laudanum, tincture, or alcoholic solution, of opium, first compounded by Paracelsus in the 16th cent. Not then known to be addictive, the preparation was widely used up through the 19th cent. to treat a variety of disorders. Many literary and artistic figures, including Coleridge, Poe, Moussorgsky, and De Quincey, are known to have been addicted.

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).

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:

• 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.
• 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.

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.

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.

Depictions in fiction

Literature

• 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 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.
• The character Cassy in Uncle Tom's Cabin kills one of her children with laudanum to prevent it from growing up in slavery.
• Samuel Taylor Coleridge wrote the poem fragment Kubla Khan immediately on waking from a laudanum-induced dream.

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 Tombstone, Mattie Blaylock, Wyatt Earp's common law wife, is depicted as a laudanum addict, true to her real-life addiction.
• In Amazing Grace, William Wilberforce is depicted as taking laudanum for sleep disorder.
• In Interview with the Vampire, Claudia tricks Lestat into drinking from the dead by leading him to two boys to whom she gave laudanum. "It killed them, unfortunately," she says, "but it keeps the blood warm."

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 used by the character Mrs. Sedley in Benjamin Britten's opera, Peter Grimes.
• Laudanum is referred to in The Decemberists' "The Legionnaire's Lament"

Video Games

• Oregon Trail II gives the player the option to buy and administer laudanum.

See also

• Paregoric
• Poppy tea
• Thomas Sydenham

References