Confessions of an English Opium-Eater (1821) is an autobiographical account written by Thomas De Quincey, about his laudanumaddiction and its effect on his life. The Confessions was "the first major work De Quincey published and the one which won him fame almost overnight..."
First published anonymously in September and October 1821 in the London Magazine, the Confessions was released in book form in 1822, and again in 1856, in an edition revised by De Quincey.
Synopsis
As originally published, De Quincey's account was organized into two parts:
Part I begins with a notice "To the Reader", to establish the
narrative frame: "I here present you, courteous reader, with the record
of a remarkable period in my life...." It is followed by the substance
of Part I,
Preliminary Confessions, devoted to the author's
childhood and youth, and concentrated upon the emotional and
psychological factors that underlay the later opium experiences —
especially the period in his late teens that De Quincey spent as a
homeless runaway in Oxford Street in London in 1802 and 1803.
Part II is split into several sections:
A relatively brief introduction and connecting passage, followed by
The Pleasures of Opium, which discusses the early and largely positive phase of the author's experience with the drug, from 1804 until 1812;
Introduction to the Pains of Opium, which delivers a second installment of autobiography, taking De Quincey from youth to maturity; and
The Pains of Opium, which recounts the extreme of the
author's opium experience (up to that time), with insomnia, nightmares,
frightening visions, and difficult physical symptoms.
Another "Notice to the Reader" attempts to clarify the chronology of the whole.
The cover of Thomas De Quincey's book Confessions of an Opium-Eater. This version was published by the Mershon Company in 1898.
Though De Quincey was later criticized for giving too much attention
to the pleasure of opium and not enough to the harsh negatives of
addiction, The Pains of Opium is in fact significantly longer than The Pleasures.
However, even when trying to convey darker truths, De Quincey's
language can seem seduced by the compelling nature of the opium
experience:
"The sense of space, and in the end, the sense of time,
were both powerfully affected. Buildings, landscapes, &c. were
exhibited in proportions so vast as the bodily eye is not fitted to
conceive. Space swelled, and was amplified to an extent of unutterable
infinity. This, however, did not disturb me so much as the vast
expansion of time; I sometimes seemed to have lived for 70 or 100 years
in one night; nay, sometimes had feelings representative of a millennium
passed in that time, or, however, of a duration far beyond the limits
of any human experience."
Style
From its first appearance, the literary style of the Confessions
attracted attention and comment. De Quincey was well-read in the
English literature of the sixteenth and seventeenth centuries, and
assimilated influences and models from Sir Thomas Browne and other writers. Arguably the most famous and often-quoted passage in the Confessions is the apostrophe to opium in the final paragraph of The Pleasures:
"Oh! just, subtle, and mighty opium! that to the hearts
of poor and rich alike, for the wounds that will never heal, and for
'the pangs that tempt the spirit to rebel,' bringest an assuaging balm;
eloquent opium! that with thy potent rhetoric stealest away the purposes
of wrath; and to the guilty man, for one night givest back the hopes of
his youth, and hands washed pure of blood...."
De Quincey modelled this passage on the apostrophe "O eloquent, just and mightie Death!" in Sir Walter Raleigh's History of the World.
Earlier in The Pleasures of Opium, De Quincey describes the long walks he took through the London streets under the drug's influence:
"Some of these rambles led me to great distances; for an
opium-eater is too happy to observe the motions of time. And sometimes
in my attempts to steer homewards, upon nautical principles, by fixing
my eye on the pole-star, and seeking ambitiously for a north-west
passage, instead of circumnavigating all the capes and headlands I had
doubled in my outward voyage, I came suddenly upon such knotty problems
of alleys, such enigmatical entries, and such sphinx's riddles of
streets without thoroughfares, as must, I conceive, baffle the audacity
of porters, and confound the intellects of hackney-coachmen."
The Confessions represents De Quincey's initial effort to write what he called "impassioned prose", an effort that he would later resume in Suspiria de Profundis (1845) and The English Mail-Coach (1849).
The 1856 revision
In
the early 1850s, De Quincey prepared the first collected edition of his
works for publisher James Hogg. For that edition, he undertook a
large-scale revision of the Confessions, more than doubling the
work's length. Most notably, he expanded the opening section on his
personal background, until it consumed more than two-thirds of the
whole. Yet he gave the book "a much weaker beginning" and detracted from
the impact of the original with digressions and inconsistencies; "the
verdict of most critics is that the earlier version is artistically
superior".
"De Quincey undoubtedly spoiled his masterpiece by revising it...
anyone who compares the two will prefer the unflagging vigour and
tension of the original version to the tired prosiness of much of the
revised one".
Influence
36 Tavistock Street in London's Covent Garden, where De Quincey wrote Confessions - photographed in 2019
The Confessions maintained a place of primacy in De Quincey's
literary output, and his literary reputation, from its first
publication; "it went through countless editions, with only occasional
intervals of a few years, and was often translated. Since there was
little systematic study of narcotics until long after his death, De
Quincey's account assumed an authoritative status and actually dominated
the scientific and public views of the effects of opium for several
generations."
Yet from the time of its publication, De Quincey's Confessions
was criticized for presenting a picture of the opium experience that
was too positive and too enticing to readers. As early as 1823, an
anonymous response, Advice to Opium Eaters, was published "to warn others from copying De Quincey." The fear of reckless imitation was not groundless: several English writers — Francis Thompson, James Thomson, William Blair, and perhaps Branwell Brontë — were led to opium use and addiction by De Quincey's literary example. Charles Baudelaire's 1860 translation and adaptation, Les paradis artificiels, spread the work's influence further. One of the characters of the Sherlock Holmes story, The Man with the Twisted Lip (1891), is an opium addict who began experimenting with the drug as a student after reading the Confessions.
De Quincey attempted to address this type of criticism. When the 1821
original was printed in book form the following year, he added an
Appendix on the withdrawal process; and he inserted significant material
on the medical aspects of opium into his 1856 revision.
More generally, De Quincey's Confessions influenced psychology and abnormal psychology, and attitudes towards dreams and imaginative literature.
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-Germanalchemist, 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 cardiacdiseases, in both adults and children. Laudanum was used during the yellow feverepidemic.
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
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."
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 petroleumdistillate 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 anhydrousmorphine. 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 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.
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.
While some drugs are illegal to possess, many governments
regulate the manufacture, distribution, marketing, sale and use of
certain drugs, for instance through a prescription system. For example, amphetamines
may be legal to possess if a doctor has prescribed them; otherwise,
possession or sale of the drug is typically a criminal offence. Only
certain drugs are banned with a "blanket prohibition" against all
possession or use (e.g., LSD). The most widely banned substances include psychoactive drugs, although blanket prohibition also extends to some steroids
and other drugs. Many governments do not criminalize the possession of a
limited quantity of certain drugs for personal use, while still
prohibiting their sale or manufacture, or possession in large
quantities. Some laws set a specific volume of a particular drug, above
which is considered ipso jure to be evidence of trafficking or sale of the drug.
Drugs, in the context of prohibition, are any of a number of psychoactive substances whose use a government or religious body seeks to control. What constitutes a drug varies by century and belief system. What is a psychoactive substance is relatively well known to modern science. Examples include a range from caffeine found in coffee, tea, and chocolate, nicotine in tobacco products; botanical extracts morphine and heroin, and synthetic compounds MDMA and Fentanyl. Almost without exception, these substances also have a medical use, in which case it is called a Pharmaceutical drug or just pharmaceutical. The use of medicine to save or extend life or to alleviate suffering is uncontroversial in most cultures. Prohibition applies to certain conditions of possession or use. Recreational use refers to the use of substances primarily for their psychoactive effect outside of a clinical situation or doctor's care.
In the twenty-first century, caffeine has pharmaceutical uses. Caffeine is used to treat bronchopulmonary dysplasia.
In most cultures, caffeine in the form of coffee or tea is
unregulated. Over 2.25 billion cups of coffee are consumed in the world
every day. Some religions, including The Church of Jesus Christ of Latter-day Saints, prohibit coffee. They believe that it is both physically and spiritually unhealthy to consume coffee.
A government's interest to control a drug may be based on its
perceived negative effects on its users, or it may simply have a revenue
interest. Great Britain prohibited the possession of untaxed tea with
the imposition of the Tea Act of 1773.
In this case, as in many others, it is not substance that is
prohibited, but the conditions under which it is possessed or consumed.
Those conditions include matters of intent, which makes the enforcement
of laws difficult. In Colorado possession of "blenders, bowls,
containers, spoons, and mixing devices" is illegal if there was intent to use them with drugs.
Many drugs, beyond their pharmaceutical and recreational uses have industrial uses. Nitrous oxide, or laughing gas is a dental anaesthetic, also used to prepare whipped cream, fuel rocket engines, and enhance the performance of race cars.
History
The cultivation, use, and trade of psychoactive and other drugs
has occurred since ancient times. Concurrently, authorities have often
restricted drug possession and trade for a variety of political and
religious reasons. In the 20th century, the United States led a major
renewed surge in drug prohibition called the "War on Drugs".
Today's War on Drugs is particularly motivated by the desire to prevent
drug use, which is perceived as detrimental to society.
Early drug laws
Huichol religion worshiped the god of Peyote, a drug.
The prohibition on alcohol under Islamic Sharia law, which is usually attributed to passages in the Qur'an, dates back to the 7th century. Although Islamic law is often interpreted as prohibiting all intoxicants (not only alcohol), the ancient practice of hashish smoking has continued throughout the history of Islam, against varying degrees of resistance. A major campaign against hashish-eating Sufis was conducted in Egypt in the 11th and 12th centuries resulting among other things in the burning of fields of cannabis.
Though the prohibition of illegal drugs was established under Sharia law, particularly against the use of hashish as a recreational drug, classical jurists of medieval Islamic jurisprudence accepted the use of hashish for medicinal and therapeutic purposes, and agreed that its "medical use, even if it leads to mental derangement,
should remain exempt [from punishment]". In the 14th century, the
Islamic scholar Az-Zarkashi spoke of "the permissibility of its use for
medical purposes if it is established that it is beneficial".
In the Ottoman Empire, Murad IV attempted to prohibit coffee drinking to Muslims as haraam, arguing that it was an intoxicant, but this ruling was overturned soon after his death in 1640. The introduction of coffee in Europe from Muslim Turkey prompted calls for it to be banned as the devil's work, although Pope Clement VIII
sanctioned its use in 1600, declaring that it was "so delicious that it
would be a pity to let the infidels have exclusive use of it". Bach's Coffee Cantata,
from the 1730s, presents vigorous debate between a girl and her father
over her desire to consume coffee. The early association between coffeehouses and seditious political activities in England, led to the banning of such establishments in the mid-17th century.
A number of Asian rulers had similarly enacted early
prohibitions, many of which were later forcefully overturned by Western
colonial powers during the 18th and 19th centuries. In 1360, for
example, King Ramathibodi I, of Ayutthaya Kingdom (now Thailand), prohibited opium consumption and trade. The prohibition lasted nearly 500 years until 1851, when King Rama IV allowed Chinese migrants to consume opium. While the Konbaung Dynasty prohibited all intoxicants and stimulants
during the reign of King Bodawpaya (1781–1819). As the British
colonized parts of Burma from 1852 they overturned local prohibitions
and established opium monopolies selling Indian produced opium.
In late Qing Imperial China, opium imported by the British East India Company was consumed by all social classes in Southern China.
Between 1821 and 1837, imports of the drug increased fivefold. The
drain of silver to India and widespread social problems that resulted
from this consumption prompted the Chinese government to attempt to end
the trade. This effort was initially successful, with the destruction of
all British opium stock in June 1839. However, to protect their commerce, the British declared war on China in the First Opium War. China was defeated and the war ended with the Treaty of Nanking, which protected foreign opium traders from Chinese law.
The first modern law in Europe for the regulating of drugs was the Pharmacy Act 1868 in the United Kingdom.
There had been previous moves to establish the medical and
pharmaceutical professions as separate, self-regulating bodies, but the General Medical Council, established in 1863, unsuccessfully attempted to assert control over drug distribution.
The Act set controls on the distribution of poisons and drugs. Poisons
could only be sold if the purchaser was known to the seller or to an
intermediary known to both, and drugs, including opium and all preparations of opium or of poppies, had to be sold in containers with the seller's name and address.
Despite the reservation of opium to professional control, general sales
did continue to a limited extent, with mixtures with less than 1 per
cent opium being unregulated.
After the legislation passed, the death rate caused by opium
immediately fell from 6.4 per million population in 1868 to 4.5 in 1869.
Deaths among children under five dropped from 20.5 per million
population between 1863 and 1867, to 12.7 per million in 1871, and
further declined to between 6 and 7 per million in the 1880s.
In the United States, the first drug law was passed in San Francisco in 1875, banning the smoking of opium in opium dens.
The reason cited was "many women and young girls, as well as young men
of respectable family, were being induced to visit the Chinese
opium-smoking dens, where they were ruined morally and otherwise." This
was followed by other laws throughout the country, and federal laws
which barred Chinese people from trafficking in opium. Though the laws
affected the use and distribution of opium by Chinese immigrants, no
action was taken against the producers of such products as laudanum, a tincture of opium and alcohol, commonly taken as a panacea
by white Americans. The distinction between its use by white Americans
and Chinese immigrants was thus based on the form in which it was
ingested: Chinese immigrants tended to smoke it, while it was often
included in various kinds of generally liquid medicines often (but not
exclusively) used by people of European descent. The laws targeted opium
smoking, but not other methods of ingestion.
Britain also passed the All-India Opium Act of 1878, which
similarly formalized social distinctions, by limiting recreational opium
sales to registered Indian opium-eaters and Chinese opium-smokers and
prohibiting its sale to workers from Burma.
Following passage of a regional law in 1895, Australia's Aboriginals Protection and Restriction of the Sale of Opium Act 1897 addressed opium addiction among Aborigines,
though it soon became a general vehicle for depriving them of basic
rights by administrative regulation. Opium sale was prohibited to the
general population in 1905, and smoking and possession was prohibited in
1908.
Despite these laws, the late 19th century saw an increase in
opiate consumption. This was due to the prescribing and dispensing of
legal opiates by physicians and pharmacists to relieve painful menstruation.
It is estimated that between 150,000 and 200,000 opiate addicts lived
in the United States at the time, and a majority of these addicts were
women.
Changing attitudes and the drug prohibition campaign
Thomas Brassey was appointed the head of the Royal Opium Commission in 1893 to investigate the opium trade and make recommendations on its legality.
Due to increasing pressure in the British parliament, the Liberal government under William Ewart Gladstone approved the appointment of a Royal Commission on Opium to India in 1893. The commission was tasked with ascertaining the impact of India's opium exports to the Far East,
and to advise whether the trade should be ended and opium consumption
itself banned in India or not. After an extended inquiry the Royal
Commission rejected the claims made by the anti-opiumists in regard to
the harm wrought to India by this traffic and the issue was buried for
another 15 years.
The missionary organizations were outraged over the Royal Commission on Opium's
conclusions and set up the Anti-Opium League in China; the league
gathered data from every Western-trained medical doctor in China and
published Opinions of Over 100 Physicians on the Use of Opium in China.
This was the first anti-drug campaign to be based on scientific
principles, and it had a tremendous impact on the state of educated
opinion in the West. In England, the home director of the China Inland Mission, Benjamin Broomhall, was an active opponent of the opium trade, writing two books to promote the banning of opium smoking: The Truth about Opium Smoking and The Chinese Opium Smoker.
In 1888, Broomhall formed and became secretary of the Christian Union
for the Severance of the British Empire with the Opium Traffic and
editor of its periodical, National Righteousness. He lobbied the British Parliament to stop the opium trade. He and James Laidlaw Maxwell
appealed to the London Missionary Conference of 1888 and the Edinburgh
Missionary Conference of 1910 to condemn the continuation of the trade.
As Broomhall lay dying, an article from The Times
was read to him with the welcome news that an international agreement
had been signed ensuring the end of the opium trade within two years.
In 1906, a motion to 'declare the opium trade "morally indefensible"
and remove Government support for it', initially unsuccessfully proposed
by Arthur Pease in 1891, was put before the House of Commons. This time the motion passed. The Chinese government banned opium soon afterwards.
These changing attitudes led to the founding of the International Opium Commission in 1909. An International Opium Convention was signed by 13 nations at The Hague on January 23, 1912 during the First International Opium Conference. This was the first international drug control treaty and it was registered in the League of Nations Treaty Series on January 23, 1922.
The Convention provided that "The contracting Powers shall use their
best endeavours to control, or to cause to be controlled, all persons
manufacturing, importing, selling, distributing, and exporting morphine,
cocaine, and their respective salts, as well as the buildings in which
these persons carry such an industry or trade."
The treaty became international law in 1919 when it was incorporated into the Treaty of Versailles. The role of the Commission was passed to the League of Nations, and all signatory nations agreed to prohibit the import, sale, distribution, export, and use of all narcotic drugs, except for medical and scientific purposes.
Prohibition
In the UK the Defence of the Realm Act 1914, passed at the onset of the First World War,
gave the government wide-ranging powers to requisition property and to
criminalise specific activities. A moral panic was whipped up by the
press in 1916 over the alleged sale of drugs to the troops of the British Indian Army. With the temporary powers of DORA, the Army Council
quickly banned the sale of all psychoactive drugs to troops, unless
required for medical reasons. However, shifts in the public attitude
towards drugs—they were beginning to be associated with prostitution, vice and immorality—led
the government to pass further unprecedented laws, banning and
criminalising the possession and dispensation of all narcotics,
including opium and cocaine. After the war, this legislation was
maintained and strengthened with the passing of the Dangerous Drugs Act 1920. Home Office control was extended to include raw opium, morphine, cocaine, ecogonine and heroin.
Hardening of Canadian attitudes toward Chinese opium users and
fear of a spread of the drug into the white population led to the
effective criminalization of opium for nonmedical use in Canada between
1908 and the mid-1920s.
The Mao Zedong government nearly eradicated both consumption and production of opium during the 1950s using social control and isolation.
Ten million addicts were forced into compulsory treatment, dealers were
executed, and opium-producing regions were planted with new crops.
Remaining opium production shifted south of the Chinese border into the Golden Triangle region. The remnant opium trade primarily served Southeast Asia, but spread to American soldiers during the Vietnam War,
with 20 percent of soldiers regarding themselves as addicted during the
peak of the epidemic in 1971. In 2003, China was estimated to have four
million regular drug users and one million registered drug addicts.
In the US, the Harrison Act was passed in 1914, and required sellers of opiates
and cocaine to get a license. While originally intended to regulate the
trade, it soon became a prohibitive law, eventually becoming legal precedent that any prescription for a narcotic given by a physician or pharmacist – even in the course of medical treatment for addiction – constituted conspiracy to violate the Harrison Act. In 1919, the Supreme Court ruled in Doremus that the Harrison Act was constitutional and in Webb that physicians could not prescribe narcotics solely for maintenance. In Jin Fuey Moy v. United States,
the court upheld that it was a violation of the Harrison Act even if a
physician provided prescription of a narcotic for an addict, and thus
subject to criminal prosecution. This is also true of the later Marijuana Tax Act in 1937. Soon, however, licensing bodies did not issue licenses, effectively banning the drugs.
The American judicial system did not initially accept drug
prohibition. Prosecutors argued that possessing drugs was a tax
violation, as no legal licenses to sell drugs were in existence; hence, a
person possessing drugs must have purchased them from an unlicensed
source. After some wrangling, this was accepted as federal jurisdiction
under the interstate commerce clause of the U.S. Constitution.
Alcohol prohibition
The prohibition of alcohol commenced in Finland in 1919 and in the
United States in 1920. Because alcohol was the most popular recreational
drug in these countries, reactions to its prohibition were far more
negative than to the prohibition of other drugs, which were commonly
associated with ethnic minorities, prostitution, and vice. Public
pressure led to the repeal of alcohol prohibition in Finland in 1932,
and in the United States in 1933. Residents of many provinces of Canada also experienced alcohol prohibition for similar periods in the first half of the 20th century.
In Sweden, a referendum
in 1922 decided against an alcohol prohibition law (with 51% of the
votes against and 49% for prohibition), but starting in 1914 (nationwide
from 1917) and until 1955 Sweden employed an alcohol rationing system
with personal liquor ration books ("motbok").
War on Drugs
American drug law enforcement agents detain a man in 2005.
In response to rising drug use among young people and the counterculture
movement, government efforts to enforce prohibition were strengthened
in many countries from the 1960s onward. Support at an international
level for the prohibition of psychoactive drug
use became a consistent feature of United States policy during both
Republican and Democratic administrations, to such an extent that US
support for foreign governments has often been contingent on their
adherence to US drug policy. Major milestones in this campaign include the introduction of the Single Convention on Narcotic Drugs in 1961, the Convention on Psychotropic Substances in 1971 and the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances
in 1988. A few developing countries where consumption of the
prohibited substances has enjoyed longstanding cultural support, long
resisted such outside pressure to pass legislation adhering to these
conventions. Nepal only did so in 1976.
California's broader 'three strikes and you're out' policy adopted in 1994 was the first mandatory sentencing
policy to gain widespread publicity and was subsequently adopted in
most United States jurisdictions. This policy mandates life imprisonment
for a third criminal conviction of any felony offense. A similar 'three
strikes' policy was introduced to the United Kingdom by the
Conservative government in 1997. This legislation enacted a mandatory
minimum sentence of seven years for those convicted for a third time of a
drug trafficking offense involving a class A drug.
Calls for legalization, relegalization or decriminalization
The
terms relegalization, legalization, and decriminalization are used with
very different meanings by different authors, something that can be
confusing when the claims are not specified. Here are some variants:
Sales of one or more drugs (e.g., marijuana) for personal use become legal, at least if sold in a certain way.
Sales of an extracts with a specific substance become legal sold in a certain way, for example on prescription.
Use or possession of small amounts for personal use do not lead to
incarceration if it is the only crime, but it is still illegal; the
court or the prosecutor can impose a fine. (In that sense, Sweden both
legalized and supported drug prohibition simultaneously.)
Use or possession of small amounts for personal use do not lead to
incarceration. The case is not treated in an ordinary court, but by a
commission that may recommend treatment or sanctions including fines.
(In that sense, Portugal both legalized and supported drug
prohibitions).
In the 2010s, movements have grown around the world proposing the relegalization and decriminalization of drugs. For instance, there is a movement for cannabis legalization in Canada, as well as the Marijuana Party of Canada. Drug liberalization policies are often supported by proponents of liberalism and libertarianism
on the grounds of individual freedom. There are also growing
countermovements. Prohibition of drugs is supported by proponents of conservative values
but also by many other types of NGO's that are not linked to
conservative political parties. A growing number of NGO organizations in
many countries have joined the international network World Federation Against Drugs. WFAD members support the United Nations narcotics conventions.
In 2002, five (former) police officers created Law Enforcement Against Prohibition, a NGO
that has gained a lot of media attention, showing that support for a
regulation of drug sales also comes from the "other side" of the drug
war and that maintaining a global corruption pyramid for the tax-free
Mafia monopoly isn't a good idea, compared to controlling access, age
and quality. The former Director of the Office of National Drug Control Policy, the Drug CzarJohn P. Walters,
has described the drug problem in the United States as a "public health
challenge", and he has publicly eschewed the notion of a "war on
drugs". He has supported additional resources for substance abuse
treatment and has touted random student drug testing as an effective
prevention strategy. However, the actions of the Office of National Drug
Control Policy continue to belie the rhetoric of a shift away from
primarily enforcement-based responses to illegal drug use.
People marching in the streets of Cape Town against the prohibition of cannabis in South Africa, May 2015
On February 22, 2008 the President of Honduras, Manuel Zelaya,
called on the world to legalize drugs, in order, he said, to prevent
the majority of violent murders occurring in Honduras. Honduras is used
by cocaine smugglers as a transiting point between Colombia
and the US. Honduras, with a population of 7 million, suffers an
average of 8–10 murders a day, with an estimated 70% being a result of
this international drug trade. The same problem is occurring in Guatemala, El Salvador, Costa Rica and Mexico, according to Zelaya. In January 2012 Colombian President Juan Manuel Santos made a plea to the United States and Europe to start a global debate about legalizing drugs. This call was echoed by the Guatemalan President Otto Pérez Molina, who announced his desire to legalize drugs, saying "What I have done is put the issue back on the table."
In a report dealing with HIV in June 2014, the World Health Organization (WHO) of the UN
called for the decriminalization of drugs particularly including
injected ones. This conclusion put WHO at odds with broader
long-standing UN policy favoring criminalization.
Eight states of the United States (Alaska, California, Colorado, Maine,
Massachusetts, Nevada, Oregon, and Washington), as well as the District
of Columbia, have legalized the sale of marijuana for personal
recreational use as of 2017, despite the fact that recreational use
remains illegal under U.S. federal law. The conflict between state and
federal law is, as of 2018, unresolved.
Drug prohib
The following individual drugs, listed under their respective family
groups (e.g., barbiturates, benzodiazepines, opiates), are the most
frequently sought after by drug users and as such are prohibited or
otherwise heavily regulated for use in many countries:
The regulation of the above drugs varies in many countries. Alcohol
possession and consumption by adults is today widely banned only in Islamic countries and certain states
of India. The United States, Finland, and Canada banned alcohol in the
early part of the 20th century; this was called Prohibition. Although
alcohol prohibition was repealed in these countries at a national level,
there are still parts of the United States that do not allow alcohol sales, even though alcohol possession may be legal. Bhutan is the only country in the world where possession and use of tobacco is illegal. New Zealand has banned the importation of chewing tobacco as part of the Smoke-free Environments Act 1990. In some parts of the world, provisions are made for the use of traditional sacraments like ayahuasca, iboga, and peyote. In Gabon, Africa, iboga (tabernanthe iboga) has been declared a national treasure and is used in rites of the Bwiti religion. The active ingredient, ibogaine, is proposed as a treatment of opioid withdrawal and various substance use disorders.
In countries where alcohol and tobacco are legal, certain
measures are frequently undertaken to discourage use of these drugs.
For example, packages of alcohol and tobacco sometimes communicate
warnings directed towards the consumer, communicating the potential
risks of partaking in the use of the substance. These drugs also
frequently have special sin taxes
associated with the purchase thereof, in order to recoup the losses
associated with public funding for the health problems the use causes in
long-term users. Restrictions on advertising also exist in many
countries, and often a state holds a monopoly on manufacture, distribution, marketing, and/or the sale of these drugs.
Legal dilemmas
In the United States, there is considerable legal debate about the impact these laws have had on Americans' civil rights.
Critics claim that the War on Drugs has lowered the evidentiary burden
required for a legal search of a suspect's dwelling or vehicle, or to
intercept a suspect's communications. However, many of the searches that result in drug arrests are often "commissions" to search a person or the person's property.
People who consent to a search, knowing full well that they
possess contraband, generally consent because they are ignorant of the
fact that they have the right to decline permission to search.
Under the laws of most U.S. states, police are not required to disclose
to suspects that they have the right to decline a search. Even when a
suspect does not give permission to search, police are often known[citation needed]
to state in arrest affidavits and even provide sworn testimony that the
suspect consented to the search, secure in the knowledge that a judge
will normally weigh all questions of credibility in favour of law
enforcement and against the accused.
Similarly, in cases where the accused does not consent to a search, courts have generally held police to a very low standard of reasonable suspicion and/or probable cause in drug cases, essentially endorsing "fishing expeditions" by stop-and-search highway interdiction police.
The sentencing statutes in the United States Code that cover controlled substances are notoriously intricate. For example, a first-time offender convicted in a single proceeding for
selling marijuana three times, and found to have carried a gun on him
all three times (even if it were not used) is subject to a minimum
sentence of 55 years in federal prison.
Drug sentencing guidelines under state law in America are
generally much less harsh than the federal sentencing guidelines,
although great irregularities exist. The vast majority of drug felonies
and almost all drug misdemeanors in the United States are prosecuted at
the state level. The federal government tends to prosecute only drug
trafficking cases involving large amounts of drugs, or cases which have
been referred to federal prosecutors by local district attorneys seeking
the harsher sentences provided under the federal sentencing guidelines.
In rare instances, some defendants are prosecuted both federally and by
the state for the same drug trafficking conduct. The United States
Supreme Court has ruled that a defendant does not face double jeopardy
if he is convicted and sentenced by both the state and federal
government for the same underlying criminal conduct.Sometimes, crimes not directly related to drug use and sale. For example, the United States recently brought charges against club owners for maintaining a place of business where a) ecstasy is known to be frequently consumed; b) paraphernalia associated with the use of ecstasy is sold and/or widely tolerated (such as glow sticks and pacifiers);
and c) "chill-out rooms" are created, where ecstasy users can cool down
(ecstasy users in club settings tend to dance for extended periods of
time, raising the user's blood temperature). These are being challenged in court by organizations such as the American Civil Liberties Union (ACLU) and Drug Policy Alliance.
Drug prohibition has created several legal dilemmas. For example, many countries allow the use of undercoverlaw enforcement
officers solely or primarily for the enforcement of laws against use of
certain drugs. Many of these officers are allegedly allowed to commit
crimes if it is necessary to maintain the secrecy of the investigation,
or in order to collect adequate evidence for a conviction.[citation needed]
Some people have criticized this practice as failing to ensure equality
under the law because it grants police officers the right to commit
crimes that no other citizen could commit without potential
consequences.
Another legal dilemma is the creation in several countries of a legal loopholes allowing for arbitrary arrest and prosecution. This is the result of several drugs such as Dimethyltryptamine, GHB, and morphine being illegal to possess but also inherently present in all humans as a result of endogenous
synthesis. Since some jurisdictions classify possession of drugs to
include having the drug present in the blood in any concentration, all
residents of such countries are technically in possession of multiple
illegal drugs at all times.
The War on Drugs has stimulated the creation of international law enforcement agencies (such as Interpol), mostly in Western countries. This has occurred because a large volume of illicit drugs come from Third-World countries.
Social control
In Hallucinations: Behavior, Experience, and Theory (1975), senior US government researchers Louis Jolyon West and Ronald K. Siegel explain how drug prohibition can be used for selective social control:
The role of drugs in the exercise
of political control is also coming under increasing discussion. Control
can be through prohibition or supply. The total or even partial
prohibition of drugs gives the government considerable leverage for
other types of control. An example would be the selective application of
drug laws ... against selected components of the population such as
members of certain minority groups or political organizations
Academic Noam Chomsky argues that drug laws are currently, and have historically, been used by the state to oppress sections of society it opposes:
Very commonly substances are
criminalized because they're associated with what's called the dangerous
classes, poor people, or working people. So for example in England in
the 19th century, there was a period when gin was criminalized and whiskey wasn't, because gin is what poor people drink.
Legal highs and prohibition
In 2013 the European Monitoring Centre for Drugs and Drug Addiction reported that there are 280 new legal drugs, known as legal highs, available in Europe. One of the best known, mephedrone, was banned in the United Kingdom in 2010. On November 24, 2010, the U.S. Drug Enforcement Administration announced it would use emergency powers to ban many synthetic cannabinoids within a month. An estimated 73 new psychoactive synthetic drugs appeared on the UK market in 2012. The response of the Home Office
has been to create a temporary class drug order which bans the
manufacture, import and supply but not the possession of named
substances.
Corruption
In
certain countries, there’s a concern that campaigns against drugs and
organized crime are a cover for crooked officials tied to drug
trafficking themselves to take out their competitors. In the United
States, Federal Bureau of Narcotics chief Harry Anslinger’s opponents accused him of takes bribes from the Mafia to enact prohibition and create a black market.
More recently in the Philippines, one death squad hitman claimed to
author Niko Vorobyov that he was being paid by military officers to
eliminate those drug dealers who failed to pay a ‘tax’. Under President Rodrigo Duterte, the Philippines has waged a bloody war against drugs that may have resulted in up to 29,000 extrajudicial killings.
Drug possession is the crime of having one or more illegal drugs in
one's possession, either for personal use, distribution, sale or
otherwise. Illegal drugs fall into different categories and sentences
vary depending on the amount, type of drug, circumstances, and
jurisdiction. In the U.S., the penalty for illegal drug possession and
sale can vary from a small fine to a prison sentence. In some states,
marijuana possession is considered to be a petty offense, with the
penalty being comparable to that of a speeding violation. In some
municipalities, possessing a small quantity of marijuana in one's own
home is not punishable at all. Generally, however, drug possession is an
arrestable offense, although first-time offenders rarely serve jail
time. Federal law makes even possession of "soft drugs", such as
cannabis, illegal, though some local governments have laws contradicting
federal laws.
In the U.S., the War on Drugs is thought to be contributing to a prison overcrowding problem. In 1996, 59.6%
of prisoners were drug-related criminals. The U.S. population grew by
about +25% from 1980 to 2000. In that same 20 year time period, the U.S.
prison population tripled, making the U.S. the world leader in both
percentage and absolute number of citizens incarcerated. The United
States has 5% of the world's population, but 25% of the prisoners.
About 90% of United States prisoners are incarcerated in state
jails. In 2016, about 200,000, under 16%, of the 1.3 million people in
these state jails, were serving time for drug offenses. 700,000 were
incarcerated for violent offenses.
Australia
A Nielsen poll in 2012 found that only 27% of voters favoured decriminalisation. Australia has steep penalties for growing and using drugs even for personal use. with Western Australia having the toughest laws.
There is an associated anti-drug culture amongst a significant number
of Australians. Law enforcement targets drugs, particularly in the party
scene. In 2012, crime statistics in Victoria revealed that police were increasingly arresting users rather than dealers, and the Liberal government banned the sale of bongs that year.
The Netherlands
In the Netherlands, cannabis and other "soft" drugs are partly
decriminalised in small quantities. The Dutch government treats the
problem as more of a public health issue than a criminal issue. Contrary
to popular belief, cannabis is still illegal, mostly to satisfy the
country's agreements with the United Nations. Coffee shops
that sell cannabis to people 18 or above are tolerated in some cities,
and pay taxes like any other business for their cannabis and hashish
sales, although distribution is a grey area that the authorities would
rather not go into as it is not decriminalised. Many "coffee shops" are
found in Amsterdam
and cater mainly to the large tourist trade; the local consumption rate
is far lower than in the US. Netherlands has the highest antidrug
related public expenditure per capita of all countries in EU (139 EUR per capita, 2004).
Similarly to the rest of the European Union
member states and American democracies, controlled drugs are illegal in
the Netherlands. Nevertheless, illegal drugs are consumed worldwide,
causing concern in the international community. According to the United Nations Drug Control Programme, results in the 2001 World Drug Report
estimate "that the extent of drug abuse in the world involves about 180
million people, which represents 3% of the global population. The
majority of drug users (80%) used cannabis, followed by amphetamine-type
stimulants such as methamphetamine, amphetamine and substances of the
ecstasy group (16%), cocaine (8%), heroin (5%) and other opiates (2%)".
The administrative bodies responsible for enforcing the drug
policies include the Ministry of Health, Welfare and Sport, the Ministry
of Justice, the Ministry of the Interior and Kingdom Relations, and the
Ministry of Finance. Local authorities also shape local policy, within
the national framework. The prohibition policy is heavily influenced by
the international community (through the United Nations), especially the
neighboring states of France and Germany, which pressure the kingdom to
be more strict, for they are directly affected through the illegal
trafficking of narcotics coming from the Netherlands.
Legally, possession, manufacturing, trafficking, importation and
exportation are forbidden. Nonetheless, it is not an offense to use
drugs (Ministry of Foreign Affairs, 2003). There are different penalties
involved when breaking the law, which may include a monetary fine,
imprisonment, or both. To apply the law, the government differentiates
between "soft" and "hard" drugs. Soft drugs are considered to produce
less harm to both the individual and society, these being used mainly
for folk medicine and recreational purposes. This category encompasses cannabis (nederwiet),
hashish and some fungi. Hard drugs are considered to cause considerable
personal harm through addiction and physical detriment, as well as
nuisance to society, by increasing crime and deteriorating families.
Cocaine, heroin, etc. belong to this category.
Along with these two categories, there is a pyramid of priority when it comes to prosecution by law enforcement agencies.
The handling and trade of hard drugs is on the zenith, being a
joint target not only by the Netherlands, but also by the international
community. This can be punished by maximum sentences of twelve years of
imprisonment and/or a fine of up to €45,000.
The second priority is given to the production and trade of soft
drugs. Deviation from the AHOJ-G criteria for coffee shops may result in
up to four years of imprisonment and/or a fine of €45,000.
The third priority focuses on hard drug users. Instead of labelling
the users of hard drugs as "criminals", the state aims to rehabilitate
users and prevent others from becoming addicted. However, disturbance to
society caused by the consumption of hard drugs can result in one year
of prison and/or a €11,250 fine. Lastly, individuals possessing more
than five grams for personal consumption, or disturbing the public, can
go to prison for one month and/or be fined €2,250.
There are varying rules within these categories, for example the
amount possessed, the role played in the transaction and the intent of
the goods.
Regarding coffee shops, the line between law and practice thins. A
coffee shop is a heavily controlled business establishment where
individuals can purchase a personal dose of soft drugs in the form of
joints, pastry, drinks and packages. In theory, these shops must abide
by governmental and local regulations, as well as meet the AHOJ-G
criteria, an acronym for: No Advertising, Hard drugs, Nuisance of any
kind, Jongeren (minors under 18), and a limit of five grams per
transaction. Additionally, the maximum stock at any time is five hundred
grams. Local governments may impose additional rules, such as closing
times, zoning (coffee shops may not be close to schools), and parking
restrictions. The rationale behind coffee shops is to keep citizens away
from the hard drugs scene, bringing them to a safe, social, and
regulated environment.
When analysing the Dutch model, both disadvantages and advantages
can be drawn when comparing the results with other countries. On a
moral argument, tolerating soft drugs can be seen as the defeat of the
government against hedonism.
Additionally, decades of growing and perfecting cannabis and hashish
has resulted in increased levels of the main active hallucinogenic
constituent tetrahydrocannabinol
(THC), as levels have doubled, making the derived products more
powerful, and therefore requiring less to achieve the desired effect.
The coffee shop will lose its license if it caught selling to minors.
Though there was a slight increase of use at the beginning, the rates
balanced out some years later. The presence of coffee shops does not
translate in public urge for experimentation. In fact, most people that
did not consume drugs before the enhancement of the policy continue not
to use them.
When compared to other countries, Dutch drug consumption falls in
the European average at six per cent regular use (twenty-one per cent
at some point in life) and considerably lower than the Anglo-Saxon
countries headed by the United States with an eight per cent recurring
use (thirty-four at some point in life). Experts have come to the
conclusion that the policies applied do not play a striking role in
these statistics, though there is debate over this issue (CEDRO, 2004).
While there has been talk for over a decade about preventing foreigners
from entering Dutch cannabis coffeeshops by requiring customers to
possess a 'weedpass', this legislation has not been enacted, so Dutch
coffeeshops continue to sell cannabis openly to both locals and
foreigners. However a small number of southern municipalities (including
Roosendaal and Maastricht) in the Netherlands now require customers to
carry identification proving that they are resident in the Netherlands.
Asia
Indonesia
Indonesia carries a maximum penalty of death for drug dealing, and a maximum of 15 years prison for drug use. In 2004, Australian citizen Schappelle Corby was convicted of smuggling 4.4 kilograms of cannabis into Bali,
a crime that carried a maximum penalty of death. Her trial reached the
verdict of guilty with a punishment of 20 years imprisonment. Corby
claimed to be an unwitting drug mule. Australian citizens known as the "Bali Nine" were caught smuggling heroin.
Two of the nine, Andrew Chan and Myuran Sukumaran, were executed April
29, 2015 along with six other foreign nationals. In August 2005,
Australian model Michelle Leslie was arrested with two ecstasy
pills. She pleaded guilty to possession and in November 2005 was
sentenced to 3 months imprisonment, which she was deemed to have already
served, and was released from prison immediately upon her admission of
guilt on the charge of possession.
At the 1961 Single Convention on Narcotic Drugs, Indonesia, along
with India, Turkey, Pakistan and some South American countries opposed
the criminalisation of drugs.
Republic of China (Taiwan)
Taiwan carries a maximum penalty of death for drug trafficking, while smoking tobacco and wine are classified as legal entertainment drug. The Department of Health is in charge of drug prohibition.
Methods of law enforcement
Because the possession of drugs is called a "victimless crime" by some analysts, as it can be committed in privacy,
the enforcement of prohibitionist laws requires methods of law
enforcement to inspect private property. In societies with strong property laws or individual rights, this may present a risk for conflicts or violations of rights.
Disrupting the market relies on eradication, interdiction and domestic
law enforcement efforts. Through cooperation with governments such as
those of Colombia, Mexico and Afghanistan,
coca (the plant source for cocaine) and poppy (the plant source for
opium and heroin) are eradicated by the United States and other allies
such as the United Kingdom, so that the crops cannot be processed into
narcotics. Eradication can be accomplished by aerial spraying or manual
eradication. However, the eradication is only temporary as the harvest
fields can usually be replanted after a certain amount of time.
The government of Colombian President Álvaro Uribe
has resisted criticism of aerial spraying of coca and poppy and has
seen major reductions in both crops according to the United Nations
Office of Crime and Drugs.
In 2003, over 1,300 square kilometers of mature coca were sprayed and
eradicated in Colombia, where at the start of the year, approximately
1,450 square kilometers had been planted. This strategic accomplishment
prevented the production over 500 tonnes of cocaine, sufficient to
supply all the cocaine users in both US and Europe for one year.
Further, it eliminated upward of $100 million of illicit income in
Colombia. No effect on prices or availability in the marketplace has
been noted, and the actual number of acres of coca planted seems to have
actually increased, largely shifting to more remote areas or into
neighboring countries. Aerial spraying also has the unintended
consequence of destroying legitimate crop fields in the process.
Interdiction is carried out primarily by aerial and naval armed
forces patrolling known trafficking zones. From South America to the
United States most drugs traverse either the Caribbean Sea or the
Eastern Pacific, usually in "go-fast"
boats that carry drug cargos and engines and little else. Drugs have
also been smuggled in makeshift submarines. In 2015, a submarine with
12,000 pounds of cocaine was seized by the US Coast Guard off of the
coast of Central America. This was the largest US drug seizure to date.
Investigation on drug trafficking often begins with the recording of unusually frequent deaths by overdose,
monitoring financial flows of suspected traffickers, or by finding
concrete elements while inspecting for other purposes. For example, a
person pulled over for traffic violations may have illicit drugs in his
or her vehicle, thus leading to an arrest and/or investigation of the
source of the materials. The United States federal government has placed
a premium on disrupting the large drug trafficking organizations that
move narcotics into and around the United States, while state and local
law enforcement focus on disrupting street-level drug dealing gangs.
Drug control strategy
Present drug control efforts utilize several techniques in the attempt to achieve their goal of eliminating illegal drug use:
Disrupting the market for drugs
Prevention efforts that rely on community activism, public
information campaigns to educate the public on the potential dangers of
drug use
Law-enforcement efforts against elements of the supply chain, through surveillance and undercover work
Providing effective and targeted substance abuse treatment to dependent users
Alternatives to prohibition
On February 11, 2009, a document called Drugs and democracy in Latin America: Towards a paradigm shift was signed by several Latin American political figures, intellectuals, writers and journalists as commissioners of the Latin American Initiative on Drugs and Democracy. The document questions the war on drugs and points out its failures.
It also indicates that prohibition has come with an extensive social
cost, especially to the countries that take part in the production of
illicit drugs. Although controversial, the document does not endorse
either the production or consumption of drugs but recommends for both a
new and an alternative approach. The document argues that drug
production and consumption has become a social taboo
that inhibits the public debate because of its relationship to crime
and as consequence it confines consumers to a small circle where they
become more vulnerable to the actions of organized crime. The authors
also demand for a close review to the prohibitive strategies of the United States
and the study of the advantages and limits of the damage reduction
strategy followed by the European Union. The proposal uses three
paradigms as an alternative:
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