Chapter 1
Narcotics, the "Milk of Paradise"

Since the beginning of time, humans have searched for ways to ease pain, the sensation of suffering or distress. Even though pain is unpleasant, it is an essential feeling; its purpose is to let the body know that something is wrong. Despite this merit, pain can be difficult to endure for long periods of time. Most of the work of early medical practitioners was simply directed at ending pain, and any effective drug was prized. Today, pain is still feared and avoided, and hundreds of medicines and treatments have been developed to treat and prevent it.

There are many classes of drugs used by the medical community to treat pain. Some of the most effective painkillers have limited usefulness because they knock the patient unconscious. Analgesics, drugs that can ease pain without causing unconsciousness, are valued because they allow the patient to continue with day-to-day activities. Scores of different analgesics block pain in a variety of ways. In pharmacology, the study of drugs and medications, analgesics are generally divided into two broad categories: narcotics and the nonnarcotics. Narcotics are the most potent pain relievers known to man. In low doses, they are highly effective analgesics.

Narcotics are a group of drugs with chemical structures similar to that of opium, a medicine derived from the sap of the opium poppy. Some are isolated directly from the opium poppy, but others can be made in the lab. Narcotics derived from the natural plant source are called opiates, and they include opium and its active ingredients, morphine and codeine. Any drug that is made in a lab is described as synthetic, or man-made. Synthetic narcotics are collectively known as opioids and they include heroin, hydrocodone, and fentanyl.

Narcotics are not only prized because they relieve pain; they also change mood and behavior, producing a relaxed feeling of well-being or relief. Therefore, they reduce the anxiety associated with pain. Most patients taking narcotics state that they are experiencing just as much pain as they did without the medication, but they find the pain less troubling.

Drugs classified as narcotics have several other effects on the body. Narcotics constrict the pupils of the eye, slow breathing rate, and widen veins of the skin, making the body look flushed and feel warm. They slow down the digestive system, including the activity of the intestines, and have been used for centuries to treat diarrhea. They have a calming action on coughs and can be administered in their treatment. Narcotics can also cause nausea and vomiting. At high doses, they affect consciousness, making it difficult for a patient to maintain a train of thought without some form of external stimulation. Extremely large amounts can bring on coma or a state of unconsciousness.

Graham Greene, novelist, explains his state of mind after trying opium for the first time:

My mind felt alert and calm—unhappiness and fear of the future became like something dimly remembered which I had thought important once. I, who feel shy at exhibiting the grossness of my French, found myself reciting a poem of Baudelaire to my companion. When I got home that night, I experienced for the first time the white night of opium. One lies relaxed and wakeful, not desiring sleep. We dread wakefulness when our thoughts are disturbed, but in this state one is calm—it would be wrong even to say one is happy—happiness disturbs the pulse. And then suddenly without warning one sleeps. Never has one slept so deeply a whole night-long sleep, and then the waking and the luminous dial of the clock showing that twenty minutes of so-called real time have gone by.²

The First Narcotics

These mind-altering effects were discovered when the first narcotics were derived from the opium poppy, Papaver somniferum. Opium poppy plants grow naturally in temperate climates around the world. They bear flowers that range in color from pure white to brilliant purple. The egg-bearing pistil, the female structure, lies at the center of an opium flower. After pollination, eggs begin maturing into seeds within the pistil, which swells to form an oval seedpod. Within a few days, the flower petals fall off leaving the seedpod exposed. The seedpod can be left on the plant, allowing the seeds to finish maturing and dry out. Or, the pod can be scored with shallow cuts of a knife to release opium. Scoring causes a thick, white resin to ooze from the slits. As it contacts the air, the resin darkens and congeals. It is scraped from the seedpod and combined with the resin from other plants to form a ball of crude opium. This is usually processed into forms for eating or smoking.

Opium has been intimately involved in the history of many ancient cultures. The Sumerians, a group who occupied the area of modern day Iraq in 3400 b.c., described the opium poppy as Hul Gil, the joy plant. They introduced opium to the Assyrians, who in turn shared it with the Babylonians. The Babylonians passed on their knowledge to the Egyptians.

Opium is featured prominently in Egyptian history. Egyptian records from 1300 b.c. show that opium consumption and trade flourished during the reigns of several famous pharaohs, including Thutmose IV, Akhenaton, and Tutankhamen, or King Tut. Historians have found opium-extracting equipment buried with important rulers, a practice designed to enable the kings to harvest opium in the next life.

Most Egyptian families kept a stock of opium in their homes. A prescription called "Remedy to Prevent the Excessive Crying of Children" was found in one home; the preparation's directions stated that opium should be mixed with "the excretions of flies found on the walls, strained to a pulp, passed through a sieve, and administered on four successive days. The crying will stop at once."³

Myths and Medicine

Egyptians carried opium across the Mediterranean Sea to Greece and Rome where the plant became so important that it was incorporated into the mythology of both cultures. In Greece, writings from 600 b.c. refer to the medical use of opium poppies in the treatment of a variety of diseases, and stories of the time abound with references to the drug. According to legend, the mythological healer Aesculapius saved the life of the hero Hippolytus with a medicine that contained only one amazing ingredient. Since statues of Aesculapius show him wearing garlands of opium poppy seedpods, historians believe that the one powerful ingredient was opium. Temples built to honor Aesculapius were tended by physician priests called Aesculapians who were considered to be the best doctors in Greece. When a sick person sought help, an Aesculapian fed the patient a large dose of opium to cause sleep. Upon awakening, the patient reported any dreams experienced under the drug's influence. The physician then prescribed a treatment based on the patient's own opium-induced dreams.

The most famous Aesculapian was Hippocrates (ca. 460–337 b.c.) who is known as the father of medicine. Although Hippocrates frowned on the public's perception of opium as a recreational drug, he did recommend it as a medicine. In his writings, he spoke of opium's curative powers in the treatment of a range of ills, including sleeplessness, various epidemics, and women's problems. One of the last great Aesculapian physicians was Galen (a.d. 131–200), a man who was considered by many to be the greatest medical mind of his time. He made a list of opium's medical uses, explaining how it

resists poison and venomous bites, cures chronic headache, vertigo, deafness, epilepsy, apoplexy, dimness of sight, loss of voice, asthma, coughs of all kinds, spitting of blood, tightness of breath, colic, the lilac poison, jaundice, hardness of the spleen stone, urinary complaints, fever, dropsies [swelling], leprosies, the trouble with which women are subject, melancholy and all pestilences.⁴

The Popularity of Opium Smoking

By the seventh century, natives of Turkey had developed a new way to use opium. Instead of eating plant parts or brewing them to make a tea, they found that heating the drug and inhaling the smoke allowed them to experience the benefits of opium much faster. As a consequence, opium's popularity as a recreational drug grew. However, the Turks did not realize that the switch from eating opium to smoking it was more likely to make users dependent on the drug. Within just a few years, opium smoking was wreaking havoc on peoples' lives. Physicians and politicians spoke out against the drug, and opium lost its status as an important medicine in many cultures.

Centuries later, opium once again found favor, this time in Europe. In the late 1500s, Paracelsus, an eccentric physician, philosopher, and healer from Switzerland, developed a new method of consuming opium. He knew that opium's components did not dissolve easily in water because they have a base, or alkaline, nature. He deduced that opium that is consumed is not completely absorbed into the body for the same reason. Through experimentation, Paracelsus found that opium could be completely dissolved in alcohol, a preparation that made it absorbable. Paracelsus created a mixture of opium in brandy that he named laudanum, literally "something to be praised." Originally, his concoction also contained strange ingredients such as crushed pearls, a medicinal plant called henbane, and frog spawn, components that consumers later found to be unnecessary. According to Paracelsus, laudanum could be used to treat any disease that caused pain. He even boasted that with his new drug, patients who had been bedridden with pain were able to regain much of their former, active lives. Students reported that "indeed he proved that patients who seemed to be dead suddenly arose."⁵

Interest in laudanum surged, and the drink was popular as a medicine and for recreational use. Men of learning sang its praises. Robert Burton (1577–1640), English scholar, priest, teacher, and author of Anatomy of Melancholy, recommended the use of laudanum for insomniacs who are kept awake "by reason of their continual cares, fears, sorrows, dry brain (which) is a symptom that much crucifies melancholy men."⁶

In 1680 Thomas Sydenham, an English physician and apothecary, revised the recipe of Paracelsus and called the new formulation Sydenham's Laudanum. Containing opium, sherry wine, saffron, cinnamon, and cloves, Sydenham's recipe tasted significantly better, and cost less, than the original. Sydenham, an enthusiastic proponent of opium, wrote, "I cannot forebear mentioning with gratitude the goodness of the Supreme Being, who has supplied afflicted mankind with opiates for their relief; no other remedy being equally powerful to overcome a great number of diseases, or to eradicate them effectually."⁷

Opium and the Arts

During the 1700s and 1800s opium was generally looked on as a treatment and a cure, not a drug of addiction. In fact, at that time the word addiction had little or no meaning to most people. Vials containing opium were cheap and readily available. Even though some people considered it to be as unrespectable as alcohol, many others embraced the drug enthusiastically. One reason for opium's acceptance in some circles was the praise and support the drug received from several influential writers.

Thomas De Quincey (1785–1859) was one of the first Europeans to pen his thoughts about opium. In 1821 he wrote "Confessions of an English Opium-Eater" describing his experiences with opium, a drug he first consumed to treat toothache pain and later began to use recreationally. De Quincey explained that he often saved his supply for important events, like a trip to the opera, because it enhanced his senses, making the experience seem larger than life. He wrote,

That my pains had vanished was now a trifle in my eyes. . . . Here was the secret of happiness, that which philosophers had disputed for so many ages, at once discovered; happiness might now be bought for a penny, carried in the waist coat pocket; portable ecstasies might be had corked up in a pint bottle; and peace of mind could be sent down by the mail.⁸

His writing popularized the drug and brought it to everyone's attention. His later work, Miseries of Opium, which detailed the agonies of addiction, was largely ignored.

Although a less vocal supporter of opium, Elizabeth Barrett Browning (1806–1861), an English poet, consumed laudanum most of her adult life. Historians disagree on her original reasons for trying laudanum, but most concur that her continued use was to treat her neurasthenia, or general discomfort, a common diagnosis among ladies of the Victorian era. When asked by her husband-to-be why she did not reduce or discontinue her laudanum use, she replied:

It might strike you as strange that I who have no pain—no acute suffering to keep down from its angles—should need dope in any shape. But I have had restlessness until it made me almost mad; at one time I lost the power of sleeping quite—and even in the day, the continual aching sense of weakness has been intolerable—besides palpitation—as if one's life, instead of giving movement to the body, were imprisoned undiminished within it, and beating and fluttering impotently to get out, at all the doors and windows. So the medical people gave me opium . . . and ever since I have called it my amreeta draught [drink of the gods], my elixir—because the tranquilizing power has been wonderful.⁹

Opium influenced the work of another English poet, Samuel Taylor Coleridge (1772–1834), who was introduced to the drug as a child, probably to treat a fever. In 1800 he took up opium again, this time to relieve back and joint pain. Coleridge realized that he was an addict and sought medical help on several occasions. However, he never kicked the opium habit. Coleridge eventually claimed that the dreams and hallucinations opium provided were the basis for his success as an author. One classic example of Coleridge's opium-induced work is the 1798 poem "Kubla Khan." Taking a small dose of opium, Coleridge went to bed early one night. After hours of vivid dreams, he awoke and recorded as much of his dream as he could remember; the rest he composed in his conscious mind. Many have interpreted the "dome" envisioned in his dream to be a place of serenity and beauty, perhaps a refuge from his gloomy life.

I would build that dome in air,

That sunny dome, those caves of ice!

And all who heard should see them there,

And all should cry, Beware! Beware!

His flashing eyes, his floating hair!

Weave a circle round him thrice,

And close your eyes with holy dread,

For he on honey-dew hath fed,

And drunk the milk of Paradise.10

Opium in America

Opium traveled with settlers to the New World in the early 1600s. Immigrants to America carried poppy seeds with them to their new home. Once established, many grew their own fields of opium poppies, scraped the resin from the seedpods, and dissolved the gooey sap in whiskey to treat pains and coughs. They also used the small black seeds in breads or pastries, or ground them to produce cooking oil.

Opium in Patent Medicines

Sydenham's formula marked the beginning of the patent medicine industry in England. By 1700 other pharmacists competed with Sydenham by creating their own opium elixirs. However, the small amount of opium being imported into the country limited sales for all retailers.

Growth of opium-based medicines took off after Thomas Dover developed Dover's Powder, a treatment for gout. Dover, a well-known sea captain, had rescued the real-life Robinson Crusoe in 1709. When his sailing career ended, Dover announced plans to spend the rest of his life healing people. But because he was already forty years old, he felt that he did not have time to go to medical school. The captain preferred to heal people with his opium elixir. His friendships with sailors who were active in the opium trade made it possible for him to get all the opium he needed. In a short while, Dover's Powder was one of the most commonly purchased self-remedies in England.

Dover's Powder was quickly followed by D.J. Collis Browne's Chlorodyne, developed as a treatment for cholera. The medicine survives today with modified ingredients. In its footsteps followed Godfrey's Cordial, one of several opium-based soothing baby syrups. Sales of this baby syrup were enormous. In 1862 a pharmacist in Nottingham estimated that he sold twelve thousand doses a week. Most were bought by poor women who had to work long hours and take care of children. Soothing syrups helped keep the children quiet. In poverty-stricken families, the syrups may have had an additional positive side effect: They suppressed hunger and therefore saved on food.

During the California gold rush (1849–1860), large numbers of Chinese immigrated to North America. These settlers from the Orient brought many of their customs with them, and established opium dens in their new home like those in China. Opium dens were quiet rooms where customers could buy and smoke opium under the watchful eye of the proprietor. For the first twenty years that the Chinese were in America, they were the only customers in the dens. Whites, viewing the dens with suspicion, did not enter. However, by 1868, American settlers began to smoke opium, much to the irritation of some local citizenry.

Many Americans feared opium smoking because they had heard rumors that it was dangerous. Even among those who appeared to make few moral judgments, opium smoking was considered to be a strange and sinful practice. For example, in 1877 the frontier town of Deadwood, South Dakota, was infamous in the Old West for its decadent nature. The settlement provided its citizens with every conceivable vice, including prostitution, drinking, and gambling. Yet, even in this tolerant setting, the sheriff was shocked to find members of the middle class smoking opium. In one investigation, he discovered small rooms furnished with cots holding "one, two, and sometimes four friends of both sexes, either dreaming off the effects of the deadly drugs, or else smoking."¹¹ Afraid of this new vice that would "quickly rob a (white) man of all semblance of manhood,"¹² the sheriff closed all ten opium dens corrupting his city.

That same year, Winslow Anderson, a physician in San Francisco, recorded that, in his opinion, at least ten thousand local residents smoked opium. He said, "A large portion of the city had taken up smoking opium, hitting the pipe as often as three times a day." He was appalled to find girls "from sixteen to twenty years of age lying half-undressed on the floor or couches, smoking with their lovers."¹³

Opium's Advocate

In the July 1842 issue of the Knickerbocker, a New York magazine, writer William Blair described his experiences with opium.

While I was sitting at tea, I felt a strange sensation, totally unlike any thing I had ever felt before; a gradual creeping thrill, which in a few minutes occupied every part of my body, lulling to sleep the before-mentioned racking pain, producing a pleasing glow from head to foot, and inducing a sensation of dreaming exhilaration (if the phrase be intelligible to others as it is to me) similar in nature but not in degree to the drowsiness caused by wine, though not inclining me to sleep; in fact far from it, that I longed to engage in some active exercise; to sing, dance, or leap . . . so vividly did I feel my vitality—for in this state of delicious exhilaration even mere excitement seemed absolute elysium [paradise]—that I could not resist the tendency to break out in the strangest vagaries, until my companions thought me deranged. . . . After I had been seated [at the play I was attending] a few minutes, the nature of the excitement changed, and a "waking sleep" succeeded. The actors on the stage vanished; the stage itself lost its reality; and before my entranced sight magnificent halls stretched out in endless succession with galley above galley, while the roof was blazing with gems, like stars whose rays alone illumined the whole building, which was tinged with strange, gigantic figures, like the wild possessors of lost globe. . . . I will not attempt farther to describe the magnificent vision which a little pill of "brown gum" had conjured up from the realm of ideal being. No words that I can command would do justice to its Titanian splendor and immensity.

Some historians suggest that in the Old West, opium smoking was more common than alcohol consumption. Famous cowboys such as Kit Carson and Wild Bill Hickock were regular customers in opium dens. Although the Old West conjures up images of saloons full of cowboys, in reality, many cowboys were lying on cots in opium dens. Opium provided a novel way to pass the day away in a pleasant, pain-free stupor.

Despite all of the fears raised by open drug use in dens, opium was still valued in the Old West as well as the rest of the world because it could stop pain. Medicine was a young science and painkillers were scarce. Many accepted practices of the time seem almost barbaric by today's standards. Bloodletting, a common treatment for almost every illness, rarely helped and sometimes killed patients. Doctors did not wash their hands before treating patients because they were unaware that germs carry disease. Surgery, performed with unsterilized equipment on dirty tables, was an extremely dangerous procedure that often resulted in death. Any time a doctor could help patients avoid surgery by relieving pain, their chances of survival improved. For this reason, physicians referred to opium as "G.O.M." or "God's Own Medicine." For many years, opiates were prescribed freely and in good conscience to relieve pain and save lives.

The Power of Pain

Today pain is much better understood than it was in the nineteenth century. It begins when certain nerve cells, or neurons, are damaged or stimulated. However, pain is not perceived at the point of injury, but in the brain. The brain is a command center that coordinates the activities of the body's nerve cells and therefore the entire body. For example, if a child's hand touches a hot surface, she immediately jerks it away and cries. Her reaction is the result of orders given by her brain. When the hand contacted the surface, a series of events were set off. First, nerve cells were stimulated. These cells sent information to the brain, which quickly interpreted the messages. The brain then sent out a string of instructions that told her to move her hand, be aware of the damage to it, feel afraid, and cry out for help.

Messages travel to and from the brain along a pathway of nerve cells. The messages themselves exist in two forms: electrical and chemical. Electrical impulses originate within stimulated nerve cells. A stimulus to a nerve cell causes several changes to occur. First, tiny pores open, allowing charged particles to flow to the interior of the cell. Their presence upsets the balance of positive and negative charges that normally exists inside and outside the cell. In turn, this imbalance creates an electrical impulse. Like falling dominoes, the impulse moves from one point to the next, traveling down the length of the cell.

Once an impulse reaches the end of a cell, it moves to the next cell in the neuron path. However, no two nerve cells in the path actually touch one another. There is a gap, a little space called a synapse, between each neuron and the next cell. When an impulse reaches the end of a neuron, the electrical impulse cannot jump across the synapse. Instead, chemical messengers called neurotransmitters carry it over. On the far or postsynaptic side of the gap, special receptors provide a docking site for the neurotransmitters. The message continues down the line of neurons to the brain. The brain then sends a response message along another path of neurons back to the point of injury.

Chemicals That Block Pain

Any chemical that interferes with the transmission of a pain impulse stops the sensation of pain. The impulse can be blocked on its trip along nerves from the site of injury to the brain, or on the return trip from the brain back to the injury.

Different medicines block pain in different ways. Some slow the production of neurotransmitters; without neurotransmitters, the electrical impulse cannot get very far. Others block the receptors in synapses, preventing neurotransmitters from docking properly and stopping the conduction of the pain impulse.

In the mid-1900s, researchers began trying to understand exactly how narcotics block pain. In experiments, researchers mixed brain tissue with narcotics that had been tagged with radioactive materials. They found that brain tissue quickly attach to small amounts of opiates. Scientists knew from previous experiments that drugs get into cells in one of two ways: directly through the cell membrane, or by special receptors. This work had shown that those which travel through the membranes are generally required in large doses to be effective. On the other hand, drugs that are transported into cells by receptors are effective in much smaller amounts. Since brain tissue in the experiments only took up small quantities of tagged opiates, investigators suspected brain cells might have receptors for them. Solomon H. Snyder and Candace Pert, working at Johns Hopkins University School of Medicine, located these receptors in 1973.

Some areas of the nervous system have more opiate receptors than others. There are a lot of receptors in the part of the spinal cord that determines one's ability to tolerate pain. Snyder explains, "Opiates relieve pain at the spinal cord level by raising pain thresholds. Thus, if you were treated with morphine, an experimenter would have to administer a more painful stimulus than normal in order for you to notice any pain at all."¹⁴

Another part of the nervous system that has plenty of opiate receptors is the part of the brain that recognizes pain. Snyder says that

the major analgesic activity of opiates is not so much a raising of the pain threshold as a blunting of the brain's subjective appreciation of pain. Patients who have been treated with morphine because of severe post-operative discomfort or extreme pain from cancer frequently tell their doctors, "It's a funny thing. The pain is still there, but it doesn't bother me."¹⁵

In short, when the brain stops worrying about the pain, the pain becomes more manageable.

The Body's Own Pain-Killers

After researchers Snyder and Pert found that the body possessed natural opiate receptors, they asked the next logical question: Since the body does not make opiates, why does the brain have special receptors for them? Scientists theorized that the body makes compounds that normally fit these receptors, and that these compounds have a chemical structure similar to that of opiates. Even before they were located, scientists named these natural chemicals "endorphins," short for "endogoneous morphine."

It is now known that endorphins, or enkephalins as some of them are called, are neurotransmitters released in response to deep pain. Endorphins are short-lived, natural chemicals that bind to the receptors then rapidly degrade. Because endorphins do not remain in brain cells for a long time, they have none of the unwanted effects of narcotics. For example, narcotics are addicting drugs, but endorphins do not have the ability to addict.

Endorphins play valuable roles in survival. When a person is in a dangerous situation, endorphins flood the body, preventing the perception of pain. This enables a person to escape from danger even if they have an injury. Runners and other athletes produce large amounts of endorphins when they push their bodies to their physical limits. Many athletes report that they never feel bad or suffer any pain until after a competition, when their endorphin levels begin to drop.

The euphoria produced by opiates can also be partially explained on a biochemical basis. In the brain, "several structures . . . are collectively referred to as the limbic system because they form a ring, or 'limbus,' surrounding the brainstem. A large body of research suggests that these structures are the major regulators of emotional behavior."¹⁶ The presence of opiate receptors in the part of the brain that helps control emotions ties opium use to feelings of happiness.

Flower Power

Opium's extraordinary power to alter sensation is due to the close fit of opium molecules with the receptors in the human brain. Opium and its derivatives match structures in the brain like keys slipping into locks. Because of its ability to relieve pain and alter perception, opium has a long history of use in religious ceremonies, medical treatments, and recreational activities. The drug has been hailed as a gift from heaven, a kiss from the gods, and an instrument to raise the dead. However, its negative effects have become apparent over the years.