/kloc-the inside story of American opium addiction in the 0 th and 9 th centuries

The man was bleeding, injured in a bar fight and in a semi-coma state. Charles Choupette, a surgeon from New Orleans, was asked to help. It was in the late 1970s of 19, and like thousands of American doctors of his time, Choupette turned to the most effective drugs in his toolbox. "I injected him with half a grain of morphine subcutaneously," Schubert wrote in his medical record. "It's like a spell, just like the minute he woke up from a coma, it's easy to rest." Doctors like Schuppert use morphine as a new specific drug. Through hypodermic injection, the drug relieves the pain, asthma, headache, delirium, tremor, gastrointestinal diseases and menstrual cramps of alcoholics. David T. Cottley, author of Dark Paradise: A History of Opium Addiction in the United States, said: "Doctors are impressed by their rapid results." It's like someone gave them a magic wand. "

By 1895, morphine and opium powder, like Oxycontin and other prescription opioids today, have led to an addiction epidemic, affecting about 1200 Americans. Before 1900, the typical opium users in the United States were white women of the upper class or middle class. Today, doctors are relearning the experience their predecessors learned a lifetime ago.

The history of American opium is as long as that of this country. During the American Revolution, China and Britain used opium to treat the sick and wounded. Benjamin Franklin used opium in his later years to deal with the severe pain caused by bladder stones. After the fatal duel between alexander hamilton and Aaron Burr, a doctor gave him tincture of opium mixed with alcohol.

The civil war triggered the opium epidemic in the United States. Coalition forces alone distributed nearly10,000 tablets of opium to soldiers, plus 2.8 million ounces of opium powder and tincture. I don't know how many soldiers went home addicted, or brought opium to alleviate the trauma of war. Courtright wrote: "Even if a disabled soldier survives the war, he is likely to meet a doctor who uses subcutaneous injections in the future." . Cortright said in "Dark Paradise" that this kind of hypodermic syringe was introduced to the United States in 1856, and was widely used to deliver morphine in the 1970s in 19, which played a greater role. He wrote: "Although it can't cure anything, it can alleviate any problem." . "Doctors and patients have a tendency to overuse."

According to the survey of Boston pharmacy, opiates accounted for 15% of all prescription drugs in Boston 1888. "From 65438 to 0890, opiates were sold in the unregulated medical market," Caroline Jean Acker wrote in her 2002 book Creating American Addicts: A Study of Addiction in the Age of Classical Anesthesia Control. "Doctors prescribe various indications for them, and pharmacists sell them to people who treat their physical and mental discomfort."

Male doctors turned to morphine to relieve menstrual cramps, "nervous system diseases" and even morning sickness in many female patients. Excessive use leads to addiction. By the end of 19, women accounted for more than 60% of opium users. Dr. Frederic Herman Hubbard wrote in the book Opium Addiction and Alcoholism published by 188 1: "The folds of uterus and ovaries lead to more women's addiction to opium than any other diseases." . However, due to the lack of medical education and other treatments, many doctors are slow to respond to this. Cortright said in a recent interview: "In the19th century, when doctors decided to prescribe tonics or prescriptions for patients, they didn't have much choice." . Financial pressure is also important: the demand for morphine from wealthy patients and the willingness of other doctors and pharmacies to provide anesthesia books.

1895 or so, at the peak of the epidemic, doctors began to slow down and reverse the situation of using opioids in the past. The progress of medicine and public health has played a certain role: it accepted the bacterial theory of diseases, vaccines and X-rays, and introduced new painkillers, such as aspirin, in 1899. The improvement of sanitary conditions means that fewer patients will be infected with dysentery or other gastrointestinal diseases, and then turn to opioids to relieve constipation and pain. Medical teachers and textbooks in the 65438+90' s often issued strong warnings about opium abuse. "By the end of 19, (if) you pick up a medical magazine about morphine addiction," Courtlet said, "you will often encounter such a sentence:' Doctors who use needles too fast are lazy, they lack experience, they lack training and they are behind the times. "The new regulations also played a role: state laws passed between 1895 and 19 15 restricted the effective prescription of opioids to patients, thus ending their supply as over-the-counter drugs."

Because doctors cause fewer patients to become addicted, another kind of users has become the new face of addicts. From 1870s to 19 10s, opium spread in the United States, and China immigrants operated opium shops in most big cities and western towns. According to Dark Paradise, they attract both China migrant workers with contracts and white Americans, especially "urban men, usually new members of the underworld". 1883, a white opium smoker said, "This is a poor town. There are no laundries in China now. Almost every one has its own layout-an opium pipe and accessories. " . Courtright said: "At the end of 19, as long as the most common drug addicts are a sick old lady, morphine or opium users, people will not really be interested in putting them in prison." . He said: "This is a serious problem, a scandal, but it is not a crime."

It changed in 19 10 and 1920. "When a typical drug addict is a young street thug, hanging out with his friends and taking heroin, it is a very different and less sympathetic picture of drug addiction."

The federal efforts to ban opium originated from its neo-colonial ambitions in the Pacific region. At that time, the Philippines was a territory controlled by the United States, and the opium trade there caused great concern. At the urging of American missionaries in Shanghai, President theodore roosevelt convened an international opium mission to meet in Shanghai. Aker wrote in the book "Creating American Addicts": "When the United States lacks national legislation to regulate the opium trade, the ability of American representatives to advocate reform in other places is very poor." Secretary of State Eli Hugan submitted a draft bill to Congress, which would ban the import of opium intended for smoking and impose two years' imprisonment on those who possess opium. "Because China people, gamblers and * * * are all suspected of smoking opium," Courtright wrote, "it is expected that no one will object."

1909 This law passed in February restricted supply and pushed up prices. An addict in new york was interviewed and accepted a study in Ackell's book. He said the price of "a can of beer" soared from $4 to $50. This makes addicts prefer more effective opiates, especially morphine and heroin.

Harrison's anesthesia method 19 14 was originally prescribed as drug opium, and later it almost became a banned drug. President Woodrow Wilson's Treasury used the bill to end the practice of many doctors prescribing opioids to "maintain" addicts' habits. 19 19 After the Supreme Court of the United States approved this legal interpretation, cities all over the country opened anesthesia clinics for drug addicts, which was a pioneer in modern methadone treatment. These clinics are short-lived; The Anesthesiology Department of the Ministry of Finance successfully closed almost all clinics with 192 1. But Courtright, who focuses on long-term maintenance, said that older and sicker addicts, such as Dr. Willis-Butler Clinic in Shreveport, Louisiana, have a good effect. He said: "One of the lessons of the treatment legend in the 20th century is that for some patients, long-term maintenance can be effective, and the effect is very good."

University of north florida history professor Kotley wrote it in 1982, and then updated it in 200 1, including heroin addiction after World War II and the drug war in Reagan era. Since then, he has been thinking about the similarities and differences between the two opium pandemics in the United States, which were separated by 120 years. He said that modern doctors have more treatment options than their counterparts in the19th century, but they have experienced more organized business activities, forcing them to prescribe some new opioid drugs, such as oxycontin. Courtright said: "The wave of drug opium addiction in the19th century is even more accidental." At the end of the 20th century and the beginning of the 20th century, there were more evil commercial factors. "

In 1982, Courtright wrote, "Our view of addiction depends largely on who is addicted." He said that this is correct today. He said: "You can't see many people advocating strict drug policies in the 1980s and imposing minimum sentences for this epidemic," he admitted.

Class and race played a role in it. "Many new drug addicts are white Americans in small towns: football players with knee injuries in high school or college, and elderly people with various chronic degenerative diseases." Contrary to the trend of 100 years ago, with the spread of drug abuse by the middle class, drug policy has become less punitive.

Courtright said that now, the country may be moving towards a more sensible policy, combining drug control with treatment and preventive education. He said: "An effective drug policy includes reducing supply and reducing demand." If you can make supply more difficult and expensive, and at the same time treat people as needed, this is a good strategy. " "