The Opioid Epidemic is over 150 Years Old
After the death of her father, a prominent hotel owner in Vancouver, Ella Henderson, started taking morphine to ease her grief. She was 33 years old, educated and intelligent, and she frequented the upper reaches of Vancouver 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 stories I read in the paper every day. 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 North Americans who lost their lives to addiction between the 1870’s and the 1920’s.
The late 19th century opiate epidemic was nearly identical to the one spreading across our country today. 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 issues related to mental illness, colonies of junkies began to appear.
Most started out like Ella Henderson, who suffered from emotional trauma and chronic pain, for which she was prescribed huge amounts of morphine. She became addicted, was abandoned by the medical community and her friends and neighbors and ultimately overdosed alone in her room. Her case mirrors the thousands of fentanyl and heroin overdoses that have made our political leaders declare a public health emergency.
Many laws were enacted by provincial governments between 1906 and 1914 but of course that did not make addiction go away. It simply pushed it underground during the 1930’s and 40’s. Widespread abuse re-emerged in the late 1950’s and lasted through the 1970’s, although in a less severe form than it had in the 19th century. This time the answer to the epidemic was a flurry of federal laws 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 our turbulent relationship with drugs.
In response to a limited legal supply, heroin, cocaine and morphine continued to be the drugs of choice in the black-market economy 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, our cities suffered from a crack-cocaine epidemic that, as it slowly diminished, 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 Canadians 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 problem for us.
First, we must hold doctors accountable—with fines and possible jail sentences—for overprescribing habit-forming drugs in the interests of profits. That was one of the immediate steps taken in the wake of stories like Henderson’s and it quickly showed results.
We must also understand that until we have a national pharmacare system for all Canadians, not just seniors and people on welfare, the incentive to sell potent drugs to addicts will always exist. The health care industry was largely unregulated in the 19th century; “buyer beware” applied to quack cures as well as medical advice and at first there was nothing the government could do to prevent doctors from overprescribing morphine.
Eventually legislators stepped in with regulations on morphine and other prescription products. And even though the health care industry is no longer the Wild West, we have lost our appreciation of the power of regulations to stop epidemics. The pharmaceutical industry has a lot of clout in Ottawa.
There are also lessons that need to be unlearned. While physicians and politicians of the late 19th century made significant progress in halting the worst features of the opioid epidemic, they tended to overreact when it came to magnitude 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, blacks, Mexicans, teenagers, musicians—anyone who, according to stereotypes, was among the typical abusers. Today we do exactly the same thing and it is so wrong.
They also allowed the the campaign against opium to justify a general attack on all drugs, even those that present a much lower risk to the public health. We are finally rolling back our 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 frustrating; even heartbreaking. But we have tackled this problem before and we have won before so we should be optimistic.
The difficult part is developing the will to confront the powerful interests that drive overprescription on one hand and over criminalization on the other hand. We need politicians willing to impose new laws and to regulate the pharmaceutical and medical marketplace in a far more disciplined way. In British Columbia, the legislature is suing Purdue Frederick, possibly the worst offending Drug Company in the opioid epidemic.
Putting drug addicts into jail not only wastes their lives but gives growth to a huge industry of policing and incarceration while allowing drug czars to be one of the principle suppliers of opioids. It’s time to legalize all addicting drugs and you will find my arguments for this in the next article.
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