a history of drug abuse and addiction in the u.s. sue rusche, co-director addiction studies program
TRANSCRIPT
History of addictive drugs in the U.S.
• Marked by a recurring pattern– Widespread use– Problems develop– Reform/Laws
Opiates
• Widespread use in 19th century– Primarily middle-, upper-middle-income
women, Civil War soldiers• Problems develop
– Highest levels of opiate addiction in history
• Reform/Laws– Passed in states– Lead to Harrison Narcotics Act of 1914
Alcohol: Cycle 1
• Widespread use 19th, early 20th century– Primarily men, all income levels
• Problems develop– Addiction– Breakup of families, other social problems
• Reform/laws – Passed in states– Lead to Prohibition
Alcohol: Cycle 2
• Widespread use– Prohibition repealed 1933– Use highest by 1980 after period when
states lowered drinking age to 18• Problems develop
– Highest ever rates of drunk-driving deaths, especially among adolescents
– 100,000 deaths per year• Reform/laws
– States raise drinking-age to 21– Pass anti-drunk driving laws
Cigarettes/Tobacco
• Widespread use – 0 cigarettes per person/1860– 4,345 cigarettes per person/1963
• Problems develop– Up to 500,000 deaths per year
• Reform/laws– Local anti-smoking laws in public places– State lawsuits result in Tobacco Settlement
Act
Medicines: Cycle 1
• Widespread use – Little understanding of disease– Only medicines were potions, elixirs
• Problems develop– Most medicines either worthless or
harmful• Reform/laws
– Public concern leads to Pure Food & Drug Act 1906
Medicines: Cycle 2
• Widespread use – Dietary Supplement Health and Education
Act of 1994– Dietary supplements exempt from FDA
control
• Problems develop– i.e. Ephedrine
• Reform/laws– Under consideration
Impossible to talk about medicines without talking about addictive
drugs• Addictive drugs have been used as
medicines throughout history– Opium and heroin– Cocaine– Cannabis– Alcohol
Put in perspective. . .
• Anesthetics not developed until 1840s
• Modern pharmaceuticals, medical procedures developed even later
Pre-1840s “anesthetics”
• Got patients very drunk• Knocked them out with blows to the
head• Hired several large men to hold them
down
Advances in chemistry, technology:
• Morphine isolated from opium (early 1800s)
• Cocaine extracted from coca leaf (mid-1800s)
• Hypodermic needle invented(mid-1800s)
Opiate addiction spread in last half of 19th century
via:• Medical administration
Doctors gave morphine to relieve symptoms, treat gynecological problems and “nervousness” in women who could afford doctors
• Civil War Doctors gave morphine to treat Civil War injuries
• Self-administration via patent medicines
Opiate addiction spread, cont.
• Medical use to “cure” addictionDenarco, Opacura
• Non-medical administration Opium smoking, eating
Absence of regulation
• No labeling requirements • People unaware of what they were
taking• Addiction spread
No requirements for safety, efficacy
• Anyone could produce, sell “medicines” – Unsafe– Ineffective– Made curative claims without benefit
of scientific proof
By early 1900s, medical consensus
developed:
• Opiates, other drugs overly prescribed• Sold to unsuspecting customers &
produced addiction• Worthless patent “medicines” being
sold • Controls needed
Public pressure for controls mounts
• States pass laws to
– Control opiates, cocaine, other addictive drugs
– End sale of worthless “medicines”
Federal Pure Food and Drug Act of 1906
(& subsequent amendments)
• Food, drugs pure• Contents labeled• Drugs must be safe and effective• Food and Drug Administration
Harrison Act of 1914(& subsequent laws)
• First law to control opiates, cocaine, other drugs
• Subsequent laws attempt to balance– Use in medicine with potential for abuse
• Marijuana Tax Act of 1937– Adds cannabis
High levels of alcohol use, problems in 1800s
• Similar effort to control alcohol
– States passed prohibition laws– 1851-1865
US Internal Revenue Act of 1862
• Taxed alcohol to raise money for Civil War
– Raised up to half of U.S. internal revenue between 1870 and 1915
Volstead Act (1919)
• Codified 18th Amendment to U.S. Constitution (Prohibition)
• Results: – Lowest levels of alcohol consumption – Lowest levels of cirrhosis deaths
Support diminished as
• Illegal supplies increased• Wood alcohol poisoning deaths
increased• Business leaders believed alcohol tax
would replace personal, corporate income tax
• U.S. repeals Prohibition in 1933
Nicotine: addictive drug that escaped control
until today• Tourists introduced cigarettes from
Europe in 1850s
• Once introduced, use spread
Government taxed cigarettes
• To raise money for Civil War
• Mass production & mass marketing led to enormous growth in production and sales
# Cigarettes produced(in thousands)
0 2,500,000
119,300,000
369,800,000
536,500,000
631,500,000
525,000,000
1860 1900 1930 1950 1970 1980 1990
First scientific study linked cigarettes, lung cancer --
1937
• By 1960s, conclusive evidence that smoking causes– Lung cancer – Heart disease – Emphysema – Many other cancers
After passage of FDA laws, drug control laws
• Nation settled into a long period of relatively little drug use
• Illicit drug use in 1962:– Less than 2 percent all ages– Less than 1 percent adolescents
1960s social protests, Vietnam War
• Drug use rose to highest levels ever. By 1979:
– 25 million Americans used drugs regularly
– One-third of adolescents, 70 percent of young adults, 65 percent of high school seniors had tried an illicit drug
Past month drug use, 2004
(in millions)
19
70
121
0
20
40
60
80
100
120
140
I llicit Drugs Tobacco Alcohol
Past-month drug use, high school seniors
1
30.7
34.2
37.638.938.9
37.236.9
32.530.5
29.229.7
27.1
24.7
21.319.7
17.216.414.4
18.3
21.923.824.6
26.225.625.924.925.725.4
24.123.4
0
5
10
15
20
25
30
35
40
45
Cost of substance abuse
• Of all preventable health problems, substance abuse causes:– More deaths– More illnesses– More disabilities
Rising drug use in 60s, 70s & development of new
technologies
• Spurred scientific investigation of drug abuse and addiction
Discovery of endogenous opioids in the brain
(early 1970s)
• Explosion of scientific knowledge– How the brain works – How drugs act on the brain
• Led to understanding– How people become addicted– Why it is so hard to recover
Drug abuse, addiction
• Result from a combination of factors
– Behavioral/biological– Genetic– Social/environmental
For more information:
1. An explanation of the
Food and Drug Administration’s
New Drug Approval Process
http://www.fda.gov/fdac/features/2002/402_drug.
html
For more information:
2. History of the
Food and Drug Administrationhttp://www.fda.gov/oc/history/default.htm
http://www.cfsan.fda.gov/~lrd/history2.html
For more information:
3. U.S. Controlled Substances
Act
http://www.dea.gov/pubs/csa.html
http://www.dea.gov/pubs/scheduling.html
Bibliography
• Austin, Gregory. Perspectives on the History of Psychoactive Substance Abuse: Research Issues 24. 1978, National Institute on Drug Abuse, Rockville, Maryland.
• Musto, David. The American Disease: Origins of Narcotic Control. 1999, Oxford University Press, Oxford, England.
• Friedman, David and Rusche, Sue. False Messengers: How Addictive Drugs Change the Brain. 1999, Harwood Academic Publishers, Amsterdam, The Netherlands.
• Brandeis University. Substance Abuse: The Nation’s Number One Health Problem. 2001, The Robert Wood Johnson Foundation, Princeton, New Jersey.
• Courtwright, David T. Dark Paradise: A History of Opiate Addiction in America. 2001, Harvard University Press, Cambridge, Massachusetts.