By James Nevius at The Guardian
America’s burgeoning opiate problem is a tragedy, but it shouldn’t come as a surprise: it stretches back to the arrival of the Mayflower in 1620.
Among the Pilgrims was physician Samuel Fuller, and in his kit bag he likely carried an early form of laudanum, the opium/alcohol tincture first created by famed chemist Paracelsus.
Like other opiates, laudanum is derived from the opium poppy (the “joy plant” as the Sumerians called it 5,000 years ago). Like all opiates, it was an effective pain killer, an anti-diarrheal and a soporific. In the rough frontier of early America, opiates helped ease the pain brought on by such ailments as smallpox, cholera and dysentery.
By the American Revolution, opium was a common medical tool. Thomas Jefferson, though generally skeptical of the medical treatments of his day, turned to laudanum in his later years to help ease his chronic diarrhea – an affliction that probably helped kill him.
He felt so much better on the drug that he wrote to a friend, “with care and laudanum I may consider myself in what is to be my habitual state.” Jefferson’s use of the word “habitual” is telling. He ultimately grew his own poppies on his Monticello estate.
By the middle of the 19th century, recreational opiate use was becoming more common. The scaremongering press condemned Chinese opium dens, playing up the drug’s immigrant associations and planting the idea that Chinese men were using opium to lure white women into having sex.
Most Americans didn’t need an opium den to get their fix, though. By then, opiates were the main ingredient in everything from teething powders to analgesics for menstrual cramps. Patent medicines – so-called because they often contained secret “patented” ingredients – flooded the market. Some served a useful purpose, but they also became easy methods to get high.
One famous product was Mrs Winslow’s Soothing Syrup, a morphine and alcohol concoction that was marketed to parents of fussy children as a “perfectly harmless and pleasant” way to produce a “natural quiet sleep, by relieving the child from pain”. After the civil war, even more potent drugs entered the market, including the opiate heroin (introduced by Bayer around the same time as aspirin) and the stimulant cocaine, which was used in everything from cough syrups to Coca-Cola (despite the company’s stringent denials).
Opium imports hit their peak in the 1890s, right around the rise of the temperance movement, perhaps because of the demonization of alcohol, or perhaps because opiate use was easier to hide.
This was the status quo until 1906, when the federal government under Teddy Roosevelt stepped in with its landmark Pure Food and Drug Act, which required any “dangerous” or “addictive” drugs to appear on the label of products. Three years later, the Smoking Opium Exclusion Act – America’s first stab at drug prohibition – banned the importation of opiates that were to be used purely for recreational use, though it’s unclear if this was really a measure to curb drug use or simply anti-Chinese legislation.
The next big drug law came in 1914, when the Harrison Narcotics Tax Act both created a federal registry of “every person who produces, imports, manufactures, compounds, deals in, dispenses, distributes, or gives away opium or coca leaves or any compound, manufacture, salt, derivative, or preparation thereof”, and levied taxes on them.
While physicians were supposedly excluded if the drugs were deemed medically necessary, the law severely limited the ability of doctors to prescribe opiates. The act singled out addiction as a moral failing, not a medical disease, which made it nearly impossible for physicians to treat anyone with an opiate dependence.
Drugs became a matter of law enforcement, not public health. That still holds a century later. Attempts by doctors to change the public conversation made little headway, and those who continued to prescribe opiates to addicts as part of treatment programs were jailed. Drug use further spiked when alcohol was banned by the passage of the 18th amendment in 1919.
When prohibition was overturned by the 21st amendment in 1933, the cocktail culture that had been created in speakeasies across the nation made drinking more socially acceptable than it ever had been. As heroin had been banned in the interim, this only further served to stigmatize recreational opiate users, who were marginalized as junkies.
After the second world war, opioids – synthetic opiates – began to enter the market in greater numbers, including drugs formulated using Hydrocodone (later popularized in the 1970s as the narcotic in Vicodin) and Oxycodone (the opiate best known today as an ingredient in Oxycontin). Many doctors – knowing the risks of addiction and dependence – embraced a sort of “opiophobia”, which caused them to shy away from prescribing pain pills frequently.
The increase in recreational drug use in the 1960s – including a spike in heroin use by soldiers in Vietnam – gave rise to both the Controlled Substances Act in 1970 and the Drug Enforcement Agency in 1973, both of which were designed to limit access to opiates. However, as doctors became increasingly convinced that they were under-treating pain – and new opioids entered the market – prescriptions for painkillers took off.
It’s no coincidence that this move was heavily endorsed by pharmaceutical companies, which had helped fund the studies that showed that doctors were under-prescribing pain medications. Meanwhile, pharmaceutical reps aggressively lobbied physicians on the value of their pills, and as Dr Celine Gounder noted in the New Yorker: “By 2010, the United States, with about five per cent of the world’s population, was consuming ninety-nine per cent of the world’s hydrocodone”.
Today, there are medical answers to opiate addiction, but until America stops stigmatizing drug users as degenerates, those answers aren’t doing much good. Regulatory hurdles prevent many physicians from being able to prescribe buprenorphine, a medicine shown to effectively treat opioid dependence.
And the DEA has done little to stem heroin in the United States. Since heroin is cheaper than prescription opiates, it is all too easy to switch from a legal prescription to illegal street drugs. On 10 March, the Senate passed a major drug treatment and prevention bill; the question remains whether it will make it into law and, if so, if it will do any good.
Tomorrow, 44 more Americans will die from prescription painkillers, according to the Centers for Disease Control and Prevention. And if history is any indication, attempting to legislate an illness away will do little other than force addicts to search for yet another way to find their fix.