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I've been rewatching Game of Thrones and have noticed that everytime someone is offered milk of the poppy they refuse it, If memory doesn't fail me, some examples would be: King Robert, Jaime Lannister and Maester Luwin.

Why do characters refuse milk of the poppy? I thought it was some form of anesthetic? Does it have nasty side-effects? Can it make you die? Or is it just to make the characters look tough?

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    Milk of the poppy is literally intended to be an opium-based drug. It affects memory, lucidity, is fatal if dosed incorrectly and is highly addictive; gameofthrones.wikia.com/wiki/Milk_of_the_poppy – Valorum Jun 22 '14 at 19:01
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    Because real men like to suffer! – user24620 Jun 22 '14 at 21:51
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    Because drugs are bad, mmmmkay. – Monty129 Jun 22 '14 at 22:17
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    Dangit, why'd you have to ask this? Now I have a craving for some milk of the poppy all of a sudden... – Omegacron Jul 3 '14 at 18:16
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    If anyone doesn't want their share of opium, I'll be glad to take it off your hands. – Wad Cheber stands with Monica Jul 28 '15 at 0:21
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In the book, several characters do accept milk of the poppy. No less a person than Eddard Stark takes it, after he's attacked by Jaime Lannister in King's Landing towards the middle of A Game of Thrones.

I do remember several times in the books when characters refuse it, often because they need to have their heads clear for some reason. I think the show creates the perception that everyone is always turning it down because when people take it in the books, it's usually mentioned in the narration; in the show, that all gets cut because it's not that important to the plot.

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    The reason is because the medicine is highly addictive. They did remove some instances of poppy from the series, but only because they were in the narrative. In the show AND the book Jaime doesn't want it because the drug is highly addictive. – Parrotmaster Jun 23 '14 at 8:20
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    @Parrotmaster That is incorrect. In the book (ASOS) Jaime does not want milk of the poppy because he is afraid that Qyburn will cut off his arm if he falls asleep. There is nothing in the book that says Jaime is afraid of addiction, or even any mention that milk of the poppy is addictive. – TLP Jun 23 '14 at 20:17
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    @TLP It's an opiate. – JFA Jun 23 '14 at 20:25
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    @TLP, yes it is, in the book it is called "milk of the poppy", so it's an opium-based drug. – Jon Hanna Jun 27 '14 at 14:02
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    I vaguely remember the books implying in some way that milk of the poppy was addictive, but I don't remember anyone ever refusing it for that reason. There was the time with Jaime that @TLP mentions, and the incident I was thinking of, when Robert refused it after he was gored by the boar because he needed to dictate his will to Ned. In general, I don't think Westerosi culture would look at addiction in the same light as ours does; look at their attitudes towards alcohol, for instance. – Torisuda Jun 27 '14 at 23:45
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"Milk of the Poppy" is simply a more ornate way of saying any opiate-based pain reliever in the G.R.R. Martin novels and televised adaptation of Game of Thrones.

As seen in this image below, the poppy flower will produce a capsule that is scored, and drained of its "milk", the opiate gum, that will be rendered down to produce heroin, hence the name "milk of the poppy".

enter image description here

Production of Raw Opium

  • Just before reaching maturity, the poppy plant produces a flower. After about a week, the flower petals fall off, leaving a capsule.

  • Raw opium gum is harvested from this capsule. The surface of the capsule is cut, or "scored," with a knife containing three or four small blades, and the opium gum oozes out through these cuts.

  • The next day, the farmer scrapes the gum off the capsules with a flat tool called a scraper. Each capsule is usually scored in this manner three to five times, or until scoring produces no more gum.

  • Poppyfields contain thousands of poppy capsules, so harvesting is very labor intensive. Once the gum is collected, the farmer sets it out to dry for several days, then wraps it in banana leaf or plastic.

  • The gum is stored until a trader comes to the village--opium gum has a very long shelf life and can gain value over time. After the harvesting process is complete, the capsules are cut from the stem, allowed to dry, then broken open so that the seeds inside the capsule can be used for next year's crop.

And like any opiate-based pain-reliever, "milk of the poppy" has several side-effects based on its use including dependence, memory-loss, and potentially lethal overdose. It makes sense only people down on their luck, with little left to lose, would accept it and its consequences long-term. People who valued mental clarity, if they were familiar with the side effects, would likely not risk any potential benefit seeing how many people fell to its many side-effects.

  • Opiate-based pain relievers came in a number of varieties on Earth including heroin, morphine, tinctures of opium and Laudanum. Considering such pain relievers were over various periods used to treat a variety of illnesses.

As one researcher has noted: "To understand the popularity of a medicine that eased -- even if only temporarily -- coughing, diarrhoea and pain, one only has to consider the living conditions at the time". In the 1850s, "cholera and dysentery regularly ripped through communities, its victims often dying from debilitating diarrhoea", and dropsy, consumption, ague and rheumatism were all too common. -- “In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines”, by Barbara Hodgson. Buffalo, New York, USA. Firefly Books, 2001, pages 44-49.

  • Opiate-based pain relievers have been experimented with heavily on Earth, since the 16th century but the growth of poppies and their derivatives have been used since before the birth of Christ. It is conceivable the lands of Westeros have had a similar long-term relationship with such opiate-derived drugs and have experience with their potential deleterious side effects as well as a part of the culture.

  • To be fair the differences between the books and the movies indicate there are users of the Milk of the Poppy depending on what events are taking place. The televised version seems more averse to it, possibly an issue with the censors.

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    While the information is very good, I think it's worth pointing out that the refusal is often situational. For example, the person refusing the milk of the poppy is doing so because they don't want to calm down at that moment. In other words, the refusal doesn't have to do with the milk of the poppy itself - rather, it's a dramatic statement that they don't want anything to soothe their pain or anger. – Sigma Ori Jun 22 '14 at 21:51
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    I think "Milk of the Poppy" is actually Laudanum rather than Heroin, since the former is often taken orally while the latter is more often taken as an injection. – System Down Jun 22 '14 at 22:05
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    @SystemDown: I agree that laudanum seems more likely than heroin, both for the reason that you give and because heroin is a very recent invention in real life, and would IMHO be out of place in A Song of Ice and Fire. (I think Thaddeus may be confusing heroin with opium.) However, I'd say that the most likely possibility is that "milk of the poppy" literally refers to poppy juice, whence all of these are derived. That's what the name sounds like, it makes sense in context, and it doesn't require advanced chemical industry. – ruakh Jun 22 '14 at 22:19
  • @SystemDown: Medical practice in Game of Thrones does not include injections, period. And Heroin in the real world was first introduced as a cure-it-all wonder drug to be taken orally. It was very successfuly and popular and recommended by many doctors, and its addictive effects considered rather mild. Until people discovered that you could get a much stronger effect by taking it intravenously. – Michael Borgwardt Jun 22 '14 at 22:21
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    I doubt there's any issue with censorship. House was shown wolfing down opiate painkillers multiple times per episode on network TV. – Wossname Jun 23 '14 at 1:21
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Side effects of Milk of the Poppy

Milk of the Poppy indeed helps with the pain but it has very dire side effects if taken over a long period.

  1. It can distress the patient with disturbing dreams.
  2. It can dull the mind of the in-taker to an incapacitating effect.
  3. It can affect appearance of the in-taker's face i.e. making it puffy.
  4. Body may develop tolerance of the medicine, thus requiring even bigger doses with that much more side effects.
  5. It can be addictive
  6. It can undermine efficiency of certain anti-infection medicines.

This is why some people prefer to bear the pain instead of going on Milk of the Poppy. King Aegon II's reaction to treatment by MOP after his second injuries taken against Lady Baela Targaryen was:

I shall not walk that road again.

The King was completely incapacitated due to MOP and regency passed to his rash brother Aemond, who made a string of mistakes which resulted in fall of King's Landing, Arrest of Queen Mother and Queen Consort, Death of Queen Consort and near-arrest of the King along with his Children. Aegon did not wish to let it happen ever again.

People who accepted Milk of the Poppy

  1. Rhaenyra Targaryen took milk of the poppy after stillborn birth of her daughter Visenya.
  2. King Aegon II took milk of the poppy after his battle with Princess Rhaenys 'Queen who never was' Targaryen.
  3. Lord Balon Greyjoy's father, Lord Quellon Greyjoy used to take milk of the poppy for his stomach aches during his old age every night.
  4. Milk of the Poppy was administered to Jon Arryn by Grand Maester Pycelle.
  5. Eddard Stark was given milk of the Poppy by Grand Maester Pycelle.
  6. Robert Baratheon took milk of the poppy after dictating his will to Eddard Stark.
  7. Jon Snow was given milk of the poppy by Maester Aemon after his fight against Wights in Lord Commander's Tower.
  8. Lord Hoster Tully was given Milk of the poppy by Maester Vyman for his stomach aches.
  9. Tyrion Lannister was given milk of the poppy after his injuries in Battle of Blackwater Bay.
  10. Prince Doran Martell takes milk of the poppy to dull his gout induced pain.
  11. Gregor Cleagane used to take a lot of MOP for his injuries taken against Prince Oberyn Martell.
  12. Quentyn Martell was given MOP by Missandei after he got burnt by Dragons.
  13. Khal Drogo drank poppy wine despite being warned of its impacts on anti-biotic treatment he had received for his wound. The wound festered as a result and Khal died.

People who refused Milk of the Poppy

  1. Jaime Lannister refused milk of the poppy however it was not due to fear of side-effects. Jaime was afraid that Qyburn would cut his whole arm if he let himself be knocked out by MOP.

People who refused further treatment on milk of the poppy

  1. King Aegon II refused another MOP treatment when he sustained new injuries against Baela Targaryen. King was determined not to walk that road again and lived rest of his life in pain.

  2. Tyrion Lannister refused further treatment on milk of the poppy after Blackwater Bay.

People who occasionally refused milk of the poppy

  1. Prince Doran Martell refused milk of the poppy once before meeting his nieces as he wanted to keep a clear head in the meeting given sinister reputation of his nieces.

People who became addicted/tolerant to milk of the poppy

  1. Gregor Cleagane used to drink milk of poppy like other people drink ale. This made him both dependent on and tolerant of milk of the poppy.

So as you can see, there is only once instance of a character refusing to take Milk of the poppy without ever have taken it before. That's Jaime.

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Not everyone refuses milk of the poppy. In Chapter 7 of AFFC, Qyburn mentions that Gregor Clegane

is plagued by blinding headaches and oft quaffs the milk of the poppy as lesser men quaff ale.

Of course, Gregor is a "frothing dog" rather than a man who might actually want to have a clear head from time to time such as Ned Stark or Tyrion.

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There are a range of opiate (poppy derived) pain killers with varying strengths and addictivemess. They have sedative effects, and also suppress the breathing reflex and slow gut action. The issue with opiates is that many of them when taken by mouth are knocked out by an enzyme in your liver called cytochrome P450 before they can get to the rest of your body. Those that are eliminated in this first pass metabolism are classified as having low oral bioavailability. An example of this is heroin which must be injected. Other opiates have higher oral bioavailability and can be swallowed eg methadone, codeine, endone. Westeros as a pre industrial culture would have had a fairly primitive method of refining poppy sap- the drug produced would have been a crude mixture of opiate compounds . It certainly would have properties of pain killer but the correct amount to take would vary from plant to plant, region to region, season to season, even between the people who prepared the extract. so the side effects of mental sedation or unconsciousness , breathing suppression, intestinal paralysis, could not be predicted and were a very real risk.

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The simple reason is trust yes its addictive being opium and clear heads are important in got. If you think The most rememberal person not taking milk of the poppy is Jaime that is because he is in the north where Lord Bolton is known to be with the Starks at the time no one knows of there deal with the Lannisters just yet but also the master has his chain striped of him. If your from the south that's enough reason in its self not to trust.

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