The 19th century book that spawned the opioid crisis

May 16, 2018 by Robert Morrison, The Conversation

In 1804, a 19-year-old Oxford University undergraduate named Thomas De Quincey swallowed a prescribed dose of opium to relieve excruciating rheumatic pain. He was never the same.

"Oh! Heavens!" he wrote of the experience in the first modern drug memoir, Confessions of an English Opium-Eater, published in 1821. "What an upheaving, from its lowest depths, of the inner spirit! What an apocalypse of the world within me!"

That the drug took away his physical pain was "a trifle," De Quincey asserted, compared to "the immensity of those positive effects which had opened before me."

Over the next eight years, De Quincey used opium to heighten his enjoyment of books, music, solitude and urban wandering. In effect, he invented recreational drug taking.

Yet all the while opium was tightening its grip on him, and in 1813 he succumbed to an addiction that tormented him until his death in 1859, more than half a century after he had first tampered with the drug.

"Who is the man who can take his leave of the realms of opium?" demanded the great 19th-century French poet Charles Baudelaire in his Artificial Paradises (1860). Not De Quincey.

And, as today's opioid crisis makes clear, not millions of others who have followed him into addiction, and who have had their lives ravaged by the drug. De Quincey's Confessions transformed perceptions of opium and mapped several crucial areas of drug experience that still provoke intense debate today.

I have conducted research into the life and writings of Thomas De Quincey for 30 years, and my work on him includes a biography, The English Opium-Eater, and a critical edition of his Confessions of an English Opium-Eater and Other Writings. My understanding of his opium addiction has benefited greatly from my consultations with Prof. Mary Olmstead of the Centre for Neuroscience Studies at Queen's University.

The oldest drug

Opium is probably the oldest drug known to humankind. It is derived from the unripe seedpod of the poppy plant, Papaver somniferum. The ancient Greek poet Homer almost certainly refers to it as "a drug to quiet all pain and strife" in his epic poem, The Odyssey, which was written in the eight or ninth century BC, and which De Quincey quotes in his Confessions.

For thousands of year, opium was the principal analgesic known to medicine. In the 16th century, the German-Swiss alchemist Paracelsus described it as "a secret remedy."

At the end of the 18th century, the great German philosopher Immanuel Kant warned of its dangers: Opium produces a "dreamy euphoria" that makes one "silent, reticent, and withdrawn," he stated in his Metaphysics of Morals (1797), and it is "therefore permitted only" for medical reasons.

In early 19th-century Britain, opium was everywhere. People of every age and class used it for self-medication like we use aspirin today. It was legal. It was cheap. It was available in a wide range of cure-alls, including Godfrey's Cordial, the Kendal Black Drop and Mother Bailey's Quieting Syrup.

It was used to treat all manner of major and minor illness, from cancer and diabetes to travelling sickness, hay fever, headache and depression. Pharmacists sold it, as did grocers, bakers, tailors, market vendors and country peddlers. There were no efforts to regulate its sale until the Pharmacy Act of 1868.

Over-prescribed

De Quincey consumed opium as "laudanum," which is prepared by dissolving opium in alcohol. Morphine, the principal active agent in opium, was isolated in 1803 and delivered with a hypodermic syringe by the 1850s.

At the beginning of the 20th century, opium was better known in the form of one of its chief derivatives: Heroin. Today, opioids are sold in powerful prescription medications, including tramadol, methadone and oxycodone. They are also, of course, widely available in illegal forms such as heroin, or in illicit forms of legal drugs —like fentanyl, a synthetic opioid.

Fuelled by decades of over-prescription, the United States gets 30 times more than it needs, and opioid overdoses kill more than 140 people daily.

Meanwhile, in other countries, patients are forced to endure severe or chronic pain because there is a shortage of the drug. Mexico gets only 36 per cent of the opioid medication it needs; China 16 per cent; India just four per cent.

De Quincey's descriptions of his opium experience have thoroughly shaped modern perceptions of the drug, and in a variety of ways. He glamorized opium in his Confessions, linking it to spectacular dream sceneries, visionary forms of creativity and intellectual, moral and emotional bliss.

In 1824, the authors of the Family Oracle of Health damned the Confessions for producing misery in those who had read it and begun to abuse opium.

They were right to worry. Many 19th- and 20th-century addicts have said explicitly that De Quincey led them to the drug.

Typically, "ever since I read De Quincey in my early teens I'd planned to try opium," Ann Marlowe confessed in 1999 in her How to Stop Time: Heroin from A to Z.

De Quincey was also the first to explore the painful cycles of intoxication, withdrawal and relapse and his accounts are deeply consonant with modern descriptions. Once he was habituated to opium, he no longer experienced anything like the euphoria he enjoyed as a recreational user.

When he determined to kick his habit, what he called "nervous misery" marked the beginning of withdrawal. If he attempted to battle through it, he was hit hard by vomiting, nausea, irritability and depression. He often fought these miseries, too, but then his resolution faltered, and he went back to opium. His intake levels gradually climbed. He spiralled toward rock bottom. The grim cycle began again.

Like the vast majority of addicts from his day to ours, De Quincey could come off opium. He just could not stay off opium.

Myth making

In one fundamental respect, however, De Quincey's account of opioid addiction does not tally with today's medical knowledge.

By common consent, the pain of opioid withdrawal usually lasts about a week and is like having a very bad flu. De Quincey tells a different story. "Think of me as of one, even when four months had passed, still agitated, writhing, throbbing, palpitating, shattered," he wrote.

Such depictions exaggerated the agonies of withdrawal and established the erroneous conviction that it is a hellishly long process. In Romancing Opiates (2006), Theodore Dalrymple condemned the uncritical acceptance and enduring impact of De Quincey's Confessions. "When it comes to drug addiction," Dalrymple stated, "literature has trumped —and over-trumped —pharmacology, history, and common-sense."

De Quincey had a deeply paradoxical relationship with opium, and more than 30 years after his addiction had taken hold, he was the first to detail the sickening confusion that so many addicts have found at the crux of their drug experience.

Opium, he asserted, was a con that could convince long-term addicts that they could lay it aside easily and within a week.

Opium was a trade-off that defeated steady exertion, but that gave irregular bursts of energy. Opium was irresistible, like a celestial lover. And opium was a blight that withered life. The collision of these competing impulses made it difficult for De Quincey to see his addiction clearly, and impossible for him to surmount it.

"Since leaving off opium," he once noted wryly, "I take a great deal too much of it for my health."

De Quincey initiated the story of modern addiction. There were countless users and abusers before him stretching back to the ancient world, but he was the first to publish a compelling narrative that explored the seductive pleasures and eviscerating pains of the drug.

He has been castigated for celebrating opium and for spreading misinformation about it. But in 1844 he was categorical about his abuse, and his harrowing words anticipate the testimonies of so many of the addicts caught up in today's opioid crisis. "Not fear or terror," De Quincey wrote, "but inexpressible misery, is the last portion of the opium-eater."

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