Laudanum: The Opioid Epidemic of the 19th Century?

By Paul Gaita 10/19/17

Similar to prescription opioids, laudanum was once a go-to treatment for a variety of ailments. 

an illustration of a hand holding a dropper

A new feature on Live Science has drawn unsettling parallels between the current opioid epidemic and a similar struggle with an addictive and debilitating medication that was prescribed to Americans in the mid to late 19th century.

The feature details the use of laudanum, a medication containing 1% morphine that was initially used for serious illnesses like tuberculosis but soon came to be used for all manner of ailments, from cough and insomnia to sleeplessness in children. As a result, its potency was a contributing factor in high rates of infant mortality, and addiction numbers on par with current statistics.

Media coverage of laudanum's dangers led to federal legislation that helped to curb its use at the dawn of the 20th century, again echoing the current state of affairs.

Laudanum is a solvent or liquid solution that contains nearly all of the alkaloids in opium, including 1% morphine and codeine. It is currently listed as a Schedule II drug under the Controlled Substances Act, though it is considered an "unapproved drug" by the Food and Drug Administration because it was manufactured prior to the Federal Food, Drug & Cosmetic Act of 1938.

It is available by prescription in both the United States and United Kingdom, and used primarily as an analgesic and antidiarrheal drug, and as opioid replacement therapy for infants born with opioid dependency issues. 

Medical practitioners began prescribing laudanum in the 16th century to combat serious illnesses such as cholera and tuberculosis, which minted its status as a cure-all.

But like 20th and 21st-century doctors who overprescribe opioid medications, the Live Science feature notes that laudanum was soon prescribed by doctors for a wide variety of health issues including insomnia, epilepsy and even menstrual cramps. And while it proved useful in certain situations—most notably, in areas struck by dysentery due to a lack of clean water—the potency of the medication proved disastrous for others. 

Due to its morphine content, laudanum was soon found to be highly addictive and debilitating to many users' health. The article quotes a letter published by the British Journal of Psychiatry in 1889 by a woman who details to her doctor her downward spiral after being prescribed laudanum for insomnia.

In the letter, she describes experiencing physical exhaustion after taking the drug, as well as a growing need for more doses that she eventually overcame by pure white-knuckle abstinence. She closes the letter by taking the doctor to task: "You doctors know all the harm those drugs do, as well as the 'victims' of them, and yet you do precious little to prevent it," she wrote.

Laudanum was also attributed to a rise in infant mortality in the late 1800s; the article cites statistics from the Registrar-General Reports, which recorded 236 deaths by infants one year of age or younger due to "narcotic deaths" in a four-year time period.

Though exact numbers of laudanum dependency during this period is unknown, the Live Science feature cites figures from a 2011 study which found that per capita, the number of opioid users in the latter decades of the 19th century was approximately three times that of those in the U.S. during the late 1990s, which the feature notes would be approximate to current epidemic statistics.

A 1906 feature in Collier's magazine is attributed in the piece as the catalyst of public outcry over laudanum use, and prompted the passage of the Pure Food and Drug Act that same year—the first of several subsequent efforts to address the use of harmful over-the-counter remedies, including the Harrison Act of 1914, which regulated the production and use of products that contained opium or cocaine.

Government regulation is also at the current forefront of combating the opioid epidemic, using legislation to crack down on the production of high-dosage opioids, among other issues.

Coordinated efforts such as these, along with more conscientious prescribing techniques and expanded media coverage—like the ones that brought laudanum under control—may also be the key to fighting the current opioid epidemic.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.