Poppy

February 2009

Papaver somniferum L. and Papaver bracteatum . Family: Papaveraceae

P. somniferum : Opium poppy , poppyseed poppy . P. bracteatum : Thebaine poppy , great scarlet poppy . Oleum Papaveris Seminis , lipiodol

Uses

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.

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. ¹

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. ^2, , ³ While growing poppies is legal, it is illegal to process what is grown into the drug form.

The chemistry of the genus Papaver is well known. When the unripened seed capsule is scored, a milky latex exudes. ^3, , ^4, The dried latex is known as opium, which contains more than 30 alkaloids. ^5, 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. ^3, , ⁵

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. ⁶ 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. ⁷

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. ^8, , ⁹ Poppy seeds and their oil contain only minuscule amounts of opium alkaloids.

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. ^10, , ¹¹

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), ^12, , ^13, while the poppy seed test and the charcoal test have been demonstrated to detect fistula in 100% of instances. ^12, , ^13, , ^14, Costs and acceptability of the poppy seed test (250 g seeds given orally) are more favorable. ¹³

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. ^15, , ^16, , ¹⁷

Other uses 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. ^8, , ^9, , ¹⁸

Clinical trials are lacking to guide dosage. Single oral doses of poppy seed 250 g have been used diagnostically. ¹⁴

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. Analysis for noscarpine, papverine, or thebaine may differentiate poppy ingestion from substance abuse. ^19, , ^20, , ^21, , ^22, , ²³

Information regarding safety and efficacy in pregnancy and lactation is lacking. The seed is generally recognized as safe when used as food.

None well documented.

Immunoglobulin E–mediated allergy to poppy seeds is rare, ^24, although case reports of anaphylactic reactions exist. ^24, , ^25, , ^26, , ^27, The poppy seed commonly used in confectionary is thermostable. In some patients, it may need to be ground in order to be allergenic. ^24, Cross-sensitization with sesame seed, hazel nut, rye grain, kiwi fruit, and buckwheat has been reported. ^24, , ²⁸

Adequate data are lacking. Thebaine has a median lethal dose of 20 mg/kg in mice. Toxicity of opium is documented. ^5, Although large doses of thebaine can induce convulsions, no case of human thebaine abuse has been reported. ⁷

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