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Opium

Also known as

Big O, chinese molasses, aunti, aunti emma, black pill, chandu, dopium, dream gun, fi-do-nie, gee, guma, midnight oil, zero, ah-pen-yen, chandoo, chinese tobacco, dover's powder, dream stick, dreams, easing powder, god's medicine, gondola, goric, great tobacco, hop/hops, joy plant, mira, 0, O.P., ope, pen yan, pin gon, pox, skee, toxy, toys, when-shee, ze, buddha, chillum, emerald city, goma, dover's deck, easing powder

Classification

Depressant, analgesic.

Overview

Opium poppy (Papaver somniferum) is the species of plant from which opium and poppy seeds are derived. It is the source for the natural and semisynthetic narcotics, including morphine (and its derivative heroin), thebaine, codeine, papaverine, and noscapine. The seed pod of the opium poppy is the principal source of most naturally occurring opioid receptor agonist opioids. The Poppy straw is the dried mature plant except the seeds, which is also used in the production of many opiates [1].

Opium is the sticky gum that oozes from the capsule of the opium poppy, from which heroin and other opiates are made from. The most powerful active ingredient in opium is morphine, which is a depressant, i.e. it slows down the body's reactions and functions in many different ways. Opium is not as strong as morphine or heroin [2].

The Opium Poppy plant has been used throughout history for both spiritual and medical uses. Opium was commonly used for treating asthma, stomach illnesses, and bad eyesight. Poppy extracts have traditionally been used to relax smooth muscle tone, making them potentially useful in the treatment of diarrhoea and abdominal cramping. Iodized poppy seed oil (Lipiodol) is used in imaging techniques in vascular hepatocellular cancer. When Opium Poppy is pharmaceutically altered, creating medications that can be used for various medical purposes, for example codeine and morphine are sedative analgesics and can relax smooth muscle tone.

Opium Poppy and its derivatives are also used for recreational purposes. Different forms of Opium and Opiates cause an euphoric high that can be extremely addictive. Regular use of opium or other opiates can result in the individuals developing a tolerance to the drug, requiring increased amounts to achieve the desired effects. Extended use of the drug, along with increased doses can result in the individual developing a physical and psychological dependency. When abruptly stopping the use of the drug, the individual may be overwhelmed by uncomfortable withdrawal symptoms, often leading to their return to opium based drugs [3].

What does it look like?

Typically, opium is found as a black or brown block of tar like powder. It is also available in liquid and solid [4].

Why take it?

Sought after effects

  • calm,
  • drowsy,
  • dreamy state of mind [2].
  • initial stimulation,
  • enhanced imagination,
  • euphoria,
  • relaxation,
  • decreased anxiety,
  • sleep [5].

Undesired effects

In normal sized doses -

  • nausea,
  • vomiting,
  • drowsiness,
  • decreased heart-rate,
  • shallow breathing [5].

In large doses -

  • headaches,
  • constipation,
  • nausea [2].

How long do its effects last?

Onset of effects

  • smoking - 15 minutes [6].
  • eating or drinking - 15 - 30 minutes [6].

Duration of effects

  • the duration of the effects of any opium compound varies from 3 - 6 hours [7].
  • the effects can last up to 12 hours [8].
  • 2 - 3 hours depending on how much smoked and your body weight [9].

Pharmacology

Opium contains many naturally-occurring chemicals called alkaloids. Alkaloids often possess pharmacological properties and so are widely used as, or as components of drugs - both medically and recreationally.

Opium contains both narcotic alkaloids (such as morphine and codeine) and non-narcotic alkaloids (such as the antispasmodic drug, papaverine). Morphine is the most abundant component of opium.

On entering the body, opium exerts its strong analgesic (painkilling) effect by binding to and activating specific receptors that are ordinarily the binding sites for endorphins. These receptors (called mu opioid receptors), are present in the CNS, the stomach and intestines.

Repeated opium use can lead to the formation of more mu opioid receptors in the brain which differ to the original ones in that they will only bind with opium and not the body's own endorphins. When opium is not used, these new receptors remain unoccupied, reducing the body's response to endorphins. This can often leave the user feeling worse than they did prior to using opium and may cause physical dependence/ tolerance, resulting in further use in an attempt to return to their original state/ experience the effects of opium as they were when it was first taken [2].

Mode of use

  • can be smoked or injected intravenously,
  • taken in pill form,
  • used in combination with other drugs, such as marijuana and/or methamphetamine [10].

Opium can be smoked, intravenously injected, or taken in pill form [4].

Usually smoked in a pipe, with nothing added, but like heroin it can be heated on tinfoil and the fumes inhaled - so-called 'chasing the dragon'. It can also be eaten or brewed into a tea and drunk [5].

Signs of usage

When a person abuses opium drugs they exhibit several telltale symptoms that can easily be recognised and the physical symptoms include -

  • pinpointed pupils when high and dilated pupils during withdrawal,
  • lethargy or 'nodding off',
  • weight loss due to bad eating habits,
  • sexual dysfunction,
  • hyperactivity followed by fatigue,
  • wearing long shirts or trousers in hot weather to cover track marks,
  • slurred speech,
  • dry mouth and nose,
  • frequent runny nose or teary eyes,
  • repeated scratching or picking at skin,
  • constipation,
  • excessive fatigue,
  • unusual or repeat episodes of nausea, vomiting, sweating, diarrhoea, and chills [11].

The signs and symptoms of Opiate abuse varies according to the variation of the drug the individual is abusing [1]. Often an individual struggling with an opiate addiction will show a wide array of mood, behavioural and physical symptoms which include but are not limited to -

  • mood swings,
  • depression,
  • anxiety,
  • euphoric mood for a few hours,
  • irritability,
  • exhaustion,
  • pain relief,
  • respiratory depression,
  • sedation,
  • muscle spasms,
  • vomiting,
  • insomnia,
  • constipation,
  • itching,
  • nausea,
  • sweating,
  • seizures,
  • coma,
  • death [1].

There are many behavioural changes that can be a sign of opiate addiction as well, these may include but are not limited to -

  • forging prescriptions for opiates,
  • stealing narcotics from friends and family,
  • robbing pharmacies and other medication dispensaries,
  • not fulfilling familial and other responsibilities,
  • decreased performance at job or school,
  • preoccupation with obtaining, using, and recovering from usage of opiates,
  • lying to others to cover the amount of drug taken,
  • withdrawing from once-pleasurable activities,
  • social isolation,
  • restlessness,
  • lethargy [1].

Effects

Overdose

  • brain damage,
  • cold or clammy skin,
  • coma,
  • confusion,
  • death,
  • dilated pupils,
  • drowsiness that won't stop,
  • heart attack,
  • laboured breathing,
  • reduced circulation,
  • reduced heart beat [11].

Many of these symptoms will occur in very mild form just from the use of opium but as symptoms persist and become more severe there becomes a need for medical intervention to ensure the safety of the individual who has possibly overdosed on the drug.

If opium withdrawal symptoms are not treated, the user will become unconscious and their respiratory system could slow down so much that the heart may stop all together. If this happens, the consequences could be very severe and may include coma, permanent brain damage or death.

Many of the symptoms of opium overdose can be treated and even reversed using medical intervention. If you suspect that you or someone you know has overdosed on opium, seek immediate medical help. Recognizing the symptoms of opium overdose early on gives you the best opportunity to get medical treatment before the consequences of the overdose become severe. The sooner the overdose is treated, the better the chances are that the user will make a full recovery and will not suffer from permanent damage to the body as a result of the overdose on drugs.

Some methods of opium or opiate abuse have fewer risks of causing overdose than others. When opium is smoked, there is a lesser risk of overdose occurring than if the drug is derived into a more potent drug such as heroin or morphine and injected. Because any drug that is injected has instant effects on the body and because it can be difficult to know the potency of street drugs, it’s easier to overdose on injected drugs such as heroin or morphine [11].

Risks

Short-term

  • tolerance [5].

Long-term

  • dependence,
  • lack of physical care,
  • constipation [5].

Dangerous interactions

Dangerous

  • Ketamine - Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.
  • MXE - This combination can potentiate the effects of the opioid
  • DXM - CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.
  • Cocaine - Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.
  • Alcohol - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely
  • GHB/GBL - The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position
  • Tramadol - Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present
  • Benzodiazepines - Central nervous system and/or respiratory - depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely [12].

Caution

  • PCP - PCP can reduce opioid tolerance, increasing the risk of overdose
  • N2O - Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.
  • Amphetamines - Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.
  • MAOIs - Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases [12].

Withdrawal

Withdrawal symptoms of Opium are worse than heroin and last longer. Just hours after the last dose of Opium and the individual will begin to experience symptoms of withdrawal. These symptoms will peak around 4 to 5 days and last weeks, for some even months [3].

The symptoms of opium withdrawal include -

  • nausea,
  • sweating,
  • cramps,
  • vomiting,
  • diarrhoea,
  • insomnia,
  • loss of appetite,
  • agitation,
  • irritability,
  • mood swings,
  • depression,
  • anxiety,
  • muscle soreness,
  • aching bones,
  • fever,
  • runny nose,
  • twitching muscles [11].

These symptoms can be mild and may not require any medical intervention or they may become very severe and difficult to cope with. When opium withdrawal symptoms are severe, doctors or treatment professionals can prescribe medications to reduce or eliminate some of the symptoms and make for an easier detox for the individual. In some cases, opium withdrawal will lead to a need for long-term medication replacement therapy [11].

Drug testing

Trying to determine exactly how long opium is detectable in the body depends on many variables, including which kind drug test is being used. Opium - also known as Laudanum, Paregoric - can be detected for a shorter time with some tests, but can be "visible" for up to three months in other tests.

The timetable for detecting opium in the system is also dependent upon each individual's metabolism, body mass, age, hydration level, physical activity, health conditions and other factors, making it almost impossible to determine an exact time opium will show up on a drug test [13].

The following is an estimated range of times, or detection windows, during which opium can be detected by various testing methods -

How long does opium stay in the urine?

Opium can be detected in the urine for 2 - 4 days [13].

How long can opium be detected in blood?

A blood test can identify Opium for up to 6 hours [13].

How long can a saliva test detect opium?

A saliva test can detect Opium for up to 1 - 4 days [13].

How long can a hair test detect opium?

Opium, like like many other drugs, can be detected with a hair follicle drug test for up to 90 days [13].

Legality

  • Class A
  • Schedule 1 (when raw)

Possible offences

  • Possession
    • Maximum sentence - 7 years imprisonment, a fine, or both,
  • Possession With Intent To Supply,
    • Maximum sentence - life imprisonment, a fine, or both,
  • Supply (including being concerned in supply, conspiracy to supply, aggravated supply and offer to supply),
    • Maximum sentence - life imprisonment, a fine, or both,
  • Production,
    • Maximum sentence - life imprisonment, a fine, or both [2].

Harm reduction

Opium is a highly addictive substance and, whilst not as powerful as heroin or morphine, it is still possible to overdose on it in its natural form [2].

  • know your limits; only take as much as you are sure your body can tolerate,
  • avoid mixing opium with other substances; in particular alcohol, as this can cause dangerous interactions, but so can other substances, including prescribed medications,
  • make sure you're in a safe place with people you trust, or at the very least someone knows where you are and can get help if necessary,
  • if you're smoking opium, make sure that all your equipment (e.g. the bong/vaporiser you use and anything you use for measuring or dividing) is thoroughly clean,
  • try to make sure the opium you use is as pure as possible; bad reactions to impurities and cutting agents are amongst the main causes of hospitalisation,
  • if you or someone you know does get opium poisoning, seek medical help immediately. Stomach pumping may be necessary, although measures such as coffee enemas or potassium permanganate in water are reported to be beneficial [2].

Paraphernalia

Opium pipe, tinfoil, matches or lighter [5].

Detox

Medication replacement therapy such as Methadone or Suboxone can be used to treat opium withdrawal. These drugs work by producing similar effects of the opium so that the body actually thinks that it is getting the opium and therefore has fewer negative reactions during the detoxification process. Unfortunately, these medications also have a risk of causing addiction and this can lead to a further need for treatment. Talk with your doctor or a treatment professional about the various medication replacement options available to you if your opium withdrawal is severe.

Other than medication, some alternative therapies can also provide effective relief for many of the symptoms of opium withdrawal. Acupuncture and massage therapy can help to reduce nausea, promote relaxation and even reduce sore muscles. Herbal remedies may also work to promote relaxation, reduce nausea and vomiting and promote better sleep during opium detox.

The best treatment for opium withdrawal is time. Over the course of about two weeks, opium withdrawal will peak and then begin to subside. The symptoms of the withdrawal will usually peak around the 5th day following discontinued use of the drug and by the 10th day, most symptoms should be gone and those that do persist will be mild. It's light at the end of the tunnel and you can rest assured that any symptoms of withdrawal that you are having trouble coping with will be gone in a week or so [11].

Most opiate addictions are severe and require the patient to undergo a strict inpatient treatment program that takes them away from temptation and puts them into an environment that promotes and supports their sobriety. While each treatment centres protocol for opiate addiction will be different, the majority offer individualised care which helps to increase the odds of the individual successfully overcoming their addiction [1]. Common treatment services offered include, but are not limited to -

  • medical detoxification,
  • individual counselling,
  • group counselling,
  • behavioural modification therapy,
  • family counselling,
  • educational lectures,
  • 12-step based treatment [1].

History

Opium poppy cultivation is known to have occurred in the 'cradle of civilisation' of lower Mesopotamia by the Sumerians at least as far back as 5,000 years ago. The Egyptians become keen cultivators of the poppy, and traded it throughout the Mediterranean. In the 4th century BCE, Alexander the Great became enamoured with opium, and introduced it throughout his vast Empire, from Eastern Europe to India. It was used medicinally in China and as a household remedy for a range of maladies in India over a thousand years ago.

During the Inquisition of the 14th century, opium was linked to the 'work of the devil' and was subsequently almost entirely purged from most of Europe. It was not 'rediscovered' until the mid-16th century, when the German-Swiss Renaissance physician Paracelsus wrote on the medicinal qualities of 'laudanum' or the 'stones of immortality'; these were essentially opium thebaicum, citrus juice and quintessence of gold, used as general purpose painkillers.

By the 18th century, Britain controlled most of the world's opium trade, mainly through the British East India Company, shipping it from India to China, where a national crisis began to emerge as large swathes of the population became addicted. This culminated in the Opium Wars (sometimes called the Anglo-Chinese Wars) of 1839 - 1860, when the Chinese government attempted to stem the flow of opium into the country, a major source of revenue for Britain.

The 19th century Romantic Movement in Britain saw a rise in the popularity of opium, its reputation enhanced by the writings of influential figures such as Byron, Shelley, Coleridge, and Dickens, and particularly Thomas de Quincey (Confessions of an English Opium-Eater) [2].

The earliest reference to use of opium is amongst Sumerian people in the Middle East 6,000 years ago. It was used as a medicine and recreational drug amongst the Ancient Greeks and by the 7th or 8th century AD commonly used in Chinese medicine.

Use in China became widespread and caused great concern to the Emperor and authorities. Most Chinese opium was imported into China from India by the East India Company. In other words a British company was the main supplier to China using opium grown in conquered lands in India and the British government benefited greatly from the tax revenue. The Chinese introduced harsh laws to try and stop their people using opium. When this did not work in 1839 the Chinese authorities in Canton seized opium from British ships and flushed it into the sea. The British sent in troops and the Chinese authorities backed down.

In 1856 a similar incident led to a second 'Opium War' with the British navy shelling Canton and opening up other ports. The opium trade increased again so that up to 15 million Chinese became regular opium smokers. The Chinese authorities made opium use legal and began to grow their own poppies. Within a few decades Chinese opium production outstripped the Indian grown supplies and British sales and influence declined. In time China became a main supply for opium use in Europe.

Opium was used in the UK (and the rest of Europe) in medicines from the 1550's and by the 17th century drugs like laudanum - a mixture of opium and alcohol - were used for all sorts of ailments including to kill pain, aid sleep, for coughs, diarrhoea, period pains and for toothache and colic in babies. This trend continued well into the 19th century with the availability of many opium-based medicines bought from grocery stores and use of opium by many famous writers and poets. Concerns about the rising number of infant deaths through opium overdose resulted in the first controls on sales of opium in 1868.

Morphine was first synthesised from opium in 1805 by a German chemist and was advertised as a new wonder medicine that was non-addictive and could even be used for the treatment of opium dependence. About 1850, the hypodermic syringe came into use and at that time people believed that smoking opium, rather than injecting opiates led to dependence. Thousands of soldiers in the American Civil War came home addicted to morphine given to them to ease the pain of their injuries. In 1874, again in Germany, heroin was first made from morphine - again it was advertised as non-addictive, this time as a substitute for morphine [14].

The history of opium dates back as far as the Neolithic and ancient times when the drug was widely used in anaesthesia as well as for ritualistic purposes. In ancient Egypt, opium was used as a pain reliever and the Indians as well as the Romans both used opium during surgical procedures. Medical texts dating back to the writings and times of Dioscorides, Galen and Avicenna also mention that use of opium as an analgesic to stop pain during medical procedures in those times.

Throughout the American Civil War, opium and various derivatives of opium were used. Morphine, opiods and synthetic opiates are all derived or come directly from the opium poppy even in today's medical use. While the medical world has had great evolutions and has manipulated opium to meet the needs of patients, the most raw form of opium, Morphine, continues to be one of the most widely used analgesic drugs even today.

Opium was used for recreational purposes throughout Chinese history during the 15th century on through the 17th century. It was nearly 300 years before the Chinese realised that smoking opium on a regular basis for recreational use was actually dangerous and could lead to physical dependence. Even once it was realised that daily opium use was dangerous, many Chinese people continued to use the drug regularly despite new warnings.

The Opium Wars were a major part of Chinese history and a direct result of a Chinese emperor attempting to stop the delivery of Opium to China during the 1800's. According to the University of Houston, Victoria, the Opium Wars, which took place in separate times in 1839 and in 1858 did not halt the production or shipping of Opium for long and by the early 1900's one in four Chinese men smoked opium regularly.

In 1909, the International Opium Commission was formed to help regulate the shipping, sale and use of opium due to the dangers that were now widely known pertaining to the regular use of the drug. At this time, opium was first being purified into morphine and heroin which were both highly potent and very powerful analgesic drugs that proved to be very much more dangerous than the raw opium itself. By the 20th century, opium was prohibited from many countries and there was great regulations to help keep opium and opiates such as the many prescription painkillers that use opium as abase out of the hands of the wrong users.

Today's opium production is mostly dominated by Afghanistan and is far less than it was many years ago. Unfortunately, despite the regulations and the procedures in place to keep opium and other opium derivatives out of the wrong hands, millions of people are still physically dependent on opium or similar drugs and need help [11].


References