A History of Drug Abuse and Addiction in the U.S. Sue Rusche, Co-director Addiction Studies Program

1. A History of Drug Abuse and Addiction in the U.S. Sue Rusche, Co-director Addiction Studies Program

2. History of addictive drugs in the U.S. • Marked by a recurring pattern • Widespread use • Problems develop • Reform/Laws

4. 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

6. 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

7. Alcohol: Cycle 2 • Widespread use • Prohibition repealed 1933 • Use highest by 1980 after period when states lowered drinking age to 18 • Problems develop • Highest ever rates of drunk-driving deaths, especially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

9. 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

11. 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

13. 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

14. 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

15. Put in perspective. . . • Anesthetics not developed until 1840s • Modern pharmaceuticals, medical procedures developed even later

16. Pre-1840s “anesthetics” • Got patients very drunk • Knocked them out with blows to the head • Hired several large men to hold them down

17. Advances in chemistry, technology: • Morphine isolated from opium (early 1800s) • Cocaine extracted from coca leaf (mid-1800s) •Hypodermic needle invented (mid-1800s)

18. 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

24. Opiate addiction spread, cont. • Medical use to “cure” addiction Denarco, Opacura • Non-medical administration Opium smoking, eating

26. U.S. importation of crude opium quadrupled in last half of 19th century

27. Patent medicines also contained other addictive drugs

32. Absence of regulation • No labeling requirements • People unaware of what they were taking • Addiction spread

33. No requirements for safety, efficacy • Anyone could produce, sell “medicines” • Unsafe • Ineffective • Made curative claims without benefit of scientific proof

39. By early 1900s, medical consensus developed: • Opiates, other drugs overly prescribed • Sold to unsuspecting customers & produced addiction • Worthless patent “medicines” being sold • Controls needed

40. Public pressure for controls mounts • States pass laws to • Control opiates, cocaine, other addictive drugs • End sale of worthless “medicines”

41. 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

42. 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

43. High levels of alcohol use, problems in 1800s • Similar effort to control alcohol • States passed prohibition laws • 1851-1865

44. 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

45. Volstead Act (1919) • Codified 18th Amendment to U.S. Constitution (Prohibition) • Results: • Lowest levels of alcohol consumption • Lowest levels of cirrhosis deaths

46. 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

47. Nicotine: addictive drug that escaped control until today • Tourists introduced cigarettes from Europe in 1850s • Once introduced, use spread

48. Government taxed cigarettes • To raise money for Civil War • Mass production & mass marketing led to enormous growth in production and sales

49. # Cigarettes produced(in thousands)

50. First scientific study linked cigarettes, lung cancer -- 1937 • By 1960s, conclusive evidence that smoking causes • Lung cancer • Heart disease • Emphysema • Many other cancers