As of this writing, America continues to struggle in the grips of what has been dubbed the “opioid epidemic,” a crisis of drug abuse and overdose driven by pharmaceutical company reassurances and increasing prescriptions of painkillers derived from opium. In 2017, the Department of Health and Human Services declared the epidemic a public health emergency. While the opioid epidemic in the United States may be of recent vintage, however, the use (and misuse) of opium is nearly as old as human history.
Evidence of opium cultivation dates back as far as 3,400 BCE, when the seeds of the opium poppy were used as food and, yes, for anesthetic purposes similar to the ones we’re familiar with today. Anti-opium propaganda from the end of the 19th century has given us an impression of opium use that is laced with pictures of smoky opium dens and decadent addicts forever “chasing the dragon,” but the use of opium throughout human history has been medicinal at least as often as it has been recreational.
Indeed, the opium poppy is the source of a wide array of related drugs. Besides heroin and morphine, the latex obtained from the seed capsules of the poppy also contains the core ingredients of a variety of analgesic drugs including codeine, thebaine and the various derivatives thereof, such as oxycodone. There have also been synthetic opioids introduced to the market over the years, including methadone and fentanyl.
In fact, morphine was the first pharmaceutical product to ever be isolated from a natural source, a process that was perfected in the early years of the 19th century. And in all the years since, no more potent pain reliever has ever been discovered—at least, not one that didn’t share morphine’s various drawbacks, including a highly addictive nature.
By the early 1800s, though, opium was already in widespread use—both in medicine and in recreation—throughout the world. Wars had been fought over the substance, which was described as having a price “equal to that of gold” in 15th century China, and writers had been inspired by it. Samuel Taylor Coleridge’s famous poem “Kubla Khan” is widely believed to be a narrative of the experience of using opium, while Thomas De Quincey’s Confessions of an English Opium-Eater, first published in 1822, is one of the earliest and most famous novels of addiction.
Because of its substantial value to both medicine and pleasure, opium was a major source of revenue for those countries which could harvest and export it. Early on, extracting the dried latex from the seed capsules of the opium poppy was done painstakingly and by hand, scoring or scratching the seed pods and letting the latex that leaked out dry before harvesting it by scraping it off. The result was a lot of work for not a lot of product, but opium was so valuable that it was considered worth it.
Indeed, opium has a rich history throughout most of the world, and was frequently mentioned in ancient medical texts. In 1527, Philippus Aureolus Theophrastus Bombastus von Hohenheim, better known as Paracelsus, returned from the East with what would become known as laudanum—a name that simply means “worthy of praise”—a tincture of opium in ethanol, reintroducing opium to Western medicine in a major way.
Laudanum became widespread—and widely used—throughout much of Europe. In the 1600s, Thomas Sydenham, known as the “father of English medicine,” wrote that, “Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium.”
Even as opium was growing in popularity in Western medicine, however, prohibitions against it were taking placing in China due to its addictive nature. Early in the 19th century, massive destruction of opium seized from British traders (or smugglers, depending on who you ask) began what is known as the First Opium War between Britain and China’s Qing dynasty. The war lasted from 1839 until 1842, as China attempted to enforce its ban on opium, which British and American traders brought from India and Turkey. It ended with the signing of the Treaty of Nanking—seen as a victory for the British.
However, the Opium Wars weren’t over. The Second Opium War kicked off between the Qing dynasty and an alliance of Britain and France in little more than a decade. Another decisive victory for the Western powers in a matter of only a few years meant that China signed treaties offering favorable tariffs and trade concessions, including opening specific “treaty ports,” such as Shanghai, in which British subjects had special rights.
Despite this, the same prohibitions that had helped to drive the Opium Wars in China were coming to the West, as well. In the 1890s, Protestant missionaries in China began compiling data about the drug’s harmful effects, forming the Anti-Opium League in China. When William Ewart Gladstone became Prime Minister of the United Kingdom in 1892, he brought with him a powerful opposition to opium and, specifically, to the Opium Wars which Britain had fought just a few years before. Gladstone’s own sister had been an imbiber of the drug, and it is said that her behavior under its influence “threatened to ruin her brother’s political career.”
In a notorious speech before Parliament, Gladstone denounced the First Opium War as “a war more unjust in its origin, a war more calculated in its progress to cover this country with permanent disgrace.” His opposition to the drug was not an outlier—it was a sign of a growing public opinion, as anti-opium advocates like those of the Anti-Opium League in China pushed a narrative of opium’s growing harm.
Even as opium’s moment in the sun was waning, it was being superseded by a variety of purified or synthetic opioids that have been developed over the intervening years. As early as the purification of morphine in 1817, it was seen as an improvement over opium in its natural state. “If soporifics are weak they do not help,” famed Italian priest and anatomist Gabriele Falloppio, who lent his name to the Fallopian tube, wrote in the 16th century, “if they are strong they are exceedingly dangerous.”
While purified and synthetic opioids helped to control dosages, they have still proven to be exceedingly dangerous, as the current opioid crisis illustrates. According to the U.S. Department of Health and Human Services, more than 70,000 Americans died of drug overdoses in 2019, while over 10 million misused prescription opioids during that same time. Yet, for all the push and pull that opium has generated over the years, no drug has yet been found that is “so universal and so efficacious” in relieving suffering, even still. Which is why we continue to prescribe opioids, epidemic or no.