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From cough medicine to deadly addiction, a century of heroin and drug-abuse policy

Yale Medicine Magazine, 1999 - Winter


A century ago, scientists at a German pharmaceutical firm investigated a chemical modification to morphine that made it more palatable as a cough suppressant. The Bayer Co., predecessor to today’s pharmaceutical giant, marketed its popular new remedy as “Heroin.” Although it worked against coughs caused by serious and then-common diseases such as tuberculosis and pneumonia, physicians and pharmacists soon noticed an unhappy side effect—patients required ever larger doses and were becoming increasingly dependent on the elixir. By 1912 it had emerged as a recreational drug among young men in New York City. Two years later, addicts were knocking at the doors of New York and Philadelphia hospitals in search of treatment.

The history of the drug’s use and abuse was the topic of One Hundred Years of Heroin, a conference held at Yale in late September. It brought together some of the nation’s leading thinkers on the drug problem, such as U.S. Sen. Daniel Patrick Moynihan of New York; Egil Krogh Jr., who directed drug policies during the Nixon administration; and Jerome H. Jaffe, M.D., who, under President Nixon, became the nation’s first so-called drug czar.

Organized by David F. Musto, M.D., professor in the Child Study Center and the Section of the History of Medicine and a leading historian of drug abuse and drug-abuse policy, the conference focused largely on the Nixon years because, according to Dr. Musto, it was then that the modern federal drug program was created. Social and political issues drove many developments in drug policy. Spurred in part by a desire to show a drop in crime before the 1972 elections, the Nixon administration began a pilot program in the District of Columbia, where half the inmates in local jails tested positive for opiates. Mr. Krogh, now a lawyer in private practice in Seattle, told the conference audience, “If we could get results in the District, we could use them across the country.” As treatment, including methadone, became available in the capital, crime did indeed drop, he says.

Another impetus for solutions to drug use started half a world away, in Vietnam, where studies found that up to a fifth of the American soldiers were addicted to heroin. On a trip to Vietnam Mr. Krogh told soldiers, “I’m here from the White House to find out about the drug problem.” Then, Mr. Krogh recalls, a soldier took a drag of marijuana and replied, “I’m from Mars, man.”

Dr. Jaffe, who was director of the Special Action Office for Drug Abuse Prevention at the time, introduced programs that reduced the addiction rate among returning Vietnam veterans. He also tried to expand treatment programs, create a research base and develop a national strategy for drugs. Money became available in greater amounts than ever before, for both treatment of addiction and training in substance-abuse treatment. “We developed more federal support in treatment capacity in the first two years than had been developed in the preceding 50,” says Dr. Jaffe.

A century after its introduction, heroin continues to pose complex medical, legal, social and public health questions and to resist efforts at control. “We seem to have a peak in heroin use every 20 to 25 years,” says Dr. Musto. “Some have explained this as ‘generational forgetting.’ Whatever the explanation, heroin will remain a problem indefinitely for those who become addicted. However, it is, in part because of methadone, more treatable than uncontrolled cocaine.”

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