View source for Laudanum

{{short description|Tincture of opium}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{distinguish|labdanum|Cistus ladanifer}}
{{Multiple issues|
{{More citations needed|date=February 2023}}
{{cleanup infobox|date=August 2023}}
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{{Infobox drug
| verifiedrevid = 451786428
| image = Laudanum.jpeg
| width = 170px
| alt = Orange transparent bottle labelled "opium tincture USP (deodorized)." There is a warning label declaring the product to be poisonous.
<!-- Combo data -->
| type = combo
| component1 = Opium
| class1 = [[Analgesic]]
| component2 = Ethanol
| class2 = [[Tincture]]

<!-- Clinical data -->
| pronounce = {{IPAc-en|ˈ|l|ɔː|d|ən|ə|m}} {{respell|LAW|dən|əm}}
| pregnancy_US = C
|tradename = Dropizol
| routes_of_administration = [[Oral administration|Oral]], [[Buccal administration|buccal]], [[Sublingual administration|sublingual]]

<!-- Legal status -->
| legal_US = Schedule II
| legal_UK = Class A
| legal_UN = Narcotic Schedule I

<!-- Identifiers -->
| ATC_prefix = A07
| ATC_suffix = DA02

<!-- Chemical data -->
}}
'''Laudanum''' is a [[tincture]] of [[opium]] containing approximately 10% powdered opium [[w/v|by weight]] (the equivalent of 1% [[morphine]]).<ref>{{cite book | quote = Also labeled Tr. Opii, Tinctura Opii Deodorati, Tincture of Deodorized Opium, Opii tinctura. Tincture of Opium, U.S.P, "yields, from each 100 cc, not less than 0.95 gm and not more than 1.05 gm of anhydrous morphine". Source: | title = The Pharmacopoeia of the United States of America | edition = 10th Decennial Revision | location = Philadelphia, USA | publisher = J. B. Lippincott Company | date = 1925 | page = 400 }}</ref> Laudanum is prepared by dissolving extracts from the [[opium poppy]] (''Papaver somniferum'') in alcohol ([[ethanol]]).

Reddish-brown in color and extremely bitter, laudanum contains several opium [[Opioid#Opium alkaloids|alkaloids]], including morphine and [[codeine]]. Laudanum was historically used to [[therapy|treat]] a variety of conditions, but its principal use was as a [[analgesic|pain medication]] and [[Cold medicine|cough suppressant]]. Until the early 20th century, laudanum was sold without a [[medical prescription|prescription]] and was a constituent of many [[patent medicine]]s. Laudanum has since been recognized as [[Addiction|addictive]] and is strictly regulated and controlled throughout most of the world. The United States [[Controlled Substances Act]], for example, lists it on [[Controlled Substances Act#Schedule II controlled substances|Schedule II]], the second strictest category.

Laudanum is known as a "whole opium" preparation since it historically contained all the alkaloids found in the [[opium poppy]], which are extracted from the dried [[latex]] of ripe seed pods (''Papaver somniferum L., succus siccus''). However, the modern drug is often processed to remove all or most of the [[noscapine]] (also called ''narcotine'') present as this is a strong [[emetic]] and does not add appreciably to the analgesic or [[antipropulsive]] properties of opium; the resulting solution is called Denarcotized Tincture of Opium or Deodorized Tincture of Opium (DTO).

Laudanum remains available by prescription in the United States (under the generic name "opium tincture") and in the European Union and United Kingdom (under the trade name Dropizol), although the drug's therapeutic indication is generally limited to controlling [[diarrhea]] when other medications have failed.

The terms ''laudanum'' and ''tincture of opium'' are generally [[synonym|interchangeable]], but in contemporary medical practice, the latter is used almost exclusively.

== History ==
===Paracelsus' laudanum===
[[Paracelsus]], a 16th-century [[German-speaking Swiss|Swiss]] [[alchemist]], experimented with various [[opium]] concoctions, and recommended opium for reducing pain. One of his preparations, a pill which he extolled as his "archanum" or "laudanum", may have contained opium.<ref name="Sigerist">{{cite journal | vauthors = Sigerist HE |title=Laudanum in the Works of Paracelsus |journal=Bull. Hist. Med. |date=1941 |volume=9 |pages=530–544 |url=http://www.samorini.it/doc1/alt_aut/sz/sigerist-laudanum-in-the-work-of-paracelsus.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://www.samorini.it/doc1/alt_aut/sz/sigerist-laudanum-in-the-work-of-paracelsus.pdf |archive-date=2022-10-09 |url-status=live |access-date=5 September 2018}}</ref> Paracelsus's laudanum was strikingly different from the standard laudanum of the 17th century and beyond, containing crushed [[pearls]], [[musk]], [[amber]], and other substances.<ref name=Davenport-Hines>{{cite book | vauthors = Davenport-Hines R | author-link1 = Richard Davenport-Hines
 | title = The Pursuit of Oblivion | year = 2004 | url = https://books.google.com/books?id=dFRd2MMrtiUC&q=laudanum+history+paracelsus&pg=PA31
 | access-date = 2009-01-16 | chapter = Early History | publisher = Norton
 | chapter-url = https://books.google.com/books?id=dFRd2MMrtiUC&q=laudanum+history+paracelsus&pg=PA31 | ref = Davenport-Hines | isbn = 9780393325454 }}</ref>

=== British laudanum ===
One researcher has documented that "Laudanum, as listed in the ''London Pharmacopoeia'' (1618), was a pill made from opium, saffron, castor, [[ambergris]], musk and nutmeg".<ref name = "Hodgson_2001">{{cite book | title = In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines | vauthors = Hodgson, Barbara | location = Buffalo, New York, USA | publisher = Firefly Books | date = 2001 }}</ref>{{rp|45}}

=== Sydenham's laudanum ===
In the 1660s [[England|English]] physician [[Thomas Sydenham]] (1624–1689) popularized a proprietary opium tincture that he also named laudanum, although it differed substantially from the laudanum of Paracelsus. In 1676 Sydenham published a seminal work, ''Medical Observations Concerning the History and Cure of Acute Diseases'', in which he promoted his brand of opium tincture, and advocated its use for a range of medical conditions.<ref name="Davenport-Hines"/>

=== 18th century ===
By the 18th century, the medicinal properties of opium and laudanum were well known, and the term "laudanum" came to refer to any combination of opium and alcohol.

In the 18th century several physicians published works about it, including [[John Jones (physician)|John Jones]], who wrote ''The Mysteries of Opium Revealed'' (1700), which was described by one commentator as "extraordinary and perfectly unintelligible".<ref>{{Cite DWB|title=JONES, JOHN (1645 - 1709), cleric |id=s-JONE-JOH-1645|access-date=2021-07-10}}</ref><ref>{{Cite book| vauthors = Hardy EG |url=https://archive.org/details/jesuscollege08hard|title=Jesus college|date=1899| location  =London | publisher = F.E. Robinson and co. |others=PIMS - University of Toronto}}</ref> The Scottish physician [[John Brown (physician, born 1735)|John Brown]], creator of the Brunonian system of medicine, recommended opium for what he termed asthenic conditions, but his system was discredited by the time of his death.<ref>{{Cite journal| vauthors = Lawrence C |date=1988|title=Cullen, Brown and the poverty of essentialism|journal=Medical History. Supplement|issue=8|pages=1–21|issn=0950-5571|pmc=2557347}}</ref><ref>{{Cite book| vauthors = Risse GB |title=New Medical Challenges during the Scottish Enlightenment|chapter-url=https://brill.com/view/book/9789004333000/B9789004333000-s007.xml|chapter=The Royal Medical Society versus Campbell Denovan: Brunonianism, the Press, and the Medical Establishment|date= January 2005 |pages=105–132|publisher=Brill|isbn=978-90-04-33300-0|language=en|doi=10.1163/9789004333000_007}}</ref> The most influential work was by [[George Young (surgeon, born 1692)|George Young]], who published a comprehensive medical text entitled ''Treatise on Opium (1753).''<ref>Young G. ''A treatise on opium, founded upon practical observations''. London: printed for A.Millar; 1753</ref> Young, an Edinburgh surgeon and physician, wrote this to counter an essay on opium by his contemporary [[Charles Alston (botanist)|Charles Alston]], professor of botany and materia medica at Edinburgh who had recommended the use of opium for a wide variety of conditions. Young countered this by emphasising the risks ''<nowiki/>'...that I may prevent such mischief as I can, I here give it as my sincere opinion... that opium is a poison by which great numbers are daily destroyed.''' Young gives a comprehensive account of the indications for the drug including its complications. He is critical about writers whose knowledge of the drug is based on chemical or animal experiments rather than clinical practice. The treatise is a detailed, balanced and valuable guide to prevailing knowledge and practice.<ref name="Davenport-Hines" /><ref>{{Cite journal|last=Macintyre|first=IM|date=2012|title=A Sceptic and an Empiric in Medicine: George Young (1692-1757) and the beginnings of the Scottish medical Enlightenment|journal=Journal of the Royal College of Physicians of Edinburgh|volume=42|issue=4|pages=352–360|doi=10.4997/JRCPE.2012.415|issn=2042-8189|pmid=23240124|doi-access=free}}</ref> As it gained popularity, opium, and after 1820, morphine, was mixed with a wide variety of agents, drugs and chemicals including mercury, hashish, cayenne pepper, ether, chloroform, belladonna, whiskey, wine and brandy."<ref name="Hodgson_2001" />{{rp|104}}

[[File:Whalley "Confessions of a laudanum drinker", 1866 Wellcome L0016409.jpg|thumb|''Confessions of a laudanum drinker'', [[The Lancet]], 1866]]During the late 18th and early 19th centuries, patients undergoing surgery were often administered laudanum and alcohol, and had their hands restrained and bodies held down while the operation was performed.<ref>{{Cite book | vauthors = Adkins L, Adkins R |url=https://books.google.com/books?id=8UIURafSXQgC |title=Eavesdropping on Jane Austen's England: How our ancestors lived two centuries ago  |publisher=Little, Brown Book Group |year=2013 |isbn=978-1-4055-1364-7 |location=London |pages=312 |language=en}}</ref>

=== 19th century ===
By the 19th century, laudanum was used in many [[patent medicine]]s to "relieve [[pain]] ... to produce [[sleep]] ... to allay irritation ... to check excessive secretions ... to support the system ... [and] as a [[soporific]]".<ref name=Potter>{{cite book |last = Potter| first = SO | title = A Compend of materia medica, therapeutics, and prescription writing... | publisher = P. Blakiston, Son & Company | year = 1902 | url = http://www.henriettesherbal.com/eclectic/potter-comp/index.html | access-date = 2007-10-13 | chapter = Opium | chapter-url = http://www.henriettesherbal.com/eclectic/potter-comp/papaver-somn.html | ref =Potter }}</ref><ref>{{cite book | title = Licit & Illicit Drugs | last = Brecher | first = EM | author-link = Edward M. Brecher | location = Boston, USA | publisher = Little, Brown | year = 1972 | chapter = Chapter 1: Nineteenth-century America{{mdash}}a 'dope fiend's paradise' | pages = 3–7 }}</ref> The limited [[pharmacopoeia]] of the day meant that opium derivatives were among the most effective of available treatments, so laudanum was widely prescribed for ailments from [[common cold|colds]] to [[meningitis]] to [[heart|cardiac]] [[disease]]s, in both adults and children. Laudanum was used during the [[yellow fever]] [[epidemic]].

Innumerable Victorian women were prescribed the drug for relief of [[Dysmenorrhea|menstrual cramps]] and vague aches. Nurses also spoon-fed laudanum to infants. The [[Romanticism|Romantic]] and [[Victorian era|Victorian]] eras were marked by the widespread use of laudanum in Europe and the United States. [[Mary Todd Lincoln|Mary Lincoln]], for example, the wife of the US president [[Abraham Lincoln]], was a laudanum addict, as was the English poet [[Samuel Taylor Coleridge]], who was famously interrupted in the middle of an opium-induced writing session of "[[Kubla Khan]]" by "a [[person on business from Porlock]]".<ref>{{cite web|url=http://lincoln.coffeetownpress.com/|title=Camel Press|website=lincoln.coffeetownpress.com}}</ref> Initially a working-class drug, laudanum was cheaper than a bottle of [[gin]] or [[wine]], because it was treated as a medication for legal purposes and not taxed as an [[alcoholic beverage]].

As one researcher has noted: "To understand the popularity of a medicine that eased{{mdash}}even if only temporarily{{mdash}}coughing, diarrhoea and pain, one only has to consider the living conditions at the time". In the 1850s, "[[cholera]] and [[dysentery]] regularly ripped through communities, its victims often dying from debilitating diarrhoea", and [[dropsy]], [[Tuberculosis|consumption]], [[Fever|ague]] and [[rheumatism]] were all too common.<ref name="Hodgson_2001" />{{rp|44–49}}

An 1869 article in ''[[Scientific American]]'' describes a farmer growing and harvesting [[poppy]] in [[Indian Springs, Georgia]], and subsequently selling the raw material to a local pharmacist who prepared laudanum.<ref>{{Cite book |url=https://books.google.com/books?id=RmM9AQAAIAAJ&q=carbonic+oxide |title=Scientific American |date=1869-05-29 |publisher=Munn & Company |pages=342 |language=en}}</ref>

=== 20th century ===
Laudanum was used in home remedies and prescriptions, as well as a single medication. For example, a 1901 medical book published for home health use gave the following two "Simple Remedy Formulas" for "dysenterry"{{sic}}: (1) Thin boiled starch, 2 ounces; Laudanum, 20 drops; "Use as an injection [meaning as an [[enema]]] every six to twelve hours"; (2) Tincture rhubarb, 1 ounce; Laudanum 4 [[Dram (unit)|drachms]]; "Dose: One teaspoonful every three hours." In a section entitled "Professional Prescriptions" is a formula for "diarrhoea (acute)": Tincture opium, deodorized, 15 drops; Subnitrate of bismuth, 2 drachms; Simple syrup, {{1/2}} ounce; Chalk mixture, 1{{1/2}} ounces, "A teaspoonful every two or three hours to a child one year old." "Diarrhoea (chronic)": Aqueous extract of ergot, 20 grains; Extract of nux vomica, 5 grains; Extract of Opium, 10 grains, "Make 20 pills. Take one pill every three or four hours."<ref>{{cite book |title=Medicology or Home Encyclopedia of Health |vauthors=Richardson JG |date=1901 |publisher=University Medical Society |location=New York, Philadelphia and London |pages=1276 and 1282}}</ref>

The early 20th century brought increased regulation of all manner of narcotics, including laudanum, as the addictive properties of opium became more widely understood, and "patent medicines came under fire, largely because of their mysterious compositions".<ref name="Hodgson_2001" />{{rp|126}} In the US, the [[Pure Food and Drug Act of 1906]] required that certain specified drugs, including alcohol, [[cocaine]], [[heroin]], [[morphine]], and [[cannabis]], be accurately labeled with contents and dosage. Previously many drugs had been sold as patent medicines with secret ingredients or misleading labels. Cocaine, heroin, cannabis, and other such drugs continued to be legally available without prescription as long as they were labeled. It is estimated that sale of patent medicines containing opiates decreased by 33% after labeling was mandated.<ref>{{cite book|url=https://books.google.com/books?id=7VrQy2d8PxYC | vauthors = Musto DF |author-link=David F. Musto|year= 1999|edition=3rd|title=The American Disease: Origins of Narcotic Control|publisher= [[Oxford University Press]]|isbn=9780198028925}}</ref> In 1906 in Britain and in 1908 in [[Canada]] "laws requiring disclosure of ingredients and limitation of narcotic content were instituted".<ref name="Hodgson_2001" />{{rp|126}}

The [[Harrison Narcotics Tax Act]] of 1914 restricted the manufacture and distribution of opiates, including laudanum, and [[coca leaf|coca]] derivatives in the US. This was followed by France's ''{{lang|fr|Loi des stupéfiants}}'' in 1916, and Britain's Dangerous Drugs Act in 1920.<ref name = "Hodgson_2001" />{{rp|126}}

Laudanum was supplied to druggists and physicians in regular and concentrated versions. For example, in 1915, Frank S. Betz Co., a medical supply company in Hammond, Indiana, advertised Tincture of Opium, U.S.P., for $2.90 per lb., Tincture of Opium Camphorated, U.S.P, for 85 cents per lb., and Tincture of Opium Deodorized, for $2.85 per lb.<ref>{{cite report | publisher = Frank S. Betz Co. | date = 1915 | title = Catalog No. N-15 | edition = Second | location = Hammond, Indiana, USA | page = 320 }}</ref> Four versions of opium as a fluid extract were also offered: (1) Opium, Concentrated (assayed) "For making Tincture Opii (Laudanum) U.S.P. Four times the strength of the regular U.S.P." tincture, for $9.35 per pint; (2) Opium, Camphorated Conc. "1 oz. making 8 ozs. Tr. Opii Camphorated U.S.P (Paregoric)" for $2.00 per pint; (3) Opium, Concentrated (Deodorized and Denarcotized) "Four times the strength of tincture, Used when Tinct. Opii U.S.P. is contraindicated" for $9.50 per pint, and (4) Opium (Aqueous), U.S.P., 1890, "Tr. (assayed) Papaver Somniferum" for $2.25 per pint.<ref>{{cite report | publisher = Frank S. Betz Co. | date = 1915 | title = Catalog No. N-15 | edition = Second | location = Hammond, Indiana, USA | page = 318 }}</ref>

In 1929–30, Parke, Davis & Co., a major US drug manufacturer based in Detroit, Michigan, sold "Opium, U.S.P. (Laudanum)", as Tincture No. 23, for $10.80 per pint (16 fluid ounces), and "Opium Camphorated, U.S.P. (Paregoric)", as Tincture No. 20, for $2.20 per pint. Concentrated versions were available. "Opium Camphorated, for U.S.P. Tincture: Liquid No. 338" was "exactly 8 ''times the strength of Tincture Opium Camphorated (Paregoric)'' [italics in original], U.S.P., "designed for preparing the tincture by direct dilution," and cost $7 per pint. Similarly, at a cost of $36 per pint, "Opium Concentrated, for U.S.P. Tincture: Liquid No. 336", was "four times the strength of the official tincture", and "designed for the extemporaneous preparation of the tincture".<ref>{{cite report | date = 1929–1930 | title = Physicians' Catalog of the Pharmaceutical and Biological Products of Parke, Davis & Company | pages = 87–88 }}</ref> The catalog also noted: "For quarter-pint bottles add 80c. per pint to the price given for pints."

Toward the middle 20th century, the use of opiates was generally limited to the treatment of pain, and opium was no longer a medically accepted 'cure-all'. Further, the pharmaceutical industry began synthesizing various [[opioid]]s, such as [[propoxyphene]], [[oxymorphone]] and [[oxycodone]]. These synthetic opioids, along with [[codeine]] and [[morphine]] were preferable to laudanum since a single opioid could be prescribed for different types of pain rather than the 'cocktail of laudanum, which contains nearly all of the opium alkaloids. Consequently, laudanum became mostly obsolete as an [[analgesic]], since its principal ingredient is [[morphine]], which can be prescribed by itself to treat pain. Until now, there has been no medical consensus on which of the two (laudanum or morphine alone) is the better choice for treating pain.

In 1970, the US adopted the [[Uniform Controlled Substances Act]], which regulated opium tincture (Laudanum) as a [[Controlled Substances Act#Schedule II controlled substances|Schedule II]] substance (currently DEA #9630),<ref>{{cite web|url=https://www.justice.gov/dea/pubs/scheduling.html | title = List of Controlled Substances | work = Office of Diversion Control | publisher = Drug Enforcement Administration, United States Department of Justice | quote = Also under Schedule II are opium extracts, opium fluidextract, opium poppy (''Papaver somniferum''), granulated opium, powdered opium, and raw or gum opium, each with an individual DEA number.|access-date=August 1, 2010|archive-url=https://web.archive.org/web/20130629153729/http://www.justice.gov/dea/pubs/scheduling.html|archive-date=June 29, 2013|url-status=dead}}</ref> placing even tighter controls on the drug.

By the late 20th century, laudanum's use was almost exclusively confined to treating severe [[diarrhea]].

=== 21st century ===
The current prescribing information for laudanum in the US states that opium tincture's sole indication is as an anti-diarrheal, although the drug is occasionally prescribed [[off-label]] for treating pain and [[neonatal withdrawal syndrome]].{{Citation needed|date=December 2022}}

== Historical varieties ==
[[File:Old bottle of laudanum (ca. 1950s).jpg|thumb|upright|Italian Sydenham laudanum tincture from the 1950s]]
Several historical varieties of laudanum exist, including [[Paracelsus]]' laudanum, [[Thomas Sydenham|Sydenham]]'s Laudanum (also known as ''tinctura opii crocata''), benzoic laudanum (''tinctura opii benzoica''),<ref>Belgische Farmacopee, 5de uitgave, 1966; part 3.</ref> and deodorized tincture of opium (the most common contemporary formulation), among others. Depending on the version, additional amounts of the substances and additional active ingredients (e.g. [[saffron]], [[sugar]], [[eugenol]]) are added, modifying its effects (e.g., amount of [[sedation]], or [[antitussive]] properties).

There is probably no single reference that lists all the pharmaceutical variations of laudanum that were created and used in different countries during centuries since it was initially formulated. The reasons are that in addition to official variations described in pharmacopeias, pharmacists and drug manufacturers were free to alter such formulas. The alcohol content of Laudanum probably varied substantially; on the labels of turn-of-the-century bottles of Laudanum, alcoholic content is stated as 48%. In contrast, the current version of Laudanum contains about 18% alcohol.

The four variations of laudanum listed here were used in the United States during the late 19th century. The first, from an 1870 publication, is "Best Turkey opium 1 oz., slice, and pour upon it boiling water 1 gill, and work it in a bowl or mortar until it is dissolved; then pour it into the bottle, and with alcohol of 70 percent proof {{1/2}} pt., rinse the dish, adding the alcohol to the preparation, shaking well, and in 24 hours it will be ready for use. Dose—From 10 to 30 drops for adults, according to the strength of the patient, or severity of the pain. Thirty drops of this laudanum will be equal to one grain of opium. And this is a much better way to prepare it than putting the opium into alcohol, or any other spirits alone, for in that case much of the opium does not dissolve."<ref>{{cite book | vauthors = Chase AW | url = https://books.google.com/books?id=BETiAAAAMAAJ | title = Dr. Chase's Recipes | location = Ann Arbor, Michigan | publisher = R. A. Beal | date = 1870 | page = 133 }}</ref> The remaining three formulas are copied from an 1890 publication of the day:
# Sydenham's Laudanum:<ref>Thomas Sydenham, an English physician, formulated this version of Laudanum in the 1660s.</ref> "According to the ''Paris Codex'' this is prepared as follows: opium, 2 ounces; saffron, 1 ounce; bruised cinnamon and bruised cloves, each 1 drachm; sherry wine, 1 pint. Mix and macerate for 15 days and filter. Twenty drops are equal to one grain of opium."
#Rousseau's Laudanum: "Dissolve 12 ounces white honey in 3 pounds warm water, and set it aside in a warm place. When fermentation begins add to it a solution of 4 ounces selected opium in 12 ounces water. Let the mixture stand for a month at a temperature of 86° Fahr.; then strain, filter, and evaporate to 10 ounces; finally strain and add 4{{1/2}} ounces proof alcohol. Seven drops of this preparation contain about 1 grain of opium."
#Tincture of Opium (Laudanum), U.S.P., attributed to the ''United States Pharmacoepia of 1863'': "Macerate 2{{1/2}} ounces opium, in moderately fine powder in 1 pint water for 3 days, with frequent agitation. Add 1 pint alcohol, and macerate for 3 days longer. Percolate, and displace 2 pints tincture by adding dilute alcohol in the percolator."<ref>{{cite book | title = Encyclopedia of Practical Receipts and Processes | vauthors = Dick WB | edition = Fifth | location = New York | publisher = Dick & Fitzgerald, Publishers | date = 1890 | pages = 416, 447 and 472 }}</ref>

== Modern status ==

===United Kingdom===
Opium tincture remains in the [[British Pharmacopoeia]], where it is referred to as Tincture of Opium, B.P., Laudanum, Thebaic Tincture or Tinctura Thebaica, and "adjusted to contain 1% w/v of anhydrous morphine."<ref>''The Extra Pharmacopeia Martindale''. Vol. 1, 24th edition. London: The Pharmaceutical Press, 1958, page 924.</ref> It is a [[Drugs controlled by the UK Misuse of Drugs Act|Class A]] substance under the Misuse of Drugs Act of 1971. At least one manufacturer ([[Macfarlan Smith]]) still produces opium tincture in the UK {{as of|2011|lc=yes}}.<ref name="Opium Tincture">{{cite web
|url = http://www.macsmith.com/index.php?page=product-list
|title = Macfarlan Smith Product List of Controlled Drugs
|access-date = 2011-02-14
|publisher = Johnson Matthey Website
|archive-date = 2011-07-14
|archive-url = https://web.archive.org/web/20110714013157/http://www.macsmith.com/index.php?page=product-list
|url-status = dead
}}</ref>
"Gee's Linctus" is also available from most UK pharmacies, especially independent stores. This contains "Opium Tincture", at 0.083&nbsp;mL, per 5&nbsp;mL.{{Citation needed|date=December 2022}}

===United States===
Tincture of Opium is available by [[Medical prescription|prescription]] in the United States. It is regulated as a [[List of Schedule II drugs|Schedule II]] drug (No. 9639) under the [[Controlled Substances Act]].

In the United States, opium tincture is marketed and distributed by several pharmaceutical firms, each producing a single formulation of the drug, which is deodorized. Each mL contains 10&nbsp;mg of anhydrous morphine (the equivalent of 100&nbsp;mg of [[List of Schedule II drugs|powdered opium]]), other opium alkaloids (except [[noscapine]]), and ethanol, 19%. It is available packaged in bottles of {{Convert|4|USoz|mL|spell=in|0}} and {{Convert|16|USoz|USpt mL|0}}.<ref>{{Cite journal | vauthors = Kelly K, Vaida AJ |date= June 2003 | journal = Pharmacy Times | volume = 69 | issue = 6 | pages = 58–63 |title=Recurring Confusion Between Opium Tincture and Paregoric |url=https://www.pharmacytimes.com/view/2003-06-7241 }}</ref>

Tincture of Opium is known as one of many "unapproved drugs" regulated by the U.S. [[Food and Drug Administration]] (FDA); the marketing and distribution of opium tincture prevails only because opium tincture was sold prior to the Federal Food, Drug & Cosmetic Act of 1938.<ref name="Unapproved Drugs">{{cite web|url = http://www.ijpc.com/RxTriad/pdf/RxTriad_V09_N02_Sample.pdf|title = Unapproved Drugs, What's the Big Deal?|access-date = 2009-01-03|publisher = International Journal of Pharmaceutical Compounding, Winter 2006|archive-url = https://web.archive.org/web/20100705075733/http://www.ijpc.com/rxtriad/pdf/RxTriad_V09_N02_Sample.pdf|archive-date = 2010-07-05|url-status = dead}}</ref> Its "grandfathered" status protects opium tincture from being required to undergo strict FDA drug reviews and subsequent approval processes. However, the FDA closely monitors the labeling of opium tincture. Bottles of opium tincture are required by the FDA to bear a bright red "[[poison|POISON]]" label given the potency of the drug and the potential for overdose (see discussion about confusion with Paregoric below). Additionally, in a warning letter to a manufacturer of opium tincture in late 2009, the FDA noted that "we found that your firm is manufacturing and distributing the prescription drug Opium Tincture USP (Deodorized – 10&nbsp;mg/mL). Based on our information, there are no FDA-approved applications on file for this drug product."<ref>{{cite web |title = Warning Letter to Ohm Laboratories | work = Inspections, Compliance, Enforcement, and Criminal Invesitations | url =  https://www.fdanews.com/ext/resources/files/archives/o/Ohm-Laboratories-WL.pdf | date = December 21, 2009 | publisher = U.S. Food and Drug Administration }}</ref>

== Pharmacology ==
Opium tincture is useful as an [[analgesic]] and [[antidiarrheal]]. Opium enhances the [[muscle tone|tone]] in the long segments of the [[Gastrointestinal physiology#Segmentation|longitudinal muscle]] and inhibits propulsive [[Gastrointestinal physiology#Contraction patterns|contraction]] of [[Gastrointestinal physiology#Segmentation|circular]] and longitudinal muscles. The pharmacological effects of opium tincture are due principally to its morphine content. The quantity of the [[papaverine]] and [[codeine]] alkaloids in opium tincture is too small to have any demonstrable central nervous system effect.<ref name="Opium Tincture Package Insert and Prescribing Information">{{cite web
|url = http://marathonpharma.com/pdfs/Opium_Tincture_PI.pdf
|title = Opium Tincture Prescribing Information
|access-date = 2009-01-03
|publisher = Marathon Pharmaceuticals, 2009
|archive-date = 2010-11-22
|archive-url = https://web.archive.org/web/20101122235016/http://marathonpharma.com/pdfs/Opium_Tincture_PI.pdf
|url-status = dead
}}</ref>

Most modern formulations of opium tincture do not contain the alkaloid [[narcotine]] (also known as [[noscapine]]), which has [[antitussive]] properties. Even modest doses of [[narcotine]] can induce profound [[nausea]] and [[vomiting]].<ref name="Principles of Pharmacy">{{cite book
|url = https://books.google.com/books?id=gRNKAAAAMAAJ&q=narcotine+unpleasant+deodorised&pg=PA231
|title = Principles of Pharmacy, entry on Tincture of Deodorized Opium
|access-date = 2008-01-27
|publisher = W.B. Saunders Company, 1917|year = 1917
}}</ref> Since opium tincture is usually prescribed for its antidiarrheal and analgesic properties (rather than as an antitussive), opium tincture without narcotine is generally preferred. This "de-narcotized" or "deodorized" opium tincture is formulated using a [[petroleum]] [[distillate]] to remove the narcotine.<ref name="Opium Tincture Package Insert and Prescribing Information"/>

Oral doses of opium tincture are rapidly absorbed in the [[gastrointestinal tract]] and metabolized in the [[liver]]. Peak plasma concentrations of the morphine content are reached in about one hour, and nearly 75% of the morphine content of the opium tincture is excreted in the urine within 48 hours after oral administration.{{Citation needed|date=December 2022}}

== Medical uses ==

===Diarrhea===
Opium tincture is indicated for the treatment of severe [[fulminant]] (intense, prolific) [[diarrhea]] that does not respond to standard therapy (e.g., [[Imodium]] or [[Lomotil]]).<ref name="Opium Tincture Package Insert and Prescribing Information"/>
The usual starting dose is 0.3&nbsp;mL to 0.6&nbsp;mL (about six to 12 drops) in a glass of water or juice four times a day.<ref name="Opium Tincture Package Insert and Prescribing Information"/> Refractory cases (such as diarrhea resulting from the complications of [[HIV/AIDS]]) may require higher than normal dosing, for example, 1 to 2&nbsp;mL every 3 hours, for a total daily dose of up to 16&nbsp;mL a day. In terminal diseases, there is no ceiling dose for opium tincture; the dose is increased slowly until diarrhea is controlled.<ref name="20 Common Problems in End-of-Life Care">{{cite book
|url = https://books.google.com/books?id=ZPgawhewn2gC&q=opium+tincture+no+maximum+dose+aids&pg=PA395|title = End of Life Care for Patients with AIDS
|access-date = 2009-01-30
|publisher = McGraw Hill, 2006|isbn = 9780070348837
|year = 2002
}}</ref>

=== Neonatal abstinence syndrome ===
Opium tincture is used to treat [[neonatal opioid withdrawal syndrome]] (NOWS) when diluted 1:25 (one part opium tincture to 25 parts water).<ref name="Goldfrank's Toxicological Emergencies">{{cite book
|url = https://books.google.com/books?id=HVYyRsuUEc0C&q=neonatal+withdrawal+syndrome+opium+tincture&pg=PA1069|title = Neonatal Withdrawal Syndromes
|access-date = 2009-01-30
|publisher = McGraw Hill, 2006|isbn = 9780071360012
|year = 2002
}}</ref> The recommended dose is 0.2&nbsp;mL of the diluted solution under the tongue every three hours, which may be increased by 0.05&nbsp;mL every three hours until no objective signs of withdrawal are observed.<ref name="Goldfrank's Toxicological Emergencies"/> In no event, however, should the dose exceed 0.7&nbsp;mL every three hours.<ref name="Goldfrank's Toxicological Emergencies"/> The opium tincture is gradually tapered over a 3- to 5-week period, at which point the newborn should be completely free of withdrawal symptoms.<ref name="Goldfrank's Toxicological Emergencies"/>

== Hazards ==
===Potency of laudanum===
Opium tincture is one of the most [[Potency (pharmacology)|potent]] oral formulations of morphine available by prescription. Accidental or deliberate [[overdose]] is common with opium tincture given the highly concentrated nature of the solution. Overdose and death may occur with a single oral dose of between 100 and 150&nbsp;mg of morphine in a healthy adult who has no tolerance to opiates.<ref name="Morphine Sulfate">{{cite web
|url = http://bulkpharm.mallinckrodt.com/_attachments/msds/MORIN.htm
|title = Material Safety Data Sheet for Morphine Sulfate
|access-date = 2009-01-16
|publisher = [[Mallinckrodt]] Pharmaceuticals
|archive-url = https://web.archive.org/web/20081015043251/http://bulkpharm.mallinckrodt.com/_attachments/msds/MORIN.htm
|archive-date = 2008-10-15
|url-status = dead
}}</ref><ref name="Medical Toxicology">{{cite book
|url = https://books.google.com/books?id=qDf3AO8nILoC&q=opium+tincture+overdose&pg=PA929|title = Medical Toxicology, Toxic Dose of Morphine (p. 929)
|access-date = 2009-03-06
|publisher = Wolter Kluwer Health
|isbn = 9780781728454
|year = 2004
}}</ref> This represents the equivalent of between two and three [[teaspoon]]s ({{convert|10|-|15|mL|mL|disp=out}}) of opium tincture. [[Suicide]] by laudanum was common in the mid-19th century.<ref>The ''Brooklyn'' (New York) ''Daily Eagle'', January 10, 1861, p. 3, reported two unrelated instances in a single day.</ref> Prudent medical judgment necessitates toward dispensing very small quantities of opium tincture in small dropper bottles or in pre-filled syringes to reduce the risk of intentional or accidental overdose.

===Danger of confusion with paregoric===
In the United States, opium tincture contains 10&nbsp;mg per mL of [[anhydrous]] [[morphine]]. By contrast, opium tincture's weaker cousin, [[paregoric]], also confusingly known as "camphorated tincture of opium", is 1/25th the strength of opium tincture, containing only 0.4&nbsp;mg of morphine per mL. A 25-fold morphine overdose may occur if opium tincture is used where paregoric is indicated. Opium tincture is almost always dosed in drops, or fractions of a mL, or less commonly, in [[Minim (unit)|minims]], while paregoric is dosed in teaspoons or tablespoons. Thus, an order for opium tincture containing directions in teaspoons is almost certainly in error. To avoid this potentially fatal outcome, the term "camphorated tincture of opium" is avoided in place of paregoric since the former can easily be mistaken for opium tincture.<ref name="ISMP">{{cite web
|url = http://www.ismp.org/hazardalerts/recruting.asp
|title = Hazard Alert! Recurring Confusion Between Tincture of Opium and Paregoric
|access-date = 2007-10-13
|publisher = Institute for Safe Medication Practices
|archive-url = https://web.archive.org/web/20071015130903/http://ismp.org/hazardalerts/recruting.asp
|archive-date = 2007-10-15
|url-status = dead
}}</ref>

In 2004, the FDA issued a "Patient Safety" news bulletin stating that "To help resolve the confusion [between opium tincture and paregoric], FDA will be working with the manufacturers of these two drugs to clarify the labeling on the containers and in the package inserts."<ref name="FDA Patient Safety News, May 2004">{{cite web
|url = http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/printer.cfm?id=224
|title = Dangerous Mixups Between Opium Tincture and Paregoric
|access-date = 2010-11-30
|publisher = FDA
}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}}</ref> Indeed, in 2005, labels for opium tincture began to include the concentration of morphine (10&nbsp;mg/mL) in large text beneath the words "Opium Tincture". The FDA has also alerted pharmacists and other medical practitioners about the dangers of confusing these drugs, and has recommended that opium tincture not be stocked as a standard item (i.e., that it should not be "on the shelf"), that opium tincture be dispensed in oral syringes, and that pharmacy software alert the dispenser if unusually large doses of opium tincture appear to be indicated.<ref name="Pharmacy Times, February 2008">{{cite web
|url = http://apha.imirus.com/Mpowered/imirusApp.jsp?volume=pt14&issue=2&page=74
|title = More Confusion Between Opium Tinctures
|access-date = 2009-01-17
|publisher = Institute for Safe Medication Practices
}}{{Dead link|date=February 2020 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

Despite the FDA's efforts over the past few years, the confusion persists, sometimes with deadly results.<ref name="Pharmacy Times">{{cite web
|url = http://www.pharmacytimes.com/issues/articles/2003-06_492.asp
|title = Recurring Confusion Between Opium Tincture and Paregoric
|access-date = 2009-01-30
|publisher = Pharmacy Times
}}{{Dead link|date=February 2020 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> The [[Institute for Safe Medication Practices]] recommends that opium tincture not be stocked at all in a pharmacy's inventory, and that "It may be time to relegate opium tincture and paregoric to the museum of outmoded opioid therapy."<ref name="ISMP"/> Despite the risk of confusion, opium tincture, like many end-stage medications, is indispensable for intractable diarrhea for terminally ill patients, such as those with AIDS and cancer.<ref name="20 Common Problems in End-of-Life Care"/>

===Misinterpretation of "DTO"===
The abbreviation "DTO," traditionally used to refer to Deodorized Tincture of Opium, is sometimes also erroneously employed to abbreviate "''diluted'' tincture of opium." Diluted tincture of opium, also known as Camphorated Tincture of Opium (Paregoric) is a 1:25 mixture of opium tincture to water prescribed to treat withdrawal symptoms in newborns whose mothers were using [[opioid]]s while pregnant. The [[United States Pharmacopeia]] and FDA recommend that practitioners refrain from using DTO in prescriptions, given this potential for confusion. In cases where pharmacists have misinterpreted DTO, and given "deodorized tincture of opium" when "diluted tincture of opium" was meant, infants have received a massive 25-fold overdose of morphine, sometimes resulting in fatalities.<ref name="ISMP"/>

===Side effects===
Side effects of laudanum are generally the same as with [[morphine]], and include [[euphoria]], [[dysphoria]], [[pruritus]], [[sedation]], [[constipation]], reduced [[tidal volume]], [[respiratory depression]], as well as [[Substance dependence|psychological dependence]], [[Drug tolerance|physical dependence]], [[miosis]], and [[xerostomia]]. Overdose can result in severe respiratory depression or collapse and death. The ethanol component can also induce adverse effects at higher doses; the side effects are the same as with alcohol.
Long-term use of laudanum in nonterminal diseases is discouraged due to the possibility of [[drug tolerance]] and addiction. Long-term use can also lead to abnormal liver function tests; specifically, prolonged morphine use can increase [[Alanine transaminase|ALT]] and [[Aspartate transaminase|AST]] blood serum levels.{{Citation needed|date=December 2022}}

===Treatment for overdose===
{{further|Opioid overdose#Treatments}}
Life-threatening overdose of opium tincture owes to the preparation's morphine content. Morphine produces a dose-dependent depressive effect on the respiratory system, which can lead to profound respiratory depression, hypoxia, coma and finally respiratory arrest and death. If overdose of opium tincture is suspected, rapid professional intervention is required. The primary concern is re-establishing a viable airway and institution of assisted or controlled ventilation if the patient is unable to breathe on their own. Other supportive measures such as the use of [[vasopressors]] and oxygen may be indicated to treat cardiac and/or pulmonary failure. Cardiac arrhythmias or arrest will require advanced life-saving measures.{{Citation needed|date=December 2022}}

Intravenous [[naloxone]] or [[nalmefene]], quick-acting opioid antagonists, are the first-line treatment to reverse respiratory depression caused by an overdose of opium tincture. Gastric lavage may be of some use in certain cases.

==Fiction==
{{In popular culture|section|date=December 2024}}
=== Literature ===
*In [[Mary Shelley]]'s novel ''[[Frankenstein]]'' (1818), Victor Frankenstein takes laudanum as his only means of sleeping and thus preserving his life while in recovery from months of fever and a series of horrible events.<ref>{{cite book|title=Frankenstein| vauthors = Shelley M | author-link1 = Mary Shelley |pages=197–198|quote=Ever since my recovery from the fever I had been in the custom of taking every night a small quantity of laudanum; for it was by means of this drug only that I was enabled to gain the rest necessary for the preservation of life. Oppressed by the recollection of my various misfortunes, I now swallowed double my usual quantity and soon slept profoundly. But sleep did not afford me respite from thought and misery; my dreams presented a thousand objects that scared me.}}</ref>
*A laudanum-addicted character also appeared in Wilkie Collins' novel ''[[Armadale (novel)|Armadale]]'' (1864–1866).<ref>{{cite web|url=https://archive.org/stream/armadale02collgoog#page/n140/mode/1up|title=''Armadale''| vauthors = Collins W |date=1866|publisher=London: Smith, Elder & Co.|page=122|access-date=2014-07-03}}</ref>
*[[Wilkie Collins]]' novel ''[[The Moonstone]]'' (1868) features laudanum "as an essential ingredient of the plot." Collins based his description of the drug's effects on his own experiences with it.<ref>{{cite web|url=https://www.theguardian.com/books/1991/nov/21/biography.wilkiecollins|title=Heroine, and after that the laudanum| vauthors = Clayton S |date=November 21, 1991|work=[[The Guardian]]|access-date=2014-07-03}}</ref> 
*Laudanum appears in [[Charles Baudelaire]]'s prose poem ''The Double Room'', published in his collection ''[[Le Spleen de Paris]]'' in 1869.<ref>{{cite web|url=https://www.metmuseum.org/art/collection/search/283741|title=Four-Page Translation of Charles Baudelaire's Prose Poem "The Double Room"|website=The Met Museum|date=August 1926 }}</ref>
*In the novel ''[[Anna Karenina]]'' (1878) by [[Leo Tolstoy]], the eponymous character becomes addicted to laudanum.
*The [[Sherlock Holmes]] short story ''[[The Man with the Twisted Lip]]'' by [[Arthur Conan Doyle]] (1891) contains a character who is addicted to laudanum. 
*Laudanum is portrayed as the surgical drug of choice for fifteenth-century physicians in [[Lawrence Schoonover]]'s novel ''The Burnished Blade'' (1948), the plot of which deals in part with the smuggling of expensive raw opium into France from the [[Empire of Trebizond]].<ref>{{cite web|url=http://oudl.osmania.ac.in/bitstream/handle/OUDL/8081/212450_The_Burnished_Blade.pdf?sequence=2|title=''The Burnished Blade''| vauthors = Shellabarger S |date=1949|publisher=London: Macmillan & Co.|pages=145, 184–187|access-date=2014-07-03|archive-url=https://web.archive.org/web/20140714173422/http://oudl.osmania.ac.in/bitstream/handle/OUDL/8081/212450_The_Burnished_Blade.pdf?sequence=2|archive-date=2014-07-14|url-status=dead}}</ref>
*[[Stephen Maturin]], one of the main characters in [[Patrick O'Brian]]'s [[Aubrey–Maturin series]] of novels (1969–2004) about the Napoleonic wars, is a sometime laudanum addict.<ref>{{cite book|url=https://books.google.com/books?id=ZPeRfe717usC&q=dr.+stephen+maturin+surgeon&pg=PA11|title=Doctors in Fiction: Lessons from Literature| vauthors = Surawicz B |date=2009|publisher=Radcliffe Publishing|page=19|access-date=2014-07-03|isbn=9781846193286}}</ref>
*In [[Eleanor Catton]]'s novel ''[[The Luminaries]]'' (2013), and the subsequent [[The Luminaries (miniseries)|TV adaptation]] (2020), many characters are addicted to laudanum and it is used to murder Crosbie Wells.
*In [[Sara Collins|Sara Collins']] novel ''The Confessions of Frannie Langton'' (2019), and the subsequent [[The Confessions of Frannie Langton (TV series)|TV adaptation]] (2022), the titular character becomes addicted to laudanum. Another main character is also addicted and ultimately commits suicide by overdosing on laudanum.
*In [[Tommy Orange]]'s novel ''Wandering Stars'' (2024), Charles Star develops an addiction to laudanum to help him forget the intergenerational traumas caused by the [[Sanlyd Creek massacre|Sand Creek Massacre]] and deportation to [[American Indian boarding schools]].

=== Film and television ===
* In 1977, in the third season, episode 11 of the television series [[Little House on the Prairie (TV series)|"Little House on the Prairie"]], "Blizzard", a majority of school children in Walnut Grove are stranded in a major blizzard while making their way home, before Christmas. As search parties head out to locate the missing, a group of mothers assist "Doc Baker", in treating the affected children's feet, in the makeshift hospital shelter set up inside the nearby school house. At one point, Caroline tells Doc Baker "The Harris girl is hurting very bad, have you got anything to help her?" (despite the girl never complaining of any discomfort). Baker responds by telling Caroline to administer only 1/2 teaspoon of laudanum, as he fears they will soon be needing more.
* In [[Philippa Gregory]]'s novel ''[[Wideacre]]'' (1987), the main character Beatrice Lacey nearly becomes addicted to laudanum when her eventual husband Dr. John MacAndrew prescribes it to her after her mother's death.
* It plays a major role in the plot of James Clavell's historical novel ''[[Gai-Jin]]'' (1993).
* In the film ''[[Tombstone (film)|Tombstone]]'' (1993), Mattie Earp, [[Wyatt Earp]]'s wife is addicted to laudanum.
* In the adaptation ''[[Interview with the Vampire (film)|Interview with the Vampire]]'' (1994), which was based on the 1976 novel with the same name, Claudia uses laudanum to try to kill [[Lestat de Lioncourt|Lestat]]: Under the pretext of making peace, she offers him some drunk noble-blood twins to feed on, when she actually had them overdose on the drug, and misled Lestat into drinking dead blood which is toxic to vampires.<ref>{{cite web|url=https://www.imdb.com/title/tt0110148/plotsummary?ref_=tt_ql_stry_2 |title=Interview with the Vampire (film): Plot summary|website=[[IMDb]]}}</ref> 
* In the film ''[[From Hell (film)|From Hell]]'' (2001), Inspector Abberline is a user of laudanum, and [[Jack the Ripper]] also uses laudanum for making his victims sleepy.
* In the TV series ''[[Deadwood (TV series)|Deadwood]]'', (2004–2006) the town doctor recommends laudanum several times, bringing a bottle of it to a patient. Initially in the series, Alma Garrett is an addict to laudanum. Trixie is a former addict.
* In the TV show ''[[American Horror Story: Murder House]]'' (2011), laudanum is repeatedly used to drug a main character, leaving him waking up unable to remember what had occurred.
* In the film ''[[Winchester (film)|Winchester]]'' (2018), Doctor Eric Price is addicted to laudanum due to his wife's suicide.<ref>{{cite web |title=Winchester (2018) |url=https://rottentomatoes.com/m/winchester |access-date=Nov 5, 2020 |work=[[Rotten Tomatoes]] |publisher=[[Fandango Media]]}}</ref> 
* In the film ''[[The Highwaymen (film)|The Highwaymen]]'' (2019), Bonnie Parker (Emily Brobst) of [[Bonnie and Clyde]] fame is addicted to laudanum.
* In season two of the series [[Warrior (TV series)|''Warrior'']] (2020), Officer Lee (Tom Weston-Jones) becomes addicted to laudanum when he uses it to offset his lingering head trauma.
* In the miniseries ''[[The North Water (miniseries)|The North Water]]'' (2021), the main character, a surgeon who takes a job on a whaling ship in the Arctic, is addicted to laudanum.
* In the series [[House of Guinness]] (2025) one of the [[Guinness]] brothers [[Benjamin Lee Guinness II]] is featured suffering alcohol and laudanum dependencies. In episode six [[Anne Lee Guinness|Anne Plunket]] asks Adelaide to get her some laudanum while she's in postnatal care

==See also==
{{Portal|Medicine}}
* ''[[Confessions of an English Opium-Eater]]''
* [[Kendal Black Drop]]
* [[Paregoric]]
* [[Poppy tea]]

== References ==
{{reflist|1=30em}}

== External links ==
{{commons category-inline}}
*[http://www.merck.com/mmpe/lexicomp/opium%20tincture.html Merck Prescribing Information for Laudanum/Opium Tincture]. Includes detailed dosage information.

{{Antidiarrheals, intestinal anti-inflammatory/anti-infective agents}}
{{Cough and cold preparations}}
{{Opioidergics}}

[[Category:Antidiarrhoeals]]
[[Category:Combination drugs]]
[[Category:History of pharmacy]]
[[Category:Opiates]]
[[Category:Swiss inventions]]
[[Category:Tinctures]]