America’s First Opioid Crisis

Before the American Civil War, opium pills and laudanum—a mix of opium and alcohol—were sold without a prescription in drugstores across the nation, but as battle injuries mounted in the early days of the war, opioid pills became one of the most essential tools in a doctor’s medical bag on both sides of the conflict, leading one Confederate medical handbook to advise that “Opium is the one indispensable drug on the battlefield—important to the surgeon, as gunpowder to the ordnance.”

A Versatile Drug

Doctors and nurses used opium and morphine mainly to treat pain, but also to stop internal bleeding, as well as for the control of vomiting and diarrhea caused by infectious diseases, leading to a tidal wave of addicted soldiers and veterans, both during and after the war. While many Civil War veterans found opioid addiction to be a life-ruining and possibly fatal condition, when medical personnel began using the relatively new invention of the hypodermic syringe to inject morphine and other liquid opioids directly into the veins of wounded soldier’s, while pain relief was nearly instantaneous, the practice proved to be far more addicting.

Medical Segregation

Black soldiers, on the other hand, rarely suffered from opioid addiction, primarily due to the racial disparities in medical care provided to Black soldiers compared to white soldiers, leading white addicted soldiers, quite without irony, to name the condition “opium slavery.” When veterans returned home after the war, ready access to opioids ballooned addiction rates in the 1870s, 80s and 90s, even among a growing legion of the non-veteran population, while Civil War physician’s heavy use of the hypodermic syringe helped mainstream the use of syringes and liquid opium throughout the United States.

Easy Access

Morphine, heroin and syringe sales became so readily available that average Americans could buy each product from the Sears and Roebuck catalog, leading to the nation’s first full-fledge opioid addiction crisis by the late 1880s, affecting one out of every 200 Americans by the the turn of the century. By the late 19th century, medical textbooks and instructors began to warn against the overuse of opioids by physicians, while most states outlawed opium-based products by 1915, making America’s first opioid crisis, a prescient foreshadowing of today’s mounting wave of overdose deaths.