felt them severely at other times." [Allen]
Painlessness; lack of vital reaction.
• "No one who swallowed this [opium] dissolved in their wine could shed a single tear that day, even for the death of his mother or father, or if they put his brother or his own son to the sword and he were there to see it done."3
• "Morphine alters the whole cycle of expansion and contraction, release and tension. The sexual function is deactivated, peristalsis inhibited, the pupils cease to react in response to light and darkness. The organism neither contracts from pain nor expands to normal sources of pleasure. It adjusts to a morphine cycle. The addict is immune to boredom. He can look at his shoes for hours or simply stay in bed. He needs no sexual outlet, no social contacts, no work, no diversion, no exercise, nothing but morphine. Morphine may relieve pain by imparting to the organism some of the qualities of the plant."4
M Pleasure or pain.
• "In sum, on earth, we must choose between pleasure first and suffering later - the addict's way - or suffering first and pleasure later - the athlete's way, as an example." [Grandgeorge]
• "I was seduced into the accursed habit [of opium eating] ignorantly. I had been bed-ridden for many months with swellings in my knees. In a medical journal I unhappily met with an account of a cure performed in a similar case, by rubbing laudanum, at the same time taking a given dose internally. It acted like a charm - like a miracle. I recovered the use of my limbs, of my appetite, of my spirits; and this continued for near a fortnight. At length the unusual stimulus subsided, the complaint returned, the supposed remedy was recurred to - but I cannot go through the dreary history. Sufficient to say, that effects were produced which acted on me by terror and cowardice of pain and sudden death."5 [my italics]
M JUDGEMENT of situations diminished.
RASH, inconsiderate BOLDNESS.
FEARLESS. Courageous.
Indifferent to pain and pleasure.
M Sadness with thoughts of death, > wine.
G Ailments and SOMNOLENCE.
Great sleepiness after a head injury; after surgery [remains stupefied].
G [Hot] PERSPIRATION.
G All SECRETIONS [stool, urine, menses] DIMINISHED, except that of the skin.
G < HEAT; > COLD.
[Hot head, hot sweat, bed seems too hot, etc.]
G < Exposure to SUN. < Warm bed. G < DURING SLEEP [ailments starting during sleep]. P Vertigo. And Buzzing noise in ears as from a bee. And Stopped sensation in ears and impaired hearing. P Meningitis. • "I was called to a house late one night to attend a teenage boy lying in a stupor. He was in bed, covered up, sweating profusely, with a very dusky face, pupils completely contracted. He screamed at me to mind out, as there were horrible things, animals crawling all over the floor. These had been tormenting him for two days. He had a pounding headache in the base of his brain and on examination a rosy red rash on his buttocks. He had vomited everything for 48 hours. [Diagnosis: meningitis.] Causation: He had been chased and caught by police, strip-searched; drugs were founbd, and he was held in police cells overnight. He was terrified and also embarrassed that his parents would find out. He ran away to friends where the symptoms had started four days later. After Opium 200c the delirium was gone within 15 minutes. The inflammation took two hours to disperse."6 P Face DARK red, swollen, hot, sweaty. Or red and pale alternately. Pupils contracted [pinpoint pupils]. P Paralytic ATONY of bowels and bladder [e.g. after laparotomy]. Reversed peristalsis. P Stool consisting of hard, black balls. [1] Viktor Jenni, Opium: New Aspects with case presentations; HL 4/93. [2] Porter and Teich [eds.], Drugs and Narcotics in History. [3] Homer, Odyssey. [4] Burroughs, The Naked Lunch. [5] Coleridge, 1814, cited in Von Bibra, Plant Intoxicants. [6] Jenni Tree, Opium in Meningitis; personal communication. Rubrics Mind Desires activity during perspiration [3]. Mental agility [3]. Anxiety if the fear or the fright remains [3/1]. Asking for nothing [2]. Audacity [1]. Blissful feeling [2]. Bulimia [1]. Content, forgets all his ailments and pains [1/1]. Has no sense of danger [1]. Contempt of death [2/1]. Delusions, assembled things, swarms, crowds, etc. [1], body is lighter than air [2], sees cats [1], he himself was dead [2], being double [1], being double, there were another self and he is not sure which will conquer the other [1/1], of big eyes [1], ugly faces [3], is in heaven [1], he is on a journey [1], legs [and arms] don't belong to her [1], sees scorpions [1/1], sees skeletons [1; Crot-c.], is under superhuman control [1]. Fear, of extravagance [1/1]1. Indifference to joy and suffering [2]. Irritability, when aroused [1], when disturbed [1]. Inclination to make noise [1]. Making many gigantic plans [1/1]. Sadness, with thoughts of death, > wine [1*]. Says he is well when very sick [3].
Head
Pain, forehead, extending to root and then to tip of nose [1*]. Waving sensation, like a heavy body swaying back and forth in forehead [1/1].
Vision
Hemiopia, vertical [1]. Objects seem large [1]. Objects seem small [1].
Hearing
Acute, for voices and talking [2], her own voice [1; Bell.].
Stomach
Nausea, > vinegar [1*]. Retching from emotions [1/1]. Slow digestion [2]. Sudden vomiting [2].
Abdomen
Paralysis of intestines after laparotomy [2/1].
Rectum
Constipation, stool remains long in rectum with no urging [3], while travelling [2]. Diarrhoea, after fright [2], from sudden joy [3].
Stool
Like black balls [3].
Bladder
Retention of urine, in newborns after passion of the nurse [2/1].
Respiration
Slow, during sleep [3].
Back
Muscles and vessels of nape of neck as if squeezed [1*].
Limbs
Sensation of lightness [2].
Sleep
Sleepiness from grief [2/1]. Sleeplessness after anger [1].
Dreams
Cats [1]. Devils [1]. Dogs [1]. Dragons [1]. Falling from a height [1]. Hummingbirds [1*].
Perspiration
Profuse during sleep [2].
Skin
Itching, perspiring parts [1].
Generals
Convulsions, epileptic, aura: congestion of blood to head [1], aura: vomiting [1; Cupr.]; epileptic, from fright of the mother [infant] [3]; from sight of strange persons [3]. Desire for narcotics [1]. Desire for walking at night [2].
* Repertory additions [Hughes].
1 Put in this way, the symptom 'fear of extravagance' is open for misinterpretation. The symptom comes from Richard Robert Madden [1798-1886] who, during his travels in Turkey in the 1820s, took two grains of opium in a coffeehouse in Constantinople. Feeling nothing of the 'expected reverie' he takes two grains more and shortly after this dose his "spirits became sensibly excited; the pleasure of the sensation seemed to depend on a universal expansion of mind and matter. My faculties appeared enlarged: everything I looked on seemed increased in volume; I had no longer the same pleasure when I closed my eyes which I had when they were open; it appeared to me as if it was only external objects, which were acted on by the imagination, and magnified into images of pleasure: in short, it was, 'the faint exquisite music of a dream' in a waking moment." Deciding to go home 'as fast as possible,' he finds himself faced with the difficult task to do so. "I was hardly sensible of my feet touching the ground, it seemed as if I slid along the street, impelled by some invisible agent." That he then fears "at every step" that he "should commit some extravagance" is to be understood as that he fears to behave in such a foolish way that other people will notice his drugged state. Hence, in true Argentum nitricum-like fashion, the symptom should be 'fear of doing something foolish [or extravagant, or embarrassing]' so that he will attract attention. One may even theorize that Madden felt that he was close to doing something shameful, since he took the drug after having observed the erratic behaviour of half a dozen Theriakis [opium eaters]. Some Theriakis await "outside the door the wished for reveries, which present to their glowing imaginations the form of the celestial houris and the enjoyments of their own paradise in all its voluptuousness." The gestures of the Theriakis inside the coffeehouse "were frightful; those who were completely under the influence of the opium talked incoherently, their features were flushed, their eyes had an unnatural brilliancy, and the general expression of their countenance was horribly wild."
Food
Aversion: [2]: Food; tobacco. [1]: Meat; onions; smoking.
Desire: [3]: Brandy. [2]: Alcohol. [1]: Beer; bread; cold drinks; sweets; wine.
Worse: [3]: Alcohol; brandy; wine. [1]: Artificial food; cold drinks.
Better: [2]: Wine. [1]: Coffee; cold drinks; sugar; vinegar; warm milk.