laudanum laudanum laudanum is a tincture of opium containing approximately 10% powdered opium by weight (the equivalent of 1% morphine). laudanum is prepared by dissolving extracts from the opium poppy (papaver somniferum) in alcohol (ethanol). laudanumcombination ofopiumanalgesicethanoltinctureclinical datapronunciation/ˈlɔːdənəm/ law-dən-əm trade namesdropizolroutes ofadministrationoral, buccal, sublingualatc codea07da02 (who) legal statuslegal status uk: class a us: schedule ii un: narcotic schedule i (verify) reddish-brown in color and extremely bitter, laudanum contains several opium alkaloids, including morphine and codeine. laudanum was historically used to treat a variety of conditions, but its principal use was as a pain medication and cough suppressant. until the early 20th century, laudanum was sold without a prescription and was a constituent of many patent medicines. laudanum has since been recognized as addictive and is strictly regulated and controlled as such throughout most of the world. the united states controlled substances act, for example, lists it on schedule ii, the second strictest category. laudanum is known as a "whole opium" preparation since it historically contained all the alkaloids found in the opium poppy, which are extracted from the dried latex of ripe seed pods (papaver somniferum l., succus siccum). however, the modern drug is often processed to remove all or most of the noscapine (also called narcotine) present as this is a strong emetic and does not add appreciably to the analgesic or antipropulsive properties of opium; the resulting solution is called denarcotized tincture of opium or deodorized tincture of opium (dto). laudanum remains available by prescription in the united states (under the generic name "opium tincture") and in the european union and united kingdom (under the trade name dropizol), although the drug's therapeutic indication is generally limited to controlling diarrhea when other medications have failed. the terms laudanum and tincture of opium are generally interchangeable, but in contemporary medical practice, the latter is used almost exclusively. history paracelsus's laudanum paracelsus, a 16th-century swiss alchemist, experimented with various opium concoctions, and recommended opium for reducing pain. one of his preparations, a pill which he extolled as his "archanum" or "laudanum", may have contained opium. paracelsus' laudanum was strikingly different from the standard laudanum of the 17th century and beyond, containing crushed pearls, musk, amber, and other substances. british laudanum one researcher has documented that "laudanum, as listed in the london pharmacopoeia (1618), was a pill made from opium, saffron, castor, ambergris, musk and nutmeg".: 45 sydenham's laudanum in the 1660s english physician thomas sydenham (1624–1689) popularized a proprietary opium tincture that he also named laudanum, although it differed substantially from the laudanum of paracelsus. in 1676 sydenham published a seminal work, medical observations concerning the history and cure of acute diseases, in which he promoted his brand of opium tincture, and advocated its use for a range of medical conditions. 18th-century by the 18th century, the medicinal properties of opium and laudanum were well known, and the term "laudanum" came to refer to any combination of opium and alcohol. in the 18th century several physicians published work about it, including john jones, who wrote the mysteries of opium revealed (1700), which was described by one commentator as "extraordinary and perfectly unintelligible." the scottish physician john brown, creator of the brunonian system of medicine, recommended opium for what he termed asthenic conditions, but his system was discredited by the time of his death. the most influential work was by george young, who published a comprehensive medical text entitled treatise on opium (1753). young, an edinburgh surgeon and physician, wrote this to counter an essay on opium by his contemporary charles alston, professor of botany and materia medica at edinburgh who had recommended the use of opium for a wide variety of conditions. young countered this by emphasising the risks '...that i may prevent such mischief as i can, i here give it as my sincere opinion... that opium is a poison by which great numbers are daily destroyed.' young gives a comprehensive account of the indications for the drug including its complications. he is critical about writers whose knowledge of the drug is based on chemical or animal experiments rather than clinical practice. the treatise is a detailed, balanced and valuable guide to prevailing knowledge and practice. as it gained popularity, opium, and after 1820, morphine, was mixed with a wide variety of agents, drugs and chemicals including mercury, hashish, cayenne pepper, ether, chloroform, belladonna, whiskey, wine and brandy.": 104 confessions of a laudanum drinker, the lancet, 1866during the late 18th and early 19th centuries, patients undergoing surgery were often administered laudanum and alcohol, and had their hands restrained and bodies held down while the operation was performed. 19th-century by 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 ... as a soporific". the limited pharmacopoeia of the day meant that opium derivatives were among the most effective 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. innumerable victorian women were prescribed the drug for relief of menstrual cramps and vague aches. nurses also spoon-fed laudanum to infants. the romantic and victorian eras were marked by the widespread use of laudanum in europe and the united states. mary todd lincoln, for example, the wife of the us president abraham lincoln, was a laudanum addict, as was the english poet samuel taylor coleridge, who was famously interrupted in the middle of an opium-induced writing session of kubla khan by a "person from porlock". 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. as one researcher has noted: "to understand the popularity of a medicine that eased—even if only temporarily—coughing, diarrhoea and pain, one only has to consider the living conditions at the time". in the 1850s, "cholera and dysentery regularly ripped through communities, its victims often dying from debilitating diarrhoea", and dropsy, consumption, ague and rheumatism were all too common.: 44–49 an 1869 article in scientific american describes a farmer growing and harvesting poppy in indian springs, georgia, and subsequently selling the raw material to a local pharmacist who prepared laudanum. 20th-century laudanum was used in home remedies and prescriptions, as well as a single medication. for example, a 1901 medical book published for home health use gave the following two "simple remedy formulas" for "dysenterry" : (1) thin boiled starch, 2 ounces; laudanum, 20 drops; "use as an injection every six to twelve hours"; (2) tincture rhubarb, 1 ounce; laudanum 4 drachms; "dose: one teaspoonful every three hours." in a section entitled "professional prescriptions" is a formula for "diarrhoea (acute)": tincture opium, deodorized, 15 drops; subnitrate of bismuth, 2 drachms; simple syrup, 1⁄2 ounce; chalk mixture, 11⁄2 ounces, "a teaspoonful every two or three hours to a child one year old." "diarrhoea (chronic)": aqueous extract of ergot, 20 grains; extract of nux vomica, 5 grains; extract of opium, 10 grains, "make 20 pills. take one pill every three or four hours." the early 20th century brought increased regulation of all manner of narcotics, including laudanum, as the addictive properties of opium became more widely understood, and "patent medicines came under fire, largely because of their mysterious compositions".: 126 in the us, the food and drug act of 1906 required that certain specified drugs, including alcohol, cocaine, heroin, morphine, and cannabis, be accurately labeled with contents and dosage. previously many drugs had been sold as patent medicines with secret ingredients or misleading labels. cocaine, heroin, cannabis, and other such drugs continued to be legally available without prescription as long as they were labeled. it is estimated that sale of patent medicines containing opiates decreased by 33% after labeling was mandated. in 1906 in britain and in 1908 in canada "laws requiring disclosure of ingredients and limitation of narcotic content were instituted".: 126 the harrison narcotics tax act of 1914 restricted the manufacture and distribution of opiates, including laudanum, and coca derivatives in the us. this was followed by france's loi des stupéfiants in 1916, and britain's dangerous drugs act in 1920.: 126 laudanum was supplied to druggists and physicians in regular and concentrated versions. for example, in 1915, frank s. betz co., a medical supply company in hammond, indiana, advertised tincture of opium, u.s.p., for $2.90 per lb., tincture of opium camphorated, u.s.p, for 85 cents per lb., and tincture of opium deodorized, for $2.85 per lb. four versions of opium as a fluid extract were also offered: (1) opium, concentrated (assayed) "for making tincture opii (laudanum) u.s.p. four times the strength of the regular u.s.p." tincture, for $9.35 per pint; (2) opium, camphorated conc. "1 oz. making 8 ozs. tr. opii camphorated u.s.p (paregoric)" for $2.00 per pint; (3) opium, concentrated (deodorized and denarcotized) "four times the strength of tincture, used when tinct. opii u.s.p. is contraindicated" for $9.50 per pint, and (4) opium (aqueous), u.s.p., 1890, "tr. (assayed) papaver somniferum" for $2.25 per pint. in 1929–30, parke, davis & co., a major us drug manufacturer based in detroit, michigan, sold "opium, u.s.p. (laudanum)", as tincture no. 23, for $10.80 per pint (16 fluid ounces), and "opium camphorated, u.s.p. (paregoric)", as tincture no. 20, for $2.20 per pint. concentrated versions were available. "opium camphorated, for u.s.p. tincture: liquid no. 338" was "exactly 8 times the strength of tincture opium camphorated (paregoric) , u.s.p., "designed for preparing the tincture by direct dilution," and cost $7 per pint. similarly, at a cost of $36 per pint, "opium concentrated, for u.s.p. tincture: liquid no. 336", was "four times the strength of the official tincture", and "designed for the extemporaneous preparation of the tincture". the catalog also noted: "for quarter-pint bottles add 80c. per pint to the price given for pints." toward the middle 20th century, the use of opiates was generally limited to the treatment of pain, and opium was no longer a medically accepted "cure-all". further, the pharmaceutical industry began synthesizing various opioids, such as propoxyphene, oxymorphone and oxycodone. these synthetic opioids, along with codeine and morphine were preferable to laudanum since a single opioid could be prescribed for different types of pain rather than the "cocktail" of laudanum, which contains nearly all of the opium alkaloids. consequently, laudanum became mostly obsolete as an analgesic, since its principal ingredient is morphine, which can be prescribed by itself to treat pain. until now, there has been no medical consensus on which of the two (laudanum or morphine alone) is the better choice for treating pain. in 1970, the us adopted the uniform controlled substances act, which regulated opium tincture (laudanum) as a schedule ii substance (currently dea #9630), placing even tighter controls on the drug. by the late 20th century, laudanum's use was almost exclusively confined to treating severe diarrhea. 21st-century the current prescribing information for laudanum in the us states that opium tincture's sole indication is as an anti-diarrheal, although the drug is occasionally prescribed off-label for treating pain and neonatal withdrawal syndrome. historical varieties italian sydenham laudanum tincture from the 1950s several historical varieties of laudanum exist, including paracelsus' laudanum, sydenham's laudanum (also known as tinctura opii crocata), benzoic laudanum (tinctura opii benzoica), and deodorized tincture of opium (the most common contemporary formulation), among others. 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 antitussive properties). there is probably no single reference that lists all the pharmaceutical variations of laudanum that were created and used in different countries during centuries since it was initially formulated. the reasons are that in addition to official variations described in pharmacopeias, pharmacists and drug manufacturers were free to alter such formulas. the alcohol content of laudanum probably varied substantially; on the labels of turn-of-the-century bottles of laudanum, alcoholic content is stated as 48%. in contrast, the current version of laudanum contains about 18% alcohol. the four variations of laudanum listed here were used in the united states during the late 19th century. the first, from an 1870 publication, is "best turkey opium 1 oz., slice, and pour upon it boiling