Whoa! You can't buy your own item.

Doctor Casey Original Antique 1923 Opium Coca Federal Narcotic Order Form Pharmacy History Channel DEA Carbondale PA Stoddard New York City

Request a custom order and have something made just for you.

This seller usually responds within 24 hours.

Doctor Casey Original Antique 1923 Opium Coca Federal Narcotic Order Form Pharmacy History Channel DEA Carbondale PA Stoddard New York City

Ask a question

$29.75 $35.00

You save $5.25 (15%)

Almost gone. There's only 1 left.


  • Vintage item from the 1920s
  • Material: us treasury department paper
  • Favorited by: 16 people
  • Gift message available
This shop accepts Etsy gift cards

Shipping & returns

Ships from United States
This item may take some time to prepare. Contact the shop to find out when it will ship.


A great original 1923 Treasury Department issued order form for Opium or Coca Leaves, or Compounds, Manufactures, Salts, Derivatives or Preparations! This 1923 issue (the red duplicate) was recently shown on the History Channel during a program on illegal drugs. This is the only issue that the government printed a lengthy list of "Instructions" on the back. Please see photos!

This form is ornate with a beautiful poppy graphic on the top corner. It was issued to Dr. Harold L. Casey, of Carbondale, PA, on March 22, 1928. An order for Salatol EMS was placed on April 15 1942. This form was kept by the doctor/pharmacist for his/her records. Unused forms had to be returned to the government.

The form is large, 10 3/4" by 8 1/2", is watermarked, "USIR", has some bends/wrinkles, two bends on one corner and age toning (not pure white), otherwise, condition is excellent!

This is a FANTASTIC piece of history and would be great to display in a pharmacy, museum or doctor's office! I am happy to answer any questions, please feel free to email and thank you for your interest! :)


5 out of 5 stars


Secure options
  • Visa
  • Mastercard
  • American Express
  • Discover
  • Paypal
  • GiftcardAccepts Etsy Gift Cards and Etsy Credits
Etsy keeps your payment information secure. Etsy shops never receive your credit card information.
All forms of payment are accepted. Whatever is the best and most convenient way for you to pay.

Returns & exchanges

Returns are accepted within seven days of purchase. I'm only happy if you are!

Shipping policies

Priority mail and overnight mail are available options, please advise if this is your preference.

You may also like

What’s wrong with this listing?

The first thing you should do is contact the seller directly.

If you’ve already done that, your item hasn’t arrived, or it’s not as described, you can report that to Etsy by opening a case.

Report a problem with an order

We take intellectual property concerns very seriously, but many of these problems can be resolved directly by the parties involved. We suggest contacting the seller directly to respectfully share your concerns.

If you’d like to file an allegation of infringement, you’ll need to follow the process described in our Copyright and Intellectual Property Policy.

Review how we define handmade, vintage and supplies

See a list of prohibited items and materials

Read our mature content policy

The item for sale is…