As this third United States opioid epidemic continues, we can look back on its predecessors. The first peaked around the end of the 19th century, when opioid products were unregulated. Bayer Pharmaceuticals introduced heroin as a cough suppressant in 1898, and heroin was widely prescribed into the 1920s. One common medical use was the treatment of menstrual pain. In 1906 the Pure Food and Drug Act required the contents of drugs to be listed on their labels, including opioids. A 1911 New York Times article asserted that “at least one druggist out of every ten exists by means of profits from the sale of habit-forming drugs, of which, of course, opium and its derivatives are most important.”

Though use of opioids was already on the decline, the 1914 Harrison Narcotics Tax Act codified national policy makers’ ambition to curb their use by taxing them. The act also regulated medical applications, permitting opioids to be used for pain treatment, but not as maintenance treatment for addiction, which was not legalized by the Supreme Court until 1925.

The Federal Medical Center in Lexington, Ky., opened in 1935 as the first center dedicated to the treatment of substance use disorders. It was the site of early addiction research experiments with methadone maintenance and other therapies.

Narcotics use spiked again in the middle of the 20th century. The Times documented growing use and overdose deaths in New York, including in a 1951 article that noted a “tremendous increase” in teenage users admitted to local hospitals. Another article in 1969 reported that arrests for narcotics in the city were up 46 percent compared with the previous year. Also in 1969, Dr. Robert DuPont found that over 40 percent of people entering jails in the District of Columbia tested positive for heroin. In 1971, The Times reported on widespread narcotic use and drug addiction by returning Vietnam veterans.

In response to this second opioid epidemic, first states, and then the federal government in 1966, passed laws permitting involuntary hospitalization of addicts. Methadone clinics were established with the Controlled Substances Act, supported by various intervention studies that found such treatment effective. The Drug Enforcement Administration was established under President Nixon to consolidate and coordinate federal antidrug activities.

During this second wave of increased narcotic use and response, in 1961, the United Nations declared access to pain medication a human right, adding that countries should provide appropriate access to pain management, including opioids. This foreshadowed the third, current wave of opioid overuse, growing out of an effort to more fully recognize and treat pain.

Today, states and federal policy makers are offering new approaches to promote responsible, safe opioid use for pain and addiction treatment, which is highly cost-effective. All states but Missouri have or will soon have drug databases to track prescribers of opioid painkillers and those that use them. States that have required doctors to check the databases before prescribing the drugs have seen large decreases in prescribing. Physicians and F.D.A. officials have called for more tamper-resistant formulations that cannot be easily crushed for snorting or adapted for injecting. And states’ expansion of access to the overdose antidote naloxone could save many lives.