There is a paucity of literature on poppy seed tea but the approximately dozen articles on the topic relate mainly to case studies of poppy seed tea dependence. An 82-year-old widow in India presented to a clinic with a 55-year history of opium use, starting with an opium candy used to relieve pain after the birth of her fourth child. Over the years, she learned to make a tea from dried poppy pods; she consumed 1 to 2 l of this beverage daily and her family brought her for treatment when poppy pods were no longer available to her and she underwent withdrawal symptoms, rated 26 on the Clinical Opioid Withdrawal Scale (COWS). She underwent detoxification under medical supervision and was then started on opioid maintenance therapy with 0.4 mg of buprenorphine and counseling. She was followed for 1 year and had experienced no relapse .
In another case report in the literature, a 43-year-old woman in Australia presented at a drug treatment center; she had been an intravenous (IV) heroin user who migrated to poppy seed tea about 10 years earlier to manage her addiction. Over the decade, she had increased her consumption to the point where she was using 5 or 6 kg of poppy seeds per week to make her tea, which she only took orally. She had tried to stop using poppy seed tea on her own, with counseling, and in residential treatments but had never been successful. Each time she discontinued poppy seed tea she experienced withdrawal symptoms of diarrhea, vomiting, sweating, anxiety, and rhinorrhea. The patient was started on buprenorphine maintenance and has been successful in maintaining this regimen .
A 26-year-old man presented at a drug treatment center with an extensive substance use disorder history. His IV heroin use started around the age of 22, which was sometimes punctuated with amphetamine binges, and by the next year he was using poppy seed tea to substitute for his heroin use, which had become prohibitively expensive (about $1000 per week). He also suffered depression and anxiety. He was drinking the solution from about 1 kg of poppy seeds per day, which he was able to purchase at a local supermarket. Over time, his use escalated to three times that amount, which he sometimes supplemented with opportunistic use of heroin, benzodiazepine, and alcohol. The patient was commenced on a methadone maintenance program that started at 30 mg but escalated over the next 12 weeks to 110 mg (at lower doses, he would “top off” with poppy seed tea). His agitation and anxiety increased when poppy seed tea was discontinued, but this was managed with venlafaxine XR 225 mg and psychological therapy .
A 26-year-old baker suffered a tonic–clonic seizure, which appeared to physicians to be the result of a toxic encephalopathy . The baker denied using drugs, but his employer noted the bakery was ordering an unusually large amount of poppy seeds. After a urine drug screen revealed the presence of morphine, the baker admitted that he drank poppy seed tea every night at the bakery, something he had learned from the other bakers when he was still an apprentice. He admitted that he had used IV heroin for several years, which he had been able to stop with poppy seed tea. He entered a methadone maintenance treatment program, which he quit after several months and resumed poppy seed tea. His poppy seed tea consumption escalated rapidly, and he stated that if he skipped poppy seed tea for 1 day, he developed withdrawal symptoms. A sample of the tea he prepared regularly for himself tested to have a morphine concentration of 0.14 mg/ml. He was drinking up to 2 l of this tea every day, which required about 4 kg of poppy seed per day. This amount was not trivial, as it translates to daily consumption of about 280 mg of morphine a day. He requested detoxification and rehabilitation. He started on extended-release morphine 60 mg twice daily to manage withdrawal and eventually tapered to 20 mg twice daily. His blood tests show a morphine concentration of 0.1 mg/ml and he has had no further seizures and stated he no longer drinks poppy seed tea .