One of the more distressing truths of America’s opioid epidemic, which now kills tens of thousands of people every year, is that it isn’t the first such crisis.
Across the 19th and 20th centuries, the United States, China and other countries saw drug abuse surge as opium and morphine were used widely as recreational drugs and medicine. In the West, doctors administered morphine liberally to their patients, while families used laudanum, an opium tincture, as a cure-all, including for pacifying colicky children. In China, many millions of people were hooked on smoking opium. In the mid-1800s, the British went into battle twice — bombing forts and killing thousands of civilians and soldiers alike — to keep the Chinese market open to drug imports in what would become known as the Opium Wars.
That history has either been forgotten or willfully ignored by many in the medical and political establishments.
Today’s opioid crisis is already the deadliest drug epidemic in American history. Opioid overdoses killed more than 45,000 people in the 12 months that ended in September, according to the Centers for Disease Control and Prevention. The epidemic is now responsible for nearly as many American deaths per year as AIDS was at the peak of that crisis.
Experts say that the death toll from opioids could climb for years to come. Millions of people are dependent on or addicted to these drugs, and many of them are increasingly turning to more potent, illicit supplies of heroin and fentanyl, which are cheap and readily available on the street and online. Yet only about 10 percent of Americans who suffer from substance abuse receive specialized addiction treatment, according to a report by the surgeon general.
We have seen this before.
As many as 313,000 people were addicted to injected morphine and smoked opium in the United States in the late 19th century, according to David Courtwright, a history professor at the University of North Florida who has written extensively about drugs. Another scholar, R.K. Newman, estimated that as many as 16.2 million Chinese were dependent on opium and smoked the drug daily.
In the United States today, about 2.6 million people suffer from opioid use disorder. But some experts say that data, which is based on a government survey, underestimates the number of pain patients who are addicted to their prescription pills because of how surveyors ask people about drug use; the actual number might exceed 5 million.
In the 19th century, like today, the medical community was largely responsible for the epidemic. Doctors did not fully appreciate the risks these drugs posed. In the 1800s, many doctors viewed morphine as a wonder drug for pain, diarrhea, nerves and alcoholism. In addition to getting homemakers, Civil War veterans and others addicted, many doctors became addicts themselves. The drug was overused in large part because there were few alternatives; aspirin, for example, didn’t become available until the late 1890s.
In his 2001 book, “Dark Paradise: A History of Opiate Addiction in America,” Courtwright notes that the use of morphine began declining as younger doctors who had been better trained started practicing medicine and as nonaddictive pain treatments became available. He also notes that many local governments across the country set up clinics that sought to help addicts — a forerunner of contemporary methadone clinics — but a hostile federal government forced virtually all of them to shut down by 1923. It did so under the misguided idea that it was wrong to keep supplying drugs to people who had become dependent on them — a view that is, regrettably, still widespread today.
Today’s opioid crisis has its roots in the 1990s, when prescriptions for painkillers like OxyContin and Vicodin started to become common. Companies like Purdue Pharma, which makes OxyContin, aggressively peddled the idea that these drugs were not addictive with the help of dubious or misinterpreted research. One short 1980 letter to The New England Journal of Medicine by Dr. Hershel Jick and Jane Porter said the risk of addiction was less than 1 percent, based on an analysis of nearly 12,000 hospital patients who were given opioid painkillers. That letter was widely — and incorrectly — cited as evidence that opioids were safe.
Federal regulators, doctors and others were swayed by pharmaceutical companies that argued for greater use of opioids; there was increasing awareness that doctors had become too unresponsive to patients who were in pain. Patient advocates and pain specialists demanded that the medical establishment recognize pain as the “fifth vital sign.”
What should we do now?
The AIDS crisis might provide public officials some lessons for how to move forward. Like with opioids, the federal government responded to that epidemic by doing next to nothing for many years. But an organized movement led in part by people with HIV and gay activists eventually forced Congress to create and fund new programs.
Lawmakers so far have fallen far short of such a vigorous effort when it comes to opioid addiction. Congress has taken what can be considered only baby steps by appropriating a total of a few billion dollars of discretionary opioid funding in recent years. This funding amounts to a pittance relative to what is needed: substantial long-term funding for prevention, addiction treatment, social services and research.
Leaders in both parties are responsible for this crisis. Presidents George W. Bush and Barack Obama and members of Congress did too little to stop it in its earlier stages. While Trump talks a lot about the problem, he seems to have few good ideas for what to do about it. As we’ve learned the hard way, without stronger leadership, the opioid epidemic will continue to wreak havoc across the country.