From household remedy to controlled substance
For decades, paregoric, also known as camphorated tincture of opium, was a familiar sight in household medicine cabinets across the United States. Parents often used the medication to calm upset children, ease the pain of teething, or treat diarrhea. The product’s over-the-counter availability was possible because it contained a relatively low concentration of opium, making it an “exempt narcotic” under the Harrison Narcotics Act of 1914. However, this exemption proved problematic, with cases of abuse rising, leading to a reevaluation of its accessibility. In response, the US government took action to restrict access to the drug.
The reclassification under the Controlled Substances Act
In 1970, the Controlled Substances Act brought significant changes to how opioid-containing medications were regulated. Under this legislation, paregoric was reclassified as a Schedule III controlled substance, effectively ending its era as a freely available medicine. The new classification meant that paregoric could no longer be purchased over-the-counter and required a prescription for dispensing. The transition from an exempt narcotic to a strictly controlled substance was driven by growing recognition of its potential for abuse and dependency, even in its diluted form.
Discontinuation and current availability
Even after its reclassification, paregoric continued to be available by prescription for several decades. However, its use has steadily declined as safer and more effective alternatives have emerged. In fact, the brand name Paregoric has been discontinued in the United States. While generic versions might still be technically available with a prescription, most physicians seldom prescribe it. In 2011, manufacture of the drug ceased for several months, though production eventually resumed. Despite this, its clinical use has become extremely rare. Today, if a physician were to prescribe it, obtaining it would require navigating a controlled substance prescription process, and its availability at pharmacies is not guaranteed.
Why is paregoric no longer the preferred treatment?
Beyond the regulatory changes, several factors contributed to the decline of paregoric's use in modern medicine.
- Risk of dependency and abuse: As an opium derivative, paregoric contains morphine and carries a risk of physical and psychological dependence. Earlier generations often abused the readily available substance, which led to significant public health concerns.
- Availability of safer alternatives: Modern pharmacology has developed numerous antidiarrheal medications that are more effective and have a lower potential for abuse than an opium tincture. Over-the-counter options like loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol) offer relief without the risks associated with controlled substances.
- Dangers of misidentification: A significant risk involves confusing paregoric with a much more potent opium tincture, known as laudanum. Though both are opium-based tinctures, laudanum is significantly stronger, and administering the wrong dose could be fatal. This risk has led to strong recommendations for using precise nomenclature and caution.
- Side effects: Like other opioids, paregoric can cause side effects such as constipation, nausea, dizziness, and sedation. For many patients, the potential side effects and risks outweigh the benefits, especially with other proven treatments available.
Paregoric vs. Laudanum vs. Modern Alternatives
To illustrate the historical context and the shift in medical practices, the following table compares paregoric with laudanum and modern alternatives like loperamide.
| Feature | Paregoric (Camphorated Tincture of Opium) | Laudanum (Tincture of Opium) | Modern Alternatives (e.g., Loperamide) |
|---|---|---|---|
| Active Ingredient | Morphine (from opium) | Morphine (from opium) | Loperamide (synthetic opioid) |
| Strength | Very low concentration (approx. 0.4mg/mL morphine) | Very high concentration (approx. 10mg/mL morphine), 25x stronger than paregoric | Not an opium derivative; acts on opioid receptors in the gut |
| Controlled Status (US) | Schedule III narcotic | Schedule II narcotic (often) | Non-controlled substance (though some formulations were Schedule V) |
| Availability | Prescription-only; rarely prescribed and brand discontinued | Prescription-only; used in specialized hospital settings | Over-the-counter for most uses |
| Primary Use | Formerly for diarrhea and pain; now extremely rare | Rarely for severe diarrhea or managing neonatal abstinence syndrome | Most commonly used for acute and chronic diarrhea |
| Potential for Abuse | Higher potential than OTCs, lower than pure opium | High potential for severe dependence | Very low potential, does not cross blood-brain barrier at normal doses |
Conclusion: The evolution of safety and efficacy in pharmacology
The question, can you buy paregoric now? leads to a historical review of how pharmacology and public health policy have evolved. While the medication was once a common household item, its status as an opium derivative ultimately led to its reclassification as a controlled substance and eventual replacement by safer and more effective alternatives. The brand name is discontinued in the US, and although some generic versions might be technically available by prescription, it is rarely if ever prescribed. The transition away from paregoric serves as a powerful example of how a deeper understanding of drug addiction and the development of modern medicines can transform standards of care, prioritizing patient safety over convenience. The regulatory shifts and the introduction of safer alternatives have made medications like loperamide the standard for treating diarrhea, rendering paregoric obsolete for general use.
Frequently asked questions about paregoric
What is paregoric?
Paregoric, or camphorated tincture of opium, is a historical medication containing a small amount of opium, along with other ingredients like camphor, benzoic acid, and anise oil. It was formerly used as an antidiarrheal, analgesic, and antitussive.
Is paregoric the same as laudanum?
No. Paregoric and laudanum are both opium tinctures but differ significantly in potency. Laudanum is about 25 times stronger than paregoric, and confusing the two can lead to a dangerous overdose.
Why was paregoric banned over-the-counter?
Paregoric was not banned outright but was reclassified as a Schedule III controlled substance under the Controlled Substances Act in 1970 due to its potential for abuse and dependence. This ended its over-the-counter availability and made it a prescription-only drug.
What replaced paregoric for treating diarrhea?
Modern medicine has developed several safer and more effective alternatives for treating diarrhea. Common over-the-counter options include loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol).
Is paregoric still manufactured?
While manufacture ceased temporarily in 2011, production of the generic drug has since resumed. However, the brand name has been discontinued, and the product is rarely prescribed or used clinically due to safer alternatives.
Can you buy paregoric online?
No, because paregoric is a Schedule III controlled substance, it cannot be legally purchased online without a valid prescription. Websites advertising it for sale are often illicit or selling unverified supplements.
What is the primary medical use of paregoric now?
Because of its abuse potential and the availability of superior alternatives, paregoric is seldom prescribed by physicians today. It has been largely replaced in clinical practice for treating diarrhea.
