Americans Have Been Addicted to Prescription Opiates For a Very, Very Long Time

By May Wilkerson 03/22/16

As the history of opiates has repeatedly shown, regulating the drug is easier said than done. 

Americans Have Been Addicted to Prescription Opiates For a Very, Very Long Time
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Unless you’ve been living under a rock, you know by now that the U.S. is facing a major opioid crisis. In 2013, about 1.9 million Americans were addicted to opiates, according to national survey data.

Use and abuse of the drugs have risen dramatically in the past decade. The Centers for Disease Control and Prevention has called it an “epidemic” and recently issued a new set of guidelines to control how doctors prescribe and distribute opioid painkillers. But though addiction to prescription painkillers and heroin, which are both opioids, has become a rather severe problem in the 21st century, Americans have been using and getting hooked on these drugs for a long time. 

A recent Wired feature chronicles our relationship with opiates, which have been used as both a medicine and a drug dating as far back as 3400 B.C., when ancient Sumerians first cultivated opium poppies, or the “joy plant,” from which opiates are derived. Centuries later, in 1908, U.S. President Theodore Roosevelt appointed the country’s first official Opium Commissioner, a doctor named Hamilton Wright. "Of all the nations of the world, the United States consumes most habit-forming drugs per capita," Wright said at the time. At that point in history, an estimated one out of every 400 Americans was addicted to opium, and more than two-thirds of these were women.

In an attempt to curb the problem, the U.S. passed the Harrison Act in 1914, which required anyone involved in the opium and cocaine trade, with the exception of doctors, to pay taxes and register with the government. By 1919, the act was updated to make it illegal for doctors to give opiates to addicts except to wean them off the drug.

In some ways, the law was effective, reducing the rates of opiate addiction among white, upper class women. But at the same time, illegal drug use increased, especially among black communities and poor, white communities.

Opium went out of fashion, but opiates remained very much a problem. Throughout the 20th century, the U.S. government tried to regulate opiates as well as other drugs, passing the Heroin Act in 1924, the Boggs Act in 1951, the Controlled Substance Act in 1970, and various other laws. But pharmaceutical companies continued to develop opiate-derived medicines, including heroin, morphine, Oxycontin, Percocet and Vicodin. 

In 1990, a Scientific American article “The Tragedy of Needless Pain” argued that many Americans were suffering from untreated pain, and claimed that the medical community was “overreacting” to fears that prescribing painkillers would lead to addiction. As a result, medical prescriptions for painkillers skyrocketed, and a few years later, the U.S. was facing an opioid abuse epidemic.

Of course, ignoring legitimate pain is not the solution. The CDC estimates that over one in ten Americans deals with chronic pain. But the problem is that opiate-derived medications are “double-edged swords,” says Nancy Campbell, a researcher specializing in the history of drug regulation at Rensselaer Polytechnic Institute. “The difference between therapeutic dose and dangerous dose is relatively thin.”

Today, the opiate situation has spiraled out of control. Between 1999 and 2014, 165,000 people died from overdoses of prescription opiates. The CDC hopes that its new guidelines—which include setting firm treatment goals, going over harms and risks with patients, and conducting check-ins—will help reduce the number of unnecessary prescriptions.

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May Wilkerson is a writer, comic and Managing Editor @someecards. Co-host of the podcast Crazy; In Bed w/alyssalimp. She is also the top Google result for "insufferable lunatic." Follow this insufferable lunatic on Twitter.