Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a history PhD student at Southern Illinois University. Enjoy!
Historians aren’t the first people national publications go for hot-takes. That may be a good thing. But I’ve always been in the camp that says historians should be more active outside of academia. So, I’ve been encouraged by publications like The New York Times and Washington Post reaching out to historians, asking them to analyze the opioid epidemic in its historical context. On the other hand, it’s been frustrating to see those opportunities squandered. An example that caught my eye was Clinton Lawson’s op-ed for the Times, published in May. It’s well-written and pleasant enough to read, but his interpretation of effective policies, then and now, resembles a DEA spokesperson more than a member of the public. Overall, his argument is aesthetic, encouraging us to avoid bad things, like racism or overhyping stories in the news, while at the same time offering the conventional wisdom: penalties and prison.
The article introduces us to Ella Henderson, a well-to-do white woman used as a sympathetic stand-in, who died of an overdose in 1877. Unfortunately, there are some problems. Most of them stem from the fact that what he claims and what the sources he cites claim, are at odds. Lawson writes, “Henderson developed an addiction at a vulnerable point in her life, found doctors who enabled it and then self-destructed.” He says, “Most started out like Ella Henderson, who suffered from emotional trauma and chronic pain, for which she was prescribed copious amounts of morphine.” Summing up her plight, he adds, “She became addicted, was abandoned by the medical community and judged by her neighbors, and ultimately overdosed in her room.” Except the newspaper account doesn’t say that. It doesn’t say she suffered from “chronic pain.” It doesn’t say she “was prescribed copious amounts of morphine.” The word doctor appears twice. The relevant lines include: Henderson died “at the residence of Dr. Stone,” the other is an antiquated reference to his wife, “Mrs. Dr. Stone.” A doctor may have prescribed her morphine, but it was legal at the time, so she could’ve just bought it.
Even if we overlook sourcing, the selection of Henderson was an odd choice to begin with, since the pharmacological effects of morphine were less significant than the circumstances she found herself in. Henderson was ostracized by friends, had her children taken away, and her father had passed away weeks before her overdose. We can (probably) infer her mother was gone, perhaps dead or just absent. Her last name, different from her father’s, suggests she was once married, but her husband was no longer in the picture. Moreover, she was kept isolated in a room by the Stone family. After that, either they must have given in. She obtained morphine somehow, culminating in overdose. To credit her overdose to a chemical compound rather than environment is simplistic, superficial, and attributes almost supernatural power to morphine. Historians should be cautious about diagnosing individuals based on what a reporter wrote more than a century ago. When the reporter used “addiction,” he meant a moral failure and character flaw, which is meaningless for the Times audience today.
This leads us to the next problem, Lawson’s tenuous connections between past and present. According to him, her “case mirrors the thousands of fentanyl and heroin overdoses.” Not really. She died in 1877. Morphine was legal then, available at the local grocery or pharmacy. Henderson does mirror the thousands of overdoses in one way: she was a polydrug user. On top of morphine, she also consumed “opium, laudanum, and whiskey.” Lawson cites two illegal drugs—fentanyl and heroin—responsible for the dramatic spike in overdoses today. He blames doctors for this, mixing up two distinct issues. The opioid epidemic was not the result of doctors and patients, but primarily non-medical users. Dr. Jeffrey Sanger writes almost weekly on this theme:
“Media and policymakers can’t disabuse themselves of the false narrative that the opioid problem is the product of doctors hooking their patients on opioids when they treat their pain, despite the large number of studies showing–and the Director of the National Institute on Drug Abuse stating—that opioids used in the medical setting have a very low addiction rate. Therefore, most opioid policy has focused on decreasing the number of pills prescribed. Reducing the number of pills also aims at making less available for ‘diversion’ into the black market. This is making many patients suffer from undertreatment of their pain and causes some, in desperation, to turn to the black market or to suicide.”
Apart from being wrong about specifics today, he is also wrong about what worked previously. According to Lawson, the problem was “contained by state and federal legislation like the Pure Food and Drug Act of 1906, the Harrison Anti-Narcotic Act of 1914 and the Heroin Act of 1924” (emphasis added). I’d concede the first point. The Heroin Act, however, accomplished nothing, zip, nada. It would be the logical equivalent of excluding vodka but keeping gin dealing with a drinking epidemic. Heroin is just the brand name for diamorphine, and other countries, including Canada and the UK, still use it in medicine. It was banned because the head of the Narcotics Bureau believed it corrupted one’s character. I was taken aback to see there are still defenders of the Harrison Act left outside of fervent anti-drug warriors, last seen in 1980s Partnership for a Drug-Free America commercials. It was counterproductive. David Courtwright quipped, “the Harrison Act closed the barn door after the horse was back in.” It rejected alternative methods and “became the first law to criminalize drug use and opiate maintenance.”
Five years after the legislation passed, the physician Edward Hunting Williams compared the law to barbaric practices once used in Europe, akin to the crime of being “possessed by demons.” He wrote in his book in 1922, Opioid Addiction: Its Handling and Treatment: “The unfortunate insane were imprisoned and subjected to every kind of cruelty, just as in the case of the vilest criminal. Yet persons continued to become insane, and usually incurably insane, in the face of the most hideous punishments.” People were “beaten, imprisoned, chained in filthy dungeons” and “our ancestors burned at the stake that pitiful group of old mad-women at Salem. But even this did not stop people from ‘going crazy.’”
These failed policies become the template for Lawson’s solution today. He says, “…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 quandary for us. First, we must hold doctors accountable—with fines and possible jail sentences—for overprescribing habit-forming drugs in the interest of profits” (emphasis added). If the overdose crisis is primarily illegal heroin and fentanyl, enhancing the power of law enforcement to police physicians, delegating authority to non-experts to determine proper medical practice, makes no sense. Plus, it is happening. The DEA has gone into overdrive, intimidating doctors, pushing arbitrary guidelines, causing distress in the lives of doctors and patients alike. Since suicide is less sexy than drugs, it rarely gets the same kind of attention. But if you’ve been paying attention, you’ve likely come across some of the gut-wrenching accounts of people committing suicide after being cut off abruptly from medication or abandoned by the medical community. To provide a glimpse into this under-covered issue, here are two snippets, one from Slate, the other from USA Today:
Turn to illegal drugs, suffer or suicide?
We were introduced to the CDC guidelines after the state of Tennessee adopted their version of these in early 2017. These were guidelines only, not laws (although Tennessee passed an opioid law in 2018), that outlined that patients on long term, ongoing care with opioid medications must be seen by a pain care provider. The CDC guidelines go further by recommending a lower dosage a pain care specialist can prescribe. My introduction to these guidelines came when comprehensive pain specialists told my husband they were cutting his medications by 75 percent. The reason that we were given was that eventually the guidelines might become law. The last thing the doctor said to my husband was “My patients’ quality of life is not worth risking my practice or my license over.” It did not matter to them that my husband was not abusing his medication or that he had been their patient for over five years. It did not matter how drastically they were reducing his quality of life. Rather than face the unbearable pain that losing his medication would cause him, my husband chose to end his life, and I supported that decision.
I hope this post is not taken as an attack on any particular article or person, but rather to illustrate the widespread substandard coverage of the opioid epidemic. Policies should not leave people with the choice of “illegal drugs, suffer or suicide.” Punishment, including more and longer jail sentences, is not only a recipe for disaster, but insane after pursuing it for decades. There is little appetite for this, one reason why civil rights organizations like the ACLU and Human Rights Watch have called for the decriminalization of drugs. International organizations like the U.N. and the World Health Organization have passed similar resolutions. More and more medical experts are coming to the consensus of the John Hopkins-Lancet Commission, and supporting harm-reduction as the centerpiece for evidence-based solutions, rather than locking people in cages and destroying lives. While I don’t have space here to lay out alternative models, countries like Denmark might be a good place to start. They offer medication-assisted treatments, like buprenorphine and methadone at pharmacies, provide free syringes and naloxone, as well as safe injection sites and heroin-assisted treatment, where not a single person has overdosed in these facilities since their implementation. As a historian and a human being, I’d much rather see substance use disorder treated as a health issue, rather than a criminal problem.