Opium

This article is about the drug. For opium-derived and opium-like substances, see Opiates and Opioids.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]

Overview

Opium is a narcotic formed from the latex released by lacerating (or "scoring") the immature seed pods of opium poppies (Papaver somniferum). It contains up to 16% morphine, an opiate alkaloid, which is most frequently processed chemically to produce heroin for the illegal drug trade. The resin also includes non-narcotic alkaloids, such as papaverine and noscapine. Meconium historically referred to related, weaker preparations made from other parts of the poppy or different species of poppies. Modern opium production is the culmination of millennia of production, in which the source poppy, methods of extraction and processing, and methods of consumption have become increasingly potent.

Cultivation of opium poppies for food, anesthesia, and ritual purposes dates back to at least the Neolithic Age. The Sumerian, Assyrian, Egyptian, Minoan, Greek, Roman, Persian and Arab Empires each made widespread use of opium, which was the most potent form of pain relief then available, allowing ancient surgeons to perform prolonged surgical procedures. Opium is mentioned in the most important medical texts of the ancient world, including the Ebers Papyrus and the writings of Dioscorides, Galen, and Avicenna. Widespread medical use of unprocessed opium continued through the American Civil War before giving way to morphine and its successors, which could be injected at a precisely controlled dosage. American morphine is still produced primarily from poppies grown and processed in India in the traditional manner, and remains the standard of pain relief for casualties of war.

Recreational use of the drug began in China in the fifteenth century, but was limited by its rarity and expense. Opium trade became more regular by the seventeenth century, when it was mixed with tobacco for smoking, and addiction was first recognized. Opium prohibition in China began in 1729, and was followed by nearly two centuries of exponentially increasing opium use. China had a positive balance sheet in trading with the British, which led to a decrease of the British silver stocks. Therefore, the British tried to make the Chinese people dependent on opium to enhance their balance, they delivered it from Indian provinces under British control. A massive confiscation of opium by the Chinese emperor, who tried to stop the opium deliveries, led to two Opium Wars in 1840 and 1858, in which consequence Britain suppressed China and traded opium all over the country. After 1860 opium use continued to increase with widespread domestic production in China, until more than a quarter of the male population was addicted by 1905. Recreational or addictive opium use in other nations remained rare into the late nineteenth century, recorded by an ambivalent literature that sometimes praised the drug.

Global regulation of opium began with the stigmatization of Chinese immigrants and opium dens, leading rapidly from town ordinances in the 1870s to the formation of the International Opium Commission in 1909. During this period the portrayal of opium in literature became squalid and violent, British opium trade was largely supplanted by domestic Chinese production, purified morphine and heroin became widely available for injection, and patent medicines containing opiates reached a peak of popularity. Opium was prohibited in many countries during the early twentieth century, leading to the modern pattern of opium production as a precursor for illegal recreational drugs or tightly regulated legal prescription drugs. Illicit opium production, now dominated by Afghanistan, has increased steadily in recent years to over 6600 tons yearly, nearly one-fifth the level of production in 1906. Opium for illegal use is generally converted into heroin, which doubles its potency, and taken by intravenous injection, which more than doubles the quantity of drug entering the body.

History

Ancient use (4200 BC - 800 BC)

Poppy crop from the Malwa region of India (probably Papaver somniferum var. album.)

The use of the opium poppy dates from time immemorial. At least seventeen finds of Papaver somniferum from Neolithic settlements have been reported throughout Switzerland, Germany, and Spain, including the placement of large numbers of poppy seed capsules at a burial site (the Cueva de los Murciélagos, or "Bat cave", in Spain), which have been carbon dated to 4200 B.C. Numerous finds of Papaver somniferum or Papaver setigerum from Bronze Age and Iron Age settlements have also been reported. The first known cultivation of opium poppies was in Mesopotamia, approximately 3400 B.C., by Sumerians who called the plant Hul Gil, the "joy plant". Tablets found at Nippur, a Sumerian spiritual center south of Baghdad, described the collection of poppy juice in the morning and its use in production of opium. Cultivation continued in the Middle East by the Assyrians, who also collected poppy juice in the morning after scoring the pods with an iron scoop; they called the juice aratpa-pal, possibly the root of Papaver. Opium production continued under the Babylonians and Egyptians.

Opium was used with poison hemlock to put people quickly and painlessly to death, but it was also used in medicine. The Ebers Papyrus, ca. 1500 B.C., describes a way to "prevent the excessive crying of children" using grains of the poppy-plant strained to a pulp. Spongia somnifera, sponges soaked in opium, were used during surgery. The Egyptians cultivated opium thebaicum in famous poppy fields around 1300 B.C. Opium was traded from Egypt by the Phoenicians and Minoans to destinations around the Mediterranean Sea, including Greece, Carthage, and Europe. By 1100 B.C. opium was cultivated on the Mediterranean island of Cyprus, where surgical quality knives were used to score the poppy pods, and opium was cultivated, traded, and smoked. Opium was also mentioned after the Persian conquest of Assyria and Babylonia in the sixth century B.C.

From the earliest finds opium has appeared to have ritual significance, and anthropologists have speculated that ancient priests may have used the drug as a proof of healing power. In Egypt, the use of opium was generally restricted to priests, magicians, and warriors, its invention credited to Thoth, and it was said to have been given by Isis to Ra as treatment for a headache. A figure of the Minoan "goddess of the narcotics", wearing a crown of three opium poppies, ca. 1300 B.C., was recovered from the Sanctuary of Gazi, Crete, together with a simple smoking apparatus. The Greek gods Hypnos (Sleep), Nyx (Night), and Thanatos (Death) were depicted wreathed in poppies or holding poppies. Poppies also frequently adorned statues of Apollo, Asklepios, Pluto, Demeter, Aphrodite, Kybele and Isis, symbolizing nocturnal oblivion.

Greece and Rome (800 BC-600 AD)

Opium was well known to the ancient Greeks. The first Greek written account of poppy production was by Hesiod in the eighth century B.C., who called the poppy plant μήκωνιον (mekonion), and its juice όπός μήκων (opos mekun). Homer described to his audience an exhausted warrior dropping his heavy helmeted head, like a drooping poppy bud. Hippocrates recognized opium as useful in treating internal diseases, diseases of women and epidemics. Alexander the Great is credited with introducing opium to India and Persia in 330 B.C. The Greeks distinguished opium from a weaker drug, "meconium". This could refer specifically to a different poppy strain e.g. Euphorbia paralias (paralion). Alternatively, "meconium" was used by Hippocrates, Pedanius Dioscorides, Pliny the Elder, and Scribonius Largus to refer to juice emanating from the leaves and fruit of the poppy, or obtained from them by boiling (see Poppy tea), or tablets formed by crushing them in a mortar and pestle. The Greek όπός or όπιον became Roman opium, and later Persian ab-yun, Arabic af-yuun, and Chinese af-yong or yaa-pian. Because variants of "opos" or "opion" are widely used to denote the sap throughout the world, even where the plant itself is known by indigenous names, it was formerly thought that the Greeks first discovered the collection of poppy sap, and that previous use had been limited to consumption of seed capsules.

Curiously, many ancient physicians described many species of poppies, giving only limited preference to Papaver somniferum. Hippocrates mentioned white, fire-red, black, and hypnotic varieties; Theophrastus described black or horned, flowing, and Heraklean varieties. The varieties from Dioscorides' pharmacopoeia have been tentatively assigned to modern species: Papaver hybridum, a "flowing" poppy that sheds its flowers rapidly, with hypnotic properties; Papaver somniferum, a cultivated garden "pouched" poppy that is good for baking bread and has white seeds and elongated flowers; Papaver orientalis, a wild "jar" poppy with elongated and involuted capsule and black seeds; another more poisonous wild poppy with a longer capsule; Glauceum luteum, a "horned" poppy growing wild by the sea; and Gratiola officinalis, the "foaming" or Heraklean poppy. It has been speculated that opium may originally have been obtained from Papaver setigerum, a close relative of Papaver somniferum from which it was once thought to have been domesticated. However, although Papaver setigerum is one of very few poppies to have a significant morphine content, early cytogenetic analysis revealed that it is a tetraploid with 22 chromosomes, compared to the 11 of Papaver somniferum, making it an unlikely ancestor.

In De Medicina (ca. 30 AD), Aulus Cornelius Celsus detailed many uses for "poppy-tears", as an emollient for painful joints and anal fissures, in anodynes (pills promoting relief of pain through sleep), in antidotes for poisoning (including the Mithridatium), for use in colic, and to promote micturition. He also recommended the juice of boiled poppy heads for procuring sleep, treating earaches, intestinal gripings, inflammation of the womb, and to reduce the flow of phlegm into the eyes. However, Celsus is thought to have used a wild poppy, Papaver rhoeas, with a very low opiate content, and in any case did not regard it as uniquely powerful. He described "poppy-tears" as one of many emollient herbs and minerals, used as an ingredient in some formulations for pain but not others.

Despite the widespread therapeutic and possible ritual use of the drug, and although drunkenness from wine was well documented, there is very little evidence that opium addiction or hedonistic use of opium occurred in the ancient world. The best candidates for opium addiction noted from ancient accounts are Ovid and the Roman emperor Marcus Aurelius. Another difference from common modern practice is that ancient authors such as Hippocrates and Celsus often described the topical use of opium or "poppy-tears" directly at the site of pain, in the eye, or introduced into a wound. When administered directly at the site of pain, morphine has recently been recognized to have a moderate analgesic effect, relying on peripheral opioid receptors, and this limited dosage does not have addictive or life-threatening effects.

Islamic Empire (600-1500 A.D.)

As the power of the Roman Empire declined, the lands to the south and east of the Mediterranean became incorporated into the Islamic Empire, which assembled the finest libraries and the most skilled physicians of the era. Many Muslims believe that the hadith of al-Bukhari prohibits every intoxicating substance as haraam, but the use of intoxicants in medicine has been widely permitted. Dioscorides' five-volume De Materia Medica, ancestor to all modern pharmacopoeias, remained in continuous use (with some improvements in Arabic versions) from the first century until 1600 A.D., and described opium, meconium and the wide range of uses prevalent in the ancient world. Somewhere between 400 and 1200 A.D., Arab traders introduced opium to China. The Persian physician, Agha Bakr Muhammad ibn Zakariya al-Razi (845-930 A.D.), who was born near Tehran and maintained a laboratory and school in Baghdad, and was a student and critic of Galen, made use of opium in anesthesia and recommended its use for the treatment of melancholy in Man la Yahduruhu Al-Tabib, a home medical manual directed toward ordinary citizens for self-treatment if a doctor was not available. The renowned opthalmologic surgeon Abu al-Qasim Ammar (936-1013 A.D.) relied on opium and mandrake as surgical anaesthetics, and wrote a treatise al-Tasrif that influenced medical thought well into the sixteenth century. The Persian physician Abū ‘Alī al-Husayn (Avicenna) described opium as the most powerful of the stupefacients, by comparison with mandrake and other highly effective herbs, in The Canon of Medicine. This classic text was translated into Latin in 1175 and later into many other languages, and remained authoritative into the seventeenth century. Şerefeddin Sabuncuoğlu used opium in the fourteenth century Ottoman Empire to treat migraine headache, sciatica, and other painful ailments.

Reintroduction to Western Medicine

Latin translation of Avicenna's Canon of Medicine, 1483

Opium became stigmatized in Europe during the Inquisition as a Middle Eastern influence, and became a taboo subject in Europe from approximately 1300 to 1500 A.D. Manuscripts of Pseudo-Apuleius' fifth-century work from the tenth and eleventh centuries refer to the use of wild poppy Papaver agreste or Papaver rhoeas (identified as Papaver silvaticum) instead of Papaver somniferum for inducing sleep and relieving pain.

The use of Paracelsus' laudanum was introduced to Western medicine in 1527, when Philip Aureolus Theophrastus Bombast von Hohenheim returned from his wanderings in Arabia with a famous sword, within the pommel of which he kept "Stones of Immortality" compounded from opium thebaicum, citrus juice, and "quintessence of gold". The name "Paracelsus" was a pseudonym signifying him the equal or better of Aulus Cornelius Celsus, whose text, which described the use of opium or a similar preparation, had recently been translated and reintroduced to medieval Europe. The Canon of Medicine, the standard medical textbook that Paracelsus burned in a public bonfire three weeks after being appointed professor at the University of Basel, also described the use of opium, though many Latin translations were of poor quality. "Laudanum" was originally the sixteenth-century term for a medicine associated with a particular physician that was widely well-regarded, but became standardized as "tincture of opium", a solution of opium in ethyl alcohol, which Paracelsus has been credited with developing. During his lifetime, Paracelsus was viewed as an adventurer who challenged the theories and mercenary motives of contemporary medicine with dangerous chemical therapies, but his therapies marked a turning point in Western medicine. In the seventeenth century laudanum was recommended for pain, sleeplessness, and diarrhea by Thomas Sydenham, the renowned "father of English medicine" or "English Hippocrates", to whom is attributed the quote, "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." Use of opium as a cure-all was reflected in the formulation of mithridatium described in the 1728 Chambers Cyclopedia, which included true opium in the mixture. Subsequently laudanum became the basis of many popular patent medicines of the nineteenth century.

The standard medical use of opium persisted well into the nineteenth century. U.S president William Henry Harrison was treated with opium in 1841, and in the American Civil War, the Union Army used 2.8 million ounces of opium tincture and powder and about 500,000 opium pills. During this time of popularity, users called opium "God's Own Medicine".

Recreational use

An opium den in 18-century China through the eyes of a Western artist.

A typical depiction of an opium smoking scene in London's Limehouse district based on fictional accounts of the day.

The earliest clear description of the use of opium as a recreational drug came from Xu Boling, who wrote in 1483 that opium was "mainly used to aid masculinity, strengthen sperm and regain vigor", and that it "enhances the art of alchemists, sex and court ladies.". He described an expedition sent by the Chenghua Emperor in 1483 to procure opium for a price "equal to that of gold" in Hainan, Fujian, Zhejiang, Sichuan and Shaanxi where it is close to Xiyu. A century later Li Shizhen listed standard medical uses of opium in his renowned Compendium of Materia Medica (1578), but also wrote that "lay people use it for the art of sex", in particular the ability to "arrest seminal emission". This association of opium with sex continued in China until the twentieth century. Opium smoking began as a privilege of the elite, and remained a great luxury into the early nineteenth century, but by 1861, Wang Tao wrote that opium was used even by rich peasants, and even a small village without a rice store would have a shop where opium was sold.

Smoking of opium came on the heels of tobacco smoking, and may have been encouraged by a brief ban on the smoking of tobacco by the Ming emperor, ending in 1644 with the Qing dynasty, which had encouraged smokers to mix in increasing amounts of opium. In 1705, Wang Shizhen wrote that "nowadays, from nobility and gentlemen down to slaves and women, all are addicted to tobacco". Tobacco in that time was frequently mixed with other herbs (this continues with clove cigarettes to the modern day), and opium was one component in the mixture. Tobacco mixed with opium was called madak (or madat), and became popular throughout China and its seafaring trade partners (such as Taiwan, Java and the Philippines) in the seventeenth century. In 1712, Engelbert Kaempfer described addiction to madak: "No commodity throughout the Indies is retailed with greater profit by the Batavians than opium, which [its] users cannot do without, nor can they come by it except it be brought by the ships of the Batavians from Bengal and Coromandel."

Fueled in part by the 1729 ban on madak, which at first effectively exempted pure opium as a potentially medicinal product, the smoking of pure opium became more popular in the eighteenth century. In 1736, the smoking of pure opium was described by Huang Shujing, involving a pipe made from bamboo rimmed with silver, stuffed with palm slices and hair, fed by a clay bowl in which a globule of molten opium was held over the flame of an oil lamp. This elaborate procedure, requiring the maintenance of pots of opium at just the right temperature for a globule to be scooped up with a needle-like skewer for smoking, formed the basis of a craft of 'paste-scooping' by which servant girls could become prostitutes as the opportunity arose.

Beginning in eighteenth century China, famine and political upheaval, as well as rumors of wealth to be had in nearby Southeast Asia, led to the Chinese Diaspora. Chinese emigrants to cities such as San Francisco, London, and New York brought with them the Chinese manner of opium smoking and the social traditions of the opium den. The Indian Diaspora distributed opium-eaters in the same way, and both social groups survived as "lascars" (seamen) and "coolies" (manual laborers). French sailors provided another major group of opium smokers, having contracted the habit in French Indochina, where the drug was promoted by the colonial government as a monopoly and source of revenue. Among white Europeans opium was more frequently consumed as laudanum or in patent medicines. Britain's All-India Opium Act of 1878 formalized social distinctions, limiting recreational opium sales to registered Indian opium-eaters and Chinese opium-smokers, and prohibiting its sale to workers from Burma. Likewise American law sought to contain addiction to immigrants by prohibiting Chinese from smoking opium in the presence of a white man.

Because of the low social status of immigrant workers, contemporary writers and media had little trouble portraying opium dens as seats of vice, white slavery, gambling, knife and revolver fights, a source for drugs causing deadly overdoses, with the potential to addict and corrupt the white population. By 1919, anti-Chinese riots attacked Limehouse, the Chinatown of London. Chinese men were deported for playing puck-apu, a popular gambling game, and sentenced to hard labor for opium possession. Both the immigrant population and the social use of opium fell into decline. Yet despite lurid literary accounts to the contrary, nineteenth century London was not a hotbed of opium smoking. The total lack of photographic evidence of opium smoking in Britain, as opposed to the relative abundance of historical photos depicting opium smoking in North America and France, indicates that the infamous Limehouse opium smoking scene was little more than fantasy on the part of British writers of the day who were intent on scandalizing their readers while drumming up the threat of the "yellow peril".

Prohibition and conflict in China

Destruction of opium in China

Main articles: Prohibition (drugs) and Opium Wars

Opium prohibition began in 1729, when Emperor Yongzheng of the Qing Dynasty, disturbed by madak smoking at court and carrying out the government's role of upholding Confucian virtue, officially prohibited the import of opium, except for a small amount for medicinal purposes. The ban punished sellers and opium den keepers, but not users of the drug. Opium prohibition in China continued until 1860, and was later resumed.

English opium ships

Under the Qing Dynasty, China opened itself to foreign trade under the Canton System through the port of Guangzhou (Canton), and traders from the British East India Company began visiting the port by the 1690s. Due to the growing British demand for Chinese tea, and the Chinese disinterest in British commodities other than silver, the British became interested in opium as a high-value commodity for which China was not self sufficient. The British traders had been purchasing small amounts of opium from India for trade since Ralph Fitch first visited in the mid-sixteenth century. Trade in opium was standardized, with production of balls of raw opium, 1.1 to 1.6 kilograms, 30% water content, wrapped in poppy leaves and petals, shipped in chests of 60-65 kilograms (one picul). Chests of opium were sold in auctions in Calcutta with the understanding that the independent purchasers would then smuggle it into China (see Opium Wars).

After the 1757 Battle of Plassey and 1764 Battle of Buxar, the British East India Company gained the power to act as diwan of Bengal, Bihar, and Orissa (See company rule in India). This allowed the company to pursue a monopoly on opium production and export in India, to encourage ryots to cultivate the cash crops of indigo and opium with cash advances, and to prohibit the "hoarding" of rice. This strategy led to the increase of the land tax to 50% of the value of crops, the starvation of ten million people in the Bengal famine of 1770, and the doubling of East India Company profits by 1777. Beginning in 1773 the British government began enacting oversight of the company's operations, culminating in the establishment of British India in response to the Indian Rebellion of 1857. Bengal opium was highly prized, commanding twice the price of the domestic Chinese product, which was regarded as inferior in quality.

Some competition came from the newly independent United States, which began to compete in Guangzhou (Canton) selling Turkish opium in the 1820s. Portuguese traders also brought opium from the independent Malwa states of western India, although by 1820 the British were able to restrict this trade by charging "pass duty" on the opium when it was forced to pass through Bombay to reach an entrepot. Despite drastic penalties and continued prohibition of opium until 1860, opium importation rose steadily from 200 chests per year under Yongzheng to 1,000 under Qianlong, 4,000 under Jiaqing, and 30,000 under Daoguang. The illegal sale of opium became one of the world's most valuable single commodity trades, and has been called "the most long continued and systematic international crime of modern times".

In response to the ever-growing number of Chinese people becoming addicted to opium, Daoguang of the Qing Dynasty took strong action to halt the import of opium, including the seizure of cargo. In 1838 the Chinese Commissioner Lin Zexu destroyed 20,000 chests of opium in Guangzhou (Canton). Given that a chest of opium was worth nearly $1,000 in 1800, this was a substantial economic loss. The British, not willing to replace the cheap opium with costly silver, began the First Opium War in 1840, winning Hong Kong and trade concessions in the first of a series of Unequal Treaties.

Map showing the amount of Opium produced in China in 1908

Following China's defeat in the Second Opium War in 1858, China was forced to legalize opium and began massive domestic production. Importation of opium peaked in 1879 at 6,700 tons, and by 1906 China was producing 85% of the world's opium, some 35,000 tons, and 27% of its adult male population was addicted - 13.5 million addicts consuming 39,000 tons of opium yearly. From 1880 to the beginning of the Communist era the British attempted to discourage the use of opium in China, but this effectively promoted the use of morphine, heroin, and cocaine, further exacerbating the problem of addiction.

Scientific evidence of the pernicious nature of opium use was largely undocumented in the 1890s when Protestant missionaries in China decided to strengthen their opposition to the trade by compiling data which would demonstrate the harm the drug did. These missionaries were generally outraged over the British government’s Royal Commission on Opium visiting India but not China. Accordingly, the missionaries first organized the Anti-Opium League among their colleagues in every mission station in China. This organization which had elected national officers and held an annual national meeting, was instrumental in gathering data from every Western-trained medical doctor in China which was then published as William H. Park, compiled "Opinions of Over 100 Physicians on the Use of Opium in China" (Shanghai: American Presbyterian Mission Press, 1899). The vast majority of these medical doctors were missionaries, the survey also included doctors who were in private practices, particularly in Shanghai and Hong Kong, as well as Chinese who had been trained in medical schools in Western countries. In England, the home director of the China Inland Mission, Benjamin Broomhall was an active opponent of the Opium trade, writing two books to promote the banning of opium smoking: The Truth about Opium Smoking and The Chinese Opium Smoker. In 1888 Broomhall formed and became secretary of the Christian Union for the Severance of the British Empire with the Opium Traffic and editor of its periodical, "National Righteousness". He lobbied the British Parliament to stop the opium trade. He and James Laidlaw Maxwell appealed to the London Missionary Conference of 1888 and the Edinburgh Missionary Conference of 1910 to condemn the continuation of the trade. When Broomhall was dying, his son Marshall read to him from The Times the welcome news that an agreement had been signed ensuring the end of the opium trade within two years.

Official Chinese resistance to opium was renewed on September 20, 1906 with an anti-opium initiative intended to eliminate the drug problem within ten years. The program relied on the turning of public sentiment against opium, with mass meetings at which opium paraphernalia was publicly burned, as well as coercive legal action and the granting of police powers to organizations such as the Fujian Anti-Opium Society. Smokers were required to register for licenses for gradually reducing rations of the drug. Addicts sometimes turned to missionaries for treatment for their addiction, though many associated these foreigners with the drug trade. The program was counted as a substantial success, with a cessation of direct British opium exports to China (but not Hong Kong) and most provinces declared free of opium production. Nonetheless, the success of the program was only temporary, with opium use rapidly increasing during the disorder following the death of Yuan Shikai in 1916.

Beginning in 1915, Chinese nationalist groups came to describe the period of military losses and Unequal Treaties as the "Century of National Humiliation", later defined to end with the conclusion of the Chinese Civil War in 1949. The Mao Zedong government is generally credited with eradicating both consumption and production of opium during the 1950s using unrestrained repression and social reform. Ten million addicts were forced into compulsory treatment, dealers were executed, and opium-producing regions were planted with new crops. Remaining opium production shifted south of the Chinese border into the Golden Triangle region, at times with the involvement of Western intelligence agencies. The remnant opium trade primarily served Southeast Asia, but spread to American soldiers during the Vietnam War, with 20% of soldiers regarding themselves as addicted during the peak of the epidemic in 1971. In 2003, China was estimated to have four million regular drug users and one million registered drug addicts.

Prohibition outside China

There were no legal restrictions on the importation or use of opium in the United States until the San Francisco, California Opium Den Ordinance which banned dens for public smoking of opium in 1875, a measure fueled by anti-Chinese sentiment and the perception that whites were starting to frequent the dens. This was followed by an 1891 California law requiring that narcotics carry warning labels and that their sales be recorded in a registry, amendments to the California Pharmacy and Poison Act in 1907 making it a crime to sell opiates without a prescription, and bans on possession of opium or opium pipes in 1909.

At the U.S. federal level, the legal actions taken reflected constitutional restrictions under the Enumerated powers doctrine prior to reinterpretation of the Commerce clause, which did not allow the federal government to enact arbitrary prohibitions but did permit arbitrary taxation. Beginning in 1883 opium importation was taxed at $6 to $300 per pound, until the Opium Exclusion Act of 1909 prohibited the importation of opium altogether. In a similar manner the Harrison Narcotics Tax Act of 1914, passed in fulfillment of the International Opium Convention of 1912, nominally placed a tax on the distribution of opiates, but served as a de facto prohibition of the drugs. Today opium is regulated by the Drug Enforcement Administration under the Controlled Substances Act.

Following passage of a regional law in 1895, Australia's Aboriginal Protection and restriction of the sale of opium act 1897, addressed opium addiction among Aborigines, though it soon became a general vehicle for depriving them of basic rights by administrative regulation. Opium sale was prohibited to the general population in 1905, and smoking and possession was prohibited in 1908.

Hardening of Canadian attitudes toward Chinese opium users and fear of a spread of the drug into the white population led to the effective criminalization of opium for non-medical use in Canada between 1908 and the mid-1920s.

In 1909 the International Opium Commission was founded, and by 1914 thirty-four nations had agreed that the production and importation of opium should be diminished. In 1924, sixty-two nations participated in a meeting of the Commission. Subsequently this role passed to the League of Nations, and all signatory nations agreed to prohibit the import, sale, distribution, export, and use of all narcotic drugs, except for medical and scientific purposes. This role was later taken up by the International Narcotics Control Board of the United Nations under Article 23 of the Single Convention on Narcotic Drugs, and subsequently under the Convention on Psychotropic Substances. Opium-producing nations are required to designate a government agency to take physical possession of licit opium crops as soon as possible after harvest and conduct all wholesaling and exporting through that agency.

Obsolescence

Bayer heroin bottle

Opium has gradually been superseded by a variety of purified, semi-synthetic, and synthetic opioids with progressively stronger effect, and by other general anesthesia. This process began in 1817, when Friedrich Wilhelm Adam Sertürner reported the isolation of pure morphine from opium after at least thirteen years of research and a nearly disastrous trial on himself and three boys. The great advantage of purified morphine was that a patient could be treated with a known dose - whereas with raw plant material, as Gabriel Fallopius once lamented, "if soporifics are weak they do not help; if they are strong they are exceedingly dangerous." Morphine was the first pharmaceutical isolated from a natural product, and this success encouraged the isolation of other alkaloids: by 1820, isolations of narcotine, strychnine, veratrine, colchicine, caffeine, and quinine were reported. Morphine sales began in 1827, by Heinrich Emanuel Merck of Darmstadt, and helped him expand his family pharmacy into the massive Merck KGaA pharmaceutical company.

Codeine was isolated in 1832 by Robiquet.

The use of diethyl ether and chloroform for general anesthesia began in 1846-1847, and rapidly displaced the use of opiates and tropane alkaloids from Solanaceae due to their relative safety.

Heroin, the first semi-synthetic opiate, was first synthesized in 1874, but was not pursued until its rediscovery in 1897 by Felix Hoffmann at the Bayer pharmaceutical company in Elberfeld, Germany. From 1898 through to 1910 heroin was marketed as a non-addictive morphine substitute and cough medicine for children. By 1902, sales made up 5% of the company's profits, and "heroinism" had attracted media attention. Oxycodone, a thebaine derivative similar to codeine, was introduced by Bayer in 1916 and promoted as a less-addictive analgesic. Preparations of the drug such as Percocet and Oxycontin remain popular to this day.

A range of synthetic opioids such as methadone (1937), pethidine (1939), fentanyl (late 1950s), and derivatives thereof have been introduced, and each is preferred for certain specialized applications. Nonetheless, morphine remains the drug of choice for American combat medics, who carry packs of syrettes containing 16 milligrams each for use on severely wounded soldiers. No drug has yet been found that can match the painkilling effect of opium without also duplicating much of its addictive potential.

Modern production and usage

Papaver somniferum

Scoring the poppy pod.

Raw opium

Main article: Opium poppy

In South American countries, opium poppies (Papaver somniferum) are technically illegal, but nonetheless appear in some nurseries as ornamentals. They are popular and attractive garden plants, whose flowers vary greatly in color, size and form. A modest amount of domestic cultivation in private gardens is not usually subject to legal controls. In part this tolerance reflects variation in addictive potency: a cultivar for opium production, Papaver somniferum L. elite, contains 92% morphine, codeine, and thebaine in its latex alkaloids, whereas the condiment cultivar "Marianne" has only one-fifth this total, with the remaining alkaloids made up mostly of narcotoline and noscapine.

Seed capsules can be dried and used for decorations, but they also contain morphine, codeine, and other alkaloids. These pods can be boiled in water to produce a bitter tea that induces a long-lasting intoxication (See Poppy tea). If allowed to mature, poppy pods can be crushed into "poppy straw" and used to produce lower quantities of morphinans. In poppies subjected to mutagenesis and selection on a mass scale, researchers have been able to use poppy straw to obtain large quantities of oripavine, a precursor to opioids and antagonists such as naltrexone.

Poppyseeds are a common and flavorsome topping for breads and cakes. One gram of poppy seeds contains up to 33 micrograms of morphine and 14 micrograms of codeine, and the Substance Abuse and Mental Health Services Administration formerly mandated that all drug screening laboratories use a standard cutoff of 300 nanograms per milliliter in urine samples. A single poppy seed roll (0.76 grams of seeds) usually did not produce a positive drug test, but a positive result was observed from eating two rolls. A slice of poppy seed cake containing nearly five grams of seeds per slice produced positive results for 24 hours. Such results are viewed as false positive indications of drug abuse, and were the basis of a legal defense. On November 30, 1998, the standard cutoff was increased to 2000 nanograms (two micrograms) per milliliter. During the Communist era in Eastern Europe, poppy stalks sold in bundles by farmers were processed by users with household chemicals to make kompot ("Polish heroin"), and poppy seeds were used to produce koknar, an opiate.

Harvesting and processing

When grown for opium production, the skin of the ripening pods of these poppies is scored by a sharp blade at a time carefully chosen so that neither rain, wind, nor dew can spoil the exudation of white, milky latex, usually in the afternoon. Incisions are made while the pods are still raw, with no more than a slight yellow tint, and must be shallow to avoid penetrating hollow inner chambers or loculi while cutting into the lactiferous vessels. In India, the special tool used to make the incisions is called a nushtar, and carries three or four blades three millimeters apart, which are scored upward along the pod. Incisions are made three or four times at intervals of two to three days, and each time the "poppy tears", which dry to a sticky brown resin, are collected the following morning. One acre harvested in this way can produce three to five kilograms of raw opium. In the Soviet Union pods were typically scored horizontally, and opium was collected three times, or else one or two collections were followed by isolation of opiates from the ripe capsules. Oil poppies, an alternative strain of P. somniferum, were also used for production of opiates from their capsules and stems.

Black tar opium seized in Afghanistan, spring 2005

Raw opium may be sold to a merchant or broker on the black market, but it usually does not travel far from the field before it is refined into morphine base, because pungent, jelly-like raw opium is bulkier and harder to smuggle. Crude laboratories in the field are capable of refining opium into morphine base by a simple acid-base extraction. A sticky, brown paste, morphine base is pressed into bricks and sun-dried, and can either be smoked or processed into heroin.

Heroin is widely preferred because of increased potency. One study in postaddicts found heroin to be approximately 2.2 times more potent than morphine by weight with a similar duration; at these relative quantities they could distinguish the drugs subjectively but had no preference. Heroin was also found to be twice as potent as morphine in surgical anesthesia. Morphine is converted into heroin by a simple chemical reaction with acetic anhydride, followed by a varying degree of purification. Especially in Mexican production, opium may be converted directly to "black tar heroin" in a simplified procedure. This form predominates in the U.S. west of the Mississippi. Relative to other preparations of heroin, it has been associated with a dramatically increased rate of HIV transmission among intravenous drug users (4% in Los Angeles vs. 40% in New York) due to technical requirements of injection, although it is also associated with greater risk of venous sclerosis and necrotizing fasciitis.

Illegal production

Main producers of opium for the heroin trade

Approximate global opium production for recreational purposes

See also: Opium production in Afghanistan and Illegal drug trade

Opium production has fallen greatly since 1906, when 41,000 tons were produced, but because 39,000 tons of that year's opium were consumed in China, overall usage in the rest of the world was much lower. In 1980, 2,000 tons of opium supplied all legal and illegal uses. Recently, opium production has increased considerably, surpassing 5,000 tons in 2002. In 2002 the price for one kilogram of opium was $300 for the farmer, $800 for purchasers in Afghanistan, and $16,000 on the streets of Europe before conversion into heroin.

Following documented trends of increasing availability mirroring increased American military and geo-political regional involvement, see the Golden Triangle region of Southeast Asia (particularly Myanmar), Colombia and Mexico, Afghanistan is currently the primary producer of the drug. After regularly producing 70% of the world's opium, Afghanistan decreased production to 74 tons per year under a ban by the Taliban in 2000, although the ban may have been intended primarily to boost prices after the country accumulated a stockpile with over two years' supply. After the 2001 war in Afghanistan, production increased again. According to DEA statistics, Afghanistan's production of oven-dried opium increased to 1,278 tons in 2002, more than doubled by 2003, and nearly doubled again during 2004. In late 2004, the U.S. government estimated that 206,000 hectares were under poppy cultivation, 4.5% of the country's total cropland, and produced 4,200 metric tons of opium, 87% of the world's supply, yielding 60% of Afghanistan's gross domestic product. In 2006, the UN Office on Drugs and Crime estimated production to have risen 59% to 407,000 acres (1,647.07056294 km²) in cultivation, yielding 6,100 tons of opium, 92% of the world's supply. The value of the resulting heroin was estimated at $3.5 billion, of which Afghan farmers were estimated to have received $700 million in revenue (of which the Taliban have been estimated to have collected anywhere from tens of millions to $140 million in taxes). For farmers, the crop can be up to ten times more profitable than wheat.

An increasingly large fraction of opium is processed into morphine base and heroin in drug labs in Afghanistan. Despite an international set of chemical controls designed to restrict availability of acetic anhydride, it enters the country, perhaps through its Central Asian neighbors which do not participate. A counternarcotics law passed in December 2005 requires Afghanistan to develop registries or regulations for tracking, storing, and owning acetic anhydride.

Besides Afghanistan, smaller quantities of opium are produced in Pakistan, the Golden Triangle region of Southeast Asia (particularly Myanmar), Colombia and Mexico.

Legal production

Main article: Opium licensing

Legal opium production is allowed under the United Nations Single Convention on Narcotic Drugs and other international drug treaties, subject to strict supervision by the law enforcement agencies of individual countries. The leading legal production method is the Gregory process, whereby the entire poppy, excluding roots and leaves, is mashed and stewed in dilute acid solutions. The alkaloids are then recovered via acid-base extraction and purified. This process was developed in the UK during World War II, when wartime shortages of many essential drugs encouraged innovation in pharmaceutical processing.

Legal production in India is much more traditional. As of 1996, opium was collected by farmers who licensed to grow 0.1 hectare of opium poppies (0.24 acres), who to maintain their licenses needed to sell 4.5 kilograms of unadulterated raw opium paste at a fixed government price of 32 rupees ($8 US) per kilogram. One kilogram represents two days' work for a family. Some additional money is made by drying the poppy heads and collecting poppy seeds, and a small fraction of opium beyond the quota may be consumed locally or diverted to the black market. The opium paste is sun-dried and stirred in large pans before it is packed into cases of 60 kilograms for export. Purification of chemical constituents is done in India for domestic production, but typically done abroad by foreign importers.

Legal opium importation from India and Turkey is conducted by Mallinckrodt, Noramco, Abbott Laboratories, and Purdue Pharma in the United States, and legal opium production is conducted by GlaxoSmithKline, Johnson and Johnson, Johnson Matthey, and Mayne in Tasmania, Australia; Sanofi Aventis in France; Shionogi Pharmaceutical in Japan; and MacFarlan Smith in the United Kingdom. The UN treaty requires that every country submit annual reports to the International Narcotics Control Board, stating that year's actual consumption of many classes of controlled drugs as well as opioids, and projecting required quantities for the next year. This is to allow trends in consumption to be monitored, and production quotas allotted.

A recent proposal from the European Senlis Council hopes to solve the problems caused by the massive quantity of opium produced illegally in Afghanistan, most of which is converted to heroin, and smuggled for sale in Europe and the USA. This proposal is to license Afghan farmers to produce opium for the world pharmaceutical market, and thereby solve another problem, that of chronic underuse of potent analgesics where required within developing nations. Part of the proposal is to overcome the "80-20 rule" that requires the U.S. to purchase 80% of its legal opium from India and Turkey to include Afghanistan, by establishing a second-tier system of supply control that complements the current INCB regulated supply and demand system by providing poppy-based medicines to countries who cannot meet their demand under the current regulations. Senlis arranged a conference in Kabul that brought drug policy experts from around the world to meet with Afghan government officials to discuss internal security, corruption issues, and legal issues within Afghanistan. In June 2007, the Council launched a "Poppy for Medicines" project that provides a technical blueprint for the implementation of an integrated control system within Afghan village-based poppy for medicine projects: the idea promotes the economic diversification by redirecting proceeds from the legal cultivation of poppy and production of poppy-based medicines (See Senlis Council).

Cultivation in the UK

In late 2006, the British government permitted the pharmaceutical company Macfarlan Smith (a Johnson Matthey company) to cultivate opium poppies in England for medicinal reasons, after Macfarlan Smith's primary source, India, decided to increase the price of export opium latex. This move is well received by British farmers, with a major opium poppy field based in Didcot, England. The British government has contradicted the Home Office's suggestion that opium cultivation can be legalized in Afghanistan for exports to the United Kingdom, helping lower poverty and internal fighting whilst helping NHS to meet the high demand for morphine and diamorphine. Opium poppy cultivation in the United Kingdom does not need a licence, however, a licence is required for those wishing to extract opium for medicinal products.

Consumption

In the industrialized world, the USA is the world's biggest consumer of prescription opioids, with Italy one of the lowest. Most opium imported into the United States is broken down into its alkaloid constituents, and whether legal or illegal, most current drug use occurs with processed derivatives such as heroin rather than with pure and untouched opium.

Intravenous injection of opiates is most used: by comparison with injection, "dragon chasing" (heating of heroin with barbital on a piece of foil) and "ack ack" (smoking of cigarettes containing heroin powder) are only 40% and 20% efficient, respectively. One study of British heroin addicts found a 12-fold excess mortality ratio (1.8% of the group dying per year). Most heroin deaths result not from overdose per se, but combination with other depressant drugs such as alcohol or benzodiazepines.

File:Akha man with opium pipe.jpg

An Akha man smokes a pipe. Although this pipe was described as an opium pipe by the photographer, a true opium pipe requires an external heat source. Still, opium can be smoked by mixing it with tobacco, as in madak and ack ack.

The smoking of opium does not involve the pyrolysis of the material as might be imagined. Rather the prepared opium is indirectly heated to temperatures at which the active alkaloids, chiefly morphine, are vaporized. In the past, smokers would utilize a specially designed opium pipe which had a removable knob-like pipe-bowl of fired earthenware attached by a metal fitting to a long, cylindrical stem. A small "pill" of opium about the size of a pea would be placed on the pipe-bowl, which was then heated by holding it over an opium lamp, a special oil lamp with a distinct funnel-like chimney to channel heat into a small area. The smoker would lie on his or her side in order to guide the pipe-bowl and the tiny pill of opium over the stream of heat rising from the chimney of the oil lamp and inhale the vaporized opium fumes as needed. Several pills of opium were smoked at a single session depending on the smoker's tolerance to the drug. The effects could last up to twelve hours.

In Eastern culture, opium is more commonly used in the form of paregoric to treat diarrhea. This is a weaker solution than laudanum, an alcoholic tincture which was prevalently used as a pain medication and sleeping aid. Tincture of opium has been prescribed for, among other things, severe diarrhea. Taken 30 minutes prior to meals it will significantly slow intestinal motility, giving the intestines greater time to absorb fluid in the stool.

Chemical and physiological properties

Morphine is the primary biologically-active chemical constituent of opium.

See also: Opioid, Opiate, and Morphinan

Opium contains two main groups of alkaloids. Those that use opium are commonly referred to as "opiats" (Coined by James St. Louis). Phenanthrenes include morphine, codeine, and thebaine, and are the main narcotic constituents. Isoquinolines such as papaverine have no significant central nervous system effects and are not regulated under the Controlled Substances Act. Morphine is by far the most prevalent and important alkaloid in opium, consisting of 10%-16% of the total, and is responsible for most of its harmful effects such as lung edema, respiratory difficulties, coma, or cardiac or respiratory collapse, with a normal lethal dose of 120 to 250 milligrams—the amount found in approximately two grams of opium. Morphine binds to and activates μ-opioid receptors in the brain, spinal cord, stomach and intestine. Regular use leads to physical tolerance and dependence. Chronic opium addicts in 1906 China or modern-day Iran consume an average of eight grams daily.

Both analgesia and drug addiction are functions of the mu opioid receptor, the class of opioid receptor first identified as responsive to morphine. Tolerance is associated with the superactivation of the receptor, which may be affected by the degree of endocytosis caused by the opioid administered, and leads to a superactivation of cyclic AMP signalling. Long-term use of morphine in palliative care and management of chronic pain can be managed without the development of drug tolerance or (physical dependence). Many techniques of drug treatment exist, including pharmacologically based treatments with naltrexone, methadone, or ibogaine.

Cultural references

There is a rich and longstanding literature by and about opium users. Thomas De Quincey's 1822 Confessions of an English Opium-Eater is one of the first and most famous literary accounts of opium addiction written from the point of view of an addict, and details both the pleasures and the dangers of the drug. De Quincey writes about the great English Romantic poet Samuel Taylor Coleridge (1772-1834), whose poem "Kubla Khan" is also widely considered to be a poem of the opium experience. Coleridge began using opium in 1791 after developing jaundice and rheumatic fever, and became a full addict after a severe attack of the disease in 1801, requiring 80-100 drops of laudanum daily. "The Lotos-Eaters", an 1832 poem by Alfred Lord Tennyson, reflects the generally favorable British attitude toward the drug. In The Count of Monte Cristo (1844), by Alexandre Dumas, père, the Count is assuaged by an edible form of opium, and his experience with it is depicted vividly.

Edgar Allan Poe presents opium in a more disturbing context in his 1838 short story "Ligeia", in which the narrator, deeply distraught for the loss of his beloved, takes solace in opium until he "had become a bounden slave in the trammels of opium", unable to distinguish fantasy from reality after taking immoderate doses of opium. In music, Hector Berlioz' 1830 Symphony Fantastique tells the tale of an artist who has poisoned himself with opium while in the depths of despair for a hopeless love. Each of the symphony's five movements takes place at a different setting and with increasingly audible effects from the drug. For example, in the fourth movement, "Marche au Supplice", the artist dreams that he is walking to his own execution. In the fifth movement, "Songe d’une Nuit du Sabbat", he dreams that he is at a witch's orgy, where he witnesses his beloved dancing wildly along to the demented Dies Irae.

Towards the end of the nineteenth century, references to opium and opium addiction in the context of crime and the foreign underclass abound in English literature, such as in the opening paragraphs of Charles Dickens's 1870 serial The Mystery of Edwin Drood and in Arthur Conan Doyle's 1891 Sherlock Holmes short story The Man with the Twisted Lip. In Oscar Wilde's 1890 The Picture of Dorian Gray, the protagonist uses an opium den as a hiding place after a murder. Opium likewise underwent a transformation in Chinese literature, becoming associated with indolence and vice by the early twentieth century.

In the twentieth century, as the use of opium was eclipsed by morphine and heroin, its role in literature became more limited, and often focused on issues related to its prohibition. In The Good Earth by Pearl S. Buck, Wang Lung, the protagonist, gets his troublesome uncle and aunt addicted to opium in order to keep them out of his hair. William S. Burroughs autobiographically describes the use of opium beside that of its derivatives. His associate Jack Black's memoir You Can't Win chronicles one man's experience both as an onlooker in the opium dens of San Francisco, and later as a "hop fiend" himself. The book and subsequent movie, The Wonderful Wizard of Oz, may allude to opium at one point in the story, when Dorothy and her friends are drawn into a field of poppies, in which they fall asleep. House of the Scorpion is a 2002 novel set in the land of Opium. Marcy Playground's self-titled album contains numerous songs about opium.

In the Seinfeld episode "The Shower Head", Elaine tests positive several times for opium after urine tests, only to discover that it comes from her regularly eating poppy seed muffins.

In the film Saw, one of the victims in the reverse bear-trap scene had an Opium overdose.

In the novel, House of the Scorpion most of the setting is in houses on the opium white poppy fields

See also

• Opium pipe
• Opium lamp
• Opium den
• Imperialism in Asia
• Jardine Matheson Holdings
• Nabidh
• Opium of the masses
• Psychoactive drug
• Sir Thomas Browne
• Forbes family
• John Keats

Further reading

• Ahmad, Diana L. The Opium Debate and Chinese Exclusion Laws in the Nineteenth-century American West (University of Nevada Press, 2007). Drugs and Racism in the Old West.
• Booth, Martin. Opium: A History. London: Simon & Schuster, Ltd., 1996.
• Day, Horace B. (1868). "The Opium Habit".
• de Quincey, Thomas (1821). "Confessions of an English opium-eater".
• Fairbank, JK. (1978) The Cambridge History of China: volume 10 part I, Cambridge, CUP
• Franck Daninos, L'opium légal produit en France, La Recherche, May 2005
• Great Britain (1913). "Agreement between Great Britain and Portugal for regulation of the opium monopolies of the colonies of Hong Kong and Macao".
• Great Britain, India office (1922). "The truth about Indian opium".
• Hai guan zong shui wu si shu (1889). "The poppy in China".
• Hideyuki Takano; The Shore Beyond Good and Evil: A Report from Inside Burma's Opium Kingdom (2002, Kotan, ISBN 0970171617)
• Latimer, Dean, and Jeff Goldberg with an Introduction by William Burroughs. Flowers in the Blood: The Story of Opium. New York: Franklin Watts, 1981
• MacPherson, Duncan (1843). "Two years in China. Narrative of the Chinese expedition, from its formation in April, 1840, to the treaty of peace in August, 1842".
• Martin, Steven. The Art of Opium Antiques. Chiang Mai: Silkworm Books, 2007.
• McCoy, Alfred W. The Politics of Heroin: CIA Complicity in the Global Drug Trade. New York: Lawrence Hill Books, 1991.
• Merwin, Samuel (1907). "Drugging a nation, the story of China and the opium curse; a personal investigation, during an extended tour, of the present conditions of the opium trade in China and its effects upon the nation".
• Morewood, Samuel (1838). "A philosophical and statistical history of the inventions and customs of ancient and modern nations in the manufacture and use of inebriating liquors; with the present practice of distillation in all its varieties: together with an extensive illustration of the consumption and effects of opium, and other stimulants used in the East, as substitutes for wine and spirits".
• Musto, David F. The American Disease: Origins of Narcotic Control. New York: Oxford University Press, 1987.
• Nye, Gideon (1873). "The morning of my life in China : comprising an outline of the history of foreign intercourse from the last year of the regime of honorable East India Company, 1833, to the imprisonment of the foreign community in 1839".
• Ouchterlony, John (1844). "The Chinese war : an account of all the operations of the British forces from the commencement to the Treaty of Nanking".
• Speer, William (1870). "The oldest and the newest empire : China and the United States".
• Thelwall, A. S. (1839). "The iniquities of the opium trade with China ; being a development of the main causes which exclude the merchants of Great Britain from the advantages of an unrestricted commercial intercourse with that vast empire. With extracts from authentic documents".
• Turner, Frederick Storrs (1876). "British opium policy and its results to India and China".

External links

• National Institute on Drug Abuse: Heroin and related topics
• Iowa Substance Abuse Information Center: Heroin and other opiates
• DEA drug information: Opium, morphine, and heroin
• Erowid: Opiates / Opioids
• Poppies.org: FAQ and opium poppy photo gallery
• Hall of Opium Virtual museum (Macromedia Flash presentation)
• Opium Museum: Opium paraphernalia and historical photos of opium smokers
• OPIUM Web: Opium Web - Banda Rock Alternativo-progresivo - Paraná - Entre Ríos - Argentina
• Opium Made Easy by Michael Pollan (originally appeared in Harper's.)
• Confessions of a Poppy Tea addict
• Geopium: Opium politics, geography, and photos (site mostly in French)
• Opium in India
• Opium in Japan
• Opium Dens of Victorian London
• From Flowers to Heroin, CIA publication
• BLTC Research: Speculations on the future of opioids
• Thailex photo: Traditional method of using opium in Thailand

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