The Use and Abuse of Opium

By F. E. Oliver, M.D.

Massachusetts State Board of Health, Third Annual Report (Boston: Wright and Potter, State Printers, 1872), 162-77.

The well-attested fact of the increased and increasing consumption of opium in the United States, during the past few years, has suggested the inquiry whether, and to what extent, the so-called opium habit can be traced among our own inhabitants, and to what causes it may fairly be attributed. If it be true that this practice, so long an endemic in Eastern and Southern Asia, has appeared among us, and, according to a recent and careful observer, is rapidly gaining ground "in a ratio very considerably increasing as every successive year arrives," it is not too soon to look about us and see how far it has intruded upon our soil, that we may be the better prepared to meet, if need be, so insidious a foe. It is obvious, in an investigation of this nature, with the limited opportunity at command, that to reach more than an approximative result would be difficult, if not impossible. Many important sources of information are carefully guarded, and the habit is so unobtrustive as often to pass unnoticed by the casual observer, the professional eye alone detecting the secret in the haggard countenance, or in some maniacal propensity characteristic of the opium eater. It will not be surprising, therefore, if the statistics thus far obtained, although suggestive, seem meagre, and in many respects unsatisfactory. The following are the questions addressed to the physicians throughout the State:- 1st. Are preparations of opium used by the people except for the relief of pain? 2d. We would like to know whether the injurious use of opium has increased of late years, and, if so, the causes of such increase?Of the one hundred and twenty-five physicians from whom replies have been received, forty report, in answer to the first question, that they know of no case of opium eating. The remaining eighty-five state that opium is used to a greater or less extent in their respective circuits. In many of the smaller towns where the habit exists, the number of those addicted to it is reported as nearly as could be ascertained. In the returns from others, the terms 4 ( few," "many" and "several" are alone given, and in still others the number is altogether omitted. From such uncertain data, it would, of course, be impossible to arrive at anything like an accurate computation. The number in the towns where it is given varies from one to twelve, the latter being the largest reported in any one. In the larger towns,-as Boston, Charlestown, Worcester and New Bedford,-the number is necessarily much larger. On inquiry among the druggists of Boston, we learn that their experience is various, there being those who have little call for the drug, and who make it a rule never to sell it without a written prescription; while others have many regular customers. One druggist states that, although he never sells it without a physician's order, he has, on an average, five or six applications for it daily, in some one of its forms. Two other prominent druggists have each six habitual purchasers. Several report one or two. Much seems to depend on locality. In the more public streets, and in parts of the city where those addicted to the habit mostly reside, the sales are much larger. In Worcester, one druggist reports that "opium is used to an alarming extent in that community." In Charlestown, inquiry was made at all the eighteen druggists' shops. Of these, "eleven have at present no regular customers; one never sells, except on prescription; the remaining six report sales to regular purchasers of opium, as follows:-each shop has an average of two, the largest number to any one being four."

In Chicopee, the druggists report that they have a great many regular customers. Many others in various parts of the State speak of the habit as quite prevalent. A prominent druggist of Boston states that "the sales of opium preparations to the country trade is out of all proportion to those of other drugs." From these statements the inference is unavoidable that the opium habit is more or less prevalent in many parts of the State; and, although it may be impossible to estimate it, the number addicted to the drug must be very considerable. The number of opium eaters in the United States, says a late anonymous writer, has been computed, from the testimony of druggists in all parts of the country, as well as from other sources, to be not less than from eighty to one hundred thousand. How far Massachusetts contributes toward her numerical quota, must, for the present, be a matter of conjecture. The daily amounts of opium reported as taken vary with the habit and idiosyncrasy of the taker. Few even approach De Quincey, whose daily laudanum potations amounted to more than half a pint, equivalent to about three hundred and twenty grains of the gum. In the town of Athol, of twelve opium eaters reported, "one person takes an ounce of laudanum daily; another, nine ounces weekly; another, two ounces monthly; two take one drachm of sulphate of morphia each, weekly; two take half that quantity in the same time; and two take a drachm of this salt each, monthly; one takes one ounce of opium, and one twice this quantity every month." In Charlestown, the largest monthly sale of the sulphate of morphia is ten drachms; the average to each of five is eight drachms monthly; of laudanurn, two persons are reported who each buy thirty ounces per month; one buys eight ounces of cr ' ude opium in the same time; one uses about one ounce of opium monthly; and two others two ounces each. In Leyden, one person is reported who takes one drachm of the sulphate of morphia weekly. In Shrewsbury, "of seven habitual opium eaters, one drachm of the sulphate of morphia, weekly, is the largest amount used."

In Shirley, one drachm of the sulphate of morphia is taken, by the one opium eater reported, in three weeks. In Swampscott, one person is reported who takes two ounces of laudanum daily. In Boston, one druggist sells to a customer one ounce of laudanum daily,-two ounces being ordered on Saturday. It will be noted that the largest quantity of crude opium taken was eight ounces per month, or about one hundred and twenty-eight grains daily. The largest reported daily amount of laudanum was one ounce. The largest monthly sale of the sulphate of morphia was ten drachms, at the rate of one-third of a drachm daily, and equivalent to not far from one hundred grains of the gum. A Boston druggist informs us that not long since, an habitual customer bought a drachm of the sulphate of morphia, one-half of which he took on the spot, and, on the following day, having disposed of the remainder, called for a draught containing an ounce and a half each of laudanum and brandy. No apparent effect followed the dose referred to. The question as to the increase "in the injurious use of opium," and the causes of such increase, where this exists, seems to have received but partial attention. Of the eighty-five correspondents above mentioned, thirty-nine make no allusion to this inquiry. Twelve are of the opinion that the habit is decidedly on the increase, twenty-eight, that it is not increasing, and six, that it is diminishing, in their respective districts. These opinions, not always based upon very accurate observation, must be taken for what they are worth. The more general opinion among the best informed druggists throughout the State is that the habit is increasing. The following extract from a communciation received from one of the State Assayers, Mr. S. Dana Hayes, will be found of especial interest in this connection:- "In reply to your inquiries, it is my opinion that the consumption of opium in Massachusetts and New England is increasing more rapidly in proportion than the population. There are so many channels through which the drug may be brought into the State, that I suppose it would be almost impossible to determine how much foreign opium is used here; but it may easily be shown that the home production increases every year. Opium has been recently made from white poppies, cultivated for the purpose, in Vermont, New Hampshire and Connecticut, the annual production being estimated by hundreds of pounds, and this has generally been absorbed in the communities where it is made. It has also been brought here from Florida and Louisiana, while comparatively large quantities are regularly sent east from California and Arizona, where its cultivation is becoming an important branch of industry, ten acres of poppies being said to yield, in Arizona, twelve hundred pounds of opium. This domestic opium is often improperly manufactured in the form of expressed juice from the whole poppy plant, including the stems, leaves and flowers, instead of the exuded sap obtained by scarifying the capsules of the plant. It is generally deficient in morphia, and is sold in balls of sticky paste, covered with green leaves, or as a semi-fluid, like thick-boiled molasses, in boxes. That which is not used where it is produced, including the shipments from California and the West, together with inferior and damaged parcels of foreign opium received and condemned at this port, is sent to Philadelphia, where it is converted into morphia and its salts, and is thus distributed through the country. "Opium and morphia are not only freely used in patent and commercial medicines, but they have now become common ingredients in many family remedies, which were formerly made at home from simple herbs and roots,-such as cough mixtures, tooth washes, lotions, liniments, enemas, poultices, healing tinctures and decoctions. Opium is consumed in the form of pills often made by very unskilful hands, and it has been found in alcoholic liquors, especially in the brandy which was sold publicly in one of the western towns of this State. "Among the most dangerous preparations of morphia are those now prescribed and sold by uneducated or villainous individuals as so-called 'cures' for persons afflicted with the uncontrollable appetite for opium-'Relie f for the Opium Eater'-; and the very existence of such nostrums certainly indicates the extent of the disease. One of these preparations consisted of a clear solution of sulphateof morphia, colored pinkish by aniline fuschine, and sweetened; the directions accompanying it were not very definite, but a dose containing about two grains of sulphate of morphia was to be taken three times a day, 'if necessary,' by the patient, when suffering badly from depression and other symptoms.

"I need only refer to the frequency of wilful and accidental poisoning and narcotization by morphia or opium, as you are familiar with such cases; but they are certainly increasing every year in this State."

In the extracts from the letters of our correspondents given below, it will be noticed that frequent mention is made of this habit, as caused by the injudicious and often unnecessary prescription of opium by the physician. So grave a statement, and one so generally endorsed, should not be allowed to pass unnoticed by those who, as guardians of the public health, are in no small meas-ure responsbile for the moral, as well as physical, welfare of their patients.It is unnecessary here to do more than allude to the other physical causes that occasionally lead to excess in the use of opium, dependent upon a depressed condition of the nervous system, induced either by occupation, overwork with deficient nutrition; or by a vicious mode of life, as prostitution, and sometimes, intemperance. Those more generally exempt from this vice are out-ofdoor laborers, and others whose occupations allow an abundance of fresh air and nourishing food, with regular hours of sleep. A deficiency in these natural stimuli, so essential to sound health, promotes a desire for artificial substitutes, and opium, where others are unavailable, is often resorted to. In England, and we suspect the same would be found true, although to a less extent, in our own country, the opium habit is especially common among the manufacturing classes, who are too apt to live regardless of all hygienic laws. The taste for opium eating among soldiers retired from the army is alluded to by a few of our correspondents. It seems also to have been noticed in England, and is probably due to the habit acquired in the service, or to shattered health, the result of campaign exposure. The fact generally remarked that wornen constitute so large a proportion of opium takers, is due, perhaps, more to moral than to physical causes. Doomed, often, to a life of disappointment, and, it may be, of physical and mental inaction, and in the smaller and more remote towns, not unfrequently, to utter seclusion, deprived of all wholesome social diversion, it is not strange that nervous depression, with all its concomitant evils, should sometimes follow,-opium being discreetly selected as the safest and most agreeable remedy. We must not omit, however, one other most important cause of this habit referred to by our correspondents, and the most general one of all that predispose to it. We allude to the simple desire for stimulatioD,-in the words of another, "that innate propensity of mankind to supply some grateful means of promoting the flow of agreeable thoughts, of emboldening the spirit to perform deeds of daring, or of steeping in forgetfulness the sense of daily sorrows." No climate and no soil is without some product of its own which furnishes, at man's bidding, a stimulating ingredient to meet this universal want. In an age, too, like our own, of unprecedented mental and physical activity, the constant over-exercise of all the faculties, together with the cares and perplexities incident to a condition of incessant unrest, create a keener appetite for some sort of stimulus. No clearer confirmation of the truth of this statement is needed than the present enormous consumption of alcohol and tobacco, as well as of those milder stimulants, tea and coffee, for which there is an ever-increasing demand.

The selection of opium in preference to other stimulants, due more often to a taste, natural or acquired, is sometimes prompted, as appears in our reports, by motives of expediency-the facility, perhaps, with which it can be procured and taken without endangering the reputation for sobriety. In one town mentioned, it was thought "more genteel" than alcohol.

The question how far the prohibition of alcoholic liquors has led to the substitution of opium, we do not propose to consider. It is a significant fact, however, that both in England and in this country, the total abstinence movement was almost immediately followed by an increased consumption of opium. In the five years after this movement began in England, the annual importations of this drug had more than doubled; and it was between 1840 and 1850, soon after teetotalism had become a fixed fact, that our own importations of opium swelled, says Dr. Calkins, in the ratio of 3.5 to 1, and when prices had become enhanced by fifty per cent "The habit of opium chewing," says Dr. S6116, "has become very prevalent in the British Islands, especially since the use of alcoholic drinks has been to so great an extent abandoned, under the influence of the fashion introduced by total abstinence societies, founded upon mere social expediency, and not upon that religious authority which enjoins temperance in all things, whether eating or drinking, whether in alcohol or in opium." And, in other countres, we find that where the heat of the climate or religious enactments restrict the use of alcohol, the inhabitants are led to seek stimulation in the use of opium. Morewood, also, in his comprehensive History of Inebriating Liquors, states that the general use of opium and other exhilarating substances, among the Mahometans, may date its origin from the mandate of the Prophet forbidding wine. These statements accord with the observations of several of our correspondents, who attribute the increasing use of opium to the difficulty of obtaining alcoholic drinks. It is a curious and interesting fact, on the other hand, that in Turkey, while the use of wine of late years has increased, that of opium has as certainly declined. We had almost omitted to mention one source of the opium appetite, more than once referred to by our correspondents: we allude to the taste implanted in infancy and childhood by nursery medication. When it is remembered that nearly all the various soothing sirups contain this drug, or some one of its preparations, in greater or less proportion, it will not be surprising that such a result should sometimes follow.

The preparations of opium reported as more commonly used are, besides the drug itself, laudanum, paregoric, sulphate of morphia and, occasionally, McMunn's Elixir. When a more prompt and stimulating effect is desired, as is often the case with those who have been addicted to alcohol, laudanum may be preferred. The sulphate of morphia seems to be growing in favor, its color and less bulk facilitating concealment, and being free from the more objectionable properties of opium. This salt is not only taken internally, but is sometimes used hypodermically. In one case reported in Boston, the whole body was covered with the scars left by the punctures of the injecting instrument. Paregoric is also largely used as a stimulant, although, as a sedative in nursery practice, it has been to a great extent superseded by the so-called "soothing sirups," in which opium is the active ingredient, as it is also in the various other abominable compounds which pass under the name of cough sirups, pectorals, cholera medicines, pain killers, etc. Our Scituate correspondent reports that infants in that town are unmercifully drugged with soothing sirups. In Winchester, also, these nostrums are mentioned as quite common, having quite displaced paregoric in the nursery. The basis of what is known as Winslow's Soothing Sirup is morphia. A recent analysis of a sample of this medicine gave one grain of the alkaloid to an ounce of the sirup; the dose for an infant, as directed, being four or five times that usually regarded as safe. Godfrey's Cordial is also used for a similar purpose, containing more than a grain of opium to the ounce. The consideration of a remedy for this habit, if such there be, hardly falls within our province. We may, perhaps, be pardoned the suggestion, however, that, based as it is upon a craving that no laws can eradicate, the allowance of those milder stimulants, everywhere in use in Continental Europe, might aid, at least, in lessening the consumption of both alcohol and opium. It is an instructive fact that, in the history of legislation, whether against opium, alcohol, tobacco or coffee, for all have, at different periods, been the subjects of legislative enactment, in no instance has the end sought been reached. Substitution, or successful evasion, has been the immediate consequence of all such efforts. In countries where the culture of the vine prevails, drunkenness and opium eating are comparatively almost unknown. It is certainly not unreasonable to suppose that the permitted use of the lighter wines, and, among malt wines, of lager beer, and the promotion of wine manufacture would tend to the prevention of the latter habit, and, in time, go far towards solving the vexed question which of late seems to have disturbed the public mind.