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Abstract
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This Issue of the Journal contains two clinical research papers that describe a cluster of acute thebaine poisonings in those ingesting tea made using poppy seeds with high thebaine content that entered the Australian food supply chain in 2022 [Citation1,Citation2].
Poppy seed tea
Mature poppy seeds do not contain opium alkaloids, but their surface can become contaminated with alkaloids as a result of pest damage and during harvest [Citation3]. Opium alkaloids detected in samples of poppy seeds and poppy seed-containing foods include phenanthrenes, principally morphine, codeine, thebaine, and oripavine, and benzylisoquinolines, principally papaverine, noscapine, and laudanosine [Citation3]. As opioids come primarily from the alkaloid residue retained on the seeds, "unwashed seeds" are an important marketing claim for purveyors of poppy seeds sold for substance misuse purposes.
Poppy seed tea is made by washing or soaking large quantities of commercially available Papaver somniferum seeds (0.2-2.0 kg of seeds are often used [Citation4]) in hot or cold water, usually in the presence of lemon juice or citric acid. Some individuals prefer to reduce the volume by boiling and adding fruit-flavoured powder. The process can take up to 12 h, but usually lasts 1-2 h. In one study, the highest transfer rates (71% for morphine, 96% for thebaine, and 100% for codeine, noscapine and papaverine) were achieved at 90 °C for 5 min [Citation5].
As poppy seeds harvested in different years or from different regions of the world contain a wide range of alkaloid concentrations, the tea prepared from differing varieties of seeds will also exhibit wide variations in the identity and concentrations of these alkaloids.
Croitoru et al. [Citation4] determined the amount of morphine and codeine in poppy seed tea made from different types of poppy seeds available on the Romanian market using four different infusion methods. Concentrations of morphine ranged between 0.1 mg/kg and 243.26 mg/kg, depending on the source and preparation. In the case of codeine, the concentrations ranged from below the level of toxicological concern to 88.58 mg/kg, again dependent on the source and preparation.
Pelders and Ros [Citation6] analyzed the concentrations of opiates present in poppy seeds from seven different origins (Dutch, Australian, Hungarian, Spanish, Czech, and two Turkish) and found the morphine concentration varied from 2 mg/kg to 251 mg/kg and codeine from 0.4 mg/kg to 57.1 mg/kg; no other opiate was detected.
In four samples of poppy seed tea prepared by investigators in New Zealand, the concentration of morphine ranged from 10 mg/kg to 105 mg/kg and the concentration of codeine from 3.1 mg/kg to 11.2 mg/kg of poppy seeds [Citation7]. Cassella et al. [Citation8] assayed Australian poppy seeds and reported a morphine concentration of 107 mg/kg, a codeine concentration of 31.8 mg/kg and a thebaine concentration of 20.7 mg/kg.
In another study reported from the United States, various poppy seed products were purchased from online sources and extracted with four home-brewing methods representative of recipes found on drug user forums [Citation9]. Morphine, codeine, and thebaine concentrations quantified in the tea extracts by liquid chromatography-tandem mass spectrometry ranged from <1 mg/kg to 2,788 mg/kg, from <1 mg/kg to 247.6 mg/kg, and from <1 mg/kg to 124 mg/kg, respectively, dependent on source and preparation [Citation9]...
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