23 January 2011

Opium addiction in rural Afghanistan is not a big deal

CNN has a heart wrenching story about Afghan infants being fed pure opium. Or at least that's what the headline says. Aside from one anecdote early in the article there's nothing else in it about children, it's all about how widespread opium addiction is in rural Balkh. Moreover, it mentions "health risks" and that opium is addictive but does not elaborate.

First of all, opium is the raw paste harvested from slit seed poppies of Papaver somniferum, but also other poppies. It is composed of a variety of substances, but the pain killers are morphine, codeine, and thebaine. Most important is morphine which typically constitutes 10-15% of the raw latex paste. It also contains codeine (1-3%) and thebaine (<%5)1. The composition matters because morphine and thebaine get extensively metabolized when you ingest them orally and only a small amount of codeine will even end up as a bioactive compound (on its own it is inert).

All of which is to say that eating opium is qualitatively different than smoking heroin or regularly popping an oxycontin. Sure, raw opium would be toxic at around two grams to you or I (assuming Google didn't lead you here looking to score), but Iranian opium addicts have no trouble ingesting eight grams or more. Furthermore, a single ounce of opium paste is rather sizeable. The article mentions a woman "roll[ing] a small ball in her fingers," so it's clear we're not talking about dangerous amounts here.

Small palliative doses ingested orally (contra smoked or snorted) are not particularly dangerous and given the conditions completely understandable. Opium will slow your GI and make your hunger less acute, it will alleviate pain, and it will reduce anxiety. While taking it chronically will undoubtedly lead to dependence it's appropriate to ask what the consequences of widespread opium addiction are in Afghanistan. This is a country whose life expectancy is 44 years and change. Opium is cheap and widely available in Afghanistan, there seem to be no Western-style attendant social problems (theft, drug-related violence, burglary, etc). Aside from some culturally imperial insinuation that they need to recognize the wisdom of drug prohibition I can't find any mention of a real problem here.

The story does make an effort to slyly convince you that opium is actually dangerous to one's health though.
[Nagibe] says her sister-in-law first gave her some when she was a young teenage bride, just 14 years old. Her children grew up addicts as well.

When her husband died, she remarried.

She said: "My new husband doesn't use drugs, nor does his family. Because of that I was able to come here and get treatment. Now as an adult I understand and I want to leave this all behind."
What does her first husband's death have to do with anything? What does she want to "leave behind"? Who knows... but aside from vaguely intimating something sinister to widespread opium use the entire exchange is meaningless.

Were this article to be written in a cultural vacuum it would be bad. In modern day America it's shameful. We, with our societal alcohol addiction are fine with a substance considerably more dangerous than morphine and one which attends considerably more social ills. Yet we have the nerve to chastise poor rural Afghanis for ingesting a cheap, plentiful, ubiquitous pain killer? (How much do Americans spend on acetaminophen [Tylenol] annually? By the by acetaminophen's therapeutic index is lower than morphine's).

Far more heartbreaking is the first image in the slideshow showing a child undoubtedly suffering from kwashiorkor and the article's subsequent obliviousness to a much larger issue: infant malnutrition.

1 Incidentally, thebaine is not used pharmacologically because many of its effects are stimulatory rather than inhibitory as the other alkaloids are. It is used as the precursor in synthesis of many opioids, such as oxycodone, though.

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