Editor’s Note: At the 2017 American Historical Association in Denver, several historians with relevant research interests participated in a roundtable discussion, “What Historians Wish People Knew about Licit and Illicit Drugs.” Keeping with the spirit of the title, Points is delighted to publish some of the panelists’ opening remarks in a temporary new series over the coming weeks. Our second installment is brought to you by Isaac Campos, associate professor at the University of Cincinnati. Also be sure to check out last week’s series premier by Miriam Kingsberg Kadia and part III by William Rorabaugh.

I’d just like to make five quick points with respect to what I wish all people knew about drug history.

First, humans have been taking psychoactive drugs since humans discovered psychoactive drugs. There seems to be a fundamental human attraction to altered states of consciousness if not a fundamental human need for it. This is old news to drug historians, but it is likely a novel idea to the average person. Thus it’s worth mentioning because it means that we are never going to live in a “drug-free world,” so we need to learn to deal intelligently with people take psychoactive drugs.

Second, drugs are not either “good” or “bad.” All drugs can be both “good” and “bad” in their interaction with humans. It’s up to humans to figure out how to make the majority of those interactions “good.” It’s just as counterproductive to call marijuana “harmless” as it is to call heroin inevitably “harmful.” Neither is true, even if the former might be closer to the truth than the latter. Neither gets us to where we want to be: that is, majority “good” outcomes.

Third, there is a lot we can learn from history, for history has shown us that “bad” outcomes are more likely to occur under certain circumstances When, for example, people excessively promote the benefits of a certain drug’s use. Here in the United States we have countless examples, from the patent medicine manufacturers of the late nineteenth century to Purdue Pharma in the late twentieth. The latter, if you are unfamiliar, sent out legions of salesman in the 1990s and 2000s to convince doctors that Oxycontin, when applied to actual pain, was non-addictive. Thank you Purdue Pharma! But we see the same phenomenon more informally among, say, marijuana advocates today who don’t realize that while the drug may have been consistently beneficial for them since the first day they used it, you can’t assume that everybody is going to have the same wonderful experience with it.

On the other end of the spectrum, we also get a lot of “bad” outcomes when people excessively demonize drugs. In my own work I’ve shown how marijuana’s reputation for causing madness in violence became a self-fulfilling prophecy in nineteenth and early twentieth century Mexico, with people learning to lash out violently after taking marijuana. In this country the “junkie” stereotype has become a kind of self-fulfilling prophecy, one that some users find romantic and thus actually pursue. There is a sweet spot somewhere between excessive promotion and excessive demonization that we need to shoot for,

Finally with respect to scenarios that produce “bad” outcomes, we might highlight the following situation: when people who are unfamiliar with a drug, or form of a drug, are exposed to that drug, especially if the new drug or drug form accelerates intoxication, and especially if the newly-exposed population involved is experiencing a lot of stress, social change, or dislocation. Here we could highlight the crack epidemic of the 1980s or our current opiate crisis. Indeed, this particular scenario runs through the center of modern drug history. We must be aware of these circumstances that tend to produce “bad” outcomes and respond to them accordingly.

My fourth big point: History and a lot of science show that social and cultural factors are fundamental in drug use outcomes. Stress, dislocation, anxiety, etc. are fertile grounds for “bad” outcomes. Furthermore, people tend to behave on drugs the way their culture dictates they should behave—my marijuana example above; fraternity brothers when they drink booze vs. tenured professors; British soccer hooligans on alcohol vs. Indian peasants in the Andes. It’s not just the “drug” and the dose. It’s the drug, and the dose, and the speed of intoxication, combined with psychology and the social and cultural setting of the drug use. All of these things combine to determine “good” and “bad” outcomes.

All of this leads to my final big point: “drug problems” are really “society problems.” Consider the current opiate crisis. Do you know when authorities in Ohio, where I reside, became convinced that Ohio had an opiate problem? When opiate deaths began to approach, and then surpassed, the number of car crash deaths in a year. This raises an important question: why are we so tolerant of car-crash deaths, so much so that their frequency has become our baseline for unacceptable accidental death in America? Harry Levine back in the 70s encouraged us to consider a similar question when he asked if drunk driving was really a drinking problem, or if we might better think about it as a transportation problem. Given that we allow people to drive around in 4,000 pound heaps of steel equipped with maps that need to be programmed, and hookups so they can plug in their telephones, and so forth, this strikes me as a pretty good question. Our tolerance of car crash deaths tells us a lot about us: we are highly tolerant of those things that make our economy go, but many of those things create just the kind of conditions that make “bad” drug use outcomes more likely: stress, isolation, overwork, loneliness, endless change, dislocation, and insecurity. When stressed, isolated, lonely people are exposed to new, stronger drugs, you end up with a problem. Our current opiate crisis is a case in point.

Thus what we ultimately need to recognize is that when we have a “drug problem,” it’s not just the drug. In fact, we should maybe thank the drug for helping us to recognize that something larger is happening that we’re probably not paying enough attention to.