A History of Drug Abuse and Addiction in the U.S.

Sue Rusche, Co-director

Addiction Studies Program

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• Widespread use– Prohibition repealed 1933– Use highest by 1980 after period when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

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

century

Patent medicines also contained other addictive

drugs

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

Drug deaths per year

20,000

100,000

430,700

Illicit Drugs Alcohol Tobacco

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

Used Illegal Drugs

No Use

America’s 8th

Grade Students

22%

SmokedCigarettes

No Use

America’s 8th

Grade Students

28%

Used Alcohol

No Use

America’s 8th

Grade Students

44%

Used Illegal Drugs

No Use

America’s 12th

Grade Students

51%

Smoked Cigarettes

No Use

America’s 12th

Grade Students

53%

Used Alcohol

No Use

America’s 12th

Grade Students

77%

Cost of substance abuse

• Of all preventable health problems, substance abuse causes:– More deaths– More illnesses– More disabilities

Economic cost of alcohol $166.5 billion

$46

$21

$12 $11$9

Illness Deaths Medical Other Crime

Economic cost of smoking $138 billion

$58

$36

$6

Medical Deaths I llness

Economic cost of drug abuse $109.9 billion

$46

$21

$12 $11

Crime Illness Deaths Medical

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

This new knowledge is the subject of our workshop

for the next two days.

(Continue)

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.