Addiction Rate and City Size. Dark paradise: opiate addiction in America before David T. House U. Senate U. With many Formulae and Prescriptions. Schneider , Helen M. Dark Paradise David T. Dark paradise: a history of opiate addiction in America David T. Charles Schuppert, a New Orleans surgeon, was summoned to help.
It was the late s, and Schuppert, like thousands of American doctors of his era, turned to the most effective drug in his kit. Physicians like Schuppert used morphine as a new-fangled wonder drug.
By , morphine and opium powders, like OxyContin and other prescription opioids today, had led to an addiction epidemic that affected roughly 1 in Americans. Before , the typical opiate addict in America was an upper-class or middle-class white woman. Today, doctors are re-learning lessons their predecessors learned more than a lifetime ago. During the American Revolution, the Continental and British armies used opium to treat sick and wounded soldiers.
Benjamin Franklin took opium late in life to cope with severe pain from a bladder stone. A doctor gave laudanum, a tincture of opium mixed with alcohol, to Alexander Hamilton after his fatal duel with Aaron Burr.
The Union Army alone issued nearly 10 million opium pills to its soldiers, plus 2. An unknown number of soldiers returned home addicted, or with war wounds that opium relieved.
The hypodermic syringe, introduced to the United States in and widely used to deliver morphine by the s, played an even greater role, argued Courtwright in Dark Paradise. Overuse led to addiction. By the late s, women made up more than 60 percent of opium addicts.
Throughout the s and s, medical journals filled with warnings about the danger of morphine addiction. But many doctors were slow to heed them, because of inadequate medical education and a shortage of other treatments. Financial pressures mattered too: demand for morphine from well-off patients, competition from other doctors and pharmacies willing to supply narcotics.
Only around , at the peak of the epidemic, did doctors begin to slow and reverse the overuse of opiates. Advances in medicine and public health played a role: acceptance of the germ theory of disease, vaccines, x-rays, and the debut of new pain relievers, such as aspirin in Better sanitation meant fewer patients contracting dysentery or other gastrointestinal diseases, then turning to opiates for their constipating and pain-relieving effects.
Educating doctors was key to fighting the epidemic. Medical instructors and textbooks from the s regularly delivered strong warnings against overusing opium.
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As doctors led fewer patients to addiction, another kind of user emerged as the new face of the addict. Opium smoking spread across the United States from the s into the s, with Chinese immigrants operating opium dens in most major cities and Western towns.
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That shift created a political opening for prohibition. That changed in the s and s, he says. The Philippines were then a territory under American control, and the opium trade there raised significant concerns. President Theodore Roosevelt called for an international opium commission to meet in Shanghai at the urging of alarmed American missionaries stationed in the region.
The law, passed in February , limited supply and drove prices up. That pushed addicts toward more potent opiates, especially morphine and heroin.
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The subsequent Harrison Narcotic Act of , originally intended as a regulation of medical opium, became a near-prohibition. After the U.
Supreme Court endorsed this interpretation of the law in , cities across the nation opened narcotic clinics for the addicted — a precursor to modern methadone treatment. But those that focused on long-term maintenance and older, sicker addicts — such as Dr. Courtwright, a history professor at the University of North Florida, wrote Dark Paradise in , then updated it in to include post-World War II heroin addiction and the Reagan-era war on drugs.
Modern doctors have a lot more treatment options than their 19th-century counterparts, he says, but they experienced a much more organized commercial campaign that pressed them to prescribe new opioids such as OxyContin. Class and race play a role in that, he acknowledges. Now, Courtwright says, the country may be heading toward a wiser policy that blends drug interdiction with treatment and preventive education.