Yes, people still use opium. Millions of people worldwide consume raw or minimally processed opium, particularly in Iran, Afghanistan, and Pakistan, which are the largest per capita consumers on the planet. Opium also has a narrow medical use and remains a classified controlled substance in the United States. But the global picture is shifting fast, as cheap synthetic opioids reshape drug markets in ways that are already reducing demand for plant-based products like opium and heroin.
Where Raw Opium Is Still Widely Used
The heartland of opium consumption today runs through South and Central Asia and the Middle East. Iran, Afghanistan, and Pakistan account for the highest rates of raw opium use per person globally, according to the International Agency for Research on Cancer. In these regions, opium has deep cultural roots. It is smoked, eaten, or dissolved in tea, sometimes as a folk remedy for pain, sometimes recreationally. Processing methods vary by region and can include air-drying, heat-drying, or boiling the raw latex scraped from poppy seed pods.
Parts of Southeast Asia also have long traditions of opium use, though consumption has declined in many areas over the past several decades due to law enforcement campaigns and crop substitution programs. North Korea reportedly still produces small amounts of opium exclusively for domestic consumption.
What Opium Actually Does in the Body
Raw opium contains a cocktail of active compounds. The most significant are morphine, codeine, thebaine, noscapine, and papaverine. Morphine is the dominant one and the reason opium is powerfully addictive. These compounds bind to opioid receptors in the brain, triggering a release of dopamine (the chemical behind feelings of pleasure) while simultaneously suppressing noradrenaline, which dulls pain signals and creates a sensation of calm and euphoria.
The binding process also blocks calcium channels in nerve cells and opens potassium channels, which together slow down nerve signaling throughout the body. This is why opioids don’t just relieve pain. They also slow breathing, reduce gut motility (causing constipation), and lower heart rate. At high enough doses, that respiratory slowdown becomes fatal.
Medical Use Is Rare but Still Exists
Opium tincture, a liquid preparation of raw opium dissolved in alcohol, is still available as a prescription medication in the United States. It is classified as a Schedule II controlled substance under the DEA’s Controlled Substances Act, alongside morphine, codeine, and hydrocodone. In 2011, the FDA granted opium tincture an orphan drug designation for treating chronic diarrhea in people with short bowel syndrome who don’t respond to standard treatments. That designation has not led to formal FDA approval for this specific use, but it signals that a small medical niche exists.
In practice, opium tincture prescriptions are exceedingly rare. Modern medicine has largely moved to isolated, standardized compounds like morphine and codeine rather than using the raw mixture. The advantage of purified drugs is precise dosing. Raw opium varies in potency from batch to batch, making it unreliable for clinical settings.
How Synthetic Opioids Are Displacing Opium
The biggest force reshaping opium’s role in the world is fentanyl. In North America, illegally manufactured fentanyl has almost entirely replaced heroin (which is itself derived from opium) as the dominant street opioid. The shift happened fast. In 2014, U.S. drug seizures found heroin outnumbering fentanyl more than 5 to 1. By 2024, that ratio had flipped dramatically: fentanyl seizures outnumbered heroin seizures nearly 6 to 1 across all 50 states.
The economics are straightforward. Fentanyl is synthesized entirely in a lab from chemical precursors, with no need for poppy fields, harvest labor, or growing seasons. This makes it radically cheaper to produce than heroin, which requires roughly 10 kilograms of raw opium to yield just 1 kilogram of morphine base, which in turn produces about 1 kilogram of heroin base. A documented manufacturing operation in Afghanistan extracted 7.8 kilograms of morphine from 70 kilograms of raw opium (an 11 percent yield) and ended up with only 3.9 kilograms of finished heroin, just 6 percent of the starting weight.
That inefficiency is a vulnerability. Mexican drug producers, who once relied on poppy farmers, now have a major cost advantage using fentanyl, and poppy farmers in Mexico have seen significant income losses as a result. The concern among researchers is that this supply shock could eventually push fentanyl into markets in Europe, Africa, and Asia that currently rely on plant-based opioids.
Long-Term Health Risks of Opium Use
Chronic opium use carries serious cardiovascular consequences. Short-term, low-dose exposure tends to lower blood pressure, but long-term use leads to hypertension. Chronic users show an overall increase in heart rhythm abnormalities on ECG tests, and the damage worsens with longer duration of use and certain routes of administration (smoking versus eating, for example).
One risk that is unique to raw opium, and often overlooked, is contamination. Street opium frequently contains lead, arsenic, and thallium as impurities. Lead accumulation is especially common and causes abdominal pain, constipation, anemia, and kidney damage. Over time, lead and other heavy metals stored in the body cause cardiac and vascular damage with potentially life-threatening consequences. This contamination risk doesn’t apply to pharmaceutical-grade opioids, making raw opium distinctly more dangerous than its isolated derivatives in ways that go beyond the drugs themselves.
Beyond the cardiovascular and toxicological risks, opium carries the same addiction profile as other opioids. Tolerance develops quickly, meaning users need increasing amounts to achieve the same effect, and withdrawal symptoms (muscle pain, nausea, insomnia, intense cravings) begin within hours of the last dose in dependent users.
Legal Status Around the World
In the United States, opium is a Schedule II controlled substance, meaning it has recognized medical use but a high potential for abuse. Possession without a prescription is a federal crime. Most countries classify opium similarly under the framework of the 1961 United Nations Single Convention on Narcotic Drugs, which restricts opium production and trade to medical and scientific purposes.
Enforcement varies enormously. In Iran, despite harsh drug laws including the death penalty for trafficking, opium remains widely available and culturally embedded. Afghanistan, which for years produced the majority of the world’s opium supply, has seen dramatic shifts in production depending on political conditions and enforcement campaigns. In practice, the legal status of opium matters less than local economics and cultural norms in determining who uses it and how much.