The History of Opium
Understanding the medications you're taking is important. Why? Preventing an accidental overdose is one good reasons. Avoiding a mixture of the wrong medications is something you can't leave to your doctor or pharmacist. They see hundreds of people every week and although they are trained and responsible for avoid mistakes, that's not going to do you much good when you're in a coma or the grave.
Doctors don't like to be questioned. Pharmacists are much more open. Whether people like to be questioned or not shouldn't figure into your questioning them. It's your life and you're responsible for protecting it.
So let's learn something about opium, the original base of pain medications.
Who Discovered Opium?
Orange poppies waving in Oriental fields are breathtaking to behold. Who first discovered their seed pods contained one of the most deadly -- or beneficial, depending on your viewpoint -- substances on earth?
As early as 3200-2600 B.C., excavations of the remains of neolithic settlements in Switzerland have shown that poppy seeds (Papaver somniferum) were already being cultivated. They may have been harvested for the 45% oil food value, but the slightly narcotic property of this plant was undoubtedly already known then.
Arabic doctors were well aware of the beneficial effects of opium and Arabic traders introduced it to the Far East. In Europe it was reintroduced by Paracelsus (1493-1541) and in 1680 it had reached England.
Far East Opium Dens
In that year, he English doctor Sydenham wrote about the pain-killing properties:
"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"'
In the Far East, opium dens were born faster than the peasants could be enslaved. People entered these dens to escape reality and lived in a constant state of pleasant opium dreams until they ran out of money or died. If they ran out of money, they were put out on the streets where they would do anything to get more money so they could re-enter their den of dreams. Desperate families would seek their loved ones in these dens and retrieve them, only to lose them again and again to the strong addiction of opium.
To depict the history of opium, Japan has created the Hall of Opium near Chiang Rai in the fabled Golden Triangle, a remote and lawless region of South-East Asia, which will open to tourists later this year.
A Blessing in the Civil War
In 1806 Friedrich Serturner was the first to extract one of these substances in its pure form. Codeine (Robiquet, 1832) and papaverine (Merck, 1848) followed.
Morphine was a blessing during the American Civil War where field conditions were so hideous often all a doctor could offer was relief from pain.
However, all was not peaches and cream. As "patent medicines" such as Laudanum were developed and widely sold in America, concern about the addictive properties first began to surface.
First International Opium Conference
American pressure led to the first International Opium Conference in 1909 at Shanghai with representatives from countries with colonial possessions in the Far East and Persia. This conference laid the foundation for the International Opium Conference in The Hague in 1911.
This conference lead to the first international convention, the Opium Convention of 23 January 1912, although its extent only obliged the affiliated countries to take measures to control the trade in opium within their own national legal systems.
The Germans, with their heavy investments in the pharmaceutical trade, were successful in having the wording changed in all articles to do with morphine and cocaine to 'try to'. The ratification of the convention was ultimately made dependent on countries not present at the conference. In sum, it was quite ineffective in controlling opium trade.
Another conference, held in The Hague in the year 1913, was just as ineffective and only at a third conference at the same place in 1914 was a protocol signed allowing the convention to take place without the signature of all participating countries.
The United States reacted by passing the Harrison Narcotics Act on December 17, 1914 which controlled the trade and made it illegal for unauthorized persons to possess heroin. The Act set a maximum fine of $2000 and/or five years imprisonment. The basis for the criminalization of the use of drugs had now been formalized! The Drug Enforcement Agency was on its way.
Heroin for Medical Purposes
World War I brought all efforts to a halt.
The matter came up again after the Treaty of Versailles was signed. This time the United States introduced the provision that all countries which had not signed and/or ratified the convention of 1912 should still do this. The convention was handed over to the League of Nations in 1920 for enforcement.
England brought the Dangerous Drugs Act into force in 1920. While America had outlawed the use of heroin for medical purposes, England upheld this purpose and found the provision of heroin to addicts to be an acceptable medical practice.
The chemical derivatives did, however, fall under the joint commitment. Heroin, more than opium, became the object of the battle. To make this battle more effective the League of Nations held two conferences which led to two Geneva Conventions: one of 11 February and one on 19 February 1925.
Legally Cultivated and Consumed
The first convention limited the domestic production of and trade in opium in the colonies in the Far East. The second extended the substances covered under the Convention to include the coca leaf, raw cocaine, ecgonine and Indian hennep. Also, the states were to step up monitoring of the preparation, trade and possession of the 'numbing' substances involved.
However, use of these were was not punishable. Opium was still being legally cultivated and consumed in the East. An opium monopoly was seen as an effective way of combating misuse.
In 1931 there were efforts to ban opium for nonmedical purposes. New conventions were signed for this purpose.
Worldwide Drug Policy
The last Geneva convention for the suppression of the illicit traffic in narcotics laid down harsher punishment, superficially imprisonment for all offenders of the provision from the relevant conventions.
Ironically enough the Americans did not sign this one because it did not go far enough.
After World War II the United Nations took over the matter. The Economic and Social Council of this organization set up the U.N. Commission of Narcotic Drugs. This Commission, made up then of 40 member states, started preparations for a worldwide drugs policy.
The Single Convention
This resulted in the Single Convention (New York, 30 March 1961) which replaced all previous conventions with one.
Now all parties are required to take the necessary legal and administrative measures to restrict the trade, production and possession of narcotics to scientific and medical purposes. All activities not directed towards these purposes are considered punishable offenses.
The convention has four lists of substances with regard of which a different regime of supervision applies, and on recommendation of the World Health Organization (WHO) the UN can add certain new substances to these lists.
Drug Abuse Not Yet a Social Problem
However it must be shown that these substances present a serious threat for public health or are involved in illicit traffic. The first is a clear criterium, the second clearly not. As long as a substance is not forbidden, production, trade and use can, of course, not be illegal!
Depending on the degree of misuse, substances from one list can be put on another. National legislation would then have to be adapted to these changes.
It is of interest with this to note when the European ratified all these conventions drug abuse was not a social problem.
Unlike all other laws, the opium laws in Europe were not introduced as a reaction to a social problem, but were more or less imposed by foreign countries, namely the United States, the '...barbarians of the West' for their 'extraordinary savage idea of stamping out all people who happen to disagree ... with their social theories' against narcotics, against alcohol and in 'their recent treatment of Socialists'.
And, the world was a victim of American Puritanism, for in Europe it was really only still in a few Chinese communities that nonmedical opium was used.
It was no longer a problem in Asia either now that the aggressive sales tactics by the colonial rulers had ended. That is also disputed in most European countries, but in the Netherlands, in Amsterdam and in Rotterdam, it was tolerated as long as its use remained limited to the Chinese.
The Pharmacology Of Opiates
The pharmacological effects of opiates result from the fact that these substances have a bit (like a key) just like the endorphins and thus directly stimulate the endorphin receptors.
Because the opiates were known earlier than the endorphins, these are usually called opiate receptors. We can trace these receptors in the brain by injecting radioactive opiates and then by monitoring where the radioactivity collects in the brain. This appears to be in very specific areas in the brain.
The first concentration of opiate receptors is formed by a nerve cell system which plays an important role in transmitting pain stimuli. A brief digression regarding pain is required here.
Alarming Aspect of Pain
If someone unexpectedly pricks herself, for instance on an improperly stored needle in the sewing box, she will already retract the injured finger (and bleeding or not, put it in her mouth) before any pain is felt. This is due to an emergency telegraph from the finger to the spinal cord from whence another message is immediately transmitted back to the arm muscles (comparable to the knee jerk reflex). At the same time, a message from the spinal cord is transmitted to the cortex of the cerebrum, which results in the first experience of pain.
Until then, there are only signals aimed at a direct reaction to end the painful stimuli. If that were to be the end of it, there is every chance that the person would put her hand into the sewing box just as carelessly on a second occasion. In order to prevent this, and to introduce a moment of learning, stimuli are sent (slowly) from the spinal cord to the part of the brainstem where the opiate receptors are located.
This area is responsible for the alarming or threatening aspect of pain and it is exactly this effect which is remedied so effectively by the administration of opiates. The feeling itself does not disappear so much as lose its threatening character. It is this which lends the opiates their pain killing (analgesic) effect.
No Effect on Sensory Perceptions
The most striking quality of this pain killing effect of opiates is that it has virtually no effect whatever on the other sensory perceptions, consciousness or the motor functions.
All other substances with a pain killing effect, such as laughing gas, alcohol, ether and barbiturates also have, in an effective dose, a definite effect on consciousness, motor coordination, the intellect and emotional control. The drowsiness which can be caused by opiates is experienced only at high dosage.
A concentration of opiate receptors are also located in the respiratory center. These cells serve as a kind of metronome, that apparatus countless people have standing on their pianos to keep the beat. This metronome regulates the breath in a similar way, with fast or slow settings according to requirements, but allowing in and out breaths to take place regularly.
Effect on Breathing, Coughing
Opiates also have an inhibiting effect on these cells: both the frequency and the depth of breathing is reduced under the influence of opiates. In the case of an overdose, respiration can come to a complete halt. Through shortage of oxygen, the heart muscles can no longer beat and as a result, brain cells die, and death occurs. Besides this, opiates inhibit sensitivity to the impulse to cough. Codeine in particular is used in many cough remedies, but even heroin is used for this purpose in England.
The third concentration is in the vomiting center, which, stimulated by the stomach (contaminated food etc.), normally causes the stomach muscles to contract, resulting in vomiting.
These cells are stimulated into activity by opiates: opiate use causes nausea and vomiting. However, tolerance for this effect is built up very quickly, although some users continue to vomit after each 'shot' for years. This effect is strongest with the opiate apomorphine, which is used medically specifically for this purpose.
Digestive System, Endocrinal System
The effect of opiates on the digestive system, which also contains large numbers of opiate receptors, has been known about for the longest period of time. Long before opiates were used as pain killers, opium was used for diarrhea: opiates inhibit intestinal peristalsis. For this reason, most heroin addicts are constipated.
Opiates also affect the endocrinal system. By influencing the hypothalamus, the part of the brain linked to the hypophysis, the conductor of the hormonal orchestra, body temperature is slightly lowered, although it goes up with chronic use of high doses. Via the hypophysis, opiates lower the amounts of cortisol and testosterone in the blood, although these effects disappear again with chronic use as a result of tolerance.
Opiates influence the pupils: they contract (miosis). This is an extremely reliable signal of opiate use. Besides this, when suffocation occurs (as a result of respiratory inhibition) in the case of an overdose, the pupils dilate (mydriasis).
Mood Changes, Euphoria
In the usual therapeutic dosage, morphine widens the veins in the skin, often giving the face, throat and upper part of the chest a flushed appearance and a warm sensation. This is due to the fact that morphine releases histamine. This is also the reason for the itching and perspiration often seen in opiate users.
The effects mentioned so far do not explain the mood changes which occur with opiateuse, and even less, the phenomenon of 'addiction'. These are dependent on the influence of opiates on the largest cell complex which is strewn with opiate receptors, the limbic system and the nucleus acumens.
In this way, opiates cause euphoria, but lessen negative stimuli such as pain and distress, leading to emotional indifference often combined with inhibition of the sexual functions. The effect is comparable to that on pain: the signal is not removed, but the emotions linked to it are.
Chronic use of all opiates leads to a definite tolerance and a strong physical dependence. The relative severity of the abstinence syndrome is in general related to the duration of efficacy, leading to the paradoxical situation in which the abstinence syndrome of heroin, although occurring extremely quickly, is nonetheless less extreme than that of methadone.