Danger, Deceit, and Death: The Story of Opiates in America

Danger, Deceit, and Death: The Story of Opiates in America

By Liz Greene 06/19/16

To know the history of opiates in North America is to know the roots of a tremendous problem; to know how ignorance and greed turned medicine into human suffering on an astronomical scale. 

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Danger, Deceit, and Death: The Story of Opiates in America
The heart of one of America’s greatest epidemics.

On the surface, Papaver somniferum (also known as the opium poppy) seems like a harmless plant. However, this lovely flower is at the heart of one of America’s greatest epidemics—opiate addiction. To know the history of opiates in North America is to know the roots of a tremendous problem—to know how ignorance and greed turned medicine into human suffering on an astronomical scale. 

Opium

Until the 19th century, opium was used for millennia in its natural form, tracing as far back as 5000 BCE in the Neolithic age. As time marched forward, medicinal and recreational use of opium spread around the world, showing up in almost every country. By the 1800s, opium had made its way to the United States, and consumption skyrocketed. 

Physicians and pharmacists prescribed opium tinctures (such as laudanum) for everything from cholera and tuberculosis to insomnia and "female complaints." As a consequence of this widespread and unregulated use, by the late 19th century between 150,000 and 200,000 people were thoroughly addicted.

Despite the rampant use of medicinal tinctures, blame for the introduction of opium to the American populace was laid directly at the feet of Chinese emigrants. 

It has been estimated that in San Francisco thirty per cent of the Chinese are addicted to smoking and that ten per cent of the entire population of Chinatown are habitual "opium drunkards." The drug is smoked as freely as tobacco. First, there are the opium dens. There are scores of these dens in the Chinese quarter of every large city. There the Chinaman can buy his pipe and smoke in peace. In San Francisco white people are forbidden to visit these dens, but they have such places of their own, which are well known to the police, and the vice is ever spreading and increasing. — C.F. Holder, Scientific American, 1898 

While Chinese emigrants to San Francisco and New York may have introduced the social traditions of the opium den, they were hardly to blame for the staggering amount of Americans already in the grip of addiction. 

Opium use had taken a toll on America, and both physicians and pharmacists were searching for an alternative. Unfortunately, the alternative that presented itself was even more deadly.

Morphine

In 1805, 21-year-old German pharmacist Friedrich Sertürner did something truly amazing—he isolated the active alkaloid morphine from crude opium. After some initial tests, Sertürner started marketing the drug to the general public as both an analgesic and as a treatment for opium and alcohol addiction. By 1827, demand was high enough for German pharmaceutical company Merck to begin to commercial manufacture of morphine. 

Morphine made its way to the Unites States by the mid 1850s, becoming extremely popular within the medical profession due to its ability to treat severe pain. However, by the 1870s, physicians had become increasingly aware of the drug’s addictive properties. Within twenty years of its arrival to the United States, morphine had become as much of a problem as opium.

Doctors were again faced with the problem of finding a sufficient alternative.

Heroin

In 1874, a chemist named C.R. Alder Wright tasked himself with finding a safer pain medication to replace morphine. He ended up discovering a chemical compound which he christened diacetylmorphine. After testing the compound on his dog—and nearly killing it in the process—he concluded the drug was toxic. He published his findings in a chemistry trade journal, tucked the formula away in his notes, and forgot about it.

Two and a half decades later, Felix Hoffmann, a chemist at Bayer Pharmaceuticals in Germany, attempted to duplicate Mr. Wright’s experiment in hopes of producing codeine. Instead, the experiment produced an acetylated form of morphine that was two times more potent than morphine itself. The head of the research department based the name of the drug on the German word "heroisch," which means "heroic, strong." It was introduced to the world as heroin.

Bayer marketed heroin as being a non-addictive substitute for morphine as well as a cough suppressant. However, despite Bayer’s claims, heroin quickly produced one of the highest rates of addiction among users. By 1913, the habit-forming dangers of heroin were apparent to everyone, and Bayer stopped producing the drug.

In 1914, Congress passed the Harrison Narcotics Tax Act in an effort to control the sale and distribution of heroin and other opioids. Under this act, the drug was still allowed to be prescribed and sold for medical purposes. However, in 1924, the United States Congress took it one step further, banning the import of crude opium for the purpose of manufacturing heroin.[10] 

Prescription Opiates in the 20th & 21st Centuries

As heroin disappeared from prescription pads into the criminal underworld, synthetic opiates rose to take its place.

In 1916, Freund and Speyer of the University of Frankfurt in Germany synthesized oxycodone from thebaine. Their hope, like many scientists before them, was that their newly discovered drug could relieve pain without causing addiction. Unfortunately, oxycodone proved to be addictive as well—though not nearly as addictive as heroin and morphine.

Americans limped through the 20th century, relying on opiate derivatives such as oxycodone, hydrocodone, and methadone—each one finding its own particular group of victims. As addiction to prescription opiates rose, the medical community reacted. The 1980s saw a reluctance in physicians to prescribe opiates, leading to pain being undertreated, even in dying patients. However, by the end of the '90s, the pendulum had swung in the other direction, with poorly trained doctors prescribing opiates liberally, often before exploring other treatments.

The 21st century has seen a startling rise in opioid related overdoses due to abuse. We’re also in the throes of a new heroin epidemic—directly related to prescription opiate addiction. While the current administration is working to stem the tide of deaths by amending opiate prescription guidelines, it’s clear that they have many years of work ahead of them. It’s a delicate process, as we must find a way to curb abuse and overdose without harming the patients who truly benefit from prescription opiates.

To address the complex problem of prescription opioid and heroin abuse in this country, we must recognize and consider the special character of this phenomenon, for we are asked not only to confront the negative and growing impact of opioid abuse on health and mortality, but also to preserve the fundamental role played by prescription opioid pain relievers in healing and reducing human suffering. That is, scientific insight must strike the right balance between providing maximum relief from suffering while minimizing associated risks and adverse effects. — Dr. Nora D. Volkow

The story of opiate addiction in America is long and troubled. We’ve seen scientific breakthroughs morph into human pain and misery, only to be followed by the same thing, again and again. It’s a vicious cycle, and one wonders if we'll ever see the end.  

Liz Greene is an animal loving, history studying, and anxiety-ridden realist from the beautiful city of trees, Boise, Idaho. You can follow her latest misadventures on her blog, Instant Lo.

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Liz Greene is an animal loving, history studying, and anxiety-ridden realist from the beautiful city of trees, Boise, Idaho. You can follow her latest misadventures on her blog, Instant Lo. Follow her on Twitter.

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