IGOR DOMSAC | August 1, 2025
The global crisis of synthetic opioids represents one of the most serious public health emergencies of our time. In countries such as the United States and Canada, the availability of fentanyl and its analogs—extremely potent and highly addictive—has overwhelmed public health systems. According to the UN and the WHO, more than 150,000 people die each year from opioid overdoses. In the U.S., deaths involving fentanyl mixed with stimulants rose from 235 in 2010 to over 34,000 in 2020.
In light of this situation, it is necessary to broaden the approach beyond prohibition and conventional pharmacological treatments. One of the most promising pathways to address this crisis involves revisiting the traditional use of opium: a complex substance, culturally significant and pharmacologically less hazardous when consumed in a controlled manner, either orally or by smoking.
Poppy: a plant steeped in history
Papaver somniferum, commonly known as opium poppy, true poppy, or corn poppy, has accompanied humankind since the Neolithic period. Archaeological remains found at sites such as La Marmotta (Italy), Le Taï (France), and Cueva de los Murciélagos (Spain) indicate its presence in agricultural contexts as early as 5700 BCE. Unlike most Neolithic crops, which were domesticated in the Fertile Crescent, the opium poppy appears to be a European contribution to the repertoire of medicinal and ritual plants. Its presence in archaeobotanical sediments from the Rhine, Rhone, Po, and Danube river basins suggests that it may have been independently domesticated in the western Mediterranean, in parallel with early agricultural developments.
The poppy grows wild in temperate regions and has been used since ancient times not only for its medicinal properties but also as food (seeds), in cosmetics, and as a sacred plant. Dried capsules, often decorated, have been found in prehistoric burials alongside grave goods, indicating a possible role in rites of passage, soul protection, or aiding the transition into death. Sumerian and Egyptian texts already described its use, and this knowledge was passed from civilization to civilization through trade routes and migration.
Various Mediterranean peoples—from the Greeks to the Iberians—used poppy capsules as funerary offerings or to induce sleep during initiation rites. In Greek mythology, deities such as Hypnos, Nyx, and Asclepius are depicted holding poppy capsules, symbols of rest, healing, and peaceful death. In Roman iconography, the plant is also associated with Somnus and Letum, linking its use to eternal sleep and divine compassion. During the European Middle Ages, medical knowledge preserved by Arab scholars maintained awareness of its properties, which resurfaced during the Renaissance and became consolidated in Enlightenment pharmacopoeias.
Properties and pharmacology of opium
Opium is obtained from the dried latex exuded by the unripe capsule of the poppy plant, typically through careful incisions on the surface of the still-green pod. Once exposed to air, this latex turns dark brown and acquires the sticky consistency characteristic of raw opium. This material contains over eighty alkaloids, including morphine, codeine, thebaine, papaverine, and noscapine, which act synergistically within the body. This rich chemical complexity gives opium a broad pharmacological profile, with a range of effects that cannot be reduced to a single active compound. Unlike modern synthetic opioids—such as fentanyl or oxycodone—which are isolated and highly concentrated molecules, natural opium offers a more modulated and gradual action, with a lower risk of immediate overdose when consumed in traditional ways (orally or by smoking).
The therapeutic properties of opium include deep and sustained analgesia, ideal for cases of chronic or severe pain, as well as sedative and hypnotic effects that promote rest in patients suffering from insomnia or persistent anxiety. It also significantly reduces intestinal motility, making it an effective antidiarrheal in emergency medical settings or in cases of severe intestinal conditions. Additionally, it has antitussive and bronchodilatory effects, historically used to treat respiratory conditions such as whooping cough or chronic bronchitis. Opium has also proven useful in managing gastrointestinal and menstrual spasms, relieving cramps and pain associated with functional disorders of the digestive and reproductive systems.
Beyond its clinical applications, traditional opium use induces a sense of bodily well-being, introspection, and emotional calm, without the abruptness, overwhelming euphoria, or compulsive drive typical of fast-acting synthetic opioids. This more contemplative and modulated quality has made it valuable not only as a medicine but also as a tool for psycho-emotional care in diverse cultural contexts.
History of opium in Western medicine
For centuries, opium was considered the most useful and versatile drug in the Western pharmacopeia. Laudanum—an alcoholic tincture of opium—was used throughout Europe to treat colic, insomnia, whooping cough, dysentery, lung diseases, and as a soothing remedy for children. In the 18th century, Welsh physician John Jones described its effects in great detail in his book The Mysteries of Opium Reveal’d (1700), praising its ability to relieve pain and mental suffering. This text stands as one of the earliest systematic accounts of the physical and psychological effects of opium.
In the 19th century, with the rise of scientific medicine and the isolation of alkaloids such as morphine (1803), codeine (1832), and the synthesis of heroin (1874), more potent pharmaceutical forms were developed. In 1853, the invention of the hypodermic syringe enabled the first subcutaneous injections of opioids, greatly enhancing their effectiveness but also increasing their addictive potential. Intravenous administration—faster and more intense—amplified the drug’s immediate effects, but also heightened the risk of dependence and overdose.
In the mid-19th century, during the height of the Romantic era, figures such as Thomas De Quincey popularized the subjective effects of opium through his famous work Confessions of an English Opium-Eater (1821), where he described both the pleasures and torments of long-term use. This period marked a culturally significant moment in the history of psychoactive substances and gave rise to a literary tradition centered on introspection, dreams, and the recreational use of opium that would influence artists, writers, and physicians across Europe.
At the same time, opium-based preparations were widely available over the counter in pharmacies and apothecaries under various brand names, including cough syrups, insomnia tonics, and child formulas like Godfrey’s Cordial or Syrup of Poppies. This accessibility led to increased use for both therapeutic and recreational purposes, until the first regulatory measures were introduced in the late 19th century in the United States and the United Kingdom. In this context, opium shifted from being a vital element of traditional medicine to becoming the focal point of a global conflict involving drugs, health, and public morality.
From common good to prohibited narcotic
The transition of opium from a traditional remedy to its demonization as an illicit drug was driven by geopolitical interests, racism, and mechanisms of social control. In the early 20th century, the international context was marked by the rise of moralist and eugenicist movements that saw drug use not only as a threat to health but also to social and racial order. The United States led an international crusade against opium through the 1912 Hague Convention, promoting its regulation under the pretext of protecting society — though with clear colonial and commercial interests.
These policies intensified with the establishment of the League of Nations’ Opium Commission and, later, the 1961 Single Convention on Narcotic Drugs, which consolidated a global prohibition regime. This treaty not only banned non-medical use of opium, but also severely restricted legal cultivation to a handful of designated countries, effectively eliminating any traditional or community-based alternatives.
Meanwhile, in regions where opium use had long been part of therapeutic or ritual practices — such as India, Iran, Morocco, or Mexico — the new laws forced these practices into illegality, triggered repression, and led to the collapse of popular medical systems. Thus, a plant that for millennia had served as a natural analgesic was replaced by more potent derivatives, more profitable for the pharmaceutical industry and more dangerous for the population.
Today, only 19 countries — none in Latin America — are authorized to cultivate poppy for legal purposes, mainly to supply the pharmaceutical industry. This exclusion has left out communities that have cultivated poppy for generations, such as those in the Golden Triangle in Asia or the Sierra of Guerrero in Mexico. The criminalization of this traditional knowledge and local economies has had devastating consequences in terms of structural violence, poverty, and forced displacement.
Ritual and domestic use of poppy in Spain
In Spain, the traditional use of poppy persisted until the mid-20th century. In some regions, infusions were prepared to soothe crying babies, relieve colic, or help elderly people sleep. In villages across Andalusia, Aragon, and Castile, it was common to collect wild capsules to make syrups and poultices. These practices, passed down orally from generation to generation, were part of a deeply rooted body of popular knowledge in rural areas—especially among women who served as caregivers, midwives, or folk healers.
Beyond its use as a sedative and analgesic, poppy was also applied as poultices to relieve inflammation, wounds, or joint pain. In some villages of the Aragonese and Navarrese Pyrenees, it was customary to prepare remedies combining macerated opium with local herbs such as chamomile, elderflower, or lavender. These were administered to treat insomnia, menstrual pain, or nervousness. “Poppy water” and “poppy syrup” remained part of the apothecary’s repertoire well into the 20th century and could be found in pharmacies across the Iberian Peninsula alongside other herbal preparations.
In southeastern regions like Murcia and Almería, some families used dried poppy capsules to make sugar-based decoctions that were given by the spoonful at bedtime. In certain local religious festivals, symbolic references to the poppy as an element of purification and eternal rest have been documented, suggesting a possible continuity of ancient ritual associations.
Spanish legislation does not explicitly prohibit the wild collection of poppy capsules (as long as they are not cultivated intensively), which opens a window of opportunity for research into its ethnopharmacological use—particularly in palliative care or community health contexts. This legal openness could support the design of scientific studies to document efficacy, traditional dosages, and modes of administration in non-industrial settings, while respecting international narcotics control standards. It would also allow for the recognition of rural therapeutic memory as part of Spain’s intangible cultural heritage.
Harm reduction and safe supply
The concept of safe supply has gained traction in Canada and other countries as a response to the fentanyl crisis. It involves providing people who use opioids with regulated and unadulterated substances, thereby reducing the risk of fatal overdoses. Within this framework, smoked or orally ingested opium represents a safer option than injecting adulterated heroin. Its effects are milder, longer-lasting, and its therapeutic margin is broader.
Recent studies in Iran have shown that opium tincture is an effective alternative for treating opioid use disorder, with therapeutic retention rates nearing 83%. Endorsed by Iran’s Ministry of Health, this treatment has been used with over 90,000 patients since 2010 and has demonstrated efficacy comparable to methadone in reducing craving, improving sleep, and enhancing quality of life.
Other clinical experiences — in Myanmar and some Francophone settings lacking access to methadone—have also utilized opium tincture as a low-cost, culturally appropriate strategy, yielding positive results in social reintegration and reducing the risks associated with injectable opioid use. In Australia, trials using opium tincture have confirmed its effectiveness for gradual detoxification, especially in individuals with a history of smoking opium.
In Europe, no such programs currently exist, but several proposals from drug policy and public health platforms have suggested exploring the tightly regulated use of raw opium (e.g., smoked gum or oral decoctions) in supervised harm reduction programs. Researchers like Zara Snapp have proposed the creation of state-run agencies that would purchase opium gum from licensed farmers and distribute it safely to users in supervised environments. This strategy could help avoid fentanyl use in adulterated markets while providing legal livelihoods for communities currently criminalized for poppy cultivation.
Such approaches partially reclaim the traditional use of opium as a medicinal and ritual substance, a practice common for centuries in many cultures across Asia, Africa, and the Middle East. Prior to the international drug control regime established in 1912, opium was widely used in non-injectable forms—such as decoctions, tinctures, or smoked gum—to relieve pain, treat insomnia, or support grieving processes. The global suppression of these practices, driven by international conventions, did not eliminate consumption but rather pushed it into more dangerous illicit markets where more potent and risky forms, such as injectable heroin, proliferated.
Drug control policies also brought about significant economic and social consequences for rural communities that had legally or tacitly cultivated poppies. The imposition of a prohibitionist model without viable alternatives forced many families into illegality. Today, in the face of the spread of fentanyl and other synthetic substances, revisiting that historical trajectory opens the door to strategies that recognize the therapeutic and cultural value of natural opium—not to idealize it, but to understand that its responsible regulation could be part of a more humane, effective, and balanced response to the current opioid crisis.
Inequities in access and proposals for equity
A recent article in The Lancet Global Health highlighted the alarming inequality in access to opioids: while high-income countries face a fentanyl overdose epidemic, in many low-income countries millions of people suffer and die without access to adequate pain relief. The Commission proposes expanding access to generic and affordable opioids, prioritizing non-patented formulations and their inclusion in primary healthcare systems.
This proposal aligns directly with the recovery of traditional uses such as opium: a natural substance, low-cost, culturally accepted, and locally producible in ways that support economic justice. Including traditional poppy-based remedies in essential health packages would be a concrete step toward reducing both suffering and structural inequalities in healthcare access.
In the same vein, Katherine Pettus, Advocacy Director at the International Association for Hospice and Palliative Care (IAHPC), has emphasized in international forums that “it’s not about being pro-opioid or anti-opioid; it’s about being pro-patient.” In response to the disparity between high-income countries and regions with fragile health systems, she has stressed the urgency of providing free generic morphine in hospitals and hospices in low-resource settings to alleviate suffering without contributing to the synthetic opioid epidemic.
She has also warned against replicating the aggressive pharmaceutical model consolidated in the West across the Global South. In her words, “the global community must develop policy options for low- and middle-income countries that avoid the choice between ignoring pain or making a deal with the devil.” The solution, she argues, lies in strengthening international networks that promote fair and responsible access, while preventing exploitation by pharmaceutical companies in weak regulatory environments.
Traditional cultivation of poppy vs. the pharmaceutical industry
While pharmaceutical companies reap enormous profits from the sale of synthetic opioids — through patented formulations, extended-release products, and aggressive marketing campaigns — thousands of small-scale farmers in Latin America, Asia, and Africa have seen their historical livelihood, rooted in poppy cultivation, marginalized and criminalized. This deep economic and regulatory asymmetry represents a form of health neocolonialism: while countries in the Global North capitalize on the analgesic effects of opioids in clinical settings, communities in the Global South face persecution and impoverishment as a direct consequence of forced eradication and interdiction policies.
This gap is further widened by the fact that traditional knowledge related to the harvesting, preparation, and dosing of opium — passed down through generations in rural and ritual contexts — has been systematically excluded from contemporary legal frameworks. Despite the fact that many of these practices are less dangerous than the use of injectable synthetic opioids, both international and national laws continue to ignore or prohibit them. This omission has fueled illegal markets dominated by violent networks and has helped entrench an extractive system in which medical benefits remain in the hands of licensed laboratories, while the risks fall on vulnerable rural populations.
Reintegrating traditional poppy use into regulated public health and solidarity-based economic systems would not only reduce structural dependence on synthetic opioids but also restore the value of local ethnobotanical knowledge, promote therapeutic sovereignty, and create legitimate livelihood opportunities. Such a transition would involve implementing models of controlled production, traceability, and community licensing that ensure pharmacological safety standards while respecting the cultural and ecological dimensions of cultivation. In short, it would be a step toward sustainable opium markets — legally recognized, environmentally responsible, and socially just.
Conclusion
In the current context of mass overdoses, declining trust in the pharmaceutical industry, and global disparities in access to medicine, reclaiming the traditional use of opium emerges not only as a legitimate proposal but as a necessary one. This is not about replacing one dogma with another, but about broadening the therapeutic horizon, integrating historically marginalized knowledge systems, and building more humane and sustainable alternatives to the dominant model of synthetic opioids.
Unlike the latter, traditional opium holds within it the accumulated knowledge of millennia—a practice of care that has shaped communities and forged relationships with nature. Its reintegration, under regulated, responsible, and culturally informed frameworks, would not only reduce health risks but also rebalance power dynamics in pharmaceutical value chains, strengthen therapeutic sovereignty, and recognize rural populations as active agents of health.
Revaluing the poppy also means rethinking the role of the State—not merely as a prohibitionist or regulator, but as a facilitator of restorative processes that reconnect public health, economic justice, and cultural memory. In the face of the devastation caused by dehumanized industrial pharmacology, this ancient plant offers a path toward reconciliation between science, tradition, and dignity.
Perhaps the time has come to listen not only to technical reports and statistics, but also to the voices of rural communities, the memory of peoples, and the deep wisdom of plants that, for centuries, have taught us how to relieve pain without causing further suffering.
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