It’s an early winter morning in Boston, the air so cold it stings the eyes. Between the high-rise towers of a sprawling medical center, this stretch of Massachusetts Avenue buzzes with the uneasy agitation befitting its nickname: “Methadone Mile.”
Lines of agitated patients queue up for a treacly shot of the stuff at one of three clinics, hoping to quash the pangs of addiction. But around them, the streets are strewn with needles—so many that the city’s Mobile Sharps Collection Team, which is responsible for their disposal, has all but given up. It’s not hard to find a user cooking, selling, or shooting up heroin in the open—or bodies slumped on sidewalks.
Heroin has hit the United States hard. Donald Trump’s declaration of a national opioid emergency last October was only a confirmation of what countless Americans have known first-hand for years. Big cities like Boston, alongside towns across rural America, have seen men and women of every background overdose and die in unprecedented number—from heroin and painkillers like Oxycontin, to powerful synthetic opioids like Fentanyl.
Yet, as Americans struggle to make sense of a public health emergency that can only be likened to the AIDS crisis of the 80s—and lobby for something better than President Trump’s toothless declaration, offered without any new funding or programs—we’re also trying to figure out how we got here. It’s too easy to see pills and powders as substances separate from the global processes that produce them, and American pharmaceutical companies have seen the value of keeping production shrouded in secrecy. But pulling back the curtain—as I’ve tried to do in my current research—helps us demystify substances, and the crises they create. Addiction may be biological and sociological, but it is also economic, with particular epidemics emerging from particular trade arrangements.
At Methadone Mile, the cheap bags of heroin lead across the border, to poppy fields and clandestine factories in Mexico’s Sinaloa and Guerrero states. The industrial strength synthetic stuff like carfentanil—originally used to tranquilize elephants—gets shipped from China in padded envelopes. But it’s Big Pharma’s pastel pills that got Americans hooked, and those pills still burst with Indian alkaloids.
The story of India’s role in America’s opium addiction is one of colonialism, geopolitics, and vested business interests—with deep repercussions for both countries. First, a quick chemistry refresher, and then the history lesson.
To make an opioid drug, you need opium (unless it’s synthetic, but more on that later). Dried-out poppy straw will do, but either way, you need big fields of Papaver somniferum. Lance the green pods and cook the sticky gum one way, and you’ve got heroin. But try another recipe, and you’ve got morphine, codeine, or thebaine—the chemical bases you can refine even further into heady painkillers.
Two centuries ago, the British started shipping the gum they made in northern India across the Himalayas. Two wars followed, and a quarter of all Chinese men found themselves unable to quit the stuff. A handful of Indian merchants got rich through smuggling, but mostly it was their colonial masters who reaped the monetary rewards. Americans were developing a taste for opium, too, particularly after Civil War veterans returned home with morphine to dull the pain of battle scars. Yet their drugs came from German companies like Merck, which bought their opium from Turkish merchants instead of Indian ones.
At the turn of the 20th century, missionaries and reformers shamed Britain out of its role as history’s worst drug dealer. The Indian alkaloid factories in Ghazipur and Neemuch were mothballed, and only the “quasi-medical” industry remained. But when the Second World War broke out, American drug companies like Merck, Mallinckrodt, and Penick worried that their purchases of Turkish opium would be endangered. Executives figured Indian opium might do in a pinch.
In the middle decades of the 20th century, Indian opium was just a workable, last-ditch resort. Its morphine content seemed too low, and India’s manufacturing techniques were no match for Turkey’s. Then came the War on Drugs.
In 1970, then-president Richard Nixon, set his sights on Turkish poppy farmers. It was the United States’ first real brush with heroin, and it was clear that the good stuff came from Anatolian fields. Turkish peasants sold some of their legal crop underground, and Corsican gangsters cooked it into smack in the port of Marseille. (The CIA helped cover things up, but that’s a different story.) Turkish heroin made its way from France to the States, and then into American spoons, needles, and veins.
Back to President Nixon, who used the full force of the American diplomatic corps to force the Turkish dictatorship into ending the legal Turkish poppy trade. The effect on the heroin trade was negligible. But within a few years, the codeine coffers had dried up, and American doctors were panicking at the prospect of a cough syrup shortage. Indian opium suddenly wasn’t looking so bad.
Before long, the old factories were churning back to life. Wolfish American manufacturers liked the high codeine content of Indian opium, and bean-counting American legislators liked that Indian bureaucrats controlled the whole production process from planting to export.
At the beginning of the 1980s, the whole operation got baked into American law. The Drug Enforcement Agency—whose predecessor, the Bureau of Narcotics and Dangerous Drugs, had set up shop in Delhi in 1973—worked to pass a piece of legislation called the “80/20 rule.” Eighty percent of opium the opium and poppy straw that United States companies imported, it declared, had to come from one of the two “traditional suppliers,” India or Turkey. (Turkey got back in on the action, reversing their poppy ban in 1974.)
The law frustrated Australia, which had started growing poppies on Tasmania with industrial efficiency, hawking top-shelf poppy straw at bargain basement prices. But according to my research into classified shipping records, American manufacturers had gotten used to the Indian stuff.
Doctors feared that their painkiller stocks would dwindle in the 1980s. Instead, they had too much. American physicians began prescribing powerful opioids for patients to use at home, not just during hospital stays. Within a decade, they’d be diagnosing pain everywhere, and American citizens would start getting hooked. (The law of the instrument: when all you have is a painkiller, everything starts looking like a backache.)
By the time everyone realized what was happening, and began to suspect that American drug companies had knowingly helped turned patients into addicts, treatment centers were big business, and the bodies were already piling up. And when legislators started clamping down on legal painkillers, determined users started turning to cheap heroin from Mexico, and powerful synthetic opioids from China.
Things didn’t look much brighter in India. When the Americans had too much Indian opium and bought less, there was a glut of product with nowhere to go. Indian pushers quickly figured out what to do. The first big heroin busts hit Delhi at the beginning of the 80s—Indian dealers first, and then the ambitious Frenchmen, Britons, Canadians, and Australians nabbed at Palam Airport.
Smuggling makes less sense where there’s good poppy grown right down the road.
Manufacturers’ signature markings on the bags led investigators to laboratories in Varanasi, and from there to places like Mandsaur district, home to sprawling poppy fields supposedly marked for the legal market. To this day, Indian officials insist that hungry addicts in Ludhiana and Amritsar are hooked on goods that come from across the border—but smuggling makes less sense where there’s good poppy grown right down the road. Meanwhile, India’s outdated narcotics law (passed under pressure from the USA) and lack of training in palliative care mean that while an illegal drug trade flourishes, medical patients are unable to get the painkillers they need.
Prime Minister Narendra Modi implores the world to “make in India,” dreaming of medical devices and aerospace components. But India’s been making good stuff for a long time: the chintz and calico that gave Europeans their first taste of real fashion, the teapots over which Americans plotted their independence, the indigo that suited armies the world over, the jute which made tough gunny sacks, and even the manhole covers sealing American sewers. And Indian poppies, transformed into pills, helped manufacture American pain, as well as a crisis at home.
Understanding how pharmaceutical companies and American regulators use Indian poppies may not clean up Methadone Mile or Punjab’s villages—but it might point to a way beyond the bodies and the blight.
Benjamin Siegel is assistant professor of history at Boston University.