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Despite negative stigmas towards opium in the United States, the use of opium derived products in the treatment of chronic pain has been reestablished. As seen in case studies today, the use of opiates in medicine, namely morphine, is seen as a safe and effective form of treatment for pain even if given over longer periods of time in controlled doses. Morphine generally doesn’t impair cognitive function when given in moderate, stable doses, and now is shown to help with neuropathic pain (pain of nerves or neurological diseases), on which it was previously thought to have no effect.

Cultivation of opium poppies for food, anesthesia, and ritual purposes dates back to at least the Neolithic Age (new stone age). The Sumerian, Assyrian, Egyptian, Indian, Minoan, Greek, Roman, Persian and Arab Empires all made widespread use of opium, which was the most potent form of pain relief then available, allowing ancient surgeons to perform prolonged surgical procedures. Anthropologists have speculated ancient priests may have used the drug as a proof of healing power. In Egypt, the use of opium was generally restricted to priests, magicians, and warriors, its invention is credited to Thoth, and it was said to have been given by Isis to Ra as treatment for a headache.

A figure of the Minoan "goddess of the narcotics", wearing a crown of three opium poppies, circa 1300 BCE, was recovered from the Sanctuary of Gazi, Crete, together with a simple smoking apparatus. The Greek gods Hypnos (Sleep), Nyx (Night), and Thanatos (Death) were depicted wreathed in poppies or holding them. Poppies also frequently adorned statues of Apollo, Asklepios, Pluto, Demeter, Aphrodite, Kybele and Isis, symbolizing nocturnal oblivion.

Opium Poppy Tears.

Opium (poppy tears, lachryma papaveris) is the dried latex obtained from the opium poppy (Papaver somniferum). Opium contains approximately 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine. The traditional method of obtaining the latex is to scratch ("score") the immature seed pods (fruits) by hand; the latex leaks out and dries to a sticky yellowish residue that is later scraped off. The modern method is to harvest and process mature plants by machine.

The production of opium itself has not changed since ancient times. Through selective breeding of the Papaver somniferum plant, the content of the phenanthrene alkaloids morphine, codeine, and to a lesser extent thebaine, has been greatly increased. In modern times, much of the thebaine, which often serves as the raw material for the synthesis for hydrocodone, hydromorphone, and other semi-synthetic opiates, originates from extracting Papaver orientale or Papaver bracteatum.

Globally, opium has gradually been superseded by a variety of purified, semi-synthetic, and synthetic opioids with progressively stronger effects, and by other general anesthetics. This process began in 1804, when Friedrich Wilhelm Adam Sertürner first isolated morphine from the opium poppy. The process continued until 1817, when Sertürner published the isolation of pure morphine from opium after at least thirteen years of research and a nearly disastrous trial on himself and three boys. The great advantage of purified morphine was that a patient could be treated with a known dose—whereas with raw plant material, as Gabriel Fallopius once lamented, "if soporifics are weak they do not help; if they are strong they are exceedingly dangerous." Morphine was the first pharmaceutical isolated from a natural product, and this success encouraged the isolation of other alkaloids: by 1820, isolations of narcotine, strychnine, veratrine, colchicine, caffeine, and quinine were reported. Morphine sales began in 1827, by Heinrich Emanuel Merck of Darmstadt, and helped him expand his family pharmacy into the Merck KGaA pharmaceutical company. Codeine was isolated in 1832 by Pierre Jean Robiquet.
The use of diethyl ether and chloroform for general anesthesia began in 1846–1847, and rapidly displaced the use of opiates and tropane alkaloids from Solanaceae due to their relative safety.

Heroin, the first semi-synthetic opiate, was first synthesized in 1874, but was not pursued until its rediscovery in 1897 by Felix Hoffmann at the Bayer pharmaceutical company in Elberfeld, Germany. From 1898 to 1910 heroin was marketed as a non-addictive morphine substitute and cough medicine for children. By 1902, sales made up 5% of the company's profits, and "heroinism" had attracted media attention. Oxycodone, a thebaine derivative similar to codeine, was introduced by Bayer in 1916 and promoted as a less-addictive analgesic. Preparations of the drug such as Percocet and OxyContin remain popular to this day.
A range of synthetic opioids such as methadone (1937), pethidine (1939), fentanyl (late 1950s), and derivatives thereof have been introduced, and each is preferred for certain specialized applications. Nonetheless, morphine remains the drug of choice for American combat medics, who carry packs of syrettes containing 16 milligrams each for use on severely wounded soldiers. No drug has been found that can match the painkilling effect of opioids without also duplicating much of their addictive potential.
Modern production and usage

Papaver somni

In South American countries, opium poppies (Papaver somniferum) are technically illegal, but nonetheless appear in some nurseries as ornamentals. They are popular and attractive garden plants, whose flowers vary greatly in color, size and form. A modest amount of domestic cultivation in private gardens is not usually subject to legal controls. In part, this tolerance reflects variation in addictive potency: a cultivar for opium production, Papaver somniferum L. elite, contains 92% morphine, codeine, and thebaine in its latex alkaloids, whereas the condiment cultivar "Marianne" has only one-fifth this total, with the remaining alkaloids made up mostly of narcotoline and noscapine.
Seed capsules can be dried and used for decorations, but they also contain morphine, codeine, and other alkaloids. These pods can be boiled in water to produce a bitter tea that induces a long-lasting intoxication (See Poppy tea). If allowed to mature, poppy pods (poppy straw) can be crushed and used to produce lower quantities of morphinans. In poppies subjected to mutagenesis and selection on a mass scale, researchers have been able to use poppy straw to obtain large quantities of oripavine, a precursor to opioids and antagonists such as naltrexone.
Poppy seeds are a common and flavorsome topping for breads and cakes. One gram of poppy seeds contains up to 33 micrograms of morphine and 14 micrograms of codeine, and the Substance Abuse and Mental Health Services Administration formerly mandated that all drug screening laboratories use a standard cutoff of 300 nanograms per milliliter in urine samples. A single poppy seed roll (0.76 grams of seeds) usually did not produce a positive drug test, but a positive result was observed from eating two rolls. A slice of poppy seed cake containing nearly five grams of seeds per slice produced positive results for 24 hours. Such results are viewed as false positive indications of drug abuse and were the basis of a legal defense. On November 30, 1998, the standard cutoff was increased to 2000 nanograms (two micrograms) per milliliter.During the Communist era in Eastern Europe, poppy stalks sold in bundles by farmers were processed by users with household chemicals to make kompot ("Polish heroin"), and poppy seeds were used to produce koknar, an opiate.

Harvesting and processing

When grown for opium production, the skin of the ripening pods of these poppies is scored by a sharp blade at a time carefully chosen so that rain, wind, and dew cannot spoil the exudation of white, milky latex, usually in the afternoon. Incisions are made while the pods are still raw, with no more than a slight yellow tint, and must be shallow to avoid penetrating hollow inner chambers or loculi while cutting into the lactiferous vessels. In Indian Subcontinent, Afghanistan, Central Asia and Iran, the special tool used to make the incisions is called a nushtar or "nishtar" (from Persian, meaning a lancet) and carries three or four blades three millimeters apart, which are scored upward along the pod. Incisions are made three or four times at intervals of two to three days, and each time the "poppy tears," which dry to a sticky brown resin, are collected the following morning. One acre harvested in this way can produce three to five kilograms of raw opium. In the Soviet Union, pods were typically scored horizontally, and opium was collected three times, or else one or two collections were followed by isolation of opiates from the ripe capsules. Oil poppies, an alternative strain of P. somniferum, were also used for production of opiates from their capsules and stem
Raw opium may be sold to a merchant or broker on the black market, but it usually does not travel far from the field before it is refined into morphine base, because pungent, jelly-like raw opium is bulkier and harder to smuggle. Crude laboratories in the field are capable of refining opium into morphine base by a simple acid-base extraction. A sticky, brown paste, morphine base is pressed into bricks and sun-dried, and can either be smoked, prepared into other forms or processed into heroin
Other methods of preparation (besides smoking), include processing into regular opium tincture (tinctura opii), laudanum, paregoric (tinctura opii camphorata), herbal wine (e.g. vinum opii), opium powder (pulvis opii), opium sirup (sirupus opii) and opium extract (extractum opii) Vinum opii is made by combining sugar, white wine, cinnamon, and cloves. Opium syrup is made by combining 997.5 part sugar syrup with 2.5 parts opium extract. Opium extract (extractum opii) finally can be made by macerating raw opium with water. To make opium extract, 20 parts water are combined with 1 part raw opium which has been boiled for 5 minutes (the latter to ease mixing).
Heroin is widely preferred because of increased potency. One study in postaddicts found heroin to be approximately 2.2 times more potent than morphine by weight with a similar duration; at these relative quantities, they could distinguish the drugs subjectively but had no preference.Heroin was also found to be twice as potent as morphine in surgical anesthesia. Morphine is converted into heroin by a simple chemical reaction with acetic anhydride, followed by a varying degree of purification. Especially in Mexican production, opium may be converted directly to "black tar heroin" in a simplified procedure. This form predominates in the U.S. west of the Mississippi. Relative to other preparations of heroin, it has been associated with a dramatically decreased rate of HIV transmission among intravenous drug users (4% in Los Angeles vs. 40% in New York) due to technical requirements of injection, although it is also associated with greater risk of venous sclerosis and necrotizing fasciitis.

Chemical and physiological properties

Opium contains two main groups of alkaloids. Phenanthrenes such as morphine, codeine, and thebaine are the main narcotic constituents. Isoquinolines such as papaverine and noscapine have no significant central nervous system effects, and are not regulated under the Controlled Substances Act. Morphine is the most prevalent and important alkaloid in opium, consisting of 10%–16% of the total, and is responsible for most of its harmful effects such as lung edema, respiratory difficulties, coma, or cardiac or respiratory collapse. Morphine binds to and activates mu opioid receptor in the brain, spinal cord, stomach and intestine. Regular use can lead to drug tolerance or physical dependence. Chronic opium addicts in 1906 China or modern-day Iran[ consume an average of eight grams of opium daily.

Both analgesia and drug addiction are functions of the mu opioid receptor, the class of opioid receptor first identified as responsive to morphine. Tolerance is associated with the superactivation of the receptor, which may be affected by the degree of endocytosis caused by the opioid administered, and leads to a superactivation of cyclic AMP signaling. Long-term use of morphine in palliative care and management of chronic pain cannot be managed without the possible development of drug tolerance or physical dependence. Many techniques of drug treatment exist, including pharmacologically based treatments with naltrexone, methadone, or ibogaine.