Note: For the manuscript I’m currently writing, I’ve been researching the heroin epidemic that has stretched into almost all corners of America. Then this week came news that the death of Prince may be linked to prescription opiates. I thought it might be helpful to share what I’ve learned about this problem with a series of posts about how this came to pass. The factors are complex, but they combined to lead to a perfect storm of abuse, ruined lives, and deaths. First, some history…
Part 1: The Holy Grail of Pain
In 1913, John D. Rockefeller established the Bureau of Social Hygiene (BSH) to promote research on that subject, particularly from a criminology standpoint. A BSH subcommittee in 1919 estimated that there were 100,000 addicts in the US, most of them addicted to cocaine. In 1929 the BSH rebranded itself as the Committee on Problems of Drug Dependence. (They’ve had other name changes and exist today as the College on Problems of Drug Dependence.) Along with research into the subject and publishing information on addiction, there was a clinical arm of the CPDD that sought the holy grail of pain relief – a medicine that could kill pain but that wasn’t addictive.
Opium has been around almost as long as civilization. It’s mentioned in Sumerian writings from 2000 BCE for a plant called hul gil, the plant of Joy. Homer may have been referring to opium in The Odyssey when he mentions a drug that, when dissolved in wine and drunk, would rob grief and anger of their sting. It was used medicinally from the time of the Greeks on for all manner of disease and symptoms. A major change came in the 1500s with the introduction of Laudanum, a liquid form of morphine. By the 1800s, laudanum and straight opium were available at grocery stores in England, and in 1860 almost 300,000 lbs. of opium was imported, mostly from Turkey but also from India. The British East India Company was hugely involved in opium importation, and it led to the Opium Wars with China. China had outlawed opium importing, so the British went to war to force the Chinese government to allow them to sell Indian opium there. (Not the history you usually learn about in school.) In the US, many people grew the opium poppy in their gardens, including Thomas Jefferson.
The addictive nature of opium was known, and so there was a push to find a non-addictive version of the drug. Strangely enough, morphine, which was developed in the early 1800s, was viewed as non-addictive, especially when it was injected following the invention of the hypodermic syringe. Missionaries in China handed out what was known as “Jesus Opium” pills as a remedy for opium addiction; the pills were made of morphine. In the 1880s, the medical community embraced cocaine as a miracle cure, including a treatment for addiction. (Coca Cola, invented by Atlanta chemist John Pemberton, was originally a medicine.) In 1898, a former dye manufacturing company that moved into pharmaceuticals – by the name of Bayer – introduced Heroin as a cough medicine. The introduction was actually delayed so that Bayer could copyright the name throughout worldwide markets. The chemist who created it, Heinrich Dresser, promoted it while preventing the production of other promising pain relievers. One compound he rejected: acetylsalicyclic acid, now known as aspirin.
Temperance organizations not only campaigned against alcohol but also against drugs, and they were supported by missionary organizations that worked in China and wanted to see opiates outlawed. Their efforts led to the Harrison Narcotic Act of 1914. Interestingly, a major part of the selling of the act was steeped in racial prejudice, with warnings that blacks under the influence of drugs were killing whites, while degenerate Mexicans were smoking marijuana and Chinese men were using drugs to seduce white women. While Southern legislators were usually opposed to more federal power, the racial argument swayed them and they supported the act. So drugs passed from commonplace in America to hiding in back alleys apart from medical use.
The criminalization of narcotics, though, had a chilling effect on their use even by doctors. It was enough to ruin a doctor’s reputation if he regularly prescribed opiates. That began to change with a major shift in how pain was viewed. Where it was originally counted as a symptom of disease, there was a push beginning in the late 1970s and early 1980s to view pain as something to be treated in and of itself. Pain clinics were started that preached a multi-discipline approach to relieving pain: counseling, exercise, and diet were components. But there was also a re-evaluation of opiate use. Why allow, say, a terminally ill patient go through agony when morphine could dull the pain. It eventually crept down to acceptance for treating chronic pain and then simply any pain.
The multi-discipline approach was successful, but it was also expensive. Eventually it was killed off by insurance companies who saw that pain could be treated cheaply simply by using drugs.
Next: The Marketing of Addiction
May, Everette & Jacobson, Arthur, “The Committee on Problems of Drug Dependence: A Legacy of the National Academy of Sciences. A Historial Account.” Drug and Alcohol Dependence, 23 (1989)
“How Asprin Turned Hero” Sunday Times, 13 September 1998
McNamara, Joseph D “Commentary: Criminalization of Drug Use” Psychiatric Times September 2000
Quinones, Sam Dreamland: The True Tale of America’s Opiate Epidemic Bloomsbury Press 2015