Milk of Paradise: A History of Opium, Lucy Inglis, Pegasus Books, February 2019, 464 pages.

Opioid drugs—including heroin, fentanyl, and prescription opioids—were responsible for nearly 50,000 overdose deaths in 2017. America is awash in them, whether stolen from a friend’s medicine cabinet, smuggled over the border, or shipped in by mail.

It is easy, in light of this carnage, to think about the opioid crisis as a fluke, an accident of the present moment. But in doing so, we forget the long and complicated relationship that humans have with all of the products, direct and indirect, of the poppy. Milk of Paradise is British historian and novelist Lucy Inglis’s effort to retell this story, from the Fertile Crescent to the hills of Appalachia. Any such history will necessarily have its faults, and Milk of Paradise has several. Nonetheless, it is an invaluable resource for any reader who wants an exhaustive understanding of the world’s opioid crisis.

Although Milk of Paradise is presented as a “history of opium” in its subtitle, there is more to it than just the history of the latex of the opium poppy (Papaver somniferum). Rather, as Inglis makes clear, opium has long been a substance of deep social, political, religious, and economic significance. It appears, Gump-like, throughout the highs and lows of civilization.

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In this story, the drugs have always had a dual nature. Opioids are essential to both modern medicine and modern criminal empires; they save lives and destroy them. This paradoxical nature, as both poison and cure, is at the center of Inglis’s history.

Strictly speaking, an opioid is any substance that—tautologically—acts on the body’s natural opioid receptor system. That system organically regulates pain and reward through the release of peptides, but can also be activated by human consumption of naturally occurring or artificially produced opioids. These drugs—opium, morphine, heroin, fentanyl, and myriad others besides—bind to the same receptors, and cause the same experience of euphoria and analgesia.

Opioids are, like alcohol or nicotine, substances that humans can use to exogenously induce certain native physiological responses. And, like alcohol and nicotine, humans have been using and abusing opioids for such purposes for thousands of years. Inglis begins her history in the Stone Age, when archeological evidence indicates early cultivation and trading of opium poppies began. The bulbs of the poppy can be scored and their opioid-rich latex drained and consumed for medicinal or recreational purpose. In its dried form, this latex is opium—the primary opioid used by humans for much of our history.

There is evidence of even these early cultures using opium as a recreational and anesthetic drug, in much the same way that it would continue to be used up through the present. Inglis notes that by 4000 B.C., bodies were being buried in Spain with poppy capsules; “the veneration of the opium poppy by western European society was underway,” she writes.

“Veneration” is the right word in more than one way. Because of its complex production process and intense potency, opium played an elevated, even religious role in numerous pre-modern and early modern cultures. It was often central to rituals, where its psychoactive effects were prized, and was a popular ingredient in mystical brews. For example, “the recipe for [a] divine elixir, known as haoma in Persia and soma in India’s vedic tradition… was a decoction of either Papaver somniferum, or Cannabis sativa,” Inglis notes.

At the same time, its analgesic and depressant effects made it a key component of medicinal preparations. Inglis cites “dwale,” the anesthetic preparation mentioned by Shakespeare that included, alongside opium, “pigs’ bile, bryony root, lettuce, and vinegar” among sundry others. For much of history, medicine and religion were not so distinct as they are today—opium’s curative properties were one and the same with its broader cosmological significance.

Opium was also a key commodity in early international trade. Inglis painstakingly traces the contours of European to Middle and far Eastern trading networks, at times straying too far from the subject of opium into general history. But she does paint a clear picture of the widespread exchange of opium, from Turkey to Europe to China and everywhere in between.

That opium was so common, and so important, is in stark contrast to opioid drugs’ social role today. A product like heroin or fentanyl is consumed on the outskirts of society; opium—although its use grew more stigmatized over time—was everywhere. This change is not an accident, nor a function of a simple increase in the strength of opioid products (though that plays a role). Rather, it is because as society changed, so too did its relationship to opium.

Milk of Paradise is necessarily a material history, but its most interesting sections embrace that fact, discussing the shifting production and process of exchange of opium as a commodity. This is what allows Inglis, for example, to make the point that “the history of opium in the East does not start with the drug itself, but with the infrastructure that allowed its introduction, then gave it the opportunity to flourish.” Because drugs are wrapped up in society, the base structure of production on which they are built is vital to their character.

Thus, the important moment of transition in opioids’ social status comes with a change in its structure of production. Specifically, opioids were transformed in the early 19th century, when German chemist Wilhelm Adam Sertürner first distilled morphine (then called “morphium”), the most potent poppy-derived opioid.

“Morphine,” Inglis writes, “heralded a new era in drug manufacture and consumption. A new, clean chemical product, fitting for the age, it produced miraculous results instantly, and appeared to have no side effects. People previously crippled by pain got up and walked from their doctor’s office.”

The invention of morphine was the moment of transition from opium as a product of nature or god to opioids as a product of human scientific ingenuity. Opium was no longer an object of veneration, but the subject of man’s will, both a product and driving force of the dissociation of medicine from religious ritual and practice.

At the same time, of course, the creation of new, semi-synthetic opioids produced unintended, and horrific, consequences. As Inglis writes, while morphine is, “named for a god, it is also a demon, and by the 1840s, Western doctors realized there was a dreadful problem with this wondrous new cure. Sertürner, in the name of science and a good night’s sleep, had unwittingly unleashed a monster.”

What follows next is the 150 years of the world’s modern struggle with opioids. “Morphinism” became a widespread social woe in both Europe and in much of east Asia. The mixing of morphine with modern technology—i.e. the hypodermic needle—bred America’s first drug crisis, as thousands of Civil War veterans came home addicted. The further refinement of morphine into diacetylmorphine, aka heroin, proved even more deadly.

Opioids retain this paradoxical nature through the rest of Inglis’s story. In the last several chapters of the book, she spends part of the time on a history of battlefield medicine in the 20th century, showing how opioids—in east Asia and Afghanistan—have simultaneously fueled wars and saved lives and minds. Even the modern opioid crisis began with the widespread adoption of opioids to combat chronic pain—an ailment for which they often remain the best available treatment.

In this sense, Milk of Paradise is instructive as an exercise in opposing whig history. Technological progress, which brought a previously natural and religious substance under the exclusive domain of science and medicine, simultaneously gave us a great healer and a great killer. The story of opium, in other words, cautions us against the hubris of assuming that industrialization, modern science, and mass production can effectively tame nature; they seem just as likely to unleash new and unexpected tragedies on us.

Milk of Paradise is by no means perfect. Long sections of the book, especially early on, spend too much time on general world history that is at best tangentially related to opium. Although it is the most up-to-date treatment of the topic, its later chapters can feel light on detail. This may be because Inglis is British, and so less concerned with the nitty-gritty of the American opioid drama a la Dreamland (2015). Readers interested in a more social history should consider the out-of-date but still solid Opium: A History (1999); those seeking a general history of drug use might consider Jill Jonnes’s Hep-Cats, Narcs, and Pipe Dreams (1999).

Still, as a work of history Milk of Paradise is exhaustive, and for those seeking context on how we got where we are, it will prove invaluable. Opium has been with humanity for thousands of years, and will be with us for thousands more. Milk of Paradise is an excellent contribution to our broader understanding of what that means.

Charles Fain Lehman is a staff writer for the Washington Free Beacon. He writes about policy, covering crime, law, drugs, immigration, and social issues. Reach him on Twitter (@CharlesFLehman) or by email at [email protected].