The history of opium in medical practice.

Poppy photo courtesy Shaun Dovey

Pain relief has been one of the primary goals of medical care since humankind began and physicians have been debating the best way to accomplish this goal since ancient Egyptian physicians first wrote down their treatments and discussed them with their colleagues.  Opium, derived from the sticky sap in the immature seed pods of the opium poppy, was the most widely used medication in the Georgian, Regency, and Victorian Era for two very good reasons: it relieved pain and it was inexpensive.

Laudanum, a strong tincture containing 10% opium contained all the alkaloids of opium, primarily morphine, was widely used and could be obtained without a prescription.  It was very potent and was used for both pain and to quiet “nervous” disorders, which we would now call anxiety disorders.  It was also the only medication available to help people sleep.  Morphine and its derivatives work by binding to receptors in the brain which normally bind natural endorphins, produced by the body to relieve pain.  The action of morphine is much stronger than endorphins and will override the action of the endorphins.  Not surprisingly, most households of the gentry and upper classes would have this useful drug in the house in case of need.

Another formulation containing tincture of opium was paregoric.  This was a complex mixture first formulated by Jakob Le Mort in the early 18th Century for the treatment of asthma, and contained “honey, licorice, flowers of Benjamin, opium, camphor, oil of aniseed, salt of tartar and spirit of wine.” By the 19th Century, paregoric was primarily used for gastrointestinal disorders such as diarrhea and the intestinal cramps associated with it (usually called abdominal colic at that time).  In this case, a side effect of the opium was what provided the relief:  opium and all of it’s relatives (including heroin, oxycodone, hydrocodone and codeine) cause the intestines to stop their peristalsis, the rhythmic progression of contractions which move the  ingested food through the length of the intestines, promoting breakdown and mixing of food into a form which could be absorbed into the rest of the body.  Cramping during a bout of diarrhea is caused by lack of coordination or spasm in these muscles, resulting in pain and expulsion of the waste products before the colon can absorb the excess water and make stools of a normal consistency.

The downside to this very effective class of pain relievers is constipation (also from suppression of peristalsis), drowsiness, and the potential for addiction. With the ready availability of laudanum and paregoric, addiction was a significant risk for users.

Both laudanum and paregoric are still available in the US and England (although by prescription only) but they are rarely prescribed since the development of non-narcotic anti-diarrheal agents such as loperamide in the mid-Twentieth Century.

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