In a letter to the country’s top medical official, the Center for Science in the Public Interest asked U.S. Surgeon General Jerome Adams to issue an advisory warning people of the dangers of contaminated, unwashed poppy seeds and poppy seed pods.

Opium and other chemicals in the unwashed seeds and seed pods have caused numerous deaths and serious overdoses, some of which caused permanent brain damage, according to the letter from leaders for the Center for Science in the Public Interest (CSPI).

online sales of the seeds and seed pods are of particular concern, according to the letter signed by CSPI leaders Peter Lurie, president, Laura MacCleery policy director, and Sarah Sorscher, deputy director of regulatory affairs. They say the products are easily obtained from websites such as amazon.com and ebay.com. They also told the surgeon general that other websites offer “recipes” for brewing tea that concentrate the opium from pounds of the seeds or pods into relatively small amounts of liquid.

Some websites and blogs also offer tips on how to determine which unwashed poppy seeds and pods to buy to obtain the highest concentrations of morphine, codeine, thebaine, and other opiate alkaloids, according to the CSPI letter.

“Typically, the fact that the seeds may be contaminated with opiates is not clearly indicated in the labeling or advertising materials, and users seeking contaminated seeds instead utilize coded language in product reviews, sometimes offered on third-party blogs, to signal which seeds are most likely to contain high concentrations of opiates,” the CSPI told the surgeon general. 

“The contaminated seeds thus remain widely available, including through the online shopping platform Amazon.com, despite the fact that the retailer has been informed multiple times of the risks of these products, including on April 25, 2018, by Sen. Tom Cotton, on July 13, 2018, by Arkansas Attorney General Leslie Rutledge, and most recently on Feb. 27 in a letter sent by the family of a victim who died from poppy seeds purchased on the platform.”

Some people who have opioid use disorder use these products as substitutes for other opioids, according to the CSPI letter and statements from the FDA and U.S. Drug Enforcement Agency. Other people have begun using the products believing they were harmless natural herbal remedies, not fully realizing the potential for dependence and abuse.

The CSPI letter to the surgeon general included a chart with information about people who have suffered severe consequences of using unwashed poppy seeds and or pods. The letter also provided history and international context for regulating such products.

“The opium poppy, Papaver somniferum, naturally produces opiate alkaloids, including morphine, codeine, and thebaine, which are concentrated in the seed pod and milky sap of the plant. The opiates found in the Papaver somniferum plant are highly addictive, leading the Drug Enforcement Administration (DEA) of the U.S. Department of Justice (DOJ) to list ‘poppy straw,’ which is defined as parts of the poppy plant other than the seeds, as a controlled substance under Schedule II of the Controlled Substances Act (CSA). As a result of this listing, and under the provisions of several international agreements, Papaver somniferum cannot be legally cultivated in the United States, and therefore raw materials must be imported to produce opioids for pharmaceutical use as well as poppy seeds sold as foods. . . 

“Poppy seeds may become contaminated with poppy straw and sap in the fields or during harvest, necessitating washing and processing to remove the alkaloids. 

“The European Commission has developed guidance on good practices to prevent and reduce the presence of opium alkaloids in poppy seeds and poppy seed products. These practices begin with selecing seeds from varieties cultivated for food use, which are bred to contain a low level of opium alkaloids. Appropriate processing can be highly effective; the combination of washing and drying can reduce morphine concentrations in highly contaminated batches of raw poppy seeds (original concentrations vary from 50 to 220 mg morphine/kg) down to concentrations below 4 mg morphine/kg without loss of quality and organoleptic properties.

“The United Kingdom has issued guidance setting a target level of 10 mg morphine/kg for the presence in poppy seeds placed on the market destined for the final consumer. . . 

“One research team at Sam Houston State University recently analyzed samples of poppy seeds purchased online and found that morphine concentrations in some samples were high enough to yield 2788 mg of morphine from 1 kilogram (2.2 lbs) of seeds, in addition to codeine and thebaine. 

“Assuming a batch of seeds with up to 2788 mg/kg of morphine, brewing 0.44 lbs. of seeds per the Mercola recipe instructions could produce up to 557 mg morphine, and 3 lbs of seeds (the maximum suggested by Chewworld.com) could yield up to 3801 mg of morphine. These amounts are well above the dose of 50 morphine mg equivalents per day demonstrated to increase the risk of overdose among patients prescribed morphine for pain treatment.

The CPSI’s letter includes links to source material documenting numerous cases of overdose, dependence, and death, “and these cases appear to be more common over time.” CSPI has identified 5 cases of non-fatal overdose, 7 cases of opioid dependence, and 13 confirmed deaths associated with the use of poppy seeds or seed pods from the medical literature, a 2010 DOJ Drug alert, and case reports in the FDA Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS) database.

“All but four of these 25 cases involved men — 84 percent — and the median age was 26 years (with a range of) 6 weeks-82 years; age was unavailable for six cases,” the letter states. “Typically, the product was administered as a tea, usually made from about 1-2 pounds of poppy seeds, but occasionally from the poppy pod. Eighteen of the cases took place in the United States, including all 13 deaths. 

“. . . based on our review, the problem appears to be worsening in recent years.”