Opium

• STATUS: Legal with a prescription; illegal as the street drug heroin
• CLASSIFICATION: Schedule I and II controlled substances
• SOURCE: Dried latex of the outer skin of the poppy plant (Papaver somniferum)
• TRANSMISSION ROUTE: Oral, intravenous, intramuscular, parenteral, transdermal, rectal, inhalant

DEFINITION: Opium is a narcotic drug produced from the poppy plant that binds to specific opioid receptors in the central nervous system to relieve pain.

History of Use

Opium is processed in a manner that has changed little from fifth-century methods. Ancient peoples also used the plant to alleviate pain and anxiety and to perform minor surgeries. Early civilizations wrote about the healing powers of opium, as did such early physicians as Dioscorides, Galen, and Avicenna. Throughout these times, written records indicate that opium was considered primarily a healing tool and not a recreational drug.

China was the next great civilization to be introduced to the opium plant through trade with the Islamic world around the fifteenth century. Chinese people also used opium for medicinal purposes, but as opium use spread, people began to find a new use for the plant. The gummy rolled-up balls of the poppy plant, which resemble clay, were smoked in special pipes that circulated air under the opium balls. The result was a euphoric and hallucinogenic experience. While smoking opium was by no means epidemic, it was popular and highly addictive.

By 1900, Friedrich Sertürner had isolated morphine from opium, Pierre Jean Robiquet had discovered codeine, and opium and opium derivatives were becoming the most popular medicines in the US. Produced by Bayer, Heroin (the brand name) was given to children as a cough syrup. Laudanum, a tincture of opium, was one of the most highly prescribed medicines, primarily to middle-class women for menstrual pains, facilitating addiction. Soon, the Harrison Act of 1914 was passed to regulate opiate use in the United States.

Opiates are now integrated into medicine as necessary tools for pain control. However, modern physicians face an increasing number of regulations in prescribing these drugs. Strict regulation of opioid drugs has gained support due to the rising rates of abuse by a small group of physicians and by the alarming rates of prescription medication abuse. This regulation has affected patient care, as physicians, especially those who care for persons with chronic pain and those who provide end-of-life or palliative care, often fear prescribing opiates. For those needing palliative care, physicians argue that denying dying patients pain medicine for fear they will develop an addiction goes against the Hippocratic oath. Even physicians who do not treat patients needing such care tend to under-prescribe pain medications. Studies show that about 50 percent of patients report that they are not receiving adequate treatment for their pain.

By the 2010s, opioid abuse had steadily increased to the point where opioid overdose was considered an epidemic by organizations such as the Centers for Disease Control and Prevention (CDC) and the US Department of Health and Human Services (HHS). In 2015, deaths resulting from drug overdose were the leading cause of death from injury in the United States, and that same year, the HHS launched an initiative targeting this epidemic. Health officials had grown particularly concerned over the increased abuse of prescription opioids, especially among younger populations. In 2017, HHS declared the US opioid crisis a public health emergency.

According to the CDC, between 1999 and 2023, around 806,000 people in the US died from an opioid overdose. In 2022, 81,806 people died of opioid overdose, an average of 224 daily opioid overdose deaths. By 2022, US overdose deaths involving commonly prescribed opioids had declined, while overdose deaths involving illegally made synthetic opioids, including fentanyl and fentanyl analogs, increased. However, 2023 saw the first decline in opioid-involved overdose deaths since 2018, totaling 79,358.

Effects and Potential Risks

Opiates work by disrupting the signals of pain sent to the brain from various channels. Some signals move through the nervous system. Other signaling systems are chemical and involve a biochemical cascade. One of the reasons why opiates are so effective is that they can block pain at many of these points.

Opiates are quick-acting; a patient in severe pain will feel instant relief through the aid of intravenous morphine, for example. Oral medication takes about twenty to thirty minutes before acting, but is extremely effective at controlling pain.

The most common side effects of opiates are constipation, sedation, nausea and vomiting, respiratory distress, tolerance, and addiction. For persons with cardiac or pulmonary disease, careful monitoring is necessary to check the patient’s breathing. This is especially relevant in hospice care, where patients may be receiving high doses of morphine, which can severely impair breathing.

Detoxification from any opiate, whether a street drug like heroin or a legally prescribed medication, is extremely difficult and can be life-threatening if not performed under medical supervision. Any person taking large doses of an opiate who attempts to detox can experience seizures, prolonged insomnia, severe depression, suicidal thoughts, anxiety, and panic attacks. Physical symptoms include vomiting, shaking, anorexia, fever, and chills. It is recommended that a person who needs help with any kind of opium addiction seek the help of a physician.

Bibliography

Booth, Martin. Opium: A History. St. Martin’s, 1999.

Harris, Nancy, editor. Opiates. Greenhaven, 2005.

Nicholson, Bruce. “Responsible Prescribing of Opioids for the Management of Chronic Pain.” Drugs, vol. 63, 2003, pp. 17–30.

"Opioids." National Institute on Drug Abuse, NIH, Nov. 2024, nida.nih.gov/research-topics/opioids. Accessed 20 Oct. 2025.

"Prescription Opioids DrugFacts." National Institute on Drug Abuse, NIH, June 2021, nida.nih.gov/publications/drugfacts/prescription-opioids. Accessed 20 Oct. 2025.

"Understanding the Opioid Overdose Epidemic." Centers for Disease Control and Prevention, 9 June 2025, www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html. Accessed 20 Oct. 2025.