Chapter 13: Opoids

Vietnam continued

-1971 reports: 10-15% American troops in Vietnam dependent on heroin. -U.s govt took action: One step was to initiate Operation Golden Flow, a urine-testing program to detect opioids in service personnel ready to leave Vietnam. -October 1971: showed that 5.1% of the 100,000 personnel tested showed traces of opioids in their urine. Most of the opioid users were in the lower ranks. -Veterans that came back from vietnam that used didn't continue heroin use in this country. Only 1-2% were using opioids 8-12 months after returning from Vietnam and being released from the service, approximately the same percentage of individuals found to be using opioids when examined for induction into the service.

Production and purity

-1972: The major source of U.S. heroin was opium grown in Turkey and converted into heroin in southern French port cities, such as Marseilles. -"french connection": accounted for as much as 80 percent of U.S. heroin before 1973. -1972: Turkey banned all opium cultivation and production in return for $35 million the United States provided to make up for the financial losses to farmers and to help them develop new cash crops. This action, combined with a cooperative effort with the French did lead to a reduction in the supply of heroin on the streets of New York in 1973. -dependence can occur in any route that produces behavioral/ physiological effects.

Mechanism of Action

-1974: A pair of molecules, leu-enkephalin and met-enkephalin, were isolated from brain extracts. -These enkephalins acted like morphine and were many times more potent. -discovery of endorphins: (endogenous morphinelike substances) that are also found in brain tissue and have potent opioid effects -dynorphins & other substances similar to those of morphine. -mu and kappa opioid receptors play a role in pain perception, while the functions of the delta receptor are not as easily understood. -sites of action may be the midbrain central gray, known to be involved in pain perception. there are many other sites of interaction between these systems and areas that relate to pain, we cannot say that we understand completely how opioids act to reduce pain.

The Changing Population of Opioid Users

-After the Harrison Act, the number of white middle-aged people using opioids orally declined -After WW2 herion use slowly increased in lower class areas of large cities. -Heroin cost: inexpensive, $1 for 3-6 ppl to get high; $2 a day was not uncommon. -1950's: Heroin use spread, increase of demand and also iincrease of price & adulteration.

Drugs in Depth: Prescribing Pain Medications: Damned If You Do and Damned If You Don't

-Chronic Pain: pain is a condition that can negatively impact an individual's quality of life, by disrupting sleep, employment, social functioning, and many other routine daily activities. -one third of US population has symptoms of chronic pain. (more than 90million) -Opioids most effective treatment of chronic pain. -celebrity deaths/drug store robberies concern abt overprescribing opioid pain medication. -Physicians arrested for"pushing pills" dispensing pain medications indiscriminately for quick cash. -Patients "doctor shop" decieving physicias in order to obtain large amounts of opiod medications.

Life saver: Heroin (alone) is not the problem

-Glee actor Cory Monteith: found dead dead in his hotel room on July 13, 2013, and the British Columbia coroner concluded that his death was the result of a toxic mixture of alcohol and heroin. -Monteith's death confirms the pernicious nature of illegal drug use and addiction that eventually ends in tragedy. -others speculate that Monteith was more vulnerable to overdose after recently going through a detox program, because his body was no longer able to tolerate high doses of heroin. -80% or more use drugs w/o obvious problems. -while it is theoretically possible to die from an overdose of heroin alone, in practical terms this is rare. (abt a quarter of the thousands of heroin related deaths/yr occur as a result from heroin alone.) -70% or more deaths are caused by combining heroin w/ other sedative, usually alcohol.

Abuse of Prescription Opioids

-Hydrocodone: (Vicodin & Lortab) -Oxygcodone: (Oxycontin & Percocet) -Taken orally, but when used recreationally they are sometimes snorted/injected. -2012: 2% of Americans 12yrs & older reported nonmedical use of a prescription pain reliever within the past month. (pain reliever use has now reached epidemic rates) -Past yrs prevalence prescription opioids has remained stable. -2002: 2% of Americans reported past month nonmedical use.

Taking Sides: Should Naloxone Be Made Available to Heroin Users?

-In major U.S. cities, hundreds of heroin users die from overdose. (with a person who might be scared to call police b/c scared they might get introuble) -Naloxone: a fast-acting opioid antagonist, can reverse opioid-induced respiratory depression and prevent death if given within minutes of an overdose. (not available to users b/c you can only get through prescription) -U.S. cities; Baltimore, Boston, Chicago, New York, and San Francisco, to initiate programs that would provide naloxone and rescue-breathing training to illicit drug users.

Articles in the NYT 2014, Minneapolis Star Tribune 2014, Rockford Register Star 2014 referred to new "heroin epidemics" in surrounding areas.

-Increased in overdose deaths, and in southeastern Ohio that statistic that triggered the news article was an increase in admissions to treatment programs. -These reports really attract attention—and increase sales and advertising revenue—so there's always a market for the stories. As we have seen before, most of this kind of illicit drug use is better viewed as occurring in localized areas, taking on more of the character of a fad than of an epidemic.

Late 19th century

-Opioid dependence was viewed as a "vice of middle life." - typical opioid user of this period was a 30- to 50-year-old white woman who functioned well and was adjusted to her life as a wife and mother. (caused a few, if any social problems) -She might have ordered "family remedy" through the mail from sears, etc. 2oz of laudanum for 18 cents or 1 1/2 pints for $2. -Problems of addiction during this period (recreational/medical) -high levels of drugs were frequently used (as of result withdrawal symptoms were severe, & the relief was to take more of the drug)

Pressures

-Oral oipiod users began to decline in response to these pressures. (primary remaining group were those who injected morphine/heroin)

February 2, 2014

-Philip Seymour Hoffman also died as a result of combining heroin with other drugs, including a benzodiazepine. -it seems that the focus on factors other than the heroin-sedative combination is distracting and irresponsible. -were missing important public health education opportunity to decrease drug related accidents. (accidents could have been prevented if we inform about potential dangers of this drug & combination)

Pharmacology; chemical characteristics

-Raw opium: 10% morphine by weight & smaller amt of codeine. -Diacetylmorphine/heroin: Addition of 2 acetyl groups to the morphine molecule. -The acetyl groups allow heroin to penetrate the blood-brain barrier more readily, & heroin is therefore two to three times more potent than morphine. -chemists tried to separate analgesic effect from their dependence producing effect. (couldn't be separated) -opioids sold as pain relievers (fentanyl, approx. 100x more potent than -Fentanyl is used primarily in conjunction with surgical anesthesia, although both fentanyl and some of its derivatives have also been manufactured illegally and sold on the streets.

1915

-U.S. Supreme Court decided that possession of smuggled opioids was a crime, and thus users not obtaining the drug from a physician became criminals with the stroke of a pen. -Addicted users could still obtain their supply of drugs on a prescription from a physician, until this avenue was removed by Supreme Court decisions in 1919 and 1922.

Physicians used opioid medications

-Understandable in light of articles that were published such as "Advantages of Substituting the Morphia Habit for the Incurably Alcoholic." in 1889. -In this way I have been able to bring peacefulness and quiet to many disturbed and distracted homes, to keep the head of a family out of the gutter and out of the lock-up/ committing crimes. etc. -he might enlarge the statistics to prove the law abiding qualities of opium eating people (gaze of morphine vs riotous devil may care of drunkard)

Late 1920's

-about half of the U.S. heroin supply apparently originated in Southwest Asia (Afghanistan, Pakistan, Iran) -Mexico; next biggest contributor w/ the golden triangle area of southeast asia producing about 15-20% of the total. -today, more than 90% of heroin originate in Afghanistan. Most of the heroin used in the US derived from poppies grown in Columbia & Mexico.

1922

-about the only source of opioids for a nonhospitalized abuser was an illegal dealer. -Cocaine illegal dealers choice b/c it was easy to conceal. -Cost was 30-50 times the price of the same drug. B/c of this cost intravenous injection became more common("bang for their buck") -Criminal activity took place by users to finance their addiction.

major increase in the use of morphine

-came as a result of two nondrug developments: -one technological and one political. The technological development was the perfection of the hypodermic syringe in 1853 by Dr. Alexander Wood. This made it possible to deliver morphine directly into the blood or tissue rather than by the much slower process of eating opium or morphine and waiting for absorption to occur from the gastrointestinal tract. -political events that sped the drug of sleep and dreams into the veins of people worldwide were the American Civil War (1861-1865), the Prussian-Austrian War (1866), and the Franco-Prussian War (1870). Military medicine characterized by the dictum "first provide relief". Morphine given by injection worked rapidly and well, and it was administered regularly in large doses to many soldiers for the reduction of pain and relief from dysentery. The percentage of veterans returning from these wars who were dependent on morphine was high enough that the illness was later called "soldier's disease" or the "army disease."

Rockefeller Drug Laws in 1973

-created mandatory minimum prison sentences of 15 years to life for possession of four ounces of drugs such as heroin, and earned New York the distinction of having the strictest drug laws in the nation. -More than 90% convicted were black/latino -After 36yrs with no changes to this law, in April 2009 Governor Patterson signed into law sweeping reforms, which eliminated the harsh sentences that the laws mandated by returning the discretion to judges who could now divert nonviolent drug abusers to treatment (instead of looking at users as criminals, see them as ppl worthy of compassion/treatment)

Taking Sides: Should Naloxone Be Made Available to Heroin Users? continued

-critics argue: by making heroin use less dangerous it sends a message that illicit drug use is condoned and will decrease the likelihood of heroin abusers seeking treatment. -Proponents; view such programs as a form of harm reduction—that is, drug users will be kept alive until they are ready to enter treatment.

Opioid Antagonists

-drugs that block the action of morphine, heroin, or other opioid agonists. -Naloxone(Narcan/nalorphine) can save a person's life by reversing the depressed respiration resulting from an opioid overdose. (if given to user who is physically dependent can give immediate withdrawal syndrome. -Naloxone & longer lasting naltrexone have been given to dependent individuals to prevent them from experiencing a high if they then use heroin.

Habituation

-has been noted in a small percentage none of the patients suffer in any way from this habituation, and that none of the symptoms which are so characteristic of chronic morphinism have ever been observed. -On the other hand, a large number of the reports refer to the fact that the same dose may be used for a long time without any habituation.

Heroin use

-has for many years been restricted to a small fraction of any population studied. -2012 National survey on drug use: Only 1% of US adults reported ever having used heroin in their lifetime. 0.2% reported use in last year. (these numbers have remained stable, but still heroin epidemic)

Increased production in S. America and Mexico

-has resulted in both greater availability and greater purity in the U.S. market. -Mid 1970's-1980's: the average purity varied from 4-6% heroin (more than 90 percent was something else the dealers used to cut the heroin). -1980's: increased shipments of increasingly pure heroin began to arrive. -1989: average street purity was estimated to be 25%. Today purity ranges for 20-40%. -price of a bag has not changed, price/milligram of actual heroin was down

Important things learned from this

-heroin addiction and compulsive use are not inevitable among occasional users.(today most users of opioid drugs are not addicted, compulsive users.) -pattern of drug use in Vietnam also supports the belief that under certain conditions—availability and low cost of the drug, limited sanctions, stress—a relatively high percentage of individuals will use opioids recreationally.

Passing of the Harrison Act in 1914

-left the status of the addict almost completely indeterminate. -did not make addiction illegal and it neither authorized nor forbade doctors to prescribe drugs regularly for addicts. -required that whatever drugs addicts obtained were to be secured from physicians registered under the act and that the fact of securing drugs be made a matter of record. -some drug users had obtained supplies from physicians before 1914, it was not necessary for them to do so since drugs were available for purchase in pharmacies and even from mail-order houses.

Mexico

-opium is processed into morphine by a different process, and the resulting pure heroin has a brown or black color. -1975: DEA estimated that 80% or more of all U.S. heroin was from Mexico. (called Brown/black tar) -Supply was plentiful price low, and the purity high. -1974: the United States began to finance opium eradication programs in Mexico. -Although it is hopeless to try to eliminate all such production, these monumental and expensive efforts did slow the importation from Mexico to some extent, & the "epidemic" of the 1970s began to decline.

Dequincy discovered

-opium was not uni-dimensional. -He detailed the pains of opium withdrawal and reported not being able to write for long periods of time due to his dependence on the drug. -DeQuincey felt compelled to provide justification for his daily use of opium: (he had been using for 10yrs) It was not for the purpose of creating pleasure, but of mitigating pain in the severest degree, that I first began to use opium as an article of daily diet. In the twenty-eighth year of my age, a most painful affection of the stomach, which I had first experienced about ten years before, attached me in great strength.

Seizures

-poor way to measure drug use trends. -reasearchers estimate that authorities capture only about one tenth of the drugs on the market. -amount of drugs seized, doesn't answer the question of whether the seizure is a representative portion of a steady market, a growing portion of a shrinking market, or a smaller portion of a growing market.

Since before 1557

-pressure had been increasing on the chinese emperors to open up the country to trade with "barbarians from the west" There was little that the Chinese were interested in importing from the "barbarians," but opium could be smuggled so profitably that it soon became the primary import. The profit the British made from selling opium paid for the tea they shipped back to England

failure to find dependence basis

-probably was the fact that heroin was initially used as a substitute for codeine, which meant oral doses of 3 to 5 mg used for brief periods of time. -Slowly the situation changed, and a 1905 text, Pharmacology and Therapeutics, took a middle ground on heroin by saying that it "is stated not to give rise to habituation. A more extended knowledge of the drug, however, would seem to indicate that the latter assertion is not entirely correct." (later on, everyone knew that heroin could produce a powerful dependence when injected in higher doses)

Lindner case in 1925

-reversed these earlier decisions & stated that a physician could prescribe drugs to nonhospitalized users just to maintain their dependence, the doctors had been harassed and arrested enough. (few physicians did so) -Federal officials pressued clinics for treatment of opioid dependence to close in 1920's

Vietnam

-scared that Vietnam conflict might produce thousands of drug users among the military personnel stationed there. -Heroin was about 95% pure and almost openly sold in South Vietnam, whereas purity in the United States was about 5% in 1969. -Southeast Asia heroin = undiluted & inexpensive. $10=250mg (enough for 10 injections) vs. United States it would be $500. -high purity of heroin: possible to get psychological effects by smoking or sniffing. -40% sniffling, about half smoking, 10% injecting heroin.

1920's (law enforcement/popular press changes)

-the general public became even less tolerant of illicit opioid users -Instead of being viewed as unfortunate victims deserving sympathy and medical assistance, habitual opioid users were now viewed as degenerates and criminals. (law enforcement approach became the primary means of addressing drug dependence)

start of 20th century

-the percentage of Americans addicted to one of the opioids was probably greater than at any other time before or since. -no less than 1 percent of the population was addicted to opioids, although accurate statistics are not available. -The opium smoking the Chinese brought to this country never became widely popular, although about one-fourth of the opium imported was smoking opium at the start of the 20th century. (maybe b/c the smoking itself occupies only about a minute and is then followed by a state of reverie that can last two or three hours) -Another reason that opium smoking did not spread was that it originated with Asians, who were scorned by whites.

Abuse after the Harrison Act

-this was a fairly simple revenue measure. -It is not the law itself that becomes important, but the court decisions and enforcement practices that evolve as the law interacts with the people it affects.

Heroin

-thousands of heroin users in the US (number has remained stable) -Americans will always use heroin -to keep them safe providing health information sounds ethical.

The 1960s and onward

-use of various drugs skyrocketed -Mainstream USA became concerned with the heroin problem of the large cities. As the drug became more demonized, the most visible users were black or Latino. (white majority had little patience/tolerance w/ ppl who were addicted to/who sold heroin) -this fueled the passage of NY state's infamous Rockefeller Drug Laws in 1973

heroin

19th century a small but important chemical transformation was made to the morphine molecule. 1874: , two acetyl groups were attached to morphine, yielding diacetylmorphine, which was given the brand name Heroin and placed on the market in 1898 by Bayer Laboratories. -chemical change was important because heroin is about three times as potent as morphine.

how do the rates of illicit prescription opioid use compare with other illicit drugs?

2012: 7.3% and 0.6% of Americans reported past-month use of marijuana and cocaine, respectively. -prescription opioid use (2%) far exceeds cocaine use but is markedly lower than marijuana use.

Opium wars

Although opium and the opium poppy had been introduced to China well before the year ad 1000, there was only a moderate level of use there by a select, elite group. -Tobacco use had spread and become so offensive that in 1644 the emperor forbade tobacco smoking in China. (part responsible for increase of opium smoking) -restriction on the use of tobacco and the population's appreciation of the pleasures of smoking led to the combining of opium and tobacco for smoking. (addition of opium led to stop craving for tobacco)

1729

China's first law against opium smoking mandated that opium shop owners be strangled. Once opium for nonmedical purposes was outlawed, it was necessary for the drug to be smuggled in from India, where poppy plantations were abundant.

What about toxicity? Are prescription opioids more likely to cause drug overdose compared with other drugs?

Drug Abuse Warning Network data, prescription opioids ranked 3rd among emergency room mentions and 1st among drug-associated deaths. (most opioid overdoses occur in combination with a sedative such as alcohol) -FDA & drug manufacturers have taken preventative measures. -FDA requires opioid manufacturers to council pts abt risks/ benefits of opioid use, while others develop "abuse deterrent" -bottom line: prescription use of pain reliever hasn't dramatically increased, real concern abt the potential for toxicity when drugs are misused.

Drugs in the media, rise & fall of heroin "epidemics"

Heroin use has always been restricted to a very small proportion of the US population, but there news reports abt the most recent "heroin epidemic" amid speculation about its rapid spread. -Triggers of these reports: death of a celebrity, arrest of some young heroin users, or the spectacular seizure of a larger drug shipment.

Shortley after 1000 ad, Biruni composed a pharmacology book

His descriptions of opium contained what some believe to be the first written description of opioid addiction.

morphine

In 1806, Frederich Sertürner published a report of more than 50 experiments, which clearly showed that he had isolated the primary active ingredient in opium. The active agent was 10 times as potent as opium. Sertürner named it morphium after Morpheus, the god of dreams.

Avicenna, Galen

In the same period the best-known Arabic physician, Avicenna, was using opium preparations very effectively and extensively in his medical practice. His writings, along with those of Galen, formed the basis of medical education in Europe as the Renaissance dawned, and thus the glories of opium were advanced. (Avicenna, a knowledgeable physician and a believer in the tenets of Islam, died as a result of drinking too much of a mixture of opium and wine.)

Opioid Abuse before the Harrison Act

In the second half of the 19th century, 3 forms of opioid addiction were developing in the United States. -The long-useful oral intake of opium, and then morphine, increased greatly as patent medicines became a standard form of self-medication. After 1850, Chinese laborers were imported in large numbers to the West Coast, and they introduced opium smoking to this country. The last form, medically the most dangerous and ultimately the most disruptive socially, was the injection of morphine.

Natural products

Morphine, codeine. semisynthetics, heroin, diamorph

opium

Opium is produced and available for collection for only a few days of the plant's life, between the time the petals drop and the seedpod matures.

Raw opium

Substance from which morphine is extracted and then heroin is derived

History of Opoids

The most likely origin of opium is in a hot, dry, Middle Eastern country several millennia ago, when someone discovered that for 7 to 10 days of its yearlong life Papaver somniferum produced a substance that, when eaten, eased pain and suffering. The opium poppy is an annual plant that grows three to four feet high with large flowers four to five inches in diameter. The flowers can be white, pink, red, purple, or violet.

there are many factors at work tending to drug enslavement

among them being the host of soothing syrups, medicated soft drinks containing cocaine, asthma remedies, catarrh remedies, consumption remedies, cough and cold remedies, and the more notorious so-called "drug addiction cures." It is often stated that medical men are frequently the chief factors in causing drug addiction.

Morphine habit was cheap

by one estimate it was 10 times as expensive to be a heavy drinker—costing 25 cents a day.

Arabic world

clutched opium to its breast. Because the Koran forbade the use of alcohol in any form, opium and hashish became the primary social drugs wherever the Islamic culture moved, and it did move. -Arabian world reached out and made contact with India and China. Opium was one of the products they traded, but they also sold the seeds of the opium poppy, and cultivation began in these countries. By the 10th century ad, opium had been referred to in Chinese medical writings.

Concern

developed over the number of people who were dependent on opioids, and this concern was a part of the motivation that led to the passage of the 1906 Pure Food and Drugs Act. In 1910, a government expert in this area made clear that this law was only a beginning: The thoughtful and foremost medical men have been and are cautioning against the free use of morphine and opium, particularly in recurring pain. The amount they are using is decreasing yearly.

Morphine

developed slowly but by 1831 the implications of Sertürner's chemical work and the medical value of morphine had become so overwhelming that this pharmacist's assistant was given the French equivalent of the Nobel Prize.

Early in 16th century

european medical phenomenon lived -Paracelsus: successful clinician & accomplushed some wondrous cures for the day (opium extract called laudanum, his secret to cure) -Paracelsus was early Renaissance supporters of opium as a panacea and referred to it as the "stone of immortality."

tobacco use

gradually reduced and soon omitted. -Although opium eating had never been very attractive to most Chinese, opium smoking spread rapidly, perhaps in part because smoking opium results in a rapid effect, compared with oral use. -smoking opium results in rapid effects

Dr. Thomas Sydenham

he has been called the English Hippocrates b/c contributions are so great. He spoke more highly of opium than did Paracelsus, saying that "without opium the healing art would cease to exist." His laudanum contained two ounces of strained opium, one ounce of saffron, a dram of cinnamon, and a dram of cloves dissolved in one pint of Canary wine, taken in small quantities.

Pharmacology of heroin and morphine

is identical, except that the two acetyl groups increase the lipid solubility of the heroin molecule, and thus the molecule enters the brain more rapidly. The additional groups are then detached, yielding morphine. Therefore, the effects of morphine and heroin are identical, except that heroin is believed to be more potent and acts faster.

1839, emperor of china

made a fatal mistake—he sent an honest man to Canton to suppress the opium smuggling. Commissioner Lin demanded that the barbarians deliver all their opium supplies to him and subjected the dealers to confinement in their houses. -the representative of the British government ordered the merchants to deliver the opium—20,000 chests (6million worth) which was destroyed & everyone was set free. -incident involving drunken American and British sailors KILLING a Chinese citizen started the Opium Wars in 1839. -british won victory over country more than 350mill citizens. -British given island of hong kong, broad trading right & $6million to reimburse the merchants whose opium had been destroyed.

Data supported belief of

medical use of opioids initiated by a physician was one, if not the, major cause of addiction in this country at that time. -1918 government report clearly indicated the physician as the major cause of addiction in individuals of "good social standing"

Synthetics

methadone; dolophine, meperidine; demerol, oxycodone; percodan; oxycontin; percocet, oxymorphone; numorphan, hydrocodone; vicodin; lortab, hydromorphone; dilaudid, dihydrocodeine, propoxyphene; Darvon, pentazocine;Talwin, fentanyl; Sublimaze.

later work into opium mysteries

more than 30 different alkaloids, with the second most important one being isolated in 1832 and named codeine, the Greek word for "poppy head."

Writers and opium; keys to paradise

most enthusiastically articulated the powers of opium was Thomas De Quincey. In his 1821 book, Confessions of an English Opium-Eater, De Quincey meticulously describes both the pleasures and pains of regular opium use.

Opium harvesters

move through the fields in the early evening and use a sharp, clawed tool to make shallow cuts into, but not through, the unripe seedpods. During the night a white substance oozes from the cuts, oxidizes to a red-brown color, and becomes gummy. In the morning the resinous substance is carefully scraped from the pod and collected in small balls. This raw opium forms the basis for the opium medicines that have been used throughout history and is the substance from which morphine is extracted and then heroin is derived.

Dequincy wrote

my pains had vanished...here was the secret of happiness, about which philosophers had disputed for so many ages, at once discovered: happiness now might be bought for a penny, and carried in a waistcoat pocket: portable ecstasies might be had corked up in a pint-bottle

opium

new opium preparations were developed in the 16th, 17th, and 18th centuries. One of these was laudanum as prepared by Dr. Thomas Sydenham, the father of English clinical medicine.

heroin marketed as

nonaddictive cough suppressant that would replace morphine and codeine. It seemed to be the perfect drug, more potent yet less harmful. (introduced commercially until 1898) -Pharmalogical actions had been reported in 1890. -January 1900= article concluded that tolerance and dependence on heroin were only minor problems.

Chinese opium trade

posed a great moral dilemma for Britain. The East India Company protested until its end that it was not smuggling opium into China, and technically it was not. From 1870 to 1893, motions in Parliament to end the extremely profitable opium commerce failed to pass but did cause a decline in the opium trade. In 1893, a moral protest against the trade was supported, but not until 1906 did the government support and pass a bill that eventually ended the opium trade in 1913.

Patent medicines

promised, and in part delivered, the perfect self-medication. They were easily available, not too expensive, socially acceptable, and they worked. The amount of alcohol and/or opioids in many of the nostrums was certain to relieve the user's aches, pains, and anxieties.

epidemic

rapidly spreading outbreak of contagious disease or by extension to any rapid spread, growth, or development of a problem.

Important extent of use of opium poppy

the Ebers papyrus (circa 1500 bc) a remedy is mentioned "to prevent the excessive crying of children." Because a later Egyptian remedy for the same purpose clearly contained opium. -Important in greek medicine. Galen, the last of the great Greek physicians, emphasized caution in the use of opium but felt that it was almost a cure-all, saying that it resists poison and venomous bites, cures chronic headache, vertigo, deafness, epilepsy, apoplexy, dimness of sight, loss of voice, asthma, coughs of all kinds, spitting of blood, tightness of breath, colic, the iliac poison, jaundice, hardness of the spleen, stone, urinary complaints, fevers, dropsies, leprosies, the troubles to which women are subject, melancholy and all pestilences.

early 19th century

the government of India was actually the British East India Company. As such, it had a monopoly on opium, which was legal in India. However, smuggling it into China was not. The East India Company auctioned chests of opium cakes to private merchants, who gave the chests to selected British firms, which sold them for a commission to Chinese merchants. In this way the British were able to have the Chinese "smuggle" the opium into China. (number of chests of opium, each w/ about 120lbs of smokable opium, imported annually by China increased from 200 in 1729 to abt 5,000 to 25,000 chests in 1838.

smuggling opium

was so profitable for everyone—the growers, the shippers, and the customs officers—that unofficial rules were gradually developed for the "game." The background to the Opium Wars is lengthy and complex, but the following can help explain why the British went to war so they could continue pouring opium into China against the wishes of the Chinese national government.