A History Of Opioids In America

We look at the long history of opioid abuse in the U.S. and the first crisis in the 19th century with morphine.

STEVE INSKEEP, HOST:

The opioid crisis is awful but not entirely new. We've heard the recent numbers. The federal government reports that more than 130 people die from opioid-related overdoses per day. We've been through something like this before, and that is the subject of the latest episode of NPR's history podcast Throughline. It is hosted by Ramtin Arablouei and Rund Abdelfatah. And they learned about the first opioid crisis in American history, which happened back in the 19th century.

RUND ABDELFATAH, BYLINE: In the early 1800s, a German pharmacist named Friedrich Serturner was hard at work conducting experiments on the opium poppy plant. He was trying to figure out how to isolate its most valuable component, the alkaloid, the ingredient in the plant that gets you high and - more importantly for his research - provides pain relief. It was something no one had been able to do before. For years, Serturner ran all sorts of tests in the lab on stray dogs and even on himself.

RAMTIN ARABLOUEI, BYLINE: Eventually, he cracked the code and managed to extract the alkaloid from the poppy plant. He called it morphine, after the Greek god of dreams Morpheus. And for the next few years, Serturner continued to study this new thing, and he started getting more and more nervous about how it might be used in the future.

BETH MACY: He says, we must be very careful with this drug. And he warns people that calamity is around the corner.

ABDELFATAH: This is Beth Macy.

MACY: I'm a journalist and an author based in Roanoke, Va.

ABDELFATAH: Her latest book is called "Dopesick."

ARABLOUEI: So several decades after morphine is discovered, Serturner's fears are realized.

ABDELFATAH: Calamity strikes an ocean away in the United States. The Civil War begins.

(SOUNDBITE OF BATTLE RE-ENACTORS YELLING)

ARABLOUEI: It's an incredibly bloody war, the deadliest in American history.

ABDELFATAH: And most of those deaths actually happen off the battlefield.

ARABLOUEI: From things like disease and infection. But there was this great new way of controlling pain.

ABDELFATAH: That new drug - morphine. And the U.S. imported a lot of it.

(SOUNDBITE OF MUSIC)

ABDELFATAH: Many soldiers became hooked and stayed hooked after the war ended.

DAVID COURTWRIGHT: There's a saying or a cliche that morphine addiction in the late 19th century was the army disease or the soldier's disease.

ARABLOUEI: This is drug historian David Courtwright. And he says that nickname hides a significant detail.

COURTWRIGHT: Which is other evidence suggests very strongly that the majority of addicts were women.

ARABLOUEI: So Courtwright says, while a lot of soldiers did return from the front addicted to morphine, it appears that as the century went on, women began to make up the majority of morphine addicts in the U.S.

(SOUNDBITE OF MUSIC)

NANCY CAMPBELL: Why was morphine prescribed in the 19th century? It's prescribed for pain of all kinds, which women tended to be diagnosed with to a much greater degree than men.

ARABLOUEI: This is Nancy Campbell. She's a historian of drugs and drug addiction.

COURTWRIGHT: Men were expected to bear pain more stoically. They were not expected to seek out doctors for every ache and pain. There were also supposed racial differences in the ability to tolerate pain.

ABDELFATAH: So if you were a white woman who could afford prescription drugs and you went to the doctor for, say, a cough or menstrual cramps, you were way more likely to leave with a prescription for morphine than anyone else. One doctor, Frederick Heman Hubbard, wrote in 1881, uterine and ovarian complications cause more ladies to fall into the opium habit than all other diseases combined.

So morphine was the catchall drug that doctors and pharmacists used for pretty much everything. And they prescribed it to women like Mrs. Matilda Webster.

CAMPBELL: Mother of nine children, who suffered from neuralgia.

ARABLOUEI: Neuralgia is a condition where nerve pain causes a stabbing, burning sensation.

CAMPBELL: She sent, one night, 1 of her 9 children to Boyd's (ph), which was her usual South Brooklyn drug store. And the child reported to the druggist that her mother was in great pain - bodily pain - and was asking for something to help her go to sleep. The druggist, who was pretty familiar with Mrs. Webster, packaged up a couple of doses of morphine.

And Mrs. Webster, instead of doing what the druggist thought she would do - which is taking a little at a time until her pain was controlled - took everything, the whole supply. And she went into a coma, lingered in a comatose state and expired 24 hours later.

ARABLOUEI: She had overdosed on morphine. And the druggist who gave her the morphine was put on trial - which Campbell says was unusual because overdoses normally were reported as deaths by natural causes. But Matilda's husband wasn't willing to let go and eventually was given...

CAMPBELL: Five thousand dollars in, you know, 1868.

ABDELFATAH: 1868 - so not long after the Civil War ended, people were already starting to suspect that morphine was potentially dangerous.

MACY: Like - warning, warning - this drug is not safe.

(SOUNDBITE OF MUSIC)

ABDELFATAH: One doctor wrote in 1884...

MACY: Prompt action is then demanded, lest our land should become stupefied by the direful effects of narcotics and thus disease physically, mentally and morally the love of liberty swallowed up by the love of opium while the masses of our people would become fit subjects for a despot.

ARABLOUEI: Still, doctors kept prescribing morphine throughout the 1800s despite the warnings, mostly because there just weren't many good alternatives. I mean, aspirin wasn't even marketed until 1899.

By the early 20th century, tens of thousands of Americans were addicted to narcotics like morphine. People were dying of overdoses, which sounds pretty familiar.

ABDELFATAH: Yeah, a lot like the crisis we're in today. People would go to the doctor's office, get a prescription for morphine, become addicted, maybe even die.

ARABLOUEI: And communities, who were mostly white, were left devastated.

ABDELFATAH: And the government was left scrambling to find some kind of solution.

ARABLOUEI: Because when you have people addicted or dying in communities, it ultimately impacts the entire country.

ABDELFATAH: So just like now, the morphine crisis probably had a lot of people asking...

MACY: Oh, my Lord. What have we unleashed on this country?

(SOUNDBITE OF MUSIC)

INSKEEP: The very latest on the past from Throughline - it is hosted by Ramtin Arablouei and Rund Abdelfatah. Find Throughline anywhere you listen to podcasts.

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