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Alcoholism is a concept that was recognized long before the Pilgrims landed at Plymouth Rock with a ship full of beer, and subsequent alcohol abuse in Colonial America is well documented. In fact, the man who is considered the “Father of Addiction Medicine,” (Dr. Benjamin Rush 1746-1813) was a signer of the Declaration of Independence and was so attuned to the problems of alcoholism and the alcoholic, that in 1810 he envisioned the creation of a “sober house,” where alcoholics would be treated and rehabilitated. Over the next several decades, countless therapies, programs and temperance societies sprung up with the intention of treating alcoholics.
Later in the nineteenth century, drug abuse also became a larger societal concern, and many of the alcohol rehabilitation programs opted to treat these patients as well. Addiction “cures” were everywhere by the end of the nineteenth century and were administered by a broad spectrum of practitioners. These ranged from legitimate physicians who were genuinely trying to help people to shameless mountebanks who promised “complete cures” within twenty-four hours.
This era marks the beginning of a shift in attitudes about drug use and abuse in the United States. In his work, “Opium and the Opium Appetite” (1871), Alonzo Calkins was one of the first people to outline approaches to opium treatment, and by the mid-1890s, the word addiction appears regularly in professional literature. During this period, however, several factions were coalescing into a movement that profoundly changed the way American society perceived drugs and the people who were addicted to them. The forces behind this shift were a combination of the medical community, the government and muckraking journalists.
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Heroin was developed in 1895 and named for the German word “heroisch,” which means heroic or strong. It was marketed as morphine substitute, and by 1898 it was a common ingredient in children’s cough medicine. All forms of opium were still being sold in over the counter medications, and with tuberculosis causing twenty-five percent of deaths, liquid heroin’s promise to restore respiratory health made it a popular choice. In 1900, The Boston Medical and Surgical Journal even proclaimed, “It’s not hypnotic, and there’s no danger of acquiring a habit.” Drug kits were readily available to consumers to purchase and be used at home. Sold by reputable pharmaceutical companies, these kits contained hypothermic needles and vials of opiates.
Patent medicines were still extremely popular and widely available. This business was akin to the Wild West; there were no laws regulating the contents of these concoctions or the amounts of narcotics used in them. Products like Dr. Collins Genuine Painless Opium Antidote boasted the merits of its product with the outrageous slogan, “never a failure in a single case.” Patent medicine companies preyed upon consumers by using boldfaced lies and making false claims about their untested and unscientific treatments. Their legitimacy was buoyed by “reliable testimonials,” from doctors and customers that were equally dubious.
Worse yet, each time a new form of opium was developed, it was invariably marketed as a way to end dependence on earlier versions of the same drug. This strategy was very popular and sold a lot of product, but it couldn’t have been further from the truth. In 1889 The American Association for the Study and Cure of Inebriety tested twenty opium and addiction cures in an effort to ascertain their ingredients. Shockingly, not only did nineteen of them contain opium, but they also contained larger amounts of drugs than the products that had caused the original addictions! Prescribing one opiate to treat withdrawal symptoms of another was still a popular practice that was made all the more confusing because drug withdrawal symptoms mimicked symptoms of other illnesses.
Things were about to change.
Several medical advancements that occurred during this period had an effect on the business of patent medicines. For starters, aspirin (developed in 1899) and other less dangerous analgesics were brought to market. These non–addictive pain relievers doubtless prevented many people from becoming opium addicts.
The acceptance of germ theory also had a huge impact on the way diseases were understood and treated. Developed between 1850 and 1920 by Louis Pasteur (a chemist) Joseph Lister (a surgeon) and Robert Koch (a physician), germ theory advanced the knowledge about disease by stating that specific microscopic organisms were responsible for specific diseases. Prior to germ theory, diseases were thought to have arisen from imbalances in bodily fluids (humoral theory). Following on the heels of this breakthrough was the development of vaccines for cholera and typhoid (1896). Previously, many households had erroneously used patent medicines to treat these diseases.
Nonetheless, patent medicines were a seventy-five million dollar a year business in the early 1900s. There was however, a rising tide of suspicion about their effectiveness.
Enter the Muckrakers
The Progressive Era (1890s – 1920s) was a period of social and political activism that was chiefly concerned with eliminating unfair business practices, government corruption and problems caused by industrialization. It was spearheaded by journalists who wrote scathing exposés to raise awareness about social injustice, women who worked to get the vote and countless activists who took on issues including urbanization, immigration and public education, just to name a few.
Many watershed events changed the course of history, including the publishing of Upton Sinclair’s The Jungle, (1905), which shone a harsh light on the deplorable practices of the meatpacking industry. Samuel Hopkins Adams continued the trend in 1906 with his damning exposé of the patent medicine business. Published over a period of several weeks by Collier’s Magazine, The Great American Fraud, was a series of articles in which Adams educated the public about the dangers of these unregulated products. In pieces dripping with sarcasm and irony, he meticulously revealed the perilous nature of these products and effectively reduced them to nothing short of snake oil. Adams had some especially choice words for companies that were despicable enough to claim they could cure cancer with a home remedy.
In his eye-opening series, Adams also laid responsibility on the publications that advertised the products. He claimed that they were complicit in the deception due to the enormous financial profits they reaped from promoting them.
Inspired by these crusaders, the government began to take action against the nefarious practices of the food and drug industries. 1906 saw the enactment of the Meat Inspection Act, which was quickly followed by the Pure Food and Drug Act. Both were the result of findings published by Dr. Harvey W. Wiley, a chemist who worked for the Department of Agriculture. Wiley’s report on the widespread use of harmful preservatives in the meatpacking industry created a greater awareness about the threat to public health. President Teddy Roosevelt, who had himself been disgusted by Sinclair’s revelations in The Jungle, signed these acts into law to protect consumers from products that claimed to be healthful without providing any scientific evidence to prove it.
With the goal of cleaning up the American food and drug industries, these acts gave unprecedented regulatory powers to the federal government. No longer could false claims be used to sell dangerous patent medicines. Drug companies were mandated to follow standards regarding the purity and strength of the medicines that they sold. And this was just the beginning of the government’s involvement in the food and drug industry.
In 1909 the initial shot was fired in the war on drugs when Congress passed the first drug prohibition law (which was also the first law to ban non-medical use of a substance). The Opium Exclusion Act banned the importation of smoking opium – the type that was largely favored by the immigrant Chinese population. The law didn’t apply to the “medicinal” opium that whites were partial to, which (unsurprisingly) fanned the flames of racism. Despite these xenophobic undertones, the State Department hoped that this action would open the door to China, who had long been perturbed by the practices of the British opium trade. Predictably, the law created a shortage of the drug, which gave rise to drug-related violence and criminal trafficking.
1909 was also the year that the first international opium conference, The Shanghai Opium Commission, convened to address the world’s narcotic problem. Several non-binding agreements were made (which lessened its impact) but it set the stage for The Hague Opium Convention, which would make more significant contributions to international drug law.
In 1912, twelve countries met at The Hague in The Netherlands to draft the international community’s next major bid at regulating the narcotics trade. It was presided over by two men representing the United States. Both were deeply concerned about opium abuse at home and abroad. Reverend Charles Brent was a Canadian transplant who became alarmed by opium abuse during his time in the Philippines, and Dr. Hamilton Wright, who had recently been appointed by President Roosevelt as the nation’s first Opium Commissioner believed that Americans “have become the greatest drug fiends in the world.” The duo was very keen on implementing laws that would control the narcotics business, but the primary objective of the Hague Opium Convention was to put restrictions on exports. In other words, it was put in place to prevent America from being controlled by the Chinese opium trade and German heroin. It wasn’t concerned with enforcing prohibitions or criminalizing its use, which is why the United States eventually withdrew from it.
These conferences laid the groundwork for what became the most consequential domestic drug law up to that point – The Harrison Narcotic Act. Approved by congress and signed into action by President Wilson in 1914, this act is what ultimately set the United States’ drug policy on the trajectory it travels to this day. Until this point addicts had been able to procure drugs and use them legally without the thought of prosecution. This law, however, initiated an era where addicts were regarded as criminals who engaged in illegal drug abuse.
The Harrison Narcotic Act was championed by Secretary of State, William Jennings Bryan (1860-1925). Bryan was a magnetic speaker and vocal proponent of prohibition, which the country was moving ever closer to by this time. The law provided a framework for how narcotics were dispensed. It included specific guidelines as to how much of a particular drug could be sold over the counter versus the larger amounts that could be prescribed by a physician. Theoretically, this meant that doctors could prescribe at their discretion, but later the wording of the law was interpreted to exclude prescriptions for addicts. This lead to disastrous repercussions for both doctors and their patients/addicts.
Despite its intentions, The Harrison Narcotic Act (also called The Law of Unintended Consequences) actually created more addicts. It also made criminals out of people for doing what they had always done without government interference. It forced addicts (most of whom were productive members of society) to get the drugs by any means possible, including resorting to crime. On the other hand, doctors who had been providing maintenance drugs to people who were classified as “addicts” were also now subject to arrest. In fact, twenty-five thousand doctors were indicted and several thousand were convicted and put in prisons for violations of this law. Lives and careers were destroyed.
By the beginning of the twentieth century Americans viewed addiction primarily as a character fault and as a moral failing (rather than a disease) and this triggered a shift to solve drug related problems with legal action. America was now home to one of the most lucrative underground drug business in the world.
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Next week: A look at some of the treatment for addiction during this period.
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