Clinicians may not be fully aware of poppy seed tea, a novel opioid made using easily obtained unwashed poppy seeds.
Poppy seed tea has similar risks to other opioids, including the potential for death, according to research led by Scott Weiner, Bicycle Health’s director of research and emergency physician. Patients who seek treatment for poppy seed tea use will require similar doses of buprenorphine to other opioids, the case series found.
The case series, published by Bicycle Health in the Journal of Addictive Diseases, analyzed 18 cases of poppy seed tea use among Bicycle Health patients.
Boston-based Bicycle Health’s treatment model employs virtual therapy, peer support and Suboxone, a medication for opioid use disorder (MOUD). The provider accepts insurance networks, including United Healthcare, Aetna and Cigna, and offers a $199 monthly self-pay fee for those without insurance.
Tea is made using unwashed poppy seeds. The seed itself does not contain opioids, but unwashed seeds may be coated in residual opioids.
Unwashed poppy seeds can be bought by the pound from online retailers. One listing advertised a pound of “raw, unwashed, and 100% unprocessed/untreated” poppy seeds for $21.99 per pound.
While poppy seeds are legal, unwashed poppy seeds containing opium alkaloids are classified as a Schedule II Controlled Substance.
The FDA has previously sent a warning letter to at least one seller who made medicinal claims about the tea.
Opiate content in poppy seeds purchased for tea can vary widely, Weiner said, and people may be drinking the tea at different concentrations up to multiple times per day. Use of the tea is relatively uncommon, with only 18 cases out of Bicycle’s 30,000 total patients treated having mentioned the tea.
Some of those who drink the tea may do so in an attempt to wean themselves off other opioids, but the tea itself is still addictive and has similar risks to other opioids, including death.
“The dangers are very similar to other opioids,” Weiner said. “There have been deaths associated with poppy seed use.”
Although sellers distribute unwashed poppy seeds online, there have been instances of legal consequences for poppy seed sellers. In Nov. 2023, a Tulsa, Oklahoma, couple was charged with drug conspiracy and other related charges after a woman made tea using poppy seeds sold by the couple and died.
“The indictment alleges that a single dose of poppy seed tea made with Lone Goose Bakery unprocessed poppy seeds coated in opium latex could expose a consumer up to approximately 1,200 milligrams of morphine,” read a statement from the U.S. Attorney’s Office of the Northern District of Oklahoma.
Although doses of buprenorphine for OUD are commonly around 16 milligrams per day, in the case study Bicycle clinicians started patients who were seeking treatment from poppy seed tea with around two milligrams.
“It sounds like our providers were almost apprehensive to start with these higher doses,” Weiner said. “But then they ended up having to ramp up to the same doses that we were giving for other opioids.”
The research demonstrated that people who took poppy seed tea were more likely to remain in treatment. Of people who took the tea, 66.7% remained in treatment after 180 days, compared to 55.6% for Bicycle’s overall retention rate.
The reasons why people drop out of treatment are highly varied, Weiner said, but social determinants like stability may play a role.
“My guess is that if you’re able to purchase large amounts of poppy seeds, have them mailed to your house, and have the availability of the equipment to make it and consume it every day, you might actually have more of like a stable living environment than some other patients that are struggling more,” he said.
In light of the study’s findings, Weiner said that providers should work towards increased awareness of novel opioids like poppy seed tea.
“Just learning about it is important,” he said. “If someone encounters a case of this and they don’t know what to do, there are resources to reach out to.”
Correction: an earlier version of this article said that unwashed poppy seeds are legal. While poppy seeds are legal, poppy seeds containing opium alkaloids are classified as a Schedule II Controlled Substance by the DEA.