Laudanum

This article is about the medicine. For other uses, see Laudanum (disambiguation).

Laudanum (ˈlȯd-nəm or ˈlȯ-də-nəm), also known as opium tincture or tincture of opium, is an alcoholic herbal preparation of opium. It is thus made by combining ethanol with opium. The term "laudanum," however, should be applied only to a specific tincture of opium containing approximately 10 milligrams of morphine per milliliter. There are several versions of laudanum including Paracelsus' laudanum, Sydenhams Laudanum (also known as tinctura opii crocata), benzoic laudanum (tinctura opii benzoica) , and deodorized tincture of opium (discussed below), among others. In addition, besides well-known versions, some people have begun making their own version of laudanum and naming it . 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 anti-tussive properties). Care should be used not to confuse laudanum with paregoric, which is also known as camphorated tincture of opium (tinctura opii camphorata) (see discussion below).

Bottle of Laudanum/Opium Tincture. Note the bright red "POISON" on the label given the potency of the drug and potential for overdose.

Preparation and maximum dosage

Regular opium tincture (or tinctura opii) is made by combining ethanol (of 70%) with opium so that a liquid containing 10 milligrams of morphine per milliliter is created. The maximum dosage is 1,5 to 5 grams.

Sydenham's laudanum is made by combining:

• 50 parts of opium extract
• 150 parts of saffron tincture
• 1 part of cinnamon oil
• 1 part eugenol
• 798 parts ethanol (of 60% purity)

The maximum dosage is 1,5 to 5 grams.

Benzoic laudanum is made by combining :

• 50 parts of opium tincture
• 5 parts of benzoic acid
• 5 parts of campher
• 2 parts of anise oil
• 940 parts of ethanol (70% pure)

The maximum dosage is 30 to 100 grams.

History

In the 16th century, Paracelsus experimented with the medical value of opium. He decided that its medical (analgesic) value was of such magnitude that he called it laudanum, from the Latin laudare, to praise, or from labdanum, the term for a plant extract. He did not know of its addictive properties.

In 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 efficacious of available treatments, so laudanum was widely prescribed for ailments from colds to meningitis to cardiac diseases, in both adults and children. Laudanum was used during the yellow fever epidemic.

The Romantic and Victorian eras were marked by the widespread use of laudanum in Europe and the United States. 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. Literary figures of note who used laudanum include:

• Lord Byron
• Jane Johnston Schoolcraft, the early American Indian writer
• Kate Chopin
• Samuel Taylor Coleridge, who was addicted for much of his adult life
• Thomas de Quincey, who turned his addiction into literary success with the publication of Confessions of an English Opium Eater
• Percy Bysshe Shelley, used laudanum to dull the pain of chronic nephritis from which he suffered.
• John Keats
• Lewis Carroll
• Iolo Morgannwg, the Welsh antiquarian
• Charles Dickens
• Antonin Artaud
• Henry Wadsworth Longfellow
• Edgar Allan Poe, who is known to have used it once in 1848
• Mattie Blaylock (common law wife of Wyatt Earp)
• Charles Baudelaire
• Branwell Brontë (brother of the Brontë sisters).
• Mary Todd Lincoln, wife of President Abraham Lincoln, misprescribed for sleep problems, which caused anxiety and hallucinations.

Upon increase of these hallucinations, more laudanum and chloral hydrate was administered, which increased the problem and led to her eventual commitment to an asylum.

• Thomas Wolfgang Schultz
• Elizabeth Barrett Browning

Political figures who used the drug included George Washington, Patrick Henry, William Wilberforce and Meriwether Lewis. Innumerable Victorian women were prescribed the drug for relief of menstrual cramps and vague aches and used it to achieve the pallid complexion associated with tuberculosis (frailty and paleness were particularly prized in women at the time). Nurses also spoon-fed laudanum to infants. The Pre-Raphaelite muse Elizabeth Siddal died of a laudanum overdose.

Depictions in fiction

Literature

• In Herman Hesse's book Steppenwolf, "an unusually strong tincture of laudanum" pg.80 1963 Bantum Books,NY, USA
• In Elizabeth Stuart Phelps's "The True Story of Guenever", Guenever enters a delusion because of the laudanum and believes that she ran off with Launcelot.
• In C.S. Forrester's book Lieutenant Hornblower, part of the Horatio Hornblower series, Captain James Sawyer is declared unfit for duty and kept bound in his cabin. His overthrowers give him laudanum to keep him quiet.
• In William Faulkner's 1935 novel Pylon, the reporter tries to buy absinthe, but is given gin with laudanum in it.
• In Thomas Harris's 2006 novel Hannibal Rising, Hannibal Lecter is asked by a condemned prisoner to give him laudanum before facing death by guillotine, in exchange for allowing his body to be used in a Paris medical school. It is later suggested that this was common practice at the time.
• In Patrick O'Brian's Aubrey–Maturin series of novels, the ship's surgeon, Stephen Maturin, both uses the drug professionally and battles his own addiction to it.
• In Alan Moore's The League of Extraordinary Gentlemen, Allan Quatermain, opium-addicted, uses his bottle of laudanum to paralyze Edward Hyde.
• In Joanne Harris's 1993 novel Sleep Pale Sister, Effie was fed laudanum to keep her out of "hysterics" and also so that she could sleep.
• The character of Oscar Hopkins in Peter Carey's novel Oscar and Lucinda (1988) uses laudanum, initially under duress, to dull his hydrophobia during his expedition from Sydney.
• Mary Shelley's character Victor Frankenstein uses laudanum to help him sleep after the death of his friend, Henry Clerval.
• In E.L. Doctorow's Ragtime, Harry K. Thaw is said to have once drank an entire bottle of laudanum.
• In Jack Finney's Time and Again, the main character, Si Morley, wonders if a live baby in an 1882 display case has been "doped up with one of the laudanum preparations I'd seen advertised in Harpers."
• Laudanum is also used as a means to circumvent Speck magic in the Soldier Son Trilogy by Robin Hobb.
• Laudanum is mentioned frequently in William S. Burroughs' Naked Lunch, and The Nova Trilogy, beginning with The Soft Machine.
• In the fourteenth chapter of James Joyce's Ulysses, Haines is depicted drinking laudanum from a phial.
• In Octavia E. Butler's Kindred, Rufus' mother uses laudanum as a medicine to relieve her pain.
• In Wilkie Collins' The Moonstone (1868), a valuable diamond, the Moonstone, is stolen by a character in a laudanum-induced stupor.
• It is mentioned in Sarah Waters' Tipping the Velvet as a way a nanny calmed the child Cyril, and thus an argument for Nancy to stay with that family and watch the child during the day.
• The character Cassy in Uncle Tom's Cabin kills one of her children with laudanum to prevent it from growing up in slavery.
• Hannibal Sefton, a tuberculosis-afflicted violinist in Barbara Hambly's Benjamin January mystery series, is addicted to laudanum, and uses it as a means of self-medication.
• It appears in the hard-boiled detective novels of Dashiell Hammett and Raymond Chandler, including Red Harvest and The Big Sleep, respectively.
• In Charles Dickens' novel The Mystery of Edwin Drood it is the drink of choice for the sinister uncle Jasper.
• In Love in the Time of Cholera by Gabriel Garcia Marquez, laudanum is the drink that America Vicuna uses to kill herself.
• In One Hundred Years of Solitude by Gabriel Garcia Marquez, Amaranta decides to poison her adopted sister Rebeca with laudanum in order to prevent the latter's marriage to Pietro Crespi, whom Amaranta secretly loves. Instead, Amaranta inadvertently poisons her innocent sister-in-law Remedios Mascote.
• In "Kal" by Judy Nunn, the character "Carmelina" is given laudanum by Lewis as a sexual enhancement; (p568)"Just a sip, my darling, just for fun", He'd said the first time he offered her the spoon.....and of course, she'd obeyed.
• In Affinity (novel) by Sarah Waters, protagonist Margaret Prior takes laudanum as advised by her doctor.
• In Cloud Atlas, one of the protagonists Adam Ewing is made to become addicted to laudanum after being fed it as medicine by another passenger without being aware of its nature.
• In Bram Stoker's Dracula several maids are incapacitated by a mixture of laudnum and wine, administered by Count Dracula in the course of his recurring nightly attacks on the weakening Lucy Westenra.
• In Titus Alone, the second book in Mervyn Peake's Gormenghast Trilogy, Sepulchrave - the 76th Earl of Gormenghast - is briefly mentioned to be a laudanum user.
• In Interview with the Vampire (from The Vampire Chronicles series by Anne Rice), Claudia gives a deadly dose of absinthe and laudanum to two orphans whom Lestat is tricked into feeding upon, thus poisoning him.
• In The House of the Scorpion by Nancy Farmer, the protagonist, Matt is accused of killing the dog of his friend, Maria, by adding laudanum to its meat.
• In Alice Munro's short story "Meneseteung", Almeda Roth, an eccentric spinster, is imagined (by the narrator) to have taken laudanum ("Many ladies did", Munro writes.)
• In Libba Bray's novels A Great and Terrible Beauty, Rebel Angels and The Sweet Far Thing, Gemma's father is addicted to laudanum as a result of the death of his wife.
• Samuel Taylor Coleridge wrote the poem fragment Kubla Khan immediately on waking from a laudanum-induced dream.
• In Robery Hicks novel The Widow of the South laudanum is mentioned by Carrie McGavock as a method of controlling grief in women whose husbands and sons had gone to war.
• Also in the novel Freaks: Alive, on the Inside, author Annette Curtis Klause has a character by the name of Ceecee harboring a dangerous secret of laudanum addiction.
• Dirk Gently's Holistic Detective Agency by Douglas Adams references Samuel Taylor Coleridge's use of Laudanum.
• In Asterix, Laudanum is one of the four Roman encampments surrounding the protagonists' village.
• In Secrets and Sacrifices by Diane Wylie, Confederate surgeon Captain Daniel Reid gives injured soldier laudanum to kill their pain.
• in the Bloody Jack series by LA Meyer there are copiuose references to tincture of opium. and its is used numerouse times throughout the series

Film

• In the 2001 movie From Hell laudanum plays an important role: Jack the Ripper is shown using it to numb his victims, while Inspector Frederick Abberline (played by Johnny Depp) uses a laudanum and absinthe mixture to see visions of the future or past.
• In John Wayne's final movie The Shootist, his character J.B. Books is suffering from terminal cancer, and his doctor E.W. Hostetler (played by James Stewart) prescribes laudanum to relieve the pain.
• In Amazing Grace, the William Wilberforce Story, there are numerous scenes of Wilberforce being given laudanum to relieve symptoms of colitis.
• In Cold Mountain the main character Inman gets a drink with laudanum from the old woman who killed her goat to feed him.
• In Master and Commander: The Far Side of the World, the doctor issues laudanum to a boy whose arm is to be amputated.
• In the 1971 movie The Beguiled, Geraldine Page's character used laudanum to sedate Clint Eastwood's character when she amputated his leg.
• In Shadow of the Vampire F.W. Murnau (played by John Malkovich) is discovered using laudanum by his cinematographer.
• In Tombstone, Mattie Blaylock, Wyatt Earp's common law wife, is depicted as a laudanum addict, true to her real-life addiction.
• In the 1995 Ang Lee adaptation of Jane Austen's Sense and Sensibility, Doctor Harris (Oliver Ford Davies) gives Laudanum to a heartbroken Marianne Dashwood (Kate Winslet) to bring down an infectious fever after she ventures out in a storm to see Willoughby's Estate.
• In the movie House of Mirth, Gillian Anderson's character Lily Bart uses laudanum to escape her troubles.
• In the film Interview with the Vampire: The Vampire Chronicles, Claudia poisons two young boys with laudanum to keep their blood warm and fool Lestat into drinking from them.
• In the 1986 movie Gothic, Lord Byron pours Bysshe Shelley a glass of wine which he refers to as "opiate," probably Laudanum
• In the 2002 made-for-TV film Dr Jekyll and Mr Hyde, a shabby and degenerate Dr Jekyll is told he "looks like a Laudanum addict"

Television

• Alma Garrett (played by Molly Parker) was addicted to laudanum in Deadwood.

• In the Hornblower television movies "The Mutiny" and "Retribution", Dr. Clive (played by David Rintoul) freely dispensed laudanum to injured or beaten seamen, to the mentally unstable Captain Sawyer (played by David Warner), and to himself.

• In an episode of the Little House on the Prairie television series titled "Blizzard", several children are experiencing pain in their hands and feet as they are warmed up in the schoolhouse after suffering from partial hypothermia and frostbite. To help them with the pain, Dr. Baker issues laudanum, but "just half a teaspoon!".

• In the first episode of the 19th season of The Simpsons, entitled "He Loves To Fly And He D'oh's", Mr. Burns has a shopping list on which "laudanum" is first on the list. Followed by: "cotton gin", "spats", "cell phone" and "Brooklyn Dodgers."

• In episode seven of the first season of Bramwell, Lady Cora Peters (played by actress Michele Dotrice) suffered acute stomach pains which turned out to be appendicitis inaccurately diagnosed as tifilitis by her doctor who prescribed a small bottle of laudanum to ease her pain.

• In many episodes of the series"Gunsmoke," Doc Adams gives laudanum to his patients.

Music

• Avec Laudenum is the title of the fifth release by the ambient group Stars of the Lid.
• "Laudanum" is the title of the fifth track on the CD Wholesale Meats and Fish by Letters to Cleo.
• Laudanum is the title of the debut album by Austrian goth rock band Whispers in the Shadow.
• Laudanum is mentioned in the song "The Legionnaire's Lament" by The Decemberists.
• Laudanum is mentioned in the song "Death Rydes Under the Frozen Moon" by Holy Ghost Revival.
• Laudanum is the name of a song by Montreal Guitar Prodigy Domininc Cifarelli's "The Chronicles of Israfel"
• Laudanum is also mentioned in the songs "Tortured Soul Asylum" and "The Byronic Man" by British band Cradle of Filth on their 2006 and 2000 albums, Thornography and Midian respectively.
• Laudanum and Poitín are mentioned in the song "The Snake With Eyes of Garnet" by Shane MacGowan (Shane MacGowan and The Popes) on his 1994 album, The Snake.
• Laudanum is used by the character Mrs. Sedley in Benjamin Britten's opera, Peter Grimes.
• "Halcion laudanum and Opium" is a line in Josh Ritter's song "Thin Blue Flame".
• In the song "I Met Everybody I Knew" by Mark Sheridan, he describes his ennui with life and wishes to end it with laudanum
• Laudanum is the title of the ninth track on the Gutter Jones (see myspace.com/gutterjones) album called "Number Two"
• Laudanum is the title of the fourth track on Velvet Cacoon's album "Genevieve"

Modern status

Contrary to popular belief, laudanum is still available by prescription in the United States. It is classified as a Schedule II drug under the Controlled Substances Act. Its most common formulation is known as "deodorized tincture of opium", (or DTO or tinctura opii deodorati), and is manufactured in the United States by Ranbaxy Pharmaceuticals. Deodorized or "denarcotized" opium means that narcotine, one of the most prevalent alkaloids in opium, has been removed, usually by a petroleum distillate. Narcotine has no analgesic properties, and frequently causes nausea and stomach upset; hence the preference for denarcotized opium. Bottles of opium tincture are required by 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).

Confusion with Paregoric

In the United States, deodorized opium tincture contains 10 mg per mL of anhydrous morphine, which represents the equivalent of 100 mg per mL of powdered opium. By contrast, laudanum's weaker cousin, paregoric, also known as camphorated tincture of opium, is 1/25th the strength of laudanum, containing only 0.4 mg of morphine per mL, which is the equivalent of 4 mg per mL of powdered opium. Caution should be employed so as not to confuse opium tincture (laudanum) with camphorated opium tincture (paregoric), since overdose may occur if the former is used when the latter has been indicated. Laudanum is almost always dosed in drops, or fractions of a mL, or less commonly, in minims, while paregoric is dosed in teaspoons. Further, the United States Pharmacopia recommends that the abbreviation "DTO" never be used in place of "deodorized tincture of opium", since DTO is sometimes erroneously employed to abbreviate "diluted tincture of opium", which is a 1:25 dilution of opium tincture and water commonly employed to treat withdrawal symptoms in newborns whose mothers are addicted to heroin or other opiates. Several infants have died of morphine overdose where a pharmacist has interpreted DTO to mean deodorized tincture of opium instead of diluted tincture of opium. Further, paregoric's synonym "camphorated tincture of opium" should not be used, since it could easily be confused with "tincture of opium" or "deodorized tincture of opium."

Indications

The only FDA-approved use for laudanum in the United States is the treatment of severe diarrhea that does not respond to mainline therapy or modalities. Common off-label uses of laudanum include the alleviation of pain, and treatment of neonatal withdrawal syndrome when diluted 1:25 (one part opium tincture to 25 parts water).

The usual adult dosage of laudanum for the treatment of diarrhea is 0.6 mL (equivalent to 6 mg of morphine) by mouth four times a day. . However, refractory cases may require larger doses; for example, the Clinical Guide to Supportive & Palliative Care for People with HIV/AIDS states that "Severe, chronic diarrhea may respond only to opioids such as oral tincture of opium. The usual starting dose is 6 drops (0.6 cc) in two ounces of water every four hours. The dose should then be titrated until symptom control is achieved. There is no maximum ceiling for tincture of opium." . The dose of laudanum for pain is generally the same as for morphine -- 1 mL (10 mg of morphine) by mouth, sublingually, or in the buccal space every four hours in opioid-naïve patients, titrated upward as needed to control the pain. Patients already habituated to opioids may require higher starting doses.

See also

• Paregoric
• Poppy tea
• Thomas Sydenham