 | |
| Combination of | |
|---|---|
| opium | analgesic |
| ethanol | tincture |
| Clinical data | |
| Pronunciation | /ˈlɔːdnəm, -dənəm/ |
| Pregnancy category |
|
| Routes of administration | Oral, buccal, sublingual |
| ATC code | |
| Legal status | |
| Legal status |
|
Reddish-brown and extremely bitter, laudanum contains almost all of the opium alkaloids, including morphine and codeine. Laudanum was historically used to treat a variety of conditions, but its principal use was as a pain medication and cough suppressant. Until the early 20th century, laudanum was sold without a prescription and was a constituent of many patent medicines. Today, laudanum is recognized as addictive and is strictly regulated and controlled as such throughout most of the world. The United States Uniform Controlled Substances Act, for one example, lists it on Schedule II.
Laudanum is known as a "whole opium" preparation since it historically contained all the opium alkaloids. Today, however, the drug is often processed to remove all or most of the noscapine (also called narcotine) present as this is a strong emetic and does not add appreciably to the analgesic or antipropulsive properties of opium; the resulting solution is called Denarcotized Tincture of Opium or Deodorized Tincture of Opium (DTO).
Laudanum remains available by prescription in the United States and theoretically in the United Kingdom, although today the drug's therapeutic indications are generally confined to controlling diarrhea, alleviating pain, and easing withdrawal symptoms in infants born to mothers addicted to heroin or other opioids. Recent enforcement action by the U.S. Food and Drug Administration (FDA) against manufacturers of paregoric and opium tincture suggests that opium tincture's availability in the U.S. may be in jeopardy.
The terms laudanum and tincture of opium are generally interchangeable, but in contemporary medical practice the latter is used almost exclusively.
History
Paracelsus von Hohenheim, a 16th-century Swiss-German alchemist, experimented with various opium
concoctions, and recommended opium for reducing pain. One of his
preparations, a pill which he extolled as his "archanum" or "laudanum",
may have contained opium. Paracelsus' laudanum was strikingly different from the standard laudanum of the 17th century and beyond, containing crushed pearls, musk, amber, and other substances. One researcher has documented that "Laudanum, as listed in the London Pharmacopoeia (1618), was a pill made from opium, saffron, castor, ambergris, musk and nutmeg".
Laudanum remained largely unknown until the 1660s when English physician Thomas Sydenham
(1624–1689) compounded a proprietary opium tincture that he also named
laudanum, although it differed substantially from the laudanum of
Paracelsus. In 1676 Sydenham published a seminal work, Medical Observations Concerning the History and Cure of Acute Diseases, in which he promoted his brand of opium tincture, and advocated its use for a range of medical conditions.
By the 18th century, the medicinal properties of opium and laudanum
were well known, and the term "laudanum" came to refer to any
combination of opium and alcohol. Several physicians, including John
Jones, John Brown, and George Young, the latter of whom published a
comprehensive medical text entitled Treatise on Opium, extolled the virtues of laudanum and recommended the drug for practically every ailment.
"Opium, and after 1820, morphine, was mixed with everything imaginable:
mercury, hashish, cayenne pepper, ether, chloroform, belladonna,
whiskey, wine and brandy."
Confessions of a laudanum drinker, The Lancet, 1866.
As one researcher has noted: "To understand the popularity of a
medicine that eased—even if only temporarily—coughing, diarrhoea and
pain, one only has to consider the living conditions at the time". In
the 1850s, "cholera and dysentery regularly ripped through communities, its victims often dying from debilitating diarrhoea", and dropsy, consumption, ague and rheumatism were all too common.
By the 19th century, laudanum was used in many patent medicines to "relieve pain ... to produce sleep ... to allay irritation ... to check excessive secretions ... to support the system ... [and] as a soporific". The limited pharmacopoeia
of the day meant that opium derivatives were among the most effective
of available treatments, so laudanum was widely prescribed for ailments
from colds to meningitis to cardiac diseases, in both adults and children. Laudanum was used during the yellow fever epidemic.
Innumerable Victorian women were prescribed the drug for relief of menstrual cramps and vague aches. Nurses also spoon-fed laudanum to infants. The Romantic and Victorian eras were marked by the widespread use of laudanum in Europe and the United States. Mary Todd Lincoln, for example, the wife of the US president Abraham Lincoln, was a laudanum addict, as was the English poet Samuel Taylor Coleridge, who was famously interrupted in the middle of an opium-induced writing session of Kubla Khan by a "person from Porlock". Initially a working class drug, laudanum was cheaper than a bottle of gin or wine, because it was treated as a medication for legal purposes and not taxed as an alcoholic beverage.
Laudanum was used in home remedies and prescriptions, as well as a
single medication. For example, a 1901 medical book published for home
health use gave the following two "Simple Remedy Formulas" for
"dysenterry" [sic]: (1) Thin boiled starch, 2 ounces; Laudanum, 20 drops; "Use as an injection [meaning as an enema] every six to twelve hours"; (2) Tincture rhubarb, 1 ounce; Laudanum 4 drachms;
"Dose: One teaspoonful every three hours." In a section entitled
"Professional Prescriptions" is a formula for "diarrhoea (acute)":
Tincture opium, deodorized, 15 drops; Subnitrate of bismuth, 2 drachms;
Simple syrup, 1⁄2 ounce; Chalk mixture, 11⁄2
ounces, "A teaspoonful every two or three hours to a child one year
old." "Diarrhoea (chronic)": Aqueous extract of ergot, 20 grains;
Extract of nux vomica, 5 grains; Extract of Opium, 10 grains, "Make 20
pills. Take one pill every three or four hours."
The early 20th century brought increased regulation of all manner
of narcotics, including laudanum, as the addictive properties of opium
became more widely understood, and "patent medicines came under fire,
largely because of their mysterious compositions". In the US, the Food and Drug Act of 1906 required that certain specified drugs, including alcohol, cocaine, heroin, morphine, and cannabis,
be accurately labeled with contents and dosage. Previously many drugs
had been sold as patent medicines with secret ingredients or misleading
labels. Cocaine, heroin, cannabis, and other such drugs continued to be
legally available without prescription as long as they were labeled. It
is estimated that sale of patent medicines containing opiates decreased
by 33% after labeling was mandated. In 1906 in Britain and in 1908 in Canada "laws requiring disclosure of ingredients and limitation of narcotic content were instituted".
The Harrison Narcotics Tax Act of 1914 restricted the manufacture and distribution of opiates, including laudanum, and coca derivatives in the US. This was followed by France's Loi des stupéfiants in 1916, and Britain's Dangerous Drugs Act in 1920.
Laudanum was supplied to druggists and physicians in regular and
concentrated versions. For example, in 1915, Frank S. Betz Co., a
medical supply company in Hammond, Indiana, advertised Tincture of
Opium, U.S.P., for $2.90 per lb., Tincture of Opium Camphorated, U.S.P,
for 85 cents per lb., and Tincture of Opium Deodorized, for $2.85 per
lb.
Four versions of opium as a fluid extract were also offered: (1) Opium,
Concentrated (assayed) "For making Tincture Opii (Laudanum) U.S.P. Four
times the strength of the regular U.S.P." tincture, for $9.35 per pint;
(2) Opium, Camphorated Conc. "1 oz. making 8 ozs. Tr. Opii Camphorated
U.S.P (Paregoric)" for $2.00 per pint; (3) Opium, Concentrated
(Deodorized and Denarcotized) "Four times the strength of tincture, Used
when Tinct. Opii U.S.P. is contraindicated" for $9.50 per pint, and (4)
Opium (Aqueous), U.S.P., 1890, "Tr. (assayed) Papayer Somniferum" for
$2.25 per pint.
In 1929–30, Parke, Davis & Co., a major US drug manufacturer
based in Detroit, Michigan, sold "Opium, U.S.P. (Laudanum)", as Tincture
No. 23, for $10.80 per pint (16 fluid ounces), and "Opium Camphorated,
U.S.P. (Paregoric)", as Tincture No. 20, for $2.20 per pint.
Concentrated versions were available. "Opium Camphorated, for U.S.P.
Tincture: Liquid No. 338" was "exactly 8 times the strength of Tincture Opium Camphorated (Paregoric)
[italics in original], U.S.P., "designed for preparing the tincture by
direct dilution," and cost $7 per pint. Similarly, at a cost of $36 per
pint, "Opium Concentrated, for U.S.P. Tincture: Liquid No. 336", was
"four times the strength of the official tincture", and "designed for
the extemporaneous preparation of the tincture". The catalog also noted: "For quarter-pint bottles add 80c. per pint to the price given for pints."
Toward the middle 20th century, the use of opiates was generally
limited to the treatment of pain, and opium was no longer a medically
accepted "cure-all". Further, the pharmaceutical industry began
synthesizing various opioids, such as propoxyphene, oxymorphone and oxycodone. These synthetic opioids, along with codeine and morphine
were preferable to laudanum since a single opioid could be prescribed
for different types of pain rather than the "cocktail" of laudanum,
which contains nearly all of the opium alkaloids. Consequently, laudanum
became mostly obsolete as an analgesic, since its principal ingredient is morphine,
which can be prescribed by itself to treat pain. Until now, there has
been no medical consensus on which of the two (laudanum or morphine
alone) is the better choice for treating pain.
In 1970, the US adopted the Uniform Controlled Substances Act, which regulated opium tincture (Laudanum) as a Schedule II substance (currently DEA #9630), placing even tighter controls on the drug.
By the late 20th century, laudanum's use was almost exclusively confined to treating severe diarrhea.
The current prescribing information for laudanum in the US states that
opium tincture's sole indication is as an anti-diarrheal, although the
drug is occasionally prescribed off-label for treating pain and neonatal withdrawal syndrome.
Historical varieties
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Italian Sydenham laudanum tincture from the 1950s
Several historical varieties of laudanum exist, including Paracelsus' laudanum, Sydenham's Laudanum (also known as tinctura opii crocata), benzoic laudanum (tinctura opii benzoica),
and deodorized tincture of opium (the most common contemporary
formulation), among others. Depending on the version, additional amounts
of the substances and additional active ingredients (e.g. saffron, sugar, eugenol) are added, modifying its effects (e.g., amount of sedation, or antitussive properties).
There is probably no single reference that lists all the
pharmaceutical variations of laudanum that were created and used in
different countries during centuries since it was initially formulated.
The reasons are that in addition to official variations described in
pharmacopeias, pharmacists and drug manufacturers were free to alter
such formulas. The alcohol content of Laudanum probably varied
substantially; on the labels of turn-of-the-century bottles of Laudanum,
alcoholic content is stated as 48%. In contrast, the current version of
Laudanum contains about 18% alcohol.
The four variations of laudanum listed here were used in the
United States during the late 19th century. The first, from an 1870
publication, is "Best Turkey opium 1 oz., slice, and pour upon it
boiling water 1 gill, and work it in a bowl or mortar until it is
dissolved; then pour it into the bottle, and with alcohol of 70 percent
proof 1⁄2 pt.,
rinse the dish, adding the alcohol to the preparation, shaking well, and
in 24 hours it will be ready for use. Dose—From 10 to 30 drops for
adults, according to the strength of the patient, or severity of the
pain. Thirty drops of this laudanum will be equal to one grain of opium.
And this is a much better way to prepare it than putting the opium into
alcohol, or any other spirits alone, for in that case much of the opium
does not dissolve." The remaining three formulas are copied from an 1890 publication of the day:
- Sydenham's Laudanum: "According to the Paris Codex this is prepared as follows: opium, 2 ounces; saffron, 1 ounce; bruised cinnamon and bruised cloves, each 1 drachm; sherry wine, 1 pint. Mix and macerate for 15 days and filter. Twenty drops are equal to one grain of opium."
- Rousseau's Laudanum: "Dissolve 12 ounces white honey in 3 pounds warm water, and set it aside in a warm place. When fermentation begins add to it a solution of 4 ounces selected opium in 12 ounces water. Let the mixture stand for a month at a temperature of 86° Fahr.; then strain, filter, and evaporate to 10 ounces; finally strain and add 41⁄2 ounces proof alcohol. Seven drops of this preparation contain about 1 grain of opium."
- Tincture of Opium (Laudanum), U.S.P., attributed to the United States Pharmacoepia of 1863: "Macerate 21⁄2 ounces opium, in moderately fine powder in 1 pint water for 3 days, with frequent agitation. Add 1 pint alcohol, and macerate for 3 days longer. Percolate, and displace 2 pints tincture by adding dilute alcohol in the percolator."
Modern status
United States
Tincture of Opium is available by prescription in the United States. It is regulated as a Schedule II drug (No. 9639) under the Controlled Substances Act.
In the United States, opium tincture is marketed and distributed
by several pharmaceutical firms, each producing a single formulation of
the drug, which is deodorized. Each mL contains 10 mg of anhydrous
morphine (the equivalent of 100 mg of powdered opium), other opium alkaloids (except noscapine),
and ethanol, 19%. It is available packaged in bottles of four US fluid
ounces (118 mL) and 16 US fluid ounces (1 US pt; 473 mL).
Tincture of Opium is known as one of many "unapproved drugs" regulated by the U.S. Food and Drug Administration
(FDA); the marketing and distribution of opium tincture prevails today
only because opium tincture was sold prior to the Federal Food, Drug
& Cosmetic Act of 1938.
Its "grandfathered" status protects opium tincture from being required
to undergo strict FDA drug reviews and subsequent approval processes.
However, the FDA closely monitors the labeling of opium tincture.
Bottles of opium tincture are required by the FDA to bear a bright red "POISON"
label given the potency of the drug and the potential for overdose (see
discussion about confusion with Paregoric below). Additionally, in a
warning letter to a manufacturer of opium tincture in late 2009, the FDA
noted that "we found that your firm is manufacturing and distributing
the prescription drug Opium Tincture USP (Deodorized – 10 mg/mL). Based
on our information, there are no FDA-approved applications on file for
this drug product."
United Kingdom
Opium tincture remains in the British Pharmacopoeia,
where it is referred to as Tincture of Opium, B.P., Laudanum, Thebaic
Tincture or Tinctura Thebaica, and "adjusted to contain 1% w/v of
anhydrous morphine." It is a Class A substance under the Misuse of Drugs Act of 1971. At least one manufacturer (Macfarlan Smith) still produces opium tincture in the UK as of 2011.
"Gee's Linctus" is also available from most UK pharmacies, especially
independent stores. This contains "Opium Tincture", at 0.083 mL, per 5
mL.
Pharmacology
Opium tincture is useful as an analgesic and antidiarrheal. Opium enhances the tone in the long segments of the longitudinal muscle and inhibits propulsive contraction of circular
and longitudinal muscles. The pharmacological effects of opium tincture
are due principally to its morphine content. The quantity of the papaverine and codeine alkaloids in opium tincture is too small to have any demonstrable central nervous system effect.
Most modern formulations of opium tincture do not contain the alkaloid narcotine (also known as noscapine), which has antitussive properties. Even modest doses of narcotine can induce profound nausea and vomiting.
Since opium tincture is usually prescribed for its antidiarrheal and
analgesic properties (rather than as an antitussive), opium tincture
without narcotine is generally preferred. This "de-narcotized" or
"deodorized" opium tincture is formulated using a petroleum distillate to remove the narcotine.
Oral doses of opium tincture are rapidly absorbed in the gastrointestinal tract and metabolized in the liver.
Peak plasma concentrations of the morphine content are reached in about
one hour, and nearly 75% of the morphine content of the opium tincture
is excreted in the urine within 48 hours after oral administration.
Medical uses
Diarrhea
Opium tincture is indicated for the treatment of severe fulminant (intense, prolific) diarrhea that does not respond to standard therapy (e.g., Imodium or Lomotil).
The usual starting dose is 0.3 mL to 0.6 mL (about six to 12 drops) in a glass of water or juice four times a day. Refractory cases (such as diarrhea resulting from the complications of HIV/AIDS)
may require higher than normal dosing, for example, 1 to 2 mL every 3
hours, for a total daily dose of up to 16mL a day. In terminal diseases,
there is no ceiling dose for opium tincture; the dose is increased
slowly until diarrhea is controlled.
Neonatal abstinence syndrome
Opium tincture is used to treat neonatal abstinence syndrome (NAS) when diluted 1:25 (one part opium tincture to 25 parts water).
The recommended dose is 0.2 mL of the diluted solution under the tongue
every three hours, which may be increased by 0.05 mL every three hours
until no objective signs of withdrawal are observed. In no event, however, should the dose exceed 0.7 mL every three hours.
The opium tincture is gradually tapered over a 3- to 5-week period, at
which point the newborn should be completely free of withdrawal
symptoms.
Pain
Given its high concentration of morphine, opium tincture is useful
for treating moderate to severe pain. The amount of codeine in the
tincture is negligible and does not have any appreciable analgesic
effect. The dose of tincture is generally the same as that of morphine
in opioid-naïve
patients, titrated upward as needed. The usual starting dose in adults
is 1.5 mL by mouth every 3 to 4 hours, representing the equivalent of 15
mg—approximately 1⁄4 grain—of morphine per dose.
Opioid-tolerant patients may require higher than normal dosing.
For the opioid tolerant patient, doses in the range of 3–6 mL every 3–4
hours would be usual. This would represent an equivalent daily dose of
between 180 mg and 480 mg of morphine.
Today, morphine and codeine are available in various forms as
single formulation products, which are easier to dose and are much
cheaper than opium tincture. Thus, opium is rarely prescribed to treat
pain in contemporary medicine. Further, opium tincture contains 17–19%
alcohol, by volume, which may complicate its use as an analgesic in
patients for whom alcohol is contraindicated.
Dosage
Extreme
caution is advised when administering doses of Tincture of Opium. Doses
should be carefully measured using an oral syringe or calibrated
dropper. Apothecary measurements should be avoided in contemporary
medical prescriptions, and the prescriber should dose opium tincture in
mL or fractions thereof. If in the prescriber's judgment dosing in drops would be appropriate, it should be borne in mind that in contemporary medicine, there are 20 drops per mL.
The differences between Tincture of Opium (Laudanum) and
Camphorated Tincture of Opium (Paregoric) are important and should be
kept in mind when administering either of these drugs. Care and caution
should always be taken in administering doses of Tincture of Opium, such
as the use of a dosage syringe or other suitable measurement device,
and by pharmacists in preparing Paregoric from Laudanum, and to note
that the dosages in this article refer to Apothecaries weight and fluid
measure. In particular, "the difference between a minim and a drop
should be borne in mind when figuring doses. A minim is always a
sixtieth part of a fluidrachm regardless of the character of the
substance, while a drop varies from a forty-fifth to a
two-hundred-and-fiftieth part, according to the surface tension of the
fluid."
Tincture of Opium (Laudanum) and Camphorated Tincture of Opium
(Paregoric) each have 50.9 drops per gram; 50.0 drops per cc; 185.0
drops per fluid drachm; and 3.10 drops per minim."
The importance of these distinctions is evident in view of the dangers
of erroneously relying upon more general descriptions of apothecaries'
fluid measures, which typically list 60 minims per fluid dram, and 8
fluid drams per fluid ounce (480 minims).
Hazards
Potency of laudanum
Opium tincture is one of the most potent oral formulations of morphine available by prescription. Accidental or deliberate overdose
is common with opium tincture given the highly concentrated nature of
the solution. Overdose and death may occur with a single oral dose of
between 100 and 150 mg of morphine in a healthy adult who has no
tolerance to opiates. This represents the equivalent of between two to three teaspoons (10–15 mL) of opium tincture. Suicide by laudanum was not uncommon in the mid-19th century.
Prudent medical judgment necessitates toward dispensing very small
quantities of opium tincture in small dropper bottles or in pre-filled
syringes to reduce the risk of intentional or accidental overdose.
Danger of confusion with paregoric
In the United States, opium tincture contains 10 mg per mL of anhydrous morphine. By contrast, opium tincture's weaker cousin, paregoric,
also confusingly known as "camphorated tincture of opium", is 1/25th
the strength of opium tincture, containing only 0.4 mg of morphine per
mL. A 25-fold morphine overdose may occur if opium tincture is used
where paregoric is indicated. Opium tincture is almost always dosed in
drops, or fractions of a mL, or less commonly, in minims,
while paregoric is dosed in teaspoons or tablespoons. Thus, an order
for opium tincture containing directions in teaspoons is almost
certainly in error. To avoid this potentially fatal outcome, the term
"camphorated tincture of opium" is avoided in place of paregoric since
the former can easily be mistaken for opium tincture.
In 2004, the FDA issued a "Patient Safety" news bulletin stating
that "To help resolve the confusion [between opium tincture and
paregoric], FDA will be working with the manufacturers of these two
drugs to clarify the labeling on the containers and in the package
inserts."
Indeed, in 2005, labels for opium tincture began to include the
concentration of morphine (10 mg/mL) in large text beneath the words
"Opium Tincture". The FDA has also alerted pharmacists and other medical
practitioners about the dangers of confusing these drugs, and has
recommended that opium tincture not be stocked as a standard item (i.e.,
that it should not be "on the shelf"), that opium tincture be dispensed
in oral syringes, and that pharmacy software alert the dispenser if
unusually large doses of opium tincture appear to be indicated.
Despite the FDA's efforts over the past few years, the confusion persists, sometimes with deadly results. The Institute for Safe Medication Practices
recommends that opium tincture not be stocked at all in a pharmacy's
inventory, and that "It may be time to relegate opium tincture and
paregoric to the museum of outmoded opioid therapy."
Despite the risk of confusion, opium tincture, like many end-stage
medications, is indispensable for intractable diarrhea for terminally
ill patients, such as those suffering from AIDS and cancer.
Misinterpretation of "DTO"
The
abbreviation "DTO," traditionally used to refer to Deodorized Tincture
of Opium, is sometimes also erroneously employed to abbreviate "diluted
tincture of opium." Diluted tincture of opium, also known as
Camphorated Tincture of Opium (Paregoric) is a 1:25 mixture of opium
tincture to water prescribed to treat withdrawal symptoms in newborns
whose mothers were using opioids while pregnant. The United States Pharmacopeia
and FDA recommend that practitioners refrain from using DTO in
prescriptions, given this potential for confusion. In cases where
pharmacists have misinterpreted DTO, and given "deodorized tincture of
opium" when "diluted tincture of opium" was meant, infants have received
a massive 25-fold overdose of morphine, sometimes resulting in
fatalities.
Side effects
Side effects of laudanum are generally the same as with morphine, and include euphoria, dysphoria, pruritus, sedation, constipation, reduced tidal volume, respiratory depression, as well as psychological dependence, physical dependence, miosis, and xerostomia.
Overdose can result in severe respiratory depression or collapse and
death. The ethanol component can also induce adverse effects at higher
doses; the side effects are the same as with alcohol.
Long-term use of laudanum in nonterminal diseases is discouraged due to
the possibility of drug tolerance and addiction. Long-term use can also lead to abnormal liver function tests; specifically, prolonged morphine use can increase ALT and AST blood serum levels.
Treatment for overdose
Life-threatening
overdose of opium tincture owes to the preparation's morphine content.
Morphine produces a dose-dependent depressive effect on the respiratory
system, which can lead to profound respiratory depression, hypoxia, coma
and finally respiratory arrest and death. If overdose of opium tincture
is suspected, rapid professional intervention is required. The primary
concern is re-establishing a viable airway and institution of assisted
or controlled ventilation if the patient is unable to breathe on his
own. Other supportive measures such as the use of vasopressors
and oxygen may be indicated to treat cardiac and/or pulmonary failure.
Cardiac arrhythmias or arrest will require advanced life-saving
measures.
Intravenous naloxone or nalmefene,
quick-acting opioid antagonists, are the first-line treatment to
reverse respiratory depression caused by an overdose of opium tincture.
Gastric lavage may be of some use in certain cases.
In fiction
- In Mary Shelley's novel Frankenstein (1818), Victor Frankenstein takes laudanum as his only means of sleeping and thus preserving his life while in recovery from months of fever and a series of horrible events.
- In Uncle Tom's Cabin (1852), an anti-slavery novel by Harriet Beecher Stowe, a slave named Cassy talks about how she killed her newborn by laudanum overdose to spare him from experiencing the horrors of slavery.
- Wilkie Collins' novel The Moonstone (1868) features laudanum "as an essential ingredient of the plot." Collins based his description of the drug's effects on his own experiences with it.
- A laudanum-addicted character also appeared in Wilkie Collins' novel Armadale (1864–66).
- Laudanum appears in Charles Baudelaire's prose poem The Double Room, published in his collection Le Spleen de Paris in 1869.
- Laudanum is portrayed as the surgical drug of choice for fifteenth-century physicians in Lawrence Schoonover's novel The Burnished Blade (1948), the plot of which deals in part with the smuggling of expensive raw opium into France from the Empire of Trebizond.
- In William Faulkner's novel Requiem for a Nun (1951), Compson, Doctor Peabody, and Ratcliffe give whiskey tainted with laudanum to a group of rowdy lynchers and a militia band that had joined together. Upon their falling asleep, they were gathered up and locked in jail while still unconscious.
- Dr Stephen Maturin, one of the main characters in Patrick O'Brian's Aubrey–Maturin series of novels (1969-2004) about the Napoleonic wars, is a sometime laudanum addict.
- Laudanum is prescribed in Glendon Swarthout's novel The Shootist (1975) to the character J.B. Books, played by John Wayne in Don Siegel's movie adaptation (1976).
- In Philippa Gregory's novel Wideacre (1987), the main character Beatrice Lacey nearly becomes addicted to laudanum when her eventual husband Dr. John MacAndrew prescribes it to her after her mother's death.
- In Dan Simmons’s novel Drood (2009) the narrator Wilkie Collins takes laudanum daily to alleviate a wide variety of pains as well as to induce sleep.
- In the horror video-game Amnesia: The Dark Descent (2010), laudanum can be found at several places in the castle, and can be used to regain health.
- In Sara Collins' novel The Confessions of Frannie Langton (2019) the titular character becomes addicted to laudanum.
