History of Stigma Associated with Addiction: Part 1

This is a piece I published on my new website, It's All Junk.  Look for the second part tomorrow!  Super informative about the history of this stigma in our country...

Dr. Vincent Dole, who died at age 93 in 2006, was considered the “Father of Methadone Maintenance Therapy.”  He was one of the original voices for recovery, pioneering Methadone Maintenance Therapy (MMT) in a time when addiction was viewed as a moral character defect.  Today, the majority of the population understands the disease model of addiction, viewing addiction as a disease of the brain, and not simply a moral character defect.  This shift in view has opened up a lot of doors for addicts, as well improving treatments for addiction.  This shift in view has also helped to decrease the stigma associated with addiction, but the disease now battles both the stigmas of addiction and mental illness vehemently.  The evolving history of this stigma, especially associated with opiates, runs deep into the history of our country, and it will likely take just as long to make a dent in eradicating it.

            In 1914, the United States passed the Harrison Narcotics Tax Act, which regulated and taxed the production, importation, and distribution of opiates.  This act actually stated, “An act to provide for the registration of, with collectors of internal revenue, and to impose a special tax on all persons who produce, import, manufacture, compound, deal in, dispense, sell, distribute, or give away opium or coca leaves, their salts, derivatives, or preparations, and for other purposes.”  The courts interpreted this act to say that physicians could prescribe opiates for normal treatment, but not for the purpose of treating addiction.  One of the explanations for this was that opiates could not be prescribed to an addict, simply because addiction was not a disease. Previous to the act, opiates and cocaine derivatives had been legal and unregulated.

 Crime had seemingly risen as a result of addiction to these substances, and it was estimated that one in 400 Americans, which was 25% of the population at that time, were addicted to opiates.  Many of these opiate addicts were women, who were prescribed these drugs by a legal physician, for “female troubles,” basically pain during menstruation.  It is estimated than between 2/3 and ¾ of all the opiate addicts in this time of our history were women.  I believe it is not merely a coincidence that the Harrison Narcotics Tax Act was passed at a time when women were fighting for their right to vote.   After several Supreme Court cases, the law determined that this act was constitutional, and opiate could not be used for maintenance purposes. 

After the Act passed, many newspapers began to run sensational stories about addiction-related crime waves.  Congress responded by banning heroin in 1924.  The media’s sensationalistic interpretation of addiction played a huge part in establishing a stigma with drug use.  This began the demonization of drugs and became the foundation for which the stigma with all drugs and addiction is built on today.  We still see this media sensation today, just look at the explosion of bath salts stories after the Miami Cannibal chewed the face off a homeless man, and the rush to ban these drugs.  It is this kind of sensationalistic coverage that only helps to boost the stigma of addiction and drugs.  In the defense of the media, though, these sensationalist stories are what sell.  Readers want the sensationalism, the gore, and also the unknown element that accompany the media’s drug hysteria.  We do live in a capitalist society, and although one may find fault with the media’s portrayal of so many issues, I also have to commend them for making a viable business of the news, especially today, as newspapers are dying out and all media is changing dramatically. 

The Harrison Narcotics Tax Act led to the incarceration of a number of doctors for prescribing opiates, and as a result under-utilization of opiates began to take hold.  Doctors feared prescribing them, and patients feared taking them, fearing that they could become addicted.  Often, morphine would not even be prescribed for a terminally ill patient in excruciating pain.  In the mind of those in this decade, dying a painful death was much better and dignified that becoming addicted to a medication.  Hence, the stigma with drug use blossomed.

Personally, I find it interesting that arresting a number of doctors really changed the ways drugs were prescribed back then.  I look at the world I live in today, where media reports have often surfaced lately, in regards to doctors being arrested for prescribing opiates.  Now, today, these arrested doctors are generally operating out of a “pill-mill,” or they are blatantly over-prescribing opiates and have several overdose deaths on their hands.  And the public also cheers these arrests on, as we are finally tackling the problem.  But, are these arrests making a difference in the way doctors prescribe opiates?  Are these arrests making a dent in the way pharmaceutical companies advertise for their painkillers?  And finally, are the patients in favor of these crackdowns? 

We live in a modern, capitalistic society, where making money often trumps everything else.  These pain clinics still want to make money, and it is a very profitable industry.  The doctors that prescribe these medications in a pain clinic make good money to do so.  In our society, that somewhat operates on greed, these seeming risks to run a pain clinic is certainly worth the rewards that will be reaped.   The financial gain for the pharmaceutical companies, the doctors, and even the insurance companies can even outweigh the fear of arrest, or any concern for the addictive properties of these medications.  I do not think this crackdown on doctors today will make much of the same dent on the prescription of opiates as it did in the past. 

William S. Burroughs wrote extensively of the effects of the Harrison Narcotics Tax Act in his memoir, Junky.  As a heroin addict, Burroughs was most affected by this Act in regards to the law, and he was arrested numerous times under the guises and restrictions brought on through this act.   By the time Burroughs was using, the Harrison Act had been in place for nearly 25 years, and the addict was often demonized, forcing him to lurk under the cover of the darkened alleyways avoiding persecution from the police, and later to avoid the persecution of the public as a result of this widespread stigma associated with drug use, and opiate use, in particular.  Burroughs said of this stigma, “Our national drug is alcohol.  We tend to regard the use of any other drug with horror.”

I think that this statement still rings true today.  Alcohol is accepted in our society, and it not only something that is viewed as acceptable, it is almost expected in certain circumstances.  Today, the use of marijuana a prescription pills are also widely accepted, and these things do not carry as much of the stigma as it once did.  On the other hand, harder drugs still carry the stigma, and the stigma with addiction has remained much the same, even if the addiction is to prescription pills. 

Look at the state of Alabama.  If a woman tests positive for drugs at the time of her child’s birth, that woman will be arrested shortly after.  She likely will end up spending months in jail, attending a rehabilitation program while her young infant is at home, without its mother.  Now, if child is born with Fetal-Alcohol Syndrome, or of the mother has alcohol in her system when the child is born, she will suffer no legal ramifications, and certainly will not be arrested.  Yet, Fetal-Alcohol Syndrome is much more damaging than any effects from drugs in utero.