Pubdate: Sun, 20 May 2018
Source: New York Times (NY)
Copyright: 2018 The New York Times Company
Author: Clinton Lawson


After the death of her father, a prominent hotel owner in Seattle,
Ella Henderson started taking morphine to ease her grief. She was 33
years old, educated and intelligent, and she frequented the upper
reaches of Seattle society. But her "thirst for morphine" soon
"dragged her down to the verge of debauchery," according to a
newspaper article in 1877 titled "A Beautiful Opium Eater." After
years of addiction, she died of an overdose.

In researching opium addiction in late-19th-century America, I've come
across countless stories like Henderson's. What is striking is how,
aside from some Victorian-era moralizing, they feel so familiar to a
21st-century reader: Henderson developed an addiction at a vulnerable
point in her life, found doctors who enabled it and then
self-destructed. She was just one of thousands of Americans who lost
their lives to addiction between the 1870s and the 1920s.

The late-19th-century opiate epidemic was nearly identical to the one
now spreading across the United States. Back then, doctors began to
prescribe a profitable and effective drug - morphine, taken via
hypodermic needle - too liberally. After a decade of overprescribing
it for minor ailments and even for issues related to mental illness, a
colony of American junkies began to emerge.

Most started out like Ella Henderson, who suffered from emotional
trauma and chronic pain, for which she was prescribed copious amounts
of morphine. She became addicted, was abandoned by the medical
community and judged by her neighbors, and ultimately overdosed alone
in her room. Her case mirrors the thousands of fentanyl and heroin
overdoses that led President Trump in October to declare opioid abuse
a public health emergency.

This first outbreak, typically traced to the popularization of
hypodermically injected morphine, began to spread in the wake of the
Civil War. It was finally contained by state and federal legislation
like the Pure Food and Drug Act of 1906, the Harrison Anti-Narcotic
Act of 1914 and the Heroin Act of 1924.

But addiction did not go away. Pushed underground during the 1930s and
'40s, widespread abuse re-emerged in the late 1950s and lasted through
the 1970s, although in a less severe form than it had in the late 19th
century. This time, the answer to the epidemic was a flurry of bills
to regulate doctors and pharmacies, or control the dissemination of
drugs, while also striking at the overall supply. It worked for the
most part, but yet again did not end America's turbulent relationship
with drugs.

In response to a limited legal supply, heroin, cocaine and morphine
continued to hold sway in the black-market economies of the streets
and side alleys. The government responded by adopting a far more
punitive approach to the problem, one centered on incarceration and
policing. Over a century after Ella Henderson's overdose, American
cities suffered from a crack-cocaine epidemic that, as it waned, gave
way to our current - and decidedly rural - heroin and fentanyl problem.

In the case of the opioid epidemic, history is literally repeating
itself. Once again, too many Americans are dying of drug overdoses,
and too many already vulnerable communities are being torn apart. Like
our predecessors at the turn of the last century, we are asking what
can be done to change the situation. Unlike them, we already know the
answers. They solved the quandary for us.

First, we must hold doctors accountable - with fines and possible jail
sentences - for overprescribing habit-forming drugs in the interest of
profits. That was one of the immediate steps taken in the wake of
stories like Henderson's, and it quickly showed results.

We also must understand that if our nation's health care remains a
privatized, for-profit industry, the incentive to sell potent drugs to
addicts will always exist. The health care industry was largely
unregulated in the late 19th century; "buyer beware" applied to quack
cures as much as to medical advice, and at first there was nothing the
government could do to prevent doctors from overprescribing morphine.

Eventually, though, legislators stepped in with regulations on
morphine and other products. And even though the health care industry
is no longer the Wild West, we have lost our appreciation of the power
of regulation to stop drug epidemics.

There are also lessons that need to be unlearned. While physicians and
politicians of the late 19th century made significant progress in
arresting the worst features of the opiate epidemic, they tended to
overreact when it came to the context of the epidemic. This led to a
shameful media campaign against Chinese immigrants, who often kept
opium dens, and the demonization of Italians, Russian Jews,
African-Americans, Mexicans, teenagers, musicians - anyone who,
according to stereotypes, was among the typical abusers. We do the
same today, at our peril.

They also allowed the campaign against opium to justify a general
attack on all drugs, even those that present a much lower risk to
public health. We are only now beginning to roll back excessive laws
on cannabis, for example, because it is painfully clear that the
reasons behind its prohibition had more to do with racial prejudice
and social hysteria than with public health concerns.

Too often we imagine that our opioid crisis is new; the fact that it
has been around, to varying degrees, for 150 years is a frustrating,
even heartbreaking thought. But we can also take inspiration from the
fact that we have tackled the problem before, and have won.

The difficult part is developing the will to confront the powerful
interests that drive overprescription on one hand and
overcriminalization on the other. We need politicians willing to
impose new laws and to regulate the pharmaceutical and medical
marketplaces in a far more disciplined way. This typically happens at
the local level first and gradually makes its way into national policy.

We have to maintain our emotional composure, avoid press hyperbole and
abandon our impulse to racialize the issue. The tendency to
incarcerate our problems often results in entire generations of less
fortunate Americans leaving high school for jail. If we do not know
our drug history, we can be sure there will be many more Ella
Hendersons in our future.

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Clinton Lawson is a doctoral candidate at the University of Montana.
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