"Dark Paradise, A History of Opiate Addiction in America" by David T. Courtwright was loaned to me by a friend who works in the field of addiction treatment. I can only hope that more addiction specialists, as well as legislators and law enforcement people, read this book.

One thing that has become clear over the past century and a half is that our society has made dealing with addiction-related problems more complex by criminalizing behavior. Vermont has recognized that addiction treatment should be the first line of defense and that is a huge step forward, but one has to wonder if total decriminalization of a drug such as heroin might be a step in the right direction.

Heroin was created in 1898 to be used as a cough suppressant. According to Courtwright, "... its liberal use led to a bout of iatrogenic addiction, although not on the scale of the morphine epidemic of the 1870s and 1880s. Unfortunately, just as physicians were becoming more circumspect in their use of the drug, heroin became popular among the young as a euphoric agent and as a substitute for smoking opium and cocaine. At first its use was concentrated in the New York City area, but because of fundamental changes in American narcotic laws, heroin spread throughout the country during the 1920s and 1930s."

It is also important to note that the hypodermic needle came into use in the 1860s and 1870s and physicians became the primary facilitators of opium and morphine addiction because many believed these drugs were a therapeutic panacea.


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Iatrogenic addiction started to decline in the early 20th century when the medical profession "largely abandoned its liberal use of opium and morphine" according to Courtwright.

The world of opiate use and abuse took on a new life when the sale and use of opiates became regulated by law with passage of the Harrison Act in 1915. A 1972 Consumer Union report commented that the Harrison Act as "a law apparently intended to ensure the orderly marketing of narcotics was converted into a law prohibiting the supplying of narcotics to addicts, even on a physician's prescription."

"Six months after passage of the act, the following appeared in an editorial in the publication American Medicine. "Narcotic drug addiction is one of the gravest and most important questions confronting the medical profession today. Instead of improving conditions the laws recently passed have made the problem more complex. Honest medical men have found such handicaps and dangers to themselves and their reputations in these laws . . . that they have simply decided to have as little to do as possible with drug addicts or their needs. . . . The druggists are in the same position and for similar reasons many of them have discontinued entirely the sale of narcotic drugs. [The addict] is denied the medical care he urgently needs, open, above-board sources from which he formerly obtained his drug supply are closed to him, and he is driven to the underworld where he can get his drug, but of course, surreptitiously and in violation of the law ...

They go on to comment that, "Abuses in the sale of narcotic drugs are increasing ... A particular sinister sequence ... is the character of the places to which (addicts) are forced to go to get their drugs and the type of people with whom they are obliged to mix. The most depraved criminals are often the dispensers of these habit-forming drugs. The moral dangers, as well as the effect on the self-respect of the addict, call for no comment. One has only to think of the stress under which the addict lives, and to recall his lack of funds, to realize the extent to which these ... afflicted individuals are under the control of the worst elements of society. In respect to female habitues the conditions are worse, if possible. Houses of ill fame are usually their sources of supply, and one has only to think of what repeated visitations to such places mean to countless good women and girls unblemished in most instances except for an unfortunate addiction to some narcotic drug-to appreciate the terrible menace."

One has to wonder if things have changed much since the late 19th and early 20th century. We should not be naïve enough to believe Americans will make heroin legal any time soon, but we have to wonder why we keep doing things the same way we have for over 100 years but expect to see better results.

Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at rbdav@comcast.net.