America Has Been Through An Opioid Crisis Before

America’s first opioid crisis came after its bloodiest war, but the lessons of the original debacle have been lost in history.
April 9, 2021, 3:34pm
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Dr. John J. Craven, medical director of the Department of the South and the physician who later attended Jefferson Davis, performs an operation during the 1863 siege of Charleston. The doctor appears to be applying a splint to the leg of a patient while a man behind him seems to be holding a white cotton cloth, likely soaked in chloroform, over the patient's mouth and face. | Location: Morris Island, South Carolina, Confederate States of America. (Photo by Corbis via Getty Images)

According to most accounts, America’s opioid crisis dates back to the late 1990s. That’s when predatory Big Pharma companies like Purdue Pharma lied to doctors, falsely claiming that opioid painkillers like Oxycontin and Opana were safe and non-addictive. Prescriptions for addictive opioids skyrocketed during the 2000s, sparking an epidemic of drug addiction that quickly spiraled out of control. 

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But while this narrative might be convenient, it isn’t the full story, because, devastating though it is, this is not America’s first opioid crisis. Its roots go far deeper. America’s earliest opioid crisis occurred 150 years ago, in the aftermath of the American Civil War, when an epidemic of prescription opioid addiction killed tens of thousands of Army veterans.  

Tragically, America’s vintage opioid addiction epidemic shares surprising and disturbing parallels with today’s opioid crisis, calling into question the familiar stories we tell ourselves about how the opioid crisis began and what it will take to solve the epidemic. 

Doctors have been prescribing opiate painkillers since the Bronze Age, and by the time the Civil War broke out in 1861, opiates were the most commonly prescribed medicines in America. 

During and after America’s bloodiest war, in which 750,000 people were killed with millions of survivors left in chronic pain, Army doctors saw opiate medicines as the most “indispensable drug[s] on the battlefield—important to the surgeon, as gunpowder to the ordinance.” Syringe-wielding surgeons gave morphine injections—cutting-edge technology back then—to dull the unbearable pain stemming from gruesome gunshot wounds and last-ditch, hacksaw amputations.

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Doctors doled out opium pills and morphine shots for practically any ailment. Off the battlefield, opium was a surprisingly effective treatment for diarrheal diseases like dysentery, which often hit troops living in squalid conditions. 

Doctors doled out opium pills and morphine shots for practically any ailment.

Naturally, thousands of Civil War veterans got addicted to opiates. Like today, most addiction started with prescriptions. Military doctors introduced soldiers to opium and morphine during the war, and sick and injured survivors simply kept on taking the medicines after leaving the Army. Like today, doctors didn’t prescribe opiate painkillers equitably to white and Black soldiers. Some racist doctors believed their Black patients couldn’t feel pain and didn’t need painkillers, while other surgeons took for themselves the painkillers that were meant for injured black soldiers. Consequently, most Civil War veterans who got addicted were white, a product of the shoddy medical care provided for Black troops.

One surgeon was booted from the U.S. Army in 1864 for abusing opium that was earmarked for the wounded Black soldiers under his care. .jpeg

There were no regulations on narcotics during the Civil War era, so the drugs were cheap and easy to get. Opium pills, morphine, and hypodermic needle kits were sold in pharmacies over the counter. You could even order them by mail from Sears. Unsurprisingly, addicted veterans were everywhere in post-Civil War America, and the opioid crisis was covered widely in the press.

But those who got addicted quickly turned in the public eye from respectable war veterans to something lesser, being derisively labeled “opium eaters,” “morphine habitués,” and “opiomaniacs” by doctors and the media. Having fought a war over the fate of slavery, Civil War veterans referred to themselves as “opium slaves.” One Union veteran, Joseph C. Darrow of Michigan, wrote that he was prescribed opium after getting sick during the war. In no time, he found himself “a slave to the Habit of using Morphine, with not a ray of hope of ever being emancipated.” 

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The outlook for addicted Civil War veterans was bleak. Thousands of ex-soldiers died from overdoses between the war’s end and the early 1900s. Like today, when addicted veterans overdosed, their families and communities were devastated. One teenage soldier, Frank Clewell, left his family in North Carolina to fight in the Civil War. He ended up sitting out much of the war in a POW camp, where he apparently got sick and started taking morphine. Clewell got released when the war ended, but before he could make it home, he died of a midnight drug overdose, alone in a chilly St. Louis hotel room. Clewell’s friends were shocked to discover his corpse the next day, and the death made national headlines. 

Between the 1860s and 1890s, hundreds of medical “inebriety” clinics catering to opioid addicts opened around the country offering addiction care.

Opium and morphine abuse were so common among Civil War veterans that addiction rippled through all facets of postwar American medicine and society. Addiction medicine became big business for the first time in American history, as veterans were desperate for addiction treatments. Between the 1860s and 1890s, hundreds of medical “inebriety” clinics catering to opioid addicts opened around the country offering addiction care. These were America’s earliest drug rehabs. 

But like today’s rehabs, these early clinics were expensive, unreliable, and out of reach for most Americans. The medical care provided at the early rehabs wasn’t very effective, either. Today, the gold standard for addiction therapy, medication-assisted treatment, relies on medicines such as methadone and buprenorphine. But this treatment wasn’t developed until the 1960s, a century after the Civil War. Instead, the methods used to treat Civil War veterans in early rehabs were primitive, usually involving slow, agonizing detox under doctors’ supervision. The idea was to gradually taper down the patient’s usual dose of morphine or opium over a few weeks. Once patients detoxed, they could go back home and get on with their lives.

Advertisement for a Civil War-era drug rehab in Louisville, Kentucky.

This method sounds doable  on paper, but it only worked some of the time. Opioid addiction causes powerful cravings that can potentially strike any time, even years after detox and into recovery. These cravings were so powerful that, without methadone or buprenorphine, relapses were common.

When veterans relapsed and started taking opioids again, they were shamed  and denounced in the media. Any drug addict who relapsed, according to one newspaper, was a sinner who simply “did not wish to be cured.” 

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This unsympathetic mentality influenced the government’s approach to the postwar addiction crisis. Grover Cleveland, president during the 1880s and ‘90s, thought addicted veterans—even those who had been war heroes—were simply bad people, and he went out of his way to punish them and their families. 

When a Union veteran, Clinton Smith, fatally overdosed in 1888, his widow Eliza applied for a military pension, like most women in the same situation. The government paid out millions of dollars in pensions every year to the wives of dead Civil War soldiers. But Cleveland thought those who were addicted and their widows didn’t deserve these benefits. He refused to grant the pension to Eliza because her dead husband “was in the habit of taking large doses of morphine.” Cleveland’s condescending , punitive mindset was the norm in the Civil War era, and, according to contemporary media coverage, most Americans agreed that addicted drug users did not deserve sympathy or government help.

The victim-blaming that emerged out of the Civil War era has influenced U.S. drug policy for more than a century. In 2017, an Ohio sheriff made headlines for refusing to let his deputies carry the overdose reversal medicine Narcan. “I’m not the one that decides if people live or die. They decide that when they stick that needle in their arm,” the sheriff explained, echoing President Cleveland’s harsh words from the 1880s. Anti-addiction rhetoric born in the Civil War era is still with us today, as strong as ever. 

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The stigma surrounding opiate use meant that addicted Civil War veterans often landed in jails and even mental institutions. Brutal prison wardens had no sympathy, abusing prisoners with drug addictions by forcing them into cold turkey withdrawal. One veteran, Cyrus Harmon, got addicted to morphine to deaden the pain of a half-healed Civil War gunshot injury. Harmon was arrested in Ohio in 1901 and sent to the state penitentiary, where the warden confiscated his morphine. When Harmon entered detox, the warden denied medical assistance, leaving the elderly veteran writhing in agony on the floor of his cell until he seized to death a few hours later. Harmon’s old Army buddies were livid, and they protested his death at the state capital. Today, over a century later, some American jails still refuse to provide medication-assisted therapy to addicted inmates.  

Considering their bleak prospects, most addicted Civil War veterans were desperate to stop using drugs. Like today, however, reputable medical care in rehabs was out of reach for most. So they tried anything, leaving the door open for predatory medical hucksters who invented bogus miracle cures for addiction. These so-called opium “antidotes,” which promised to cure addiction in the privacy of customers’ homes, were pervasive. Newspapers and magazines from the 1870s and ‘80s were loaded with advertisements for these antidotes. People suspected of being “addicts” even received unsolicited postcards—the Gilded Age version of spam emails—hawking these potions. 

Postcard advertising a popular Civil War-era addiction “cure.” Courtesy of Boston Museum of Fine Arts.

Predictably, these miracle cures were too good to be true. Desperate consumers didn’t realize it, but Civil War-era addiction antidotes actually contained opiates. Antidote peddlers promised that their “cures” relied on non-opiate active ingredients, but they lied. So instead of curing addiction, the fake cures actually prolonged it, unbeknown to the customers who shelled out thousands of dollars on the expensive products, only to be left in poverty and still addicted. In an era before the FDA or robust consumer protection laws, there was no check on medical scam artists, who made fortunes profiting on Civil War veterans’ addiction. Today, a new wave of miracle cures falsely promise to cure opioid addiction, evoking Civil War-era opium antidote scams. Dangerous, expensive detox schemes, like the Church of Scientology’s Narconon and Purif and unproven plant-based substances like ibogaine and kratom claim to cure opioid addiction. But customers often end up even worse off than before, just like Civil War veterans who shelled out for opium antidotes.

Doctors never managed to solve the Civil War’s opioid crisis. The tragedy only ended when addicted veterans died off slowly over time. Most veterans never managed to escape addiction, and swallowing opium pills and injecting morphine year-after-year took a major toll on veterans’ bodies and health. The injections left men emaciated, weak, and prone to life-threatening infections. “Morphinists” were notorious for sporting infected skin abscesses caused by dirty needles. (This was before the “germ theory of disease” was widely known, so most people didn’t recognize the need to use clean needles). Decades before the development of modern antibiotics in the 1940s, these infections could be fatal. Eventually, enough addicted Civil War veterans got sick and died or fatally overdosed that ex-soldiers faded from view. 

Engraving of a Civil War-era morphine user, documenting the abscesses that resulted from re-using dirty needles before “the germ theory of disease” became popular

Engraving of a Civil War-era morphine user, documenting the abscesses that resulted from re-using dirty needles before “the germ theory of disease” became popular

During the early 1900s, Civil War veterans were replaced by other cohorts of drug-users. The pharmaceutical company Bayer introduced heroin around 1900, marketing  the drug as a cough medicine. Heroin  was more than double the strength of morphine, so it quickly became popular among younger Americans who preferred  heroin over less-potent opiates . Soon heroin users began catching the attention of cops in big cities like New York and Philadelphia. About the same time, xenophobes cited opium smoking among some Chinese immigrants—in reality a small problem, compared to medicinal opiate abuse among whites—to justify racist anti-immigration laws, sparking  a news panic over the issue. The racist belief that Chinese opium dens snared white people into addiction also inspired some of the nation’s first drug laws in the 1870s and ‘80s, which were aimed more at upholding racial segregation than actually stamping out opiate use. After the U.S. invaded and colonized the Philippines in 1898, it banned the opium trade, doubling down on racist drug laws and keeping the issue in the news cycle. Eventually, heroin users and opium smokers replaced aging Civil War veterans as the stereotypical American drug addict. By the 1910s, a national panic over heroin abuse and opium smoking sparked the U.S.’s first heavy-handed drug laws. By that point, people began to forget about America’s Civil War-era opioid crisis. 

But forgetting about America’s first opioid crisis helped spark today’s epidemic. Just like after the Civil War, today’s opioid crisis stemmed in part from doctors’ careless overprescribing. Similarly, the lack of effective regulations on the medical marketplace allowed for rampant fraud in addiction medicine, both in the late 1800s and today. In Civil War America, the stigmatization of drug addiction, pervasive victim-blaming, and the jailing of addicted people, proved totally ineffective solutions. These responses only made the post-Civil War addiction epidemic worse.

If American doctors and drug policy makers had taken a hard look at Civil War America’s opioid crisis, they might have learned the lessons this dark history has to offer. Maybe the U.S. could have avoided the tragedy of today’s opioid crisis. Instead, Americans forgot about the U.S.’s first opioid crisis, and we ended up repeating it 150 years later.