Opium

How an Ancient Flower Shaped and Poisoned Our World

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By John H. Halpern, MD

By David Blistein

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From a psychiatrist on the frontlines of addiction medicine and an expert on the history of drug use comes the “authoritative, engaging, and accessible” history of the flower that helped to build (Booklist) — and now threatens — modern society.

Opioid addiction is fast becoming the most deadly crisis in American history. In 2018, it claimed nearly fifty thousand lives — more than gunshots and car crashes combined, and almost as many Americans as were killed in the entire Vietnam War. But even as the overdose crisis ravages our nation — straining our prison system, dividing families, and defying virtually every legislative solution to treat it — few understand how it came to be.

Opium tells the “fascinating” (Lit Hub) and at times harrowing tale of how we arrived at today’s crisis, “mak[ing] timely and startling connections among painkillers, politics, finance, and society” (Laurence Bergreen). The story begins with the discovery of poppy artifacts in ancient Mesopotamia, and goes on to explore how Greek physicians and obscure chemists discovered opium’s effects and refined its power, how colonial empires marketed it around the world, and eventually how international drug companies developed a range of powerful synthetic opioids that led to an epidemic of addiction.

Throughout, Dr. John Halpern and David Blistein reveal the fascinating role that opium has played in building our modern world, from trade networks to medical protocols to drug enforcement policies. Most importantly, they disentangle how crucial misjudgments, patterns of greed, and racial stereotypes served to transform one of nature’s most effective painkillers into a source of unspeakable pain — and how, using the insights of history, state-of-the-art science, and a compassionate approach to the illness of addiction, we can overcome today’s overdose epidemic.

This urgent and masterfully woven narrative tells an epic story of how one beautiful flower became the fascination of leaders, tycoons, and nations through the centuries and in their hands exposed the fragility of our civilization.

An NPR Best Book of the Year
“A landmark project.” — Dr. Andrew Weil
“Engrossing and highly readable.” — Sam Quinones
“An astonishing journey through time and space.” — Julie Holland, MD
“The most important, provocative, and challenging book I’ve read in a long time.” — Laurence Bergreen

Excerpt

The problem of chronic opium intoxication…is so extremely complex and far-reaching, so intimately interwoven with public health, commerce, and trade, and social customs, and has evolved so insidiously that we may well ask if the use of opium ever was confined to its sole valuable function namely, that of a therapeutic agent…among the western nations, the United States seems to have acquired the reputation…of being more widely and harmfully affected than any other.

—New York Bureau of Social Hygiene, Inc., 1928
 

If there is a war on drugs, then many of our family members are the enemy. And I don’t know how you wage war on your own family.

—Robert Wakefield, Traffic (2000)




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Preface

How could it be?”

The family and friends of more than 70,000 people say words to that effect every year after hearing that someone they knew died from an overdose.

I never expected to be one of them.

After all, I’m a psychiatrist with a focus on addiction medicine. I know the symptoms and have been trained to spot the warning signs, skills I’ve honed—or thought I had honed—through decades of practice.

Paul Roderick, as I will call him in an effort to preserve his family’s privacy, was my beloved friend—smart, grandly inquisitive, loyal, funny, strong, and an excellent chess player. When we first met, I sensed an undercurrent of childhood rejections, self-parenting, and toxic events in his past, but over the years I watched as he seemed to find the independence and stability he yearned for.

In 1995, I invited him to New Mexico to help me on a federally funded project in which I was comparing the neurocognitive function and mental health of a few disperse groups: Members of the Native American Church (NAC) who had participated in at least 100 prayer services (in which mescaline-containing peyote is ingested for non-drug sacramental purposes) but never had problems with drugs or alcohol; former alcoholics who reported heavy drinking for at least ten years, but had been sober for three months or more; and Navajo tribespeople who never drank or used drugs nor were members of the NAC and didn’t regularly participate in their prayer services.

Paul wasn’t a researcher at the time. Actually, he didn’t know quite what he was then or would be. He was working at the mental health center where we met and doing some freelance Spanish translations for a textbook company, while trying to figure out what to do with the rest of his life. One possibility was working in the fields of mental health or neuroscience, and the project seemed a perfect opportunity for him to find out more about both. The fact that he knew Spanish, and could get along with anybody in any language, made him the perfect person to greet our “test subjects” as well as explain the process to relatives and entertain any kids who tagged along so that they did not interrupt their parents’ treatment.

I later learned that there was another reason Paul had agreed to join me—a woman named Jenny Anderson, who was the project’s whip-smart neuropsychologist. Based solely on my description of her talents, Paul had decided he was in love with her. Paul was like that.

To his dismay, however, he learned from our other team members after arriving in Albuquerque—having traveled 2,000 miles in his beat-up VW Jetta—that Jenny already had a boyfriend. And not just any boyfriend: a young, good-looking, bearded guy named Jeff with a serious trust fund who lived just an hour away in Santa Fe.

To help Paul get over his apparent heartbreak, we drove out to Chaco Canyon, a remote but famous sacred site for the Hopi and Navajo, where there are some of the most remarkable petroglyphs and other pre-Columbian relics in the United States. A pilgrimage to Chaco is a rite of passage for any serious student of Southwest Native American culture.

There was no moon that night, so Paul howled at the Milky Way instead—in despair over the fact the universe was denying him the girl of his dreams, albeit one he had hardly met.

But I persuaded him to stay, and after work each day, Jenny, Paul, and I usually had dinner together, during which he tried to win her over by regularly belittling her boyfriend Jeff in ways that made the fact that she was attracted to him seem utterly absurd.

I should have sensed that these two brilliant researchers were on a collision course. In addition to his irresistibly winning personality, Paul had a number of extraordinary traits going for him—in particular that he looked like Brad Pitt, was in great shape, and loved the outdoors. Perhaps I should have realized it was inevitable that they would get together when she admitted one evening that she had left Harvard for New Mexico because she wanted to do her fieldwork in a place where she could wear a tattoo and drive a pickup.

Shortly thereafter, Jeff was history, and by the time our project was over, Paul and Jenny were living together in New Mexico. While she continued working in neuropsychology, Paul got a job with the University of New Mexico tabulating trends in domestic violence and participating in Native American healthcare initiatives. To my surprise, at thirty-three, he decided it was time to really settle down, so he went to UNM’s Medical School. His first job was as a primary-care family physician working for an area Pueblo.

While we rarely saw each other over the next two decades, we talked regularly, sharing stories of our professional lives, marriages, and parenting, as well as our hopes and dreams for the future—one of which was to spend a week camping together in Navajo country with our then ten-year-old sons.

The perfect opportunity presented itself in the late spring of 2017 when we heard that one of our closest friends on the reservation, an Arizona state judge, was going to officiate his own eldest daughter’s wedding. The ceremony would be held in a spectacular sacred setting: a place where the roof was the sky itself; ponderosa pines dwarfed the highest cathedral spires; and rough-hewn logs served as pews. Our plan was to meet up before the wedding and spend a few days camping at an obscure Navajo summer refuge in the Chuska Mountains. It was one of my favorite places in the Southwest, a mini Switzerland where crystal-clear brooks cut through lush high valleys of meadow grass, where the Navajo would take their cattle to cool off from the summer valley heat. Best of all, the area is virtually inaccessible, with sharp, angular volcanic rocks along the rim keeping out anything but the sturdiest off-road vehicles.

I arrived along with my son, Noah, and my fiancée, Ann, before Paul made it there. After surviving the scorching heat in the valley floor, Noah decided to spend the night outside in a hammock with his sleeping bag. Before long, however, the temperature dropped to 20 degrees and he joined us in the back of our rental SUV.

Paul and his family didn’t arrive that night. In fact, they didn’t arrive the next morning either. Or the day after that.

I tried calling again and again, but just getting a signal on my cell phone was a challenge. Each time, I had to climb onto a mountain ledge, set the phone on a rock, put it on speaker; and as soon as I managed to grab a bar of signal strength, I’d find myself leaving yet another voicemail message:

“Hey Paul! Where are you? I left you the directions. You said you were coming, man. Everyone will be asking me about you, soon, because YOU told ME that you were coming! I mean really…if you aren’t going to come then just say so.”

I was annoyed, but I was also worried. He lived five or six hours away and weather could throw a wrench in the best plans, but we’d flown all the way out from the East Coast, done that same drive, and arrived in plenty of time. Where was he?

After we came off the mountain and had a reliable signal, I called him repeatedly until he finally picked up. He explained that he and his wife were having some difficulties and one thing led to another and it just couldn’t work out. I told him I understood. (After all, I was divorced and traveling with my fiancée.) But actually, I wasn’t being honest with him. I didn’t understand. Relationship problems were one thing, but not showing up for that wedding caused me and our friend the judge unnecessary concern and, more important, showed a disregard for the Native culture we’d both revered all these years.

Paul eventually suggested we come and spend the night before we took our early morning flight back east. We didn’t reach his house until close to midnight. Paul’s wife and kids were asleep, but we stayed up, talking quietly, long into the night. It felt like old times again.

He apologized for not meeting up with us to camp, especially for the fact that our sons had missed the chance to get to know each other. We talked about coming out again for another camping trip. Mostly, though, we talked about our lives. I was curious about what it was like being a family-practice doctor working for a Native American tribe, and he had lots of questions for me about what it was like to run a for-profit hospital for treating drug addiction—a turn in my career that surprised him as much as it had myself, since neither of us thought I’d ever give up my professorship at Harvard Medical School and practice at McLean Hospital. He said he was proud of me for taking the risk and making the move.

As the conversation went on, I began to look at him with more of a clinical eye. His eyes looked tired, perhaps a little sad, and I was surprised at how much weight he had put on. He never really satisfied my concern about his no-show at the wedding, but I didn’t want to press him.

At 4 a.m. we needed to drive to the airport so, after a final hug, we left. I later learned that when he said goodbye to my fiancée, he told her, “I’m sorry. I feel I never got to know you.” She took it to mean that he felt bad for not attending the wedding and replied encouragingly that we had all agreed to go camping together another time.

Catching himself, Paul reassured her: “That’s right. Of course.”

But I never saw my friend again. By the end of the week, he had put a bullet through his residency diploma and another through his head.

His suicide note explained that he had struggled in secret with a drug addiction. Like many addicts, he’d originally been prescribed opioids to deal with a bad knee from running and later chronic back pain. When he tried to stop, he found he couldn’t. I would come to learn that he’d tried Suboxone® to help him get through withdrawal, though for some reason he’d stopped taking it.

I couldn’t believe he didn’t trust me enough to tell me—even though he would have known that I, of all people, would have not just totally understood his pain but had the resources to help him.

Ironically, Paul’s addiction was not as bad as that of many of my patients who have recovered. Unlike those patients, however, my friend didn’t share his pain, didn’t seek out psychotherapy or join a 12-step program for support. He didn’t get on methadone or a regulated Suboxone program. He never checked himself into a detox unit or psychiatric facility. And most painful for me, he didn’t pick up the phone, even once, to tell his friend who loved him that he needed my help.

*  *  *

It can be the simple things that hurt most when we lose someone close to us: every chess table I walk by reminds me how we’d promised to spend our retirement playing every chance we got. My heart will forever ache for him.

Now, we are all at a loss: Paul’s family, friends, his patients, and all those whose lives he’d made better.

As a physician on the front lines, I try, one patient at a time, to change this dynamic of addiction and death that has somehow emerged from fields of bright red poppy flowers. Every time a patient dies—and yes, everyone who works in this field has patients who die—it hurts.

As the late Cardinal Bernardin said to me when I graduated from college, “I used to think there is something extra special about being a Catholic priest, but now that I’m dying of cancer and see all the care provided to me and other patients, I recognize that this ‘specialness’ can be found in many other professions. Just as it is between priest and parishioner so it is between doctor and patient. We share a moral covenant before God.”

Paul’s story is an ancient one, and in a strange way it contains for me a message of hope. We are at a cusp of history in which we can develop a more informed approach to opioids. We can understand how drugs derived from (or inspired by) the milky seedpod of the innocent-looking opium poppy have had such a profound impact on the human condition. We can take advantage of new insights and recovery tools to bring about a revolution in the care of opiate abuse and dependence.

Soon, we may have solutions for severe and chronic pain that will keep people from going down the road on which Paul lost his way, as well as remedies that will make it easier to help others find their way back. Until then, the work we must do—to confront the stigma, shame, moral judgments, and self-serving political arguments that swirl around the disease of addiction, as well as create systems that make it possible to help all those who suffer—is enormous and important.

The story of my friend—whose embarrassment became apparent only in retrospect, and whose fear of being stigmatized could have contributed to his decision to end his life—is one reason this book needed to be written. Every year, there are tens of thousands more.

—John H. Halpern, MD

 




Introduction

Opium is reluctant to give up its secrets.

The physician’s painkiller is the addict’s poison. The poet’s dream is the parent’s nightmare. The vigilante’s laws are the dealer’s opportunity.

The very word opium means more things to more people than any other natural substance on earth. In the early 1900s, a famous doctor referred to it as “God’s Own Medicine,”1 while a fiery anti-opium crusader called it “the deadliest foe that has ever menaced [humanity’s] future.”2

Opium wasn’t always considered the scourge it is today. Rather, for thousands of years, it was a key ingredient in many formulas developed to relieve pain. Addiction was rare. Overdoses were almost unheard of.

Today, however, opioid addiction is fast becoming the most deadly crisis in American history. In 2017, 47,600 people died of opioid-related overdoses—more than gunshots and car crashes combined…and almost as many as were killed in the entire Vietnam War. The disease is straining our prison system, dividing families, and defying virtually every legislative solution to treat it.

Opium’s history is as complex as it is disturbing. To understand it, we need to examine the papyruses of ancient Egyptian scribes for whom opium was an essential ingredient in a wide range of remedies; the edicts of Chinese emperors who watched in horror as addiction debilitated large swaths of the population; the propaganda of anti-drug vigilantes whose scare tactics often only increased the awareness and use of opioids; and, finally, the latest breakthroughs in prevention and treatment that hold out the promise of real solutions.

We need to watch Portuguese sailors blend opium with tobacco to make a more potent smoke; a nineteenth-century Chinese official destroy 3 million pounds of British opium in a futile attempt to end his country’s opioid epidemic; and, at the end of the twentieth century, a modern pharmaceutical company develop a medicine for end-of-life pain that has turned into the deadliest drug in history.

In particular, we must learn from our past attempts to solve the problem—and how some of those attempts have only made the problem much, much worse.

 

1 William Osler (1849–1919)—one of the founders of Johns Hopkins Hospital.

2 Richmond Hobson (1870–1937), “The Struggle of Mankind Against Its Deadliest Foe.” Also, see Ch. 26.




PART I

Opium in Antiquity




Chapter 1

The Mysterious Origins of the Opium Poppy

Though we can learn many things about the origins of opium by studying archaeology, ethnobotany, and genetics, to understand the role it played in ancient societies, a little mythology comes in handy.

According to no less an authority than William Burroughs, the notorious heroin addict, cultural icon, pioneer of drug use among the “Beat Generation,” and author of the controversial novel Naked Lunch, the first opium addicts were members of a Cro-Magnon tribe called the Unglings who lived in the Alps 30,000 years ago.

In a marvelous and presumably drug-infused fantasy called God’s Own Medicine,1 Burroughs imagines members of this tribe as “Homo sapiens like you or me—or the folks next door, wearing animal skins and carrying stone axes.” He goes on to propose that it’s late summer and they are walking through a field of flowers. One of the elders, crippled by rheumatism, falls to his knees. He finds himself face-to-face with a strange-looking seedpod oozing a crusty brown sap. It smells really bad, but looks sweet like honey, so he tastes some. Sadly, it’s terribly bitter. Feeling worse than before, he drags himself to his feet and stumbles forward.

A while later, he feels less pain in his joints, stands up straighter, and begins to walk without staggering. A few steps farther along, he throws his staff to the ground, looks to the heavens, and starts thinking thoughts that he never thought before—that perhaps no human brain has ever thought before.

One of those thoughts is that he should tell his people to gather as many of those pods as they can, scrape off the dried sticky stuff, and fill as many gourds as possible for future use.

That winter is far more pleasant than usual.

By the next spring, however, Burroughs imagines that the sap is all gone and the old Ungling’s people appear bereft. They’re not in the mood to do any hunting or gathering or fishing. As his joints begin to creak again, the wise elder, who is now perceived to have magical powers, has a vision (or so he says) that they need to go back to where they camped that fateful day the year before in order to collect more of those pods. For the first time, the movement of a people is driven by a hunger for a drug rather than food.

Allegorical as the story may be, it is this dependency—which Burroughs understood all too well—that would eventually make opium a versatile and valuable commodity in world trade, resulting in strange wars and even stranger bedfellows.

The empirical evidence for opium’s origins isn’t all that much more reliable than Burroughs’s legend. Researchers have spent their entire careers laboring at remote archaeological sites trying to find it. They’ve examined inscriptions on pottery and pictographs on papyruses. Some have looked through undisturbed firepits and prehistoric privies for poppy pods or even individual seeds, or subjected skeletal human remains (e.g., tissue, hair, teeth, bone marrow) to radioimmunoassay, gas/liquid chromatography, and mass spectrometry.2

Unfortunately, finding and testing samples of opium residue in or on an artifact that’s been exposed to thousands of years of wear and tear—not to mention possible contamination by random acts of unkind vandalism—is a whole lot harder than testing a batch of street heroin to see if it’s pure. As a result, we can’t be sure whether opium use originated in southwest Europe, southeast Europe, central Europe, the northern Mediterranean, or Asia Minor—or even Egypt, northern Europe, Great Britain, or various Asian locations.

The best way to find the origin of a plant is to find one growing in the wild with similar DNA, which would indicate how an existing wild plant had mutated into a new cultivar (either by accident or human breeding). However, no one has ever found a legitimate ancient wild ancestor of the opium poppy, Papaver somniferum.

While researchers have discovered other varieties of poppies that make some of the same alkaloids as the opium poppy, this single species of a single genus of a single family is the only one with any significant amount of morphine.3

The first evidence that Neolithic hominids and the opium poppy crossed paths was discovered in 1854 in the small Swiss town of Mellen on the southeast shore of Lake Zurich.4 That winter was historically dry and cold—bad for kids who went off to school without their mittens, but good, it would turn out, for local entrepreneurs who wanted to turn their town into a tourist destination for folks from Zurich.

Until then, those tourists had just been waving at the locals from steamers that took them on leisurely summer cruises down the lake, because the city didn’t have a place for those boats to dock and, therefore, was missing out on all the Swiss francs the tourists might spend eating, drinking, and buying local crafts. But the drought that winter exposed the shores of the lake bed, giving the people of Mellen the opportunity to set log footings into the sand without working underwater. Imagine their surprise when they started digging and discovered that someone had been there first: buried in the lake bed were dozens of poles nearly 7,000 years old.

Mellen’s prehistoric inhabitants had not been building docks for tourists from Zurich, but rather constructing pile dwellings—long communal buildings built on stilts. The raised structures protected them from flooding, wild animals, and enemies, while giving them easy access to water and arable, unforested land. Plus, in wet seasons, they could fish through the living-room windows. These pole buildings—prototypical communes—were up to 200 feet long. Out back, the lake people grew wheat, apples, peas, lentils, flax, barley, and, as it turned out, poppies, which could have met their nutritional as well as their analgesic needs.5

Another early sign of poppy use was discovered in the 1990s at an underwater dig at a site north of Rome called La Marmotta. The site flooded around 5700 BC, preserving the settlement mostly intact. There, archaeologists found not only remains of what appear to be poppy seeds, but also of a thirty-five-foot-long canoe dug out from a single oak tree, which would be perfect for sailing off into the Mediterranean to develop early trade routes.6

Poppy remains have also been found at Neolithic settlements in the Rhine, Rhône, and other river valleys in Europe, where people had discovered not only how to build settlements and to farm, but how to make functional objects. Two of the advanced tribes in these areas are particularly famous for their distinctive styles of pottery. One is known as the linearbandkeramik (abbreviated LBK) because of the linear bands that decorate their pots. The other group, La Hoguette, settled in the Rhône Valley, where its people tempered their clay with bone for greater strength and decorated their pots with impressed or incised images.7 Archaeologists have found poppy residue in both types of pottery, suggesting that the groups interacted through trade and/or war.

Halfway across the continent, another culture—this one in southern Spain—was growing poppies as well. In a cave called Cueva de los Murciélagos, poppy capsules were found woven into grass baskets that had been placed next to human skeletons, along with other signs of respect for the dead, such as flowers, sea snails, and gemstones. In the bones of one skeleton and the jaws of another were traces of actual opium consumption.8

Genre:

On Sale
Aug 13, 2019
Page Count
352 pages
Publisher
Hachette Books
ISBN-13
9780316417655

John H. Halpern, MD

About the Author

John H. Halpern, MD, a psychiatrist in private practice, previously served as medical director of the Boston Center for Addiction Treatment, the largest substance-use disorder hospital in New England. He completed his residency and a fellowship in addiction research at Harvard Medical School programs. He spent over 20 years on the faculty of Harvard Medical School and during his professorship served as the director of his own research laboratory at McLean Hospital, supported by private grants and National Institute on Drug Abuse funding.

David Blistein wrote the award-winning PBS documentary The Mayo Clinic: Faith – Hope – Science and is currently writing a film about Henry David Thoreau as well as a comprehensive three-part series on brain disorders and mental health. He also co-wrote Cancer: The Emperor of All Maladies and The Gene for PBS and is the author of David’s Inferno, a book that combines personal anecdotes with insights into manic-depression and descriptions of how it is diagnosed and treated.

Learn more about this author