Laudanum has most commonly been used in the treatment of pain and as a cough suppressant. Before the 20th century, it could be purchased without a prescription. Today, however, laudanum is a highly controlled substance in most areas of the world and is considered to be highly addictive and dangerous if misused.
Laudanum can be obtained in the United States by prescription, and its indications are often limited to pain relief, diarrhea, and as opioid replacement therapy for infants born addicted to opioids. In the last decade, however, the Food and Drug Administration has taken verbal action against at least one maker of opium tincture, indicating that laudanum’s availability in the U.S. may be limited in the future.
A Brief History
Laudanum was first developed in the 16th century by Swiss-German alchemist Paracelsus. However, his original formulation was quite a bit different than how it later evolved. It originally contained opium, pearl, musk, and amber, among other ingredients, possibly including saffron, castor, and nutmeg.
Through the years, alcohol, such as whiskey and wine, was also added in varying amounts, as well as a variety of substances to modify certain properties of the tincture. These include but are not limited to cinnamon, cloves, mercury, hashish, belladonna, cayenne, chloroform, and ether.
In the 1660s, Thomas Sydenham, English physician, developed another opium tincture that he also referred to as laudanum, although there were significant differences from Paracelsus’ original formula. By the 18th century, the medicinal properties of laudanum were well-known, and the drug was often hailed as a panacea of sorts.
The drug’s popularity was said to be due in part to the serious medical conditions that existed during that time, such as cholera, dysentery, and consumption (tuberculosis) that produced symptoms such as pain, coughing, vomiting, and life-threatening diarrhea and dehydration.
By the 19th century, laudanum was added to many medicines for reasons such as pain relief, the promotion of sleep, and to mitigate irritation or inflammation. Keep in mind that there weren’t many medications available at this time, so drugs like opium and its ilk were used for just about everything. It was even used by Victorian women for menstrual cramps.
By the early 20th century, many drugs were being regulated, laudanum included. The Food and Drug Act of 1906 mandated that certain drugs, such as alcohol, cannabis, cocaine, and opiates be labeled with ingredients and recommended dosage. The sale of such medicines decreased substantially after the labeling of contents was required.
The Harrison Narcotics Tax Act of 1914 restricted coca and opiate manufacture and distribution in the U.S. After this measure, the drug was only legally released to pharmacists and physicians, sometimes in concentrated forms.
By the mid-20th century, opiates were no longer considered panaceas and their use was often limited to pain relief.
Eventually, pharmaceutical companies began developing synthetic opioids such as oxymorphone and oxycodone. These were preferred over laudanum, which by this time was considered to be a potentially dangerous cocktail that was overkill in many cases.
In 1970 the Uniform Controlled Substance Act was adopted in the U.S. and laudanum was then placed as a Schedule II substance. Since that time, laudanum has become virtually obsolete as a treatment for pain, as it’s main ingredient morphine can be prescribed by itself. Its use is now primarily limited to the treatment of severe diarrhea, and occasionally neonatal withdrawal syndrome.
Laudanum is now primarily referred to as “opium tincture” and is considered to be one of many unapproved drugs regulated by the FDA. The only reason why opium tincture is still manufactured and distributed is that it was sold before the Federal Food, Drug & Cosmetic Act of 1938, a status that does not require these formulations to undergo FDA drug reviews and approval processes.
Despite that, the FDA does require certain labeling on opium tinctures, such as a bright red POISON label. And while the drug is technically unapproved, it does not appear that the FDA is actively trying to ban or restrict its use. Still, in 2009, the FDA wrote a warning letter to an opium tincture manufacturer, which stated the following:
“[Regarding] your unapproved drugs, we found that your firm is manufacturing and distributing the prescription drug Opium Tincture USP…Based on our information, there are no FDA-approved applications on file for this drug product.”
Laudanum or opium tincture side effects are very similar to morphine and include dysphoria, pruritus (itching), sedation, constipation, dependence, and respiratory depression, which may be life-threatening. An overdose can result in unconsciousness and death, and the added alcohol can also induce effects at higher doses.
Treatment for Overdose
Life-threatening overdoses of laudanum occur due to the high morphine content, which can lead to severe respiratory depression, hypoxia, coma, and respiratory arrest.
Moreover, opium tincture overdose is an emergency situation and victims should be given access to professional intervention as soon as possible.
Sufferers may need assistance with breathing and possibly be put on controlled ventilation. The use of naloxone, a drug that reverses the effects of an opiate or opioid overdose is also a powerful life-saving tool that can be administered.
Like all opioids and opiates, laudanum or opium tincture may have its place in pharmacology for the treatment of certain severe conditions. However, it is highly addictive and is a serious potential health risk, which includes overdose and death.
Laudanum’s history as a popular analgesic comes before a time of modern medicine in which more treatments are available for more conditions, and drugs are regulated and developed into formulas that are less dangerous or abuse-deterrent.