Question 2: What is the history of opioid addiction in the United States?

Answer: Opioid addiction in the United States can be documented in three broad time periods:

• 1860-1910
• 1910-1950
• 1950-Present

1860-1910
Although opioids have been used as pain medications and antianxiety drugs throughout recorded history, it was not until the U.S. Civil War of 1861-1865 that widespread prevalence of opioid addiction was documented in the United States (Hentoff, 1965). The synthesis of heroin in 1874 and its commercial marketing as a "wonder drug" contributed to a pattern of iatrogenic addiction that continued into the early 1900s, with physicians, pharmacists, and patent medicine salesmen dispensing narcotics freely to patients who were primarily middle-aged, middle-class women (Courtwright, 1992; United Nations Department of Social Affairs, 1953; Acker, 2002). The Institute of Medicine estimated that by 1900, perhaps 300,000 Americans were addicted to opiates (Courtwright, 1992).

1910-1950
Between 1910 and 1950, opioid addiction was rarely prevalent among U.S. patients inadvertently addicted to a medical cure. The Institute of Medicine describes how successive waves of immigration and urbanization contributed to a population of opioid abusers who were in their teens or early 20s, unmarried, poor, primarily male, ethnic minorities who experimented with drugs for nonmedical purposes (Courtwright, 1992).

1950-Present
Intravenous use of heroin intensified in the United States after WWII, reaching epidemic proportions in urban centers during the 1950s and 1960s (Joseph, Stancliff, and Langrod, 2000). In 1967, the National Survey on Drug Use and Health (NSDUH) began collecting data on heroin use. The survey documents dramatic increases in the initiation of heroin use during the early 1970s and between 1995 and 2002 (Substance Abuse and Mental Health Services Administration, 2005), when the annual number of new heroin users ranged from 121,000 to 164,000. The National Institute on Drug Abuse (NIDA) reports that, during this period, most new users were age 18 or older (on average, 75 percent) and most were male (National Institute on Drug Abuse, 2005a). The 2003 NSDUH found that an estimated 3.7 million Americans had used heroin at some time in their lives and 314,000 in the past year. The group that represented the highest number of those users was age 26 or older (National Institute on Drug Abuse, 2005a). NIDA also reports that heroin use in 2003 was stable at low levels (National Institute on Drug Abuse, 2005b).

References

Acker CJ. Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control. Baltimore, MD: Johns Hopkins University Press, 2002.

Courtwright D. A century of American narcotic policy. In: Institute of Medicine. Treating Drug Problems: Volume 2. Washington, DC: IOM, 1992, pp. 1-62. Available online at: books.nap.edu/openbook.php?isbn=0309043964. [Accessed March 23, 2006.]

Hentoff N. The treatment of patients - I. The New Yorker 1965;June 26:32-77.

Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. The Mount Sinai Journal of Medicine 2000;67(5 & 6):347-64. Available online at: www.mssm.edu/msjournal/67/6756.shtml. [Accessed March 23, 2006.]

National Institute on Drug Abuse. Research Report Series: Heroin Abuse and Addiction. Bethesda, MD: NIDA, 2005a. Available online at: www.drugabuse.gov/ResearchReports/Heroin/Heroin.html. [Accessed March 26, 2006.]

National Institute on Drug Abuse. NIDA Info Facts: Heroin. Bethesda, MD: NIDA, 2005b. Available online at: www.drugabuse.gov/infofacts/heroin.html. [Accessed March 26, 2006.]

Substance Abuse and Mental Health Services Administration. Table 4.4A Numbers (in Thousands) of Persons Who Initiated Heroin Use in the United States, Their Mean Age at First Use, and Rates of First Use (per 1,000 Person-Years of Exposure): 1965-2003, Based on 2002-2004 NSDUHs. Results From the 2004 National Survey on Drug Use and Health, Detailed Tables. Rockville, MD: SAMHSA Office of Applied Statistics, 2005. Available online at: www.oas.samhsa.gov/nsduh/2k4nsduh/2k4tabs/Sect4peTabs1to15.pdf. [Accessed March 26, 2006.]

United Nations Department of Social Affairs. History of heroin. Bulletin on Narcotics 1953;V(2):3-16. Available online at: www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1955-01-01_1_page011.html. [Accessed March 22, 2006.]