Peter Pontiac was a Dutch underground illustrator and cartoon artist who started using opium around 1970. Opium was then sold in Chinatown in Amsterdam. When heroin entered the market Pontiac switched to this much stronger drug heroin. He made drawings about his harsh life as a drug user. Of these drawings the ‘Map of Junkie Mokum’ is one of the most impressive pieces. The map shows in detail and with a lot of humor how street life in Amsterdam looked like in the late 1980s and early 1990s. Pontiac died in 2015 of hepatitis C – a disease very common among injecting drug users – almost twenty years after he had stopped using drugs.

SEX WORK

Behind Central Station you see a sex worker with withdrawal symptoms, while a 25 guilder bill is standing in front of her with an erection.

CHET BAKER

Jazz artist Chet Baker died by falling out of a window on the Prins Hendrikkade, probably under influence of drugs. Baker once mentioned he liked to inject ‘speedballs’, a combination of cocaine and heroin.

‘JUNKIE ON THE TOILET’

Someone in the train shouts to the check taker: ‘There is a junky on the toilet!’ In the 1980s there were no drug consumption rooms or shelters for people who use drugs. People had to shoot their heroin in street alleys, porches or public toilets.

CAT AND MOUSE

In the Red Light district it was common in the 1980s for the police to chase drugs users and dealers. It was a cat and mouse game that never stopped until the city council decided to start offering health services to people who use drugs instead of chasing them. This health approach turned out to be the solution to a lot of problems that arose from drug using and dealing in the city.

DENTIST FOR DRUG USERS

On top of the next drawing you find the prison known as the Bijlmerbajes, where inmates fantasize over making money and having sex. A bit below you see the ‘Jellinek Tandarts’, a dentist who is specialized in treating the damaged teeth of people who use drugs and people living on the streets. It’s next to the ‘spuitomruil’ one of the many places where injecting heroin users could exchange their used needle for new ones.

During the 1970s and 1980s use of the addictive opiate heroin took a flight in Amsterdam and other Dutch cities. The flower power era of cannabis and LSD was over, and society was in economic crisis.

The strong opiate heroin was often used by people who sought comfort in difficult situations, as a refuge out of daily life or to deal with trauma and pain. While heroin can be smoked or snorted, the most notorious use was by people injecting it. Because it directly enters the blood stream, almost instantly the user gets an intense euphoric rush that lasts for hours. When people use it daily for about two weeks the body gets dependent. This means that as soon as the rush is finished, you start feeling sick.

Due to the HIV (AIDS) epidemic in the 1980s it became apparent that sharing used needles was the biggest reason of transmission of the virus among drug users.  Supplying clean needles for free, and opioid substitution (giving methadone instead of heroin) turned out to be very effective in improving the health and stabilizing the lives of heroin users.

Heroin paraphernalia include :

Hypodermic needle: used to inject the liquefied drug into a vein or sometimes a muscle.

Cotton balls: to strain the liquid drug and pull out chunks of impurities that did not melt.

Spoons or bottle caps: vessels to “cook” the drug, or turn tar, solidified, or powdered heroin into a liquid for injection.

Tie-off: often a shoelace, piece of rubber hose, or string that ties off a limb – usually an arm – and change blood flow to make veins pop ou.t

Lighter or candle: the heat source used to melt heroin into a liquid.

Artist life has taken its toll on many people we know from their music, movies or writing. Opiates have relaxing and euphoric effects. Artists could use them to relax and cope with the stress of stage presence and constant pressure to perform. While in the former century the illegal opiate heroin was a common cause of overdose among artists, in more recent years legal opioid pain killers such as oxycodone and fentanyl are often involved. The black market of opioids is bigger than ever, and there is no supervision on illegal production. It is difficult for consumers to know the content of medication sold on the black market. Both pop artist Prince and rap singer Lil Peep probably took pills, cut with fentanyl, without them being aware of it.

While opium cultivation and use dates back to 3400 BC in Mesopotamia, and several civilizations have abundant records of opium use, trade and cultivation, most people associate opium use with the Chinese community. Opium smoking (copying the use of pipes from western sailors) only became popular in China in the 17^th-18^th centuries. The tradition of smoking in an opium den then found its way via Chinese migrants practicing their traditions into the Western world.

The layout, or kit for opium smoking consists of a pipe, spirit lamp, a large needle and a container of opium paste. Other items include a sponge, scissors, for trimming wick of the lamp, scales for measuring the opium, and a scraper for cleaning.

The effects of opium are euphoric and relaxing. It slows down your breath and heartrate, and you can feel sleepy, up to a level, you want to close your eyes and lay down, just to feel the rush going through body and mind. But first, the spirit lamp is lit and the smoker makes himself comfortable in a reclining position. Then, taking a pea-sized ball of the opium paste and with the end of a long needle, you hold it over the flame of the lamp until the opium bubble swells and turns golden. The gooey mass is stretched into long strings in order to heat the substance better, repeating the procedure several times. After being properly heated, you roll it back into a small ball and quickly push it into the hole in the bowl. By holding the bowl close to the flame the ball opium heats up and evaporates. This is the point where you take a deep pull at the pipe until the opium is completely consumed. While smoking the opium should not be burned, but evaporated. Because the pipe is often very long, up to half a meter, the fume cools down a bit before it enters the mouth.

Opium smoking is a ritual that takes some time. Opium pipes were often quite beautiful, made out of ivory, bamboo, turtle and buffalo horn. Often they were decorated with traditional engravings in the metal parts.

Morphine is probably the best known painkiller among the opiates. It was commercially brought on the market in 1827. Its use was stimulated by the introduction of the hypodermic syringe in the 1850s.The strong opiate has been and still is used in medicine to treat severe pain, for example after an operation or a serious injury. It has also proven its usefulness for wounded soldiers on the battlefield. The use of morphine in military medicine became widespread during the American Civil War (1861–1865), leading to high numbers of addicted soldiers, and the Franco- German War (1870–1871), and was extensive during both world wars of the 20^th century. Soldiers were administered morphine in cases of severe wounds and amputations.

Due to the invention of the hollow needles and syringes in the 1850s morphine was easy to administer. It can be injected in a vein or in the muscle, but also administered orally. Its maximum effect is reached after about 20 minutes when administered intravenously and 60 minutes when administered orally, while the duration of its effect is 3–7 hours.

The morphine syringe used in World War II was similar to a superglue tube. After breaking the seal, the hollow needle was inserted under the skin at a shallow angle and the tube flattened between the thumb and fingers. Opiates slow your breathing and heartrate, which makes an overdose potentially fatal. Therefore, soldiers pinned the used tube to the receiving soldier’s collar to inform others of the dose administered.

Another risk of opiate use that many soldiers weren’t aware of was getting withdrawal symptoms. Long term opioid use led to morphine addiction in many soldiers to be known as ‘soldier’s disease’.

Despite these drawbacks, morphine has essentially been the most important tool to treat severe pain for almost two hundred years.

* Miniature delivered by Roger Hurkmans Design

Joan Gideon Loten (1710-1789), former Governor of Makassar and Ceylon at the Dutch East Indies Company, wrote in detail about his opium use. His notebook, kept in Utrecht University Library, contains notations about the people he met in daily life, bird sightings, and thoughts and questions to himself.

The notebook contains a detailed daily account of his intake of opium, ingested in the form of drops of liquid laudanum or as grains of opium crystal. He reflected upon the side effects of his opium use. On 14 April 1783, he remarked:

‘Strong cramps in right hand and fingers, writing was impossible for 1,5 hours. This has happened many times before, and almost always at the same time. Question: Does the opium here do good or harm?’.  

Although he was a reluctant user of opium, he concluded in 1775 that he:

‘would not reject this medicine, because it is the only ‘friend’ I have found in the large waste bin of the Materia Medica’. 

He described his situation:

‘Every day I am troubled at least by two attacks of unbearable convulsions around the diaphragm. The first at 04:00 in the morning wakes me up from my first sleep and the second usually comes at 18:00 in the evening. These spasms only disappear with the use of opium or liquid: laudanum. When I should not use this medication, I should never be able to undress, neither to lie down, nor to enjoy a single moment of sleep, or even to clean my inside, which often became hard when I remained seating in my chair for six even seven days, without removing my clothes, not being able to endure the movements of taking anything off’. 

In January 1772 he took a very high dose of opium:

‘The 17th I felt so poorly with spasm after spasm that I took at the same time laudanum in doses of 50, 60, 70, 75 drops within 18 hours 400 drops of that opiate. The last dose stopped the spasms. However, I did not sleep that night… Without lying I can declare that with the exception of opium, I never experienced any evident relief from any medicine from the Materia Medica. More than once, I was warned that it is dangerous for patients to take it carelessly. The careful use is very unprofitable for the doctors and also (because it is a cheap medicine) for the pharmacists. I really regret that I have to use it, which causes that I often postpone the intake, which is further strengthened by my aversion of its smell and taste’.  

In 1783 Loten used opiates every day and specified the number of drops he took in the morning, afternoon, evening, and night.  His intake of the drug doubled over the following years. However, the notebook shows that Loten was active almost every day, making visits, receiving visitors, and taking carriage rides around Utrecht, perhaps indication that the opium medication was effective in suppressing the worst symptoms of his asthma.

The medicinal use of opium has not been restricted to adults. Since the 17th century opium syrups were used to keep children quiet and get them to sleep. Doctors complained in the 19th century that one of these syrups, Requies Pur (‘Kids Rest’), was given too freely to children. After the isolation of morphine from opium patent medicines were introduced that often contained opiates; for example in 1845 Mrs. Winslow’s Soothing Syrup, that contained morphine sulphate. It claimed to ‘sooth any human or animal’, and it effectively quieted restless infants and small children, more especially in case of teething. The syrup was widely marketed in the UK and the USA. In 1911 the American Medical  Association issued a publication calling Mrs. Winslow’s Soothing Syrup ‘Baby Killer’. It took until 1930 before the drug was taken off the market.

Paracelsus (1493-1541) was a Swiss physician and philosopher who advocated the use of opium, or laudanum, in western medicine. He is also known for formulating one of the most important principles in toxicology: ‘The dose makes the poison’.

Paracelsus pointed out that any substance (whether drug or essential nutrient) has the capacity to harm and thus behave like a poison. Not only opium, but also water can be fatal if you take too much. Everything depends on the dose.

Paracelsus stimulated the increasing popularity of opium in medicine from the 16^th century onward. The physician referred to opium as the alchemical ‘stone of immortality’. He called his opium medicine ‘laudanum’. Laudanum, from the Latin word laudare, means ‘to praise’. Paracelsus was known for having strong feelings toward the drug. Laudanum was ‘superior to all other heroic remedies’, according to him.

Johannes Oporinus, acquainted with Paracelsus, said:

‘He had pills which he called laudanum which looked like pieces of mouse shit. He boasted he could, with these pills, wake up the dead.’

These pills were a mixture of opium with plant and animal based ingredients. Mentioned are frog spawn, spices, musk, oils and horn.

In the seventeenth century English physician Thomas Sydenham prescribed laudanum as an opium tincture (opium in an alcohol solution). Laudanum and other opium products were prescribed during epidemics of the plague, sedating patients and assisting them in ‘sweating out’ the disease.

Laudanum became generally available in pharmacies up until the twentieth century.

The poppy (papaver somniferum) is the source of the sedative drug opium, which is the base of morphine, heroine and all other opiates. Somniferum means ‘sleep-inducing’. The ‘sleep poppy’ was already cultivated in lower Mesopotamia around 3400 BC. The Sumerians called it the joyous plant. Since then it was cultivated by the Assyrians, Babylonians and Egyptians.

Papaver Somniferum flourishes in dry, warm climates and today the vast majority of opium poppies are grown in the mountains crossing southern Asia from Turkey through Pakistan and Laos. Nowadays Afghanistan is the biggest poppy cultivator of the world, and hence a major source for the global heroin market. Besides Asia, poppy-based products such as heroin are  increasingly exported from Latin America.

About three months after the poppy seeds are planted, brightly-colored flowers bloom at the tips of greenish, tubular stems. As the petals fall away, they expose an egg-shaped seed pod.

Inside the pod is an opaque, milky sap.  When you cut the pod open, it drips out. This is opium in its crudest form.

As the sap oozes out, it turns darker and thicker, forming a brownish-black gum. Farmers collect the gum by scraping it off with a knife, bundle it into bricks or balls and wrap them in plastic or leaves. From there it is sold to smugglers and traders who disseminate it to the rest of the world.

Source: https://www.pbs.org/wgbh/pages/frontline/shows/heroin/transform/

Today, the profession ‘pharmacist’ is protected by law: only someone who has successfully completed a university degree in pharmacy and passed the pharmacy exam may call himself a ‘pharmacist’. In this way, the national government wants to protect patients against incompetent and careless actions by healthcare providers and to guarantee that the quality of healthcare in the Netherlands is and remains high. For the same reason, pharmacists, just like doctors, are subject to medical disciplinary law.  

In the Middle Ages and the early modern period, you would learn the trade primarily in practice: on the work floor of the pharmacy. The trade was a craft taught by a master to an apprentice. The quality of the practitioners of the craft was monitored by the guild. In their city, these professional organisations were responsible for the examination of pharmacy students, and checked the quality of the products pharmacists had in stock. 

 A pharmacist’s apprentice had to pass an exam, which consisted of a theoretical and a practical part. For the theoretical part, it was important that students had knowledge about the drying systems used in the pharmacy, the simplicia that served as raw materials for the preparation of medicines. In addition, it was tested whether the examination candidate had sufficient knowledge of Latin, of sizes, weights and symbols used in pharmacies and of the effect and dosage of medicines and toxic substances. 

During the 17th, 18th and 19th centuries pharmacies all over Amsterdam sold opium and opium-containing medicines such as theriac and laudanum without prescription. In 1636 opium was registered in the first Amsterdam city pharmacopeia, that contained an official list of medicines. 

Opium sold by pharmacies was used for medication and as sleeping drug. But there are also stories that opium was abused for suicide, murder, or date rape.  

Opium was enlisted in the new Dutch drug law in 1919. Opium-products were no longer available in pharmacies throughout the city without medical prescription. The first Opiumwet (opium law) made production and distribution of opiates for non-medical purposes illegal in 1920. In 1927 consumption without medical prescription was made illegal as well. The Opiumwet is still the cornerstone of the Netherlands’ drug policies, and a topic of debate. 

The ravaging Covid-19 pandemic almost has pushed into oblivion the fact that America is still struggling with an immense addiction crisis. Opioids use – including pain killers, heroin, and opioids such as fentanyl – became a serious crisis over the last 20 years, especially in the USA.

Drug overdose deaths rose from 16,849 in 1999 to 93,331 in 2020 according to the Centers for Disease Control and Prevention, of which more than 65.000 involved opioids. On a yearly basis the causality rate is only slightly below the combined number of victims of firearm violence and car accidents. The 2020 statistics indicate that the US opioid epidemic shows a new upsurge in the number of drug overdose deaths. And Covid-19 helped to worsen the addiction crisis by stimulating drug use among adolescents. In the past two decades, more than 800,000 Americans have lost their lives to the opioid crisis.

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain killers. Healthcare providers began to prescribe them at greater rates.

This led to widespread use before it became clear that these medications could indeed be highly addictive. Opioid overdose rates began to increase. In 2020, more than 65,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and fentanyl, a powerful synthetic opioid, sold on the black market. That same year, an estimated 1.7 million people in the United States suffered from dependency on pain killers. It turned out that about 10% of people in the United States using opioid pain killers for chronic pain developed dependency, including having withdrawal symptoms.

Artist and activist Domenic Esposito, who has a brother who coped with opioid dependency, placed a statue of a huge spoon with heroin in front of the building of pharmaceutical company Purdue to show that selling opioid painkillers was no different than selling heroin.

Image by Gregg Vigliotti for The New York Times 

A member of the Sackler family that owns Purdue Pharma testified August 2021 that his family bears a ‘moral responsibility’ to help abate the U.S. opioid crisis but said it ‘will not contribute financially unless it receives broad legal protections’. The settlement includes releases protecting the Sackler family against future opioid-related litigation in exchange for a 4.5 billion USD contribution to opioid abatement programs. Opponents of the deal say these releases should be more limited.

In November 2021 a federal jury in Cleveland found that three of the nation’s largest pharmacy chains – CVS Health, Walmart and Walgreens – had substantially contributed to the crisis of opioid overdoses and deaths in two Ohio counties. This was the first successful case in which the drug industry has been held accountable for the opioid crisis.

The verdict – the first from a jury in an opioid case — was encouraging for thousands of lawsuits in the US because they are all relying on the same legal strategy: demonstrating that pharmaceutical companies contributed to an unprecedented public health crisis.

Changes in the eye, such as pupil size, motion, and color of the whites, can be an indicator to see if someone is under influence of a drug. 

Pinpoint pupils are a very common symptom of opioid use.  Your pinpoints will shrink when you use:

• heroin
• morphine
• oxycodone
• fentanyl
• methadone
• codeine

Bloodshot eyes are a common symptom of taking alcohol, cocaine, and cannabis. These occur because blood vessels in the eyes expand. Other drugs may cause the eyes to water, the eyelids to become heavy, or the pupils to dilate. For example, use of amphetamine like drugs will make the pupil expand.  

Signs of overdose 

Recognizing the signs of opioid overdose can save a life. Here are some things to look for: 

• Small, constricted pinpoint pupils 
• Falling asleep or losing consciousness 
• Slow, weak, or no breathing
• Choking or gurgling sounds 
• Limp body 
• Cold and/or clammy skin 
• Discolored skin (especially in lips and nails) 

What to do if you think someone is overdosing 

It may be hard to tell whether a person is high or experiencing an overdose. If you aren’t sure, treat it like an overdose—you could save a life.

• Call an ambulance  
• Try to keep the person awake 
• Lay the person on their side to prevent choking. 
• Stay with the person 

Heroin is an illegal opioid that gives a euphoric rush. It is notorious for its addictive powers, and risk of overdose. It can be a white or brown powder.

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. Fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for pain caused by cancer.

Only a small pinch is enough to kill an adult person. It is a major contributor to overdoses in the U.S and in Europe.

Most fentanyl-related overdoses are caused by fentanyl produced in illegal labs. Because fentanyl is extremely potent it is often added to other drugs, making these drugs cheaper, more potent, more addictive, and more dangerous.

Fentanyl is available in different forms, including liquid and powder. Powdered fentanyl is white or yellowish and looks like many other drugs. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills resembling prescription opioids. Pills or drugs that contain fentanyl are extremely dangerous, even more so when people are unaware that their drugs contain fentanyl. This was reputedly the case with Prince who took pain killers without knowing they contained fentanyl, to cope with physical injuries.

Advertisement for medication containing opiates goes back a long way.

Heroin in 1900

The German company Bayer markets heroin around 1900 as their prime product. ‘Splendid sedative’ they write in their advertisement, both for adults as for kids. Heroin turns out to be an international hit. In 1910 the medical society starts warning for addiction, overdose and fatal casualties. In 1919 heroin is taken of the free market and is regulated through the Opium Law (opiumwet). Since the 1930s heroin isn’t prescribed anymore by doctors, and gets labeled as ‘dangerous drug’.

Eukodal (oxycodone) in 1941

The pain killer Eukodal (oxycodone) is developed during World War I to produce a less addictive alternative to heroin and morphine. It doesnt take long before it becomes evident that Eukodal is as at least as addictive as the other opioids are. But it does takes more than 50 years before advertisement of oxycodone will be banned.

Mrs. Winslow’s Soothing Syrup

Winslow’s Soothing Syrup was widely marketed in the 19^th century in the UK and USA. It contained morphine sulphate and was commonly used as a painkiller for children that suffered discomfort from teething, but also as a sedative for restless kids. It took until 1930 before the drug was taken off the market.

Oxycodone

In 1997 oxyxodone pharmaceutical companies started to bombard society woth advertisements. The total spending on advertisement increased from $11.4 billion to $29.9 billion from 1996 to 2005.  In the Purdue advertisements they claimed that the risk of addiction among patients treated for pain wass less than 1%. They promoted that oxycodone should be used much more often because it was the ‘best, strongest pain medication’.

Later it turned out that oxycodone was very addicitive, and that 5% of people who couldnt get their prescriptions extended switched to heroin.

Pharmaceutical companies who promoted the medicin and covered up information about the risks are currently sued for billions to compensate for the societal damage. Half a million people have died because of the opioid crisis, and this number is increasing rapidly each year.

Yellow routes: Opium trade

The Dutch held a monopoly on the import and distribution of opium in colonized Indonesia in the 19th and 20th century. At one point more than 15% of colonial revenues came from the opium trade. Most of the opium was produced in Bengal in British India and imported in Batavia (now Jakarta). From there it was distributed through the Dutch East Indies. The monopoly continued until the Japanese invasion in the Second World War (1942) and decolonization.

Green routes: Heroin trade

 After the Second World War opium cultivation thrived in the highlands of the Golden Triangle (on the borders of Thailand, Myanmar, and Laos). In the 1960s chemists produced heroin out of this opium. Chinese traders distributed the heroin through Hong Kong and later Singapore into the Western world. 

 In the 1970s Turkish heroin, manufactured form Afghan heroin, became more popular. Afghanistan developed into the largest opium producer in the world. While Chinese heroin was mostly smuggled by airplane, Turkish and Kurdish smugglers made use of the new European highway system that was uncontrollable for law enforcement.  

From 2010 onwards there was a large increase in heroin-related deaths in the US due to the massive influx of cheap Mexican heroin. Criminal networks fulfilled the needs of large numbers of prescription opioid-addicted patients, who no longer had access to the stricter controlled medical market sources and had to resort to non-medical opioid channels.   

Red routes: Opioids trade 

The production chain of opioids starts for the greater part in Tasmania, an Island 150 miles south of mainland Australia. Tasmania farmers grow a poppy plant that is particularly rich in the opiate alkaloid thebaine on thousands of acres of land. The poppies are then exported to opioid production facilities in the US, and China where the thebaine is chemically transformed into oxycodone, hydrocodone or fentanyl crystalline powders. The powders are used by the various international opioid pillmakers to produce  narcotics for the medical markets in the US, Europe and Asia. However, part of production ends up in non-medical markets mainly in the US. Chinese pillmakers are accused of dumping illegally the most potent opioid fentanyl on the non-medical US market.  

The Israel based multinational generic pillmaker Teva Pharmaceuticals is one of the major global opioid producers.