A little bit of history

Until the early twentieth century, physicians had few effective medications to treat diseases, so they tended to overuse opioids. Even if no cures were produced, the patient felt better. Those physicians who freely prescribed opioids were more popular than their more cautious colleagues with parsimonious prescribing habits. However, opium products, as well as marijuana and cocaine, could be obtained without a prescription at the local druggist’s.
In addition to their legitimate use, for the treatment of pain, cough, and diarrhea, opioids were also used to treat nervous conditions of all sorts, asthma, gynecological disorders, skin rashes, hiccups, and masturbation. The drugs were of questionable or of no value for such disorders, and exposed those patients to the risk of addiction.

Morphine, named for Morpheus, the Greek god of dreams, was first produced commercially in 1827, and soon was used for many painful conditions. Like the original opioids, morphine products could be purchased without a prescription, in the patent medicines of that era. Commercial morphine was a breakthrough because it had a higher potency than previously available opioids, and came in pill form, in predictable doses. When the hypodermic was invented, around the time of the Civil War, it was an ideal drug, as injections of morphine provided quick pain relief for injured soldiers. Civil War veterans were given morphine for relatively long periods of time. The public thought so many Civil War veterans were addicted to opioids that it was called, “the soldiers’ disease.”
In reality, the middle and upper classes, especially women, had the highest addiction rate of any demographic group in the late 1800’s and early 1900’s. Women went to doctors more frequently than men, especially if they could afford to do so. Many of these women were diagnosed with “nervous ailments,” requiring opioids. Opioids did relieve anxiety, temporarily, but carried the risk of opioid addiction. Here we see the beginnings of iatrogenic (caused by a doctor or medical treatment prescribed by a doctor) addiction.
By the turn of the century, the average addict was a middle aged, middle class white female, found in greatest relative numbers in the South. This group of addicts was nearly inconspicuous, as they quietly continued their opioid addictions in the home, with over the counter, prescription, or patent medications containing opioids.
Chinese immigrants brought the habit of smoking opium with them, as they emigrated to the United States. Since these young immigrant males were of the lower social status, their addiction was viewed with alarm and disgust, while the war veterans and middle class female addicts were viewed with more compassion for their plight. The latter groups were perceived as more sympathetic, because they developed the disease of opioid addiction from medication prescribed by a doctor, and not through their own fault.

In the late nineteenth and early twentieth centuries, patent medicines affected opioid addiction rates. Prior to the passage of the Pure Food and Drug Act, in 1906, manufacturers of non-prescription tonics or elixirs could legally include addictive substances into their potions, without disclosing the contents. Many Americans unknowingly took patent medications containing opioids, usually either morphine or opium. Some patent medications also contained alcohol and cocaine, which made them understandably popular. As a result, people using patent medicines developed addictions. The poor, less able to afford a visit to the doctor, were more likely to use, and become addicted to, these patent medicines.

…to be continued…

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