The United States is in the throes of an “unprecedented opioid epidemic,” the Centers for Disease Control reports. The crisis has spurred calls for action to halt the rising death toll, which has devastated rural communities.
It’s true that there’s an opioid epidemic, a public health disaster. It’s not true that it’s unprecedented. A remarkably similar epidemic beset the country some 150 years ago. The story of that earlier catastrophe offers some sobering lessons as to how to address the problem.
Opioids are a broad class of drugs that relieve pain by acting directly on the central nervous system. They include substances such as morphine and its close cousin, heroin, both derived from the opium poppy. There are also synthetic versions, such as fentanyl, and medications that are derived from a mix of natural and synthetic sources, such as oxycodone.
Opioid addiction can take many forms, but the current crisis began with the use and abuse of legal painkillers in the 1990s, and has since metastasized into a larger epidemic, with heroin playing an outsized role.
All of this is depressingly familiar. The first great U.S. opiate-addiction epidemic began much the same way, with medications handed out by well-meaning doctors who embraced a wondrous new class of drugs as the answer to a wide range of aches and pains.
The pharmacologist Nathaniel Chapman, writing in 1817, held up opium as the most useful drug in the physician’s arsenal, arguing that there was “scarcely one morbid affection or disordered condition” that would fail to respond to its wonder-working powers.
Though there’s some evidence that opiate dependency had become a problem as early as the 1840s, it wasn’t until the 1860s and 1870s that addiction became widespread. The key, according to historian David Courtwright, was the adoption of the hypodermic needle in the 1870s.
Before this innovation, physicians administered opiates orally. Hypodermic needles, by contrast, delivered morphine directly into a patient’s veins with no side effects, yielding immediate results. As Courtwright notes: “For the first time in the entire history of medicine near-instantaneous, symptomatic relief for a wide range of diseases was possible. A syringe of morphine was, in a very real sense, a magic wand.”
An enthusiastic medical profession began injecting morphine on a vast scale for all manner of aches and pains, much the way that a more recent generation of doctors began prescribing Oxycontin and other legal drugs in a reaction against widespread undertreatment of pain. Wounded veterans became addicts, but so, too, did people suffering from arthritis. Women also became addicts en masse, thanks to the practice of treating menstrual cramps — or for that matter, any female complaint of pain — with injections of morphine.
Skeptics in the medical profession warned about the dangers of administering too much morphine. Yet these warnings generally fell on deaf ears. Some of the problem lay with the doctors themselves. One well-regarded doctor put it this way: “Opium is often the lazy physician’s remedy.”
In the end, though, the medical profession largely solved the problem on its own. As awareness of physicians’ role in fostering addiction spread, medical schools taught to avoid prescribing morphine except under carefully controlled circumstances.
And as the medical profession started to police its ranks, shaming those who enabled addiction, the epidemic began to burn itself out. “Old addicts died off faster than new ones were created,” Courtwright writes. The smaller group of addicts who became the face of opiate addition tended to be poorer “pleasure users” who picked up the habit in the criminal underworld.
Today’s opioid epidemic is similar to the one that came and went more than a century ago. While there is plenty of room for government assistance in funding treatment for addicts, never mind regulation of drugs, history suggests that the medical profession will ultimately play the most important role.
There are some promising signs. The number of opioid prescriptions written by doctors has dropped by small amounts over the past few years, though some of the evidence suggests that the decline has more to do with patients anxious about the potential for addiction.
Still, it took decades during the 19th century for doctors to shy away from injecting patients with morphine for the slightest complaint. It may take just as long before doctors kick the habit of prescribing powerful pain pills.
Stephen Mihm, an associate professor of history at the University of Georgia, is a contributor to Bloomberg View.