OPIUM

OFFICIAL NAMES: Opium, laudanum, paregoric, Dover's powder

STREET NAMES: Big O, black stuff, block, gum, hop/hops, ah-pen-yen, Aunti, Aunti Emma, black, black pill, chandoo/chandu, Chinese molasses, Chinese tobacco, dopium, Dover's deck, dream gun, dream stick, dreams, easing powder, fi-do-nie, gee, God's medicine, gondola, goric, great tobacco, guma, joy plant, midnight oil, O, O.P., ope, pen yan, pin gon, pin yen, pox, skee, toxy, toys, when-shee, ze, zero

DRUG CLASSIFICATIONS: Schedule II, narcotic

OVERVIEW

Opium, the parent of heroin and a myriad of other addictive derivatives, has a long and fascinating history. Opium has been used for medical, religious, and recreational purposes, and has been featured in, and used to inspire, art, literature, and poetry. As an international commodity, it has been the focus of regulation, legislation, even war. Opium's addictive and detrimental effects have caused untold suffering throughout history. Its ability to relieve pain has brought untold relief to the injured, ill, and dying.

Opium is a naturally occurring narcotic derived from the annual plant Papaver somniferum, widely known as the opium poppy. Although readily recognized in many countries and even celebrated at various times and places in history, the opium poppy lives legally in the United States and many other countries today only in memory and myth. For example, these poppies are popularly recognized in the United States for their role in the children's story, The Wizard of Oz, as the flowers the Wicked Witch used to put Dorothy and her companions to sleep as they traveled to the Emerald City in the mythical land of Oz. However, the true history of the drug and the poppy flower tells an intriguing story in itself.

Scholars have suggested several origins for the opium poppy, including southern Europe, Turkey, and northwestern Africa. Exactly when opium came into medicinal and recreational use is also uncertain; however, it is clear that the cultivation of the plant and use of opium are ancient practices, dating to 4000 b.c. or even earlier. Poppy seeds and seed pods have been discovered in the remains of Neolithic lake villages in what is now Switzerland. The Sumerians referred to the opium poppy as Hul Gil, the "joy plant." The Assyrians, Babylonians, and Egyptians cultivated the opium poppy with trade routes extending into Greece and Europe. The opium derivative, thebaine, even takes its name from poppy fields in the ancient Egyptian city of Thebes. Poppies appeared in Homer's Illiad and Odyssey and Virgil's Aeneid. Several Roman gods were regularly depicted with poppies. It has even been suggested that the vinegar and gall offered to Jesus Christ during his crucifixion was an opium mixture.

Arab traders introduced the opium poppy east into China sometime between the fifth and the eighth century. It was later traded to Europe by the Venetians and then by the Portuguese. Well-known explorers Columbus, Magellan, and Vasco de Gama were all instructed to find opium.

Opium became very popular, especially in Southeast Asia. Among its attractions, opium provided medicine, cheap recreation, and an alternative to alcohol. It was also affordable to the poor and enabled them to do with less food.

Opium cultivation and use became especially prevalent in India and later in China where the Chinese smoked an opium-tobacco mixture (madak or madhak). Sometime during the mid-1700s, they began to smoke pure opium—a habit that spread from the wealthy to the common people. British merchants, in particular, capitalized on the Chinese demand for opium. By building on their already thriving colonial Indian tea trade, the merchants readily dominated opium trade with China. Tensions between Britain and China over the opium trade eventually resulted in the Opium Wars, two separate conflicts occurring during 1839–42 and 1856–60. A number of Westerners made great profits in the opium trade, reputedly including John Cushing, John Jacob Astor, and Warren Delano II (grandfather of U.S. President Franklin Delano Roosevelt).

In the 1800s, Chinese immigrants took their opium-smoking habit around the globe. Chinese laborers were kept impoverished by their habit when by their creditors would sell them high-priced opium. However, opium smoking and the medicinal use of opium increasingly gained popularity across all levels of society. A number of famous people used or became addicted to opium, including writers who used opium while seeking to enhance creativity, imagination, and spontaneity. Writers that embraced opium during this general period include Goethe, Samuel Taylor Coleridge, William Wordsworth, John Keats, Sir Walter Scott, Lord Byron, Elizabeth Barrett Browning, and Edgar Allen Poe. Thomas De Quincey even wrote an autobiographical book, Confessions of an English Opium-Eater.

By the late 1800s, an unregulated patent medicine trade was booming across the United States. These medicines were actually unpatented concoctions, many containing opium; patent medicines that followed contained morphine, heroin, or cocaine. Similar to today's over-the-counter medicines, these concoctions were readily available for purchase in pharmacies, grocery stores, bookstores, and even by mail order without a doctor's prescription. They were marketed as treatments for ailments ranging from athlete's foot to cancer and were frequently promoted for their painkilling and "soothing" properties. Dover's Powder (a mixture of ipecac and opium) and Mrs. Winslow's Soothing Syrup (a cough suppressant) were two popular products.

Use of opium-laced medicines was also widespread in Britain. Since there were no laws required labeling the content of these medicines until the Pure Food and Drug Act of 1906, many users were unaware of exactly what was in their medicine bottle.

Not fully understanding the processes or implications of addiction, physicians encouraged the use of these medicines, which resulted in a growing addiction problem in the United States. The development of opium derivatives compounded the problem. For example, the discovery of morphine, a powerful painkiller derived from opium, and the invention of the hypodermic needle combined to create a new and efficient way to administer drugs. For the first time in history, a powerful painkiller could be administered in a measurable dose. The method was readily embraced by the medical community and provided untold relief for those injured or suffering from dysentery during the Civil War. However, so many soldiers became addicted that morphine addiction came to be known as the "soldier's disease." Heroin, another opium derivative, was isolated in the late 1800s. Due to its depressant effects on the respiratory system, heroin was widely touted as a cough and lung medicine, a welcome intervention in an era before tuberculosis could be cured with antibiotics. Ironically, it was even hailed as a cure for opium addiction at one point.

Addiction was widespread by the turn of the twentieth century, especially among the middle and upper classes, and many addicts were young to middle-aged white women who had originally taken addictive substances under the advice of their physicians. Although there are no verifiable statistics from that time, estimates range from 100,000 to more than one million addicts in the United States. Unlike today, opium use was not associated with criminality but with illness.

As a result of various government efforts, many patent medicines were eliminated from the market. Legislative efforts continued throughout the century. The 1970 passage of the Controlled Substances Act (CSA), Title II of the Comprehensive Drug Abuse Prevention and Control Act, established comprehensive federal guidelines for controlling narcotics that consolidated previous laws.

CHEMICAL/ORGANIC COMPOSITION

Opium is classified as a narcotic. By definition, narcotics have analgesic (or painkilling) properties as well as effects beyond lessening pain, such as producing euphoria and addiction. Opium has long been valued for its analgesic effects. However, not all analgesics are narcotics, because they do not produce these side effects; aspirin and Tylenol are examples of non-narcotic analgesics.

Raw opium is harvested from the seed pod of the opium poppy. As many as 50 substances called alkaloids can then be derived from opium, and the opium can be further processed. Alkaloids are naturally occurring plant products that possess some pharmacological activity, and are found in other plants as well as opium poppies. Cocaine and nicotine are examples of alkaloids derived from the coca plant and the tobacco plant, respectively. Because of their chemical composition, alkaloids are often used in producing medicines.

The alkaloids derived from opium are collectively known as opiates. Morphine, codeine, and thebaine are well-known opium derivatives. Paregoric is an opium tincture (opium in an alcohol mixture).

Semisynthetic and synthetic narcotics are also produced that have opiate-like effects; these narcotics are collectively known as opioids. They include methadone and the designer drug fentanyl, and a number of commonly prescribed medicines such as Darvon, Demerol, Dilaudid, Orlaam, OxyContin, Percodan, Talwin, and Vicodin.

Opium production

The poppies that produce opium grow to be 3–5 ft(1.5 m) tall, produce brightly colored flowers ranging from white, to pink, red, or purple, and do well in warm, dry climates. The plant is an annual, meaning it must be re-planted each season, and will flower and produce the seed pod from which opium is derived only once in its 120-day growth cycle. Many popular varieties of poppy produce three to five of these mature pods per plant.

After the poppies bloom, petals drop off and farmers are able to collect the opium from the unripe seed pod in the center of the flower. Illicitly harvesting opium is labor-intensive work that must be done by hand. The pod is slit with specially designed knives. Called taping, scoring, or lancing, the slit is made just deep enough to get the white latex-like sap to ooze onto the outside of the pod where the farmer allows it to dry. After the sap darkens and thickens into a sticky gum, the farmer collects it by scraping it off with another specially designed tool. This sap is raw opium. High-quality opium will be brown and sticky.

The pods can continue to ooze their sap for several days, so the farmer may tap pods to collect the opium several times. Some of the most productive seed pods will also be harvested to provide seeds for the next year's crop. On average, a single pod produces less than 80 mg of raw opium, according to the United States Drug Enforcement Administration (DEA). An area of2.5 acres (1 hectare) may yield roughly 17.6–33 lb (8–15 kg) of raw opium.

After harvesting, the wet resin must be dried for several days. It will then be wrapped and stored. If dried correctly, it can be stored for an indefinite period. The DEA has reports of opium that has been stored for 10 years without deteriorating.

Raw opium may be smoked, but it is usually "cooked" first, a process in which the raw opium is boiled in water. The opium dissolves and impurities such as twigs and dirt are removed by straining. This leaves a clear, brown liquid called "liquid opium," which is then re-heated until the water evaporates and all that remains is a thick paste. The paste is then sun-dried to the proper consistency for smoking or eating.

Both raw and cooked opium contain alkaloids. These alkaloids can be extracted from the opium to produce opium derivatives for legal pharmaceuticals or for illegal consumption, such as morphine and heroin. The morphine alkaloid content, which ranges from 8% to 12%, determines the quality of the opium.

Morphine is extracted first, and the resulting product can then be converted into heroin. Addicts generally do not use morphine base because it is not readily water soluble, thus not easily absorbed by the body. Further purification is required to produce a more pure product, morphine hydrochloride. This more refined morphine is commonly pressed into a 2 x 4 x 5 in (5 x 10 x 2 cm) block (also called a "brick") weighing approximately 3 lb (1.3 kg). It takes approximately 28.7 lb (13 kg) of opium to produce one of these morphine blocks.

Morphine can then be converted into heroin base and, finally, into heroin. Because of the odor of the chemicals used, heroin conversion labs may be located in rural areas. In the first step of this process, morphine is converted into a tan-colored heroin base that is approximately 70% pure heroin. In step two, this base can then be converted into smokable heroin (also known as heroin no. 3) or injectible heroin (also known as heroin no. 4).

INGESTION METHODS

Opium and synthetic narcotics can be processed such that they can be swallowed or eaten, drank in a variety of mixtures, smoked, injected, inhaled, or absorbed. Poppy farmers may even experience some effects of opium by walking through their fields after tapping the seed pods. Traditionally, however, opium is taken orally or smoked. Opium is sometimes flavored with spices to disguise its bitter taste, or mixed with wine, sugar, and/or honey; sugar or tobacco is sometimes mixed with opium for smoking. Opium ingestion is rare in the United States and other developed countries today.

THERAPEUTIC USE

Therapeutic uses of opium have been known for centuries. Ancient Assyrian medical writings mentioned poppy juice. Ancient Greek physicians knew the medicinal effects of poppies as did Hippocrates, the "father of medicine" (460–377 b.c.), and Hua To, Chinese surgeon of the Three Kingdoms (a.d. 220–264). In ancient Rome, opium was used both as a religious drug and as a poison to commit suicides or murders. Hannibal allegedly committed suicide by taking opium and Nero's mother poisoned a stepson with opium to assure Nero's ascendance to power. In more recent times, opium use was widespread in the United States and Britain during the nineteenth century. Opium and its derivatives were used as a treatment for almost every ailment, as well as by addicts, and by artists seeking recreation and enhanced creativity.

Several powerful and important modern medicines are derived from opium or are synthetic or semi-synthetic narcotics with opiate-like effects. Many of these medicines are primarily used to control pain but are also used to control coughs and diarrhea, and as anesthesia.

USAGE TRENDS

Even though the developed world's appetite for smoking or eating opium is not large, it still exists. The DEA estimates that the U.S. market for cooked opium, consumed by opium smokers, is still as much as 2.2 tons (2 metric tons) annually. Much of this market is apparently among Laotian Hmong and Mien refugees who have settled in Northern California, Minnesota, and Wisconsin.

In the United States and other developed countries, illicit opium derivatives such as heroin or licit synthetic opioids such as Vicodin have generally replaced the use of smoked or eaten opium. According to Drug Abuse Warning Network (DAWN) data provided by the Sub-stance Abuse and Mental Health Services Administration (SAMHSA), there were more than 82,000 emergency department admissions for narcotic analgesics/narcotic analgesic combinations in 2000. Only 167 of these visits were for opium and opium combinations.

Prescription opioids are often the drugs of choice for physicians and other health care professionals who become substance abusers. Their jobs often grant them easy access to pharmaceuticals, and these prescription drugs provide standardized doses without the dangers encountered in obtaining street drugs. These users frequently favor Demerol, Dilaudid, methadone, and morphine.

Opium use in developing nations

In some developing countries, particularly around the poppy fields themselves, opium is used for its medicinal and recreational effects. Opium smoking and/or eating is still a problem in rural areas where the poppies are cultivated. By some estimates, perhaps as much as 25% of the opium produced in Southeast Asia is consumed by opium poppy farmers.

Poppy farmers commonly smoke opium to fight hunger, cold, and chronic pain. Opium also retains a variety of other uses in developing countries. For example, Afghan carpet weavers eat opium to ease pain and to work longer hours. Opium is also used in some developing areas as a form of childcare to keep children quiet while parents work or to soothe their fussiness. It also serves as a treatment for diarrhea. Indeed, the widespread practice of using opium to treat diarrhea and malaria has been noted as an important factor in its rapid and early establishment throughout India, western China, and Southeast Asia, where these ailments were common. Additionally, opium has been believed in various places and points in history to have aphrodisiac (sexually enhancing) properties.

Opium also has a history of use with animals. For example, trainers have used opium balls in domesticating and training elephants. Increasing an elephant's opium allowance has also been used to control them during musth when a rutting, testosterone-driven male elephant might otherwise go on a rampage. For centuries, horses have also been given opium to prepare them for long journeys or military patrols.

MENTAL AND PHYSIOLOGICAL EFFECTS

Opium has been used for centuries for its analgesic (pain-relieving) properties. The opium derivative morphine has long been considered the standard narcotic to which all pain-relieving drugs are compared. These narcotics act on the central nervous system, relieving pain by interrupting pain messages in the brain or spinal cord. Opiates bind to special receptor sites in different parts of the brain and body that are active in transmitting pain signals.

Opium derivatives also have antitussive effects, meaning they suppress the cough reflex. Because of this effect, codeine is a frequently used ingredient in cough syrups. Opiates also slow digestion by slowing messages to the smooth muscles and reducing intestinal secretions. This effect makes them useful in treating diarrhea, but may also lead to constipation, a common problem for those who abuse opium. Additionally, users' heart rate, blood pressure, and respiration slow.

Other central nervous effects of opium and its derivatives include drowsiness, sedation, nausea, weakness, faintness, agitation, restlessness, nervousness, and decreased sex drive. Users may become very sleepy. In some rare cases, effects may include delirium and insomnia. Long-term narcotic use can lead to addiction, depression, difficulty sleeping or concentrating, agitation, tremors, seizures, and an increased sensitivity to pain. An extremely dangerous effect of these drugs is their depressive effect on the respiratory system, which may lead to unconsciousness, coma, and sometimes a rapid death. Users may also experience mood changes, euphoria, dysphoria (feeling unwell or unhappy), mental cloudiness, disorientation, or hallucinations.

These potential effects are impacted by such factors as circumstances of use (e.g., medical use supervised by medical professionals versus abuse), dosage, and route of administration. In general, effects increase as drug potency increases. The onset of these effects ranges from an immediate response to the drug to the user experiencing the impact 30–60 minutes later. The duration of their effects lasts from three to seven hours.

All opium derivatives are addictive and have the potential to be abused. For abusers, these substances produce a strong dependence, a complex concept. In simple terms, long-term opiate use changes the workings of nerve cells in the brain. These cells come to need the drug. The body needs the drug or it will experience effects from the drug's withdrawal. However, many myths surround opiate withdrawal. While it has been described as tortuous (a perspective often perpetuated by the media), other reports equate it to a severe case of the flu. Common withdrawal symptoms include cramps, a runny nose, chills, and muscle aches that are generally over in 24–48 hours.

Tolerance also develops with continued use, meaning that larger doses are needed to achieve the same psychoactive effect. Dosage, route of administration, and medical versus nonmedical use also play a role here. For example, abusers develop a psychological dependence on the drug. They develop a craving for the drug once it is removed. However, this craving does not generally develop among patients taking opioids for relief of severe pain. Pain patients do not continue to seek the drug to satisfy the cravings experienced by abusers. However, like abusers, pain patients do build up a tolerance to the drug. Also, like abusers, they may experience symptoms of physical withdrawal when they stop using the drug.

Harmful side effects

When using opium and its derivatives, the most obvious risk is coma or death from respiratory failure.

Medical professionals are well aware of the potential side effects of opiates and administer them according to strict guidelines. However, overdoses and negative side effects also may occur when taking prescribed drugs; prescription drugs may be diverted from medical use to abuse. Strong painkillers such as Vicodin and OxyContin are likely candidates for abuse. However, for users of street drugs, risks may be especially pronounced.

One group at risk for experiencing unwanted side effects from any drug use are pregnant women. Opioids cross the placenta and some are excreted in breast milk. Some types of prescription opioids may be used during pregnancy on a short-term basis under the direction of a medical professional. Ultimately though, pregnant women should always be guided by the advice of their physicians.

Patients who experience severe pain, either chronically from an illness or short-term from an injury or surgery, are another group with a special interest in the side effects of narcotics. One medical controversy revolves around the extent to which physicians should use powerful narcotics to relieve a patient's suffering. The fear that patients would become addicted (opiophobia) led to cases of doctors under-prescribing pain medication. Research has shown, however, that these fears are largely unfounded. Doctors have also been accused of over-prescribing these medications, leading to additional fears among physicians that legal consequences could result if they liberally prescribe opiate derivatives for patients in severe pain. An unfortunate result was that some patients were not prescribed the strong medicines necessary to alleviate their pain. This controversy led to guidelines from the federal Agency for Health Care Policy and Research addressing pain treatments. Additionally, research is underway seeking compounds that will result in effective pain-relief with smaller doses or no euphoric high.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

Drug mixing, taking two or more drugs in combination, may alleviate or intensify the effects. Opiates' pain-relieving effects may be intensified by the use of other drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Such use should be monitored by medical professionals to guard against stomach bleeding or organ damage.

When opium is abused, it may be combined with other licit or illicit drugs. In these cases, opium may be mixed with tobacco or other vegetable matter for smoking, a mixture called madak (or madhak). An A-bomb is a marijuana cigarette that contains heroin or opium, while Buddha is a strong form of marijuana spiked with opium. Opium may also be mixed with hashish in a concoction called black Russian or black hash.

Flavoring substances can also be added to opium, including spices, sugar, and/or honey to disguise its bitter taste. It is also mixed into opium wine mixtures, some of which are called Yen Shee Suey. Dross, the residue remaining in the pipe after prepared opium has been smoked, may be mixed with raw opium. Re-using this dross is a cost-cutting measure in opium production.

TREATMENT AND REHABILITATION

An assortment of treatments for opiate drug abusers are tailored to the needs of each user, including behavioral interventions such as counseling, psychotherapy, family therapy, and the use of support groups, treatment with medications, or some combination of both of these approaches. Research has even looked at acupuncture as part of treatment programs. Programs vary greatly in length and may include outpatient and/or inpatient treatments.

Medically assisted narcotic treatment programs use medications that suppress withdrawal symptoms and drug cravings while the person undergoes behavioral therapy and/or receives other health-related services.

These maintenance therapies supply regular doses of a drug that keeps the addict from experiencing withdrawal symptoms, drug cravings, or highs. Methadone and LAAM (levo-alpha-acetyl-methadol) are medications often used in these programs.

Heroin abusers comprise the vast majority of those in treatment for opiate abuse. According to the SAMHSA's Treatment Episode Data Set (TEDS), only 1% of admissions for addiction treatment recorded in 1999 were related to opiates other than heroin. However, the number of these admissions that was for opium itself cannot be determined from the available data because opium is categorized with all other drugs with morphine-like effects. Methadone was part of the treatment plan for 22% of those admitted.

Treatment programs are also needed to address the concerns of opiate users in developing countries. For example, some Afghan refugee camps have found a need to treat refugees for opium addiction. These refugees include laborers and those dealing with the pain of war wounds. In such situations, treatment options may include alternative medication and education.

PERSONAL AND SOCIAL CONSEQUENCES

Opium and its derivatives are addictive substances. In the developing countries where poppies are cultivated and opium is produced, peasants make more producing opium than they could make cultivating legitimate crops. The trade-offs they face include the personal consequences of addiction, the ethnic tensions fueled by the drug trade, the empowerment of drug lords, and corrupt politics, among others.

Poppy cultivation and opium processing also have consequences for the environment. Waste from morphine extraction can cause environmental damage when dumped by processors. In addition to water pollution from this chemical dumping, other environmental concerns include the deforestation that may occur when clearing land for poppy cultivation, soil erosion, and dangers to wildlife in the area where these chemicals are dumped.

LEGAL CONSEQUENCES

Opium poppies are grown and opium legally produced on government-regulated farms in a handful of countries including India, Turkey, and Tasmania in Australia. For most legal commercial production, alkaloids are extracted through a process of milling the "poppy straw." Rather than going through the entire opium-producing stage, the dried pods (the "poppy straw") are processed to obtain morphine, codeine, and thebaine and the seeds are sold as well. Unlike traditional illicit opium production, this process may be done with mechanized agricultural equipment.

One major benefit of this extract is for legitimate medicinal use. The DEA estimates that more than 500 tons (455,000 kg) of opium or its equivalent in poppy straw are annually imported into the United States for this purpose. The poppy also has other legitimate uses. For example, mature poppy seeds are used in the food industry such as in cake and bread decorations, and added to some dishes for crunchiness or flavor. (Alkaloids are only found in the ripening pod; mature pods cease to manufacture alkaloids.) Poppy seed can be pressed into cooking oil. Poppy seed oil is also legitimately used in artists' oil paints and in manufacturing perfumes. Throughout history, opium has also sometimes been used in religious rituals.

The possession of opium poppies was outlawed in the United States in 1942 by the Opium Poppy Control Act. Growing opium poppies is illegal in most countries. However, a number of areas around the world are infamous for their poppy cultivation. The countries of Laos, Burma, and Thailand comprise the Southeast Asian poppy growing area known as the Golden Triangle. The DEA estimates that Southeast Asian poppy fields produced nearly 3 million lb (1.4 million kg) of opium during 2000. Opium poppies are also illegally cultivated in Southwest Asia across a swatch known as the Golden Crescent, an area cutting across Pakistan, Iran, and Afghanistan. According to the U.N. Economic and Social Council Commission on Narcotic Drugs, illicit opium production is also reported in varying amounts in Armenia, Belarus, Colombia, Egypt, Guatemala, India, Italy, Japan, Kyrgyzstan, Latvia, Lebanon, Lithuania, Mexico, Peru, Portugal, Spain, Turkey, Uzbekistan, and Venezuela.

The U.N. Office for Drug Control and Crime Prevention (UNODCCP) reports that Afghanistan had emerged as the leading single source of illicit opium worldwide by 2000. In that year, Afghanistan produced as much as eight million lb (3.6 million kg) of opium, accounting for 70% of the world's illicit opium and 80% of the heroin reaching Europe. Afghan's Taliban rulers implemented a ban on opium poppy cultivation in 2001 and indications are that only 165,000 lb (75,000 kg) of opium were produced in Afghanistan that year. However, the UNODCCP reports that cultivation resumed after the fall of the Taliban due both to lawlessness and to farmers seeking to survive an ongoing drought. The main routes for smuggling Afghan opium to Europe and, in some cases, on to the United States are through Tajikistan, central Asia, and Eastern Europe; through Iran and Turkey to the Balkans; and through Pakistan.

In 2000, 430,000 lb (195,000 kg) of illegal opium were seized worldwide. The majority of these seizures (80%) were made by Iran, which seized approximately 364,000 lb (165,000 kg) of opium during that year.

Countries with the largest opium seizures in Southeast Asia tended to be those with the largest production.

Efforts to curb poppy cultivation have involved a variety of strategies including drug enforcement, the implementation of various legal frameworks, promoting alternative crops and sources of income, eradication efforts that use pesticides to kill plants, and economic interventions such as setting up rural credit systems. Some approaches focus on reducing drug demand and establishing rehabilitation, prevention, and/or drug abuse programs. In addition to reducing trafficking in drugs, some efforts focus on reducing the sale or trafficking of the chemicals used in the refinement process.

The U.N. Commission on Narcotic Drugs recommends that drug strategies also address money laundering, advising agencies to develop knowledge in this arena from experts such as the Turkish International Academy against Drugs and Organized Crime (TADOC). Other recommended training involves identifying drug couriers, establishing regional information exchanges on drug traffickers and current methods of operation, and training and equipping investigators to target major crime figures and financiers. Other recommendations emphasize government cooperation in information exchange, law enforcement efforts, and efforts to curb money laundering. Such cooperation would avoid duplication of effort and maximize resources. They also encourage governments to use the media in supporting their initiatives. The commission also encourages forward-looking drug strategies that look toward future trends and seek ways to interrupt smugglers' use of technology, with special attention given to sea routes and cargo containers.

Each of these strategies faces a number of challenges. Basic supply-and-demand economics impact drug prices. Opium prices fluctuate depending on a number of factors, including the production cycle, weather conditions that help or hinder poppy output, the availability of chemicals required to process the opium, the quality of the drug, and the local supply of opium and heroin. Opium prices saw large declines after the September 11, 2001, terrorist attacks but had recovered by March 2002, according to the U.N. Commission on Narcotic Drugs.

Opium traders buy the raw opium from farmers. In Southeast Asia, the price for raw opium in 1999–2000 ranged from $150 to $350 per kilogram. The price is marked up as the opium goes through each stage of processing and refinement. For example, the DEA reports that cooked opium is usually marked up approximately 20%. The price is then marked up again as the opium is refined into morphine base, morphine, heroin base, and heroin.

Opium production requires little infrastructure. Efforts to encourage alternative crops commonly find inadequate market infrastructures and transportation systems for handling legitimate crops. Targeting the chemicals necessary for processing the opium can be problematic in that many of the chemicals also have legitimate uses. The opium trade may be one element in on going ethnic conflicts. Additionally, when opium supplies are interrupted in one country, another source tends to take its place. In the late 1970s, the controversial defoliant Agent Orange was used to eliminate Mexican poppy fields. Golden Crescent opium production rapidly increased in response to the decreased Mexican supply.

The 1961 U.N. Single Convention on Drugs called for the eradication of opium in 25 years. A 1998 U.N. General Assembly Special Session called for eradication in 10 years. Instead of leading to the elimination of opium, some observers have argued that such goals are unattainable and sap ever-increasing amounts of resources. Many of these observers argue that the real keys to drug control lie in solving the economic and social problems that underlie drug production such as poverty, inequality, and political turmoil. Some observers contend that answers lie in decriminalization or legalization and a return to the view that addicts should be treated as if they are ill rather than lawbreakers. Other observers suggest that such stringent goals as those put forth by the U.N. are imperative in effectively waging any war on drugs.

Drug control efforts have often attempted to reduce both supply and demand. Strategies have included combinations of a range of legal and economic penalties, technologies, treatments, and educational and prevention efforts. The idea that currently illegal drugs should be legalized, or decriminalized, is also hotly debated. In brief, advocates of legalization or decriminalization contend that low rates of drug interdiction and high rates of use and drug-related crime mean that drug control efforts are not working. Their arguments include assumptions that drug prices would decrease; drug-related crime and corruption would decline, thereby freeing law enforcement resources for other needs; quality could be controlled; revenue would be produced for the government; and drug use would not increase significantly. Opponents of legalization argue that the behavioral, criminal, social, and public health problems that would arise would be considerable. They also point to high rates of legal alcohol and tobacco use as examples of what would happen to use rates if many currently illegal drugs were made legal. They cite evidence including the low rate of opium use in the United States today compared to the widespread use at the turn of the twentieth century in support of this last point.

Legal history

As medical understanding of addiction grew in the late 1800s, so too did the calls for reform of patent medicines and drug use in the United States. Many commentators have also connected the development of U.S. drug laws with growing racial fears. Concerns were raised that opium smoking was spreading beyond Chinese immigrants to the wider population and that blacks and Mexicans were unable to handle the growing drug use among those populations. News stories alleged the seduction of white women in Chinese opium dens and attributed a range of antisocial behaviors to minority users of illegal drugs. This began the current stigmatization of drug abusers as being outside mainstream society and as criminals rather than ill persons.

In 1909, Congressional legislation stopped the importation of smokable opium or opium derivatives except for medicinal purposes. The Harrison Narcotics Act of 1914 placed further controls on narcotics by addressing drug content, prescriptive, manufacturing, distribution, record-keeping, and taxation requirements. Under this act, only those licensed to do so could possess these drugs and they could only be prescribed for legitimate medical purposes, not for addict maintenance. A 1919 Supreme Court ruling upheld this position, consequently leading to strong narcotics regulations and ultimately to the current war on drugs.

After federal bans on opium, black markets developed to supply the demand. World War II temporarily interrupted opium smuggling routes. After the war, smuggling resumed with the U.S. government becoming involved in struggles in Southeast Asia that are sometimes blamed for fostering opium production and the heroin trade.

The development of synthetic narcotics was also encouraged by war needs. However, drug control efforts were somewhat haphazard. Although as of 1946 the Federal Bureau of Narcotics (FBN) oversaw potentially addictive synthetic narcotics, non-narcotics drugs and drug abuse were not adequately controlled. The Controlled Substances Act (CSA), Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 attempted to fill this void. It established regulations, including controls on narcotics, which covered a range of drug control activities. The CSA schedule still includes regulations covering opium in the United States.

Federal guidelines, regulations, and penalties

In the United States, the CSA classifies drugs into schedules according to their medical use, potential for abuse, and ability to produce dependence. The CSA places opium derivatives under different schedules. Opium, morphine, and methadone are Schedule II drugs. Schedule II drugs have high abuse potential, some accepted medical use in the United States, and a likelihood of severe psychological or physical dependence if abused. Federal trafficking penalties for a first offense of2.2 lb (1 kg) or more of a Schedule II substance is 10 years to life (20, if a death is involved) and fines of up to four million dollars for individuals and 10 million dollars for organizations. A second offense carries a minimum 20-year sentence and fines not to exceed eight and 20 million dollars.

Codeine is a Schedule III drug. These drugs have less potential for abuse than Schedule I or II drugs, an accepted medical use in the United States, and the likeli-hood of moderate or low physical dependence if abused. Federal trafficking penalties for a first offense of a Schedule III substance is not more than five years and fines of up to $250,000 for individuals and one million dollars for organizations. A second offense carries a maximum of 30 years to life if a death is involved and fines up to two and 10 million dollars.

Talwin, another opium derivative, is a Schedule IV narcotic. Schedule IV drugs have less potential for abuse than Schedule III drugs, an accepted medical use in the United States, and the likelihood of limited physical or psychological dependence if abused. Federal trafficking penalties for a first offense of a Schedule III substance is not more than three years and fines of up to $250,000 for individuals and one million dollars for organizations. A second offense carries a maximum of 30 years to life if a death is involved and fines up to two and 10 million dollars.

Non-prescription cough medicines with codeine are Schedule V drugs, which have a low potential for abuse compared to Schedule IV drugs, an accepted medical use in the United States, and the likelihood of limited physical or psychological dependence if abused. Federal trafficking penalties for a first offense of a Schedule V substance is not more than one year and fines of up to $100,000 for individuals and $250,000 for organizations. A second offense carries a maximum of 30 years to life if a death is involved and fines up to two and 10 million dollars.

See also Codeine; Heroin; Morphine; Oxycodone

RESOURCES

Books

Berlin, Laini, ed. Physician's Drug Handbook. 8th ed. Spring-house, PA: Springhouse Corp., 1999.

Booth, Martin. Opium: A History. New York: St. Martin's Press,1998.

Courtwright, David T. Dark Paradise: A History of Opiate Addiction in America. Cambridge, MA: Harvard University Press,2001.

Courtwright, David T. Forces of Habit. Cambridge, MA: Harvard University Press, 2001.

Inciardi, James A. The War on Drugs III: The Continuing Saga of the Mysteries and Miseries of Intoxication, Addiction, Crime, and Public Policy. Boston: Allyn and Bacon, 2001.

Musto, David F. The American Disease: Origins of Narcotic Control. New York: Oxford University Press, 1999.

Periodicals

Baldauf, Scott. "Afghan Weavers Unravel a Trade Tradition: Opium Use." Christian Science Monitor Electronic Edition (March 28, 2001). <http://www.csmonitor.com/durable/2001/03/28/fp7s2-csm.shtml>.

Food and Drug Administration. "The Story of the Laws Behind the Labels: Part I. The 1906 Food and Drugs Act." FDA Consumer(June 1981). <http://www.cfsan.fda.gov/~lrd/history1.html>.

Other

"Beyond the ABCs: Opioids and Pregnancy." Alberta Alcohol and Drug Abuse Commission. 2002 (July 8, 2002). <http://corp.aadac.com/drugs/beyond/opioidspreg.asp>.

Emergency Department Trends from the Drug Abuse Warning Network, Preliminary Estimates January-June 2001, with Revised Estimates 1994-2000. DAWN Series D-20, DHHS Publication No. (SMA) 02-3634. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA),2002. <http://www.samhsa.gov/oas/dawn/TrndED/2001/Text/TrndEDtxt.PDF>.

Illicit Drug Traffic and Supply: World Situation with Regard to Illicit Drug Trafficking and Action Taken by Subsidiary Bodies of the Commission on Narcotic Drugs United Nations Economic and Social Council, Commission on Narcotic Drugs, 45th Session, Vienna, 11-15 March, 2002. <http://www.odccp.org/pdf/document_2001-12-21_2.pdf>.

Opium Poppy Cultivation and Heroin Processing in Southeast Asia. U.S. Drug Enforcement Administration, DEA 20026, March 2001. <http://www.usdoj.gov/dea/pubs/intel/20026/20026.html>.

"Opium Throughout History." The Opium Kings. PBS Frontline. <http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html>.

The Price Dynamics of Southeast Asian Heroin. U.S. Drug Enforcement Administration, Intelligence Brief, February 2001. <http://www.usdoj.gov/dea/pubs/intel/01004-intelbrief.pdf>.

Treatment Episode Data Set (TEDS): 1994-1999. National Admissions to Substance Abuse Treatment Services. DASIS Series S-14, DHHS Publication No. (SMA) 01-3550. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA), 2001. <http://www.samhsa.gov/oas/teds/99TEDS/99Teds.pdf>.

Organizations

Drug Enforcement Administration (DEA), 2401 Jefferson Davis Highway, Alexandria, VA, USA, 22301, (800) 882-9539, <http://www.usdoj.gov/dea/index.htm>.

National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, [email protected], <http://www.nida.nih.gov/>.

Office of National Drug Control Policy (ONDCP); Drug Policy Information Clearinghouse, P.O. Box 6000, Rockville, MD, USA, 20849-6000, (301) 519-5212, (800) 666-3332, [email protected], <http://www.whitehousedrugpolicy.gov/>.

United Nations Office for Drug Control and Crime Prevention (UNODCCP); Vienna International Centre, P.O. Box 500, Vienna, Austria, A-1400, 43 1 26060 0, 43 1 26060 5866, [email protected], <http://www.undcp.org/>.

Kathy S. Stolley, Ph.D.