Poppy
Scientific Name(s): Papaver bracteatum, Papaver somniferum L.
Common Name(s): Great scarlet poppy, Lipiodol, Oleum Papaveris Seminis, Opium poppy, Poppyseed poppy, Thebaine poppy
Medically reviewed by Drugs.com. Last updated on Jan 22, 2024.
Clinical Overview
Use
Poppy extracts have traditionally been used to relax smooth muscle tone, making them potentially useful in the treatment of diarrhea and abdominal cramping. The extract has been used as a sedative analgesic and antitussive. Poppy seed oil is used as a vehicle for chemotherapy delivery and to diagnose fistulae. However, there are no clinical trials to support these uses. Morphine is prepared from the opium poppy.
Dosing
Clinical trials are lacking to guide dosage.
Contraindications
Contraindications have not been identified.
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking. The seed is generally recognized as safe when used as food.
Interactions
None well documented.
Adverse Reactions
Opium is known for its highly addictive qualities. It has been associated with poisoning and characterized by symptoms of sedation, sluggishness, and abdominal contractions. Allergy and anaphylaxis to poppy seed have been reported.
Toxicology
No data is available in humans.
Scientific Family
- Papaveraceae
Botany
Seventy to 100 different varieties of the poppy exist. The opium poppy is a small annual, but other poppy species may be annual, biennial, or perennial. The bright showy flowers of the genus Papaver range in color from white to deep reds and purples. The seeds of the plants vary in color from light cream to blue-black and are numerous and minutely pitted. Sap from the seed pods may be white, orange, or red.PLANTS 2007
History
The earliest accounts of the use of poppy preparations date to the ancient Sumerians in Mesopotamia, where the plant was used medicinally and was known as hul gil (the plant of joy). The medicinal uses of poppy were described by the ancient Greeks and opium, as an addictive agent, was identified by Arabic physicians more than 900 years ago. Because of the wide distribution of the opium poppy, its use has been recognized by most major cultures. Opium was widely used in the United States during the Civil War to treat wounded soldiers, who often developed a dependence. The alkaloid morphine was purified from crude opium in 1803. In 1874, morphine was reacted with acetic anhydride to yield heroin. This compound was developed by the Bayer pharmaceutical company in Germany for cough, chest pain, and pneumonia and was later recognized to have a high addiction potential. Derivatives of opium alkaloids continue to play a major role as antitussives, antidiarrheals, and analgesics. Their abuse potential remains high, and efforts to curtail the illicit cultivation of the opium poppy have had limited success. Poppy seeds are used in the preparation of confections and breads.Hoffman 1990, Calixto 2000 While growing poppies is legal, it is illegal to process what is grown into the drug form.
Chemistry
The chemistry of the genus Papaver is well known. When the unripened seed capsule is scored, a milky latex exudes.Calixto 2000, Simon 1984 The dried latex is known as opium, which contains more than 30 alkaloids.Duke 1985 The most important of these alkaloids are morphine (20%), noscapine (5%), codeine (2%), papaverine (2%), and thebaine (1%). Codeine is the most widely used opium alkaloid and is obtained from natural sources or through the methylation of morphine or synthetic transformation of thebaine.Calixto 2000, Duke 1985
Because of the medicinal importance of morphine derivatives, efforts have been made to identify a species of Papaver that contains high levels of a suitable starting compound for the commercial synthesis of codeine. In some varieties of P. bracteatum, thebaine constitutes 98% of the total alkaloid content.Nyman 1979 Commercially, thebaine may be readily converted to codeine, oxycodone, hydrocodone, or dihydrocodeine. P. bracteatum may become the species of choice as a legal source of alkaloid precursors.Theuns 1986
Poppy seed oil, used as a vehicle for pharmacological substances as well as oil-based paints, varnishes, soaps and liniments contains saturated palmitic and stearic acids and oleic, linoleic, alpha-linolenic, and other unsaturated fatty acids.Untoro 2006, Krist 2005 Poppy seeds and their oil contain only minuscule amounts of opium alkaloids.
Uses and Pharmacology
The pharmacologic effects of morphine alkaloids differ widely. Codeine and morphine are sedative analgesics and can relax smooth muscle tone, making them useful in the treatment of diarrhea and abdominal cramping. Codeine and its derivatives are used as antitussives. Papaverine relaxes involuntary smooth muscle and increases cerebral blood flow. Chemical modifications of the alkaloids enable different receptor-dependent activities to be elicited. The addictive characteristics of the opium alkaloids have been recognized for millenia.Ronsoni 1999, Kaplan 1994
Colovesical fistula
A few studies have evaluated the poppy seed test for the diagnosis of fistulae. Newer diagnostic methods have a varying success rate (70% to 80% for computerized tomography scans and 80% for radio-labeled chromium)Wensky 2006, Kwon 2008 while the poppy seed test and the charcoal test have been demonstrated to detect fistula in 100% of instances.Wensky 2006, Kwon 2008, Schwaibold 2001 Costs and acceptability of the poppy seed test (250 g seeds given orally) are more favorable.Kwon 2008
Hepatocellular cancer
Iodized poppy seed oil (Lipiodol) is used in imaging techniques in vascular hepatocellular cancer, because of the preferential accumulation of poppy seed oil in hepatocellular cancer cells. For this reason, iodized poppy seed oil is used as an adjuvant or vehicle to deliver chemotherapeutic agents (eg, cyclosporine A, cisplatin) to tumor sites.Buscombe 2002, Fujiyama 2003, Abe 2002
Iodine deficiency
Iodized poppy seed oil has been studied as a source of iodine in deficient individuals. Results varied compared with iodized salt and iodized peanut oil.Untoro 2006, Krist 2005, Huda 2001
Dosing
Clinical trials are lacking to guide dosage. Single oral doses of poppy seed 250 g have been used diagnostically.Schwaibold 2001
Attention has focused on the detection of morphine and codeine in urine following the ingestion of foods prepared with poppy seeds, and has resulted in confusion in testing for drugs of abuse.Chang 2012 Analysis for noscarpine, papverine, or thebaine may differentiate poppy ingestion from substance abuse.Chang 2012, Hayes 1987, Miller 1994, Paul 1996, Cassella 1997
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking. The seed is generally recognized as safe when used as food.
Interactions
None well documented. A case report exists of a fatality in which the benzodiazepine fenazepam was used concurrently with poppy seed tea.(Bailey 2010)
Adverse Reactions
Immunoglobulin E–mediated allergy to poppy seeds is rare(Oppel 2006) although case reports of anaphylactic reactions exist.(Oppel 2006, Gamboa 1997, Frantzen 2000, Crivellaro 1999) The poppy seed commonly used in confectionary is thermostable. In some patients, it may need to be ground in order to be allergenic.(Oppel 2006) Cross-sensitization with sesame seed, hazel nut, rye grain, kiwi fruit, and buckwheat has been reported.(Oppel 2006, Jensen-Jarolim 1999) A case report exists of bowel obstruction due to consumption of large quantities of poppy seeds.(Schuppener 2017)
Dependence requiring buprenorphine treatment has been documented in a 34-year-old man with a 5-year recent history of consuming poppy seed tea. His history included a 10-year overall history of opioid use disorder in which he transitioned from heroin to episodic use of pharmaceutical opioids, and ultimately the sole use of poppy seed tea for the last 5 years. Recovery was ultimately achieved with depot buprenorphine treatment.(Arunogiri 2021)
Toxicology
Adequate data are lacking. Thebaine has a median lethal dose of 20 mg/kg in mice. Toxicity of opium is documented,Duke 1985 as is toxicity from parenteral poppy seed tea.Monaghan 2013 Although large doses of thebaine can induce convulsions, no case of human thebaine abuse has been reported.Theuns 1986
References
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