Tag Archives: opiates

Nov 1 2016

Morphine, Myth & The Civil War: Before Cause and Effect

Editorial by Terry Gotham

Last week, we spoke about the gendering of drug use in America and how that may have led to the original wave of drug prohibition laws. This was one example of the  many times where drug use was distorted as a justification for it to be outlawed. One of the biggest myths associated with heroin usage was that the Civil War “created 500,000 addicts.” This is of course not the case, so let’s unpack the various reasons brought up to justify this erroneous attribution. An exceptional paper published in War In History by Jonathan Lewy of Harvard University helps to round up the main reasons this assumption is wrong, which I’ll be quoting from liberally.

One of the easiest ways people explain the deluge of opiate & whiskey addicts during the last quarter of the 19th century & the first 2 decades of the 20th was the invention of the hypodermic syringe. The Civil War doctor did use opium for much more than just killing pain. Opium was used for diarrhea, dysentery, stomachache, gallstones, hemorrhoids, tetanus, typhus, syphilus & “neuralgia” (an anachronistic diagnosis that loosely translates to peripheral neuropathy today). But, remember, it’s 1860. Opium powder was usually sprinkled on top of the wounds suffered by soldiers in the field. By the end of the Civil War, a little over 2,000 hypodermic syringes had been fabricated & distributed to the 11,000 surgeons employed by the Union Army, which is one of the pieces of evidence used to support the claim that the modern heroin addict was created by the Civil War.

There’s one crucial difference between a modern syringe & those that were used, especially at the beginning of the Civil War. The first syringes were dull. That’s right, doctors had to puncture your skin first using a lancet (yes, that’s where the journal name comes from), before using the dull and large gauge syringe to deliver the medicine. So, the most hyperbolic claim, that soldiers were shooting up because they were taught to do so at field hospitals and by doctors, can immediately be dismissed. If any of you had nightmares that involved Requiem For A Dream and civil war uniforms, you can put that aside.

Not only was injection drug use essentially impossible, Confederate surgeons had little to no access to spare opium. The Confederacy attempted to grow poppy fields to supply their armies with opium. This sounds like a good idea in theory, but resulted in exceptionally poor quality poppy crops and an inferior supply of pain killers for the Confederate Army. Resulted in the Confederacy relying on smugglers & blockade runners to bring it down from the North, as one of the first examples of drug running in the USA.  The North was buying opium on the world market, as their Navy gave them access to trade with Europe. And boy did they take advantage of that. The Federal Army consumed 10 million opium pills and 80 tons of opium powder & laudanum tinctures before the surrender at Appomattox was signed.

People weren’t converting pills into inject-ready substance in the field, and the Confederacy couldn’t even get its hands on syringes and medical staff/training using them. When you’re taking a small pile of opium and spreading it over a wound with a knife, the person receiving care doesn’t know they’re “doing heroin.” It’s hard to develop a drug habit when you don’t know what drug you’re craving.

There were anecdotal cases of physicians becoming addicted to the morphine, but as a record, this was always classified as misuse, not addiction. General Benjamin Butler discovered one such doctor, and relieved him of his duty. However, no note of addiction, health problems, or vice was mentioned, merely a note of dereliction of duty. This is corroborated by The Medical & Surgical History of the War of the Rebellion, a six-volume epic tome documenting the case histories of the various field surgeons across the US Army. 13 years of records were submitted, accounting for all of the ailments, diseases and afflictions that these doctors, surgeons and field hospital directors encountered. Zero cases of addiction, or anything resembling the modern, conventional definitions of substance abuse/addiction appear.

This isn’t to say that the maladies associated with excess substance use weren’t known. But the idea that the substance use, if continued, would cause dependence or other negative consequences, hadn’t entered the greater medical world, and wouldn’t for years. The Manual of Military Surgery, introduced in 1861, noted that morphine & laudanum (tincture of 10% opium in alcohol) should be used in managing pain and amputation-related hardship. Interestingly, and without further definition, the reader is warned to not abuse the drugs “lest they induce fatal oppression of the brain.” For serious, no other context is given, you can see for yourself on page 50:

“Reaction must be promoted by the cautious use of stimulants ;while pain is allayed by morphia orlaudanum given with more than ordinary circumspection, lest it induce fatal oppression of the brain.” ~Samuel Gross

Could “fatal oppression” be like our modern definition of “brain death?” You betcha. Will we ever know if it was, definitively, and not the fog, memory loss or other neurological side effects of opiate use described at the time? No, which is a huge problem. It’s really easy to assume, but we need confirming evidence and there simply isn’t any. And, to put this lack of information in context, in the late 19th Century, the closest thing to “addiction” most people were aware of was the “habit” (Source Bias warning: Vaguely pearl clutchy, but still relevant historical portrayal of the time).  Alcohol had been seen to be habit forming as early as 1819, but morphine wasn’t seen in the same light. Using opium was seen as roughly equivalent to swearing, paying for sex, gambling and gossiping. If you couldn’t resist the temptation of drink or poon or dope, you were a sinner, or morally weak, not sick. But in 1877, 12 years after the end of the Civil War, that changed. Die Morphiumsucht was published by Eduard Levinstein, connecting drug use with a craving for more drugs, for the first time in the wider, respected medical literature. And I do really mean for the first time. Between 1864 & 1875, when Levinstein lectured publicly on the topic for the first time, only 24 articles discussed pathology stemming from drug use. In the decade after? Over 230. It’s kind of hard to have a mass of people “addicted to drugs” when they couldn’t access the drugs, and “addiction” wasn’t a word at the time. Oh, and the people weren’t there either.

The USA documented approximately 10,000 habitual opium uses (referred to as habitues) in 1842, with that number peaking at 313,000 in 1896, according to some. However that number gets turned on its head when it’s documented in the same source that there were more women habitues than men. Grief caused by becoming a widow explains why all the women are getting high, but, if all of the soldiers are dead, where is the epidemic of strung out veterans? They weren’t in the Sanatoriums, as a casual review of the Second Annual Report to the Citizens in the Delaware County American shows. Even back in 1868, right at the end of the war, when soldiers were most vulnerable to opiates, 2 out of 26 under his care, were there for opium. The rest? Booze. Additionally, they were in there because of social use or physician prescription, not because they even fought in the war. In the “National Homes” in and around Milwaukee,  only one veteran was admitted to the entire system for non-alcoholic drug use between 1867 & 1872. To put that in perspective, 36 people have died from Fentanyl overdoses alone in Milwaukee this year

Were there people who developed habits? Absolutely. The Confederate vet Doc Pemberton was wounded at the battle of Athens, Georgia and became addicted to cocaine after being given it on the battlefield. After the war, as an unemployed chemist, he created a brew of cocaine and kola nut extract, as an attempt to keep up with the hooch being slung at the saloon across the street. Were there a giant pile of strung out drug addicts walking around after the war? No. What were there? A bunch of wounded veterans.

Lewy really does sum it up quite nicely in his conclusion, so I won’t try to out do his words:

Some contemporaries claimed their experience in the war prompted their addiction. A few decades later, Crothers and other physicians supported the notion that the war caused addiction, but not based on fact, at least statistical fact, but was due to the understanding that wars caused trauma. One can only assume that, with the amount of drugs consumed by the armies of the Civil War, a few soldiers and perhaps even a General or two became addicted to drugs, but it would be next to impossible to determine how many (were), and whether this was, indeed, a historical trend. Especially since addiction was only recognized as a full fledged disease several decades after the war.
~Johnathan Lewy, The Army Disease: Drug Addiction and The Civil War (2013)

Finally, it’s important to note that this fear of drug zombie veterans have been used as a justification for drug laws ever since. A heroin resurgence coincided with the end of World War II, the Korean war sparked rumors that Communists were attempting to dope American youth to beguile them, Vietnam managed to vilify drafted soldiers, decrying their drug habits before they even returned, and the war in Afghanistan is already being blamed for heroin use among soldiers. There will always be people attempting to justify drug prohibition using the trope that veterans would be the most vulnerable of American citizens. Yet, this continues not to be the case, even to this day. Don’t believe the hype. Drug use is an ineffective, yet popular way to cope with trauma, whether you were part of a unit that saw incoming fire at the Battle of Gettysburg or if you’re just growing up in rural America after Bain Capital sent all of the jobs in your town away.

Oct 28 2016

Lazarus Parties, Heroin & the Continued Evolution of Harm Reduction

I’m taking a quick break from my series on the History of Addiction & Society because I’ve been tracking a disconcerting story for the last week. You may have seen it posted by one of your more conservative/pearl clutch-y friends this week, and if not, expect it before election day.

A smattering of local coverage, based around Toledo, Ohio, describes a Lazarus or “Narc” party. Heroin users will do heroin with other users, and in case one of the users overdoses, a sober person who isn’t using, administers Naloxone, or by its common retail name, Narcan. The implication is that because a user was standing by with Narcan, that’s the actual problem. The presence of the OD reversal substance is emboldening heroin users. To test their limits, or to even try using it in different ways, like shooting it, instead of just snorting or smoking it. Instead of preventing death, some are attempting to claim it’s making some people’s use more adventurous.

To research the work I release here on Burners.me, I maintain a quiet presence in a lot of different circles, so a lot of the time, I get to experience how mutually exclusive groups respond to stories. Today, I saw both a pool of researchers, doctors, law enforcement officials AND a group of ravers, talking about the same story, this “Lazarus Party” story. Oh yea, and in case you didn’t go to Sunday School, it’s called a Lazarus Party, because Jesus raises Lazarus from the dead as proof of his Jesus-ness. But, here’s the thing. Are there any actual, confirmed reports of recreational users calling them Lazarus Parties? No, of course there aren’t. But there “might” be, especially if you believe poorly sourced news & blowhards with agendas. Just in case you don’t believe me, ask a member of each political party their thoughts on FBI Director Comey & his investigation, and you’ll see how easily facts can be distorted or ignored to suit a pre-existing bias.

Larry Clark -

Larry Clark – “Tulsa” (1971)

What was amazing about what I saw, was the same mixed field of ignorance, trolling and reason within two opposite populations of commenters. One was a thread where you saw users, scenesters, and sober party attendees, the other was  entirely by people with respectable, well paying jobs, in and around the substance use, abuse & control sectors. Having the same argument. It’s one thing when two of your hippie festival friends argue about the purpose of “Narc” parties, with the dude who has the Deep Mind Acid filter on his profile picture, correcting a burn out when it comes to how Naloxone is used. It’s quite another thing when an ER Coordinator makes the same correction to someone who works in a rehab program.  The two arguments raged all day. At the time of writing, the festie kid argument had died down, but the med/substance abuse professionals was still going back and forth, and did so long into the night. And you thought you took your job home with you.

The facts of the situation are slightly less terrifying. Because Fentanyl, Carfentanyl, U-47700, W-18 and an array of other substances are present in the recreational opiate supply, opiate users have begun to switch off dosing to ensure they’re not all high if someone OD’s. The reports elaborated that people were starting to do heroin in groups more, in response to the tidal wave of Fentanyl-exacerbated OD deaths currently plaguing North America. Of course, if more than 1 person is doing an illegal drug in a room, the media thinks it’s a party.

The inherent idiocy in this line of reasoning should be apparent to everyone who has watched fear mongering and confusion go hand in hand. Thankfully, every time I saw this discussion occur, the intelligent and sensible among those willing to comment rose to the occasion and reminded everyone involved that harm reduction and opiate usage patterns evolve with time. In this case, it looks like people are starting to understand the inherent dangers of their habit, and pivoting around them. Not because they want to do “more drugs” or have a party, but because they don’t want to die. This seems like a no-brainer, but it’s actually deeply subversive when it comes to the traditional line of reasoning that prohibitionists use.

chicago-vice

In both this case, and the example from last week, the idea that drugs take control of you, or that you can’t engage in rational thought while under the influence, was the central pylon in the argumentative infrastructure supporting the case that all drugs are bad and humans shouldn’t have the choice to consume substances, especially to excess. But the narrative that I heard from both elder ravers and MD’s who ran emergency rooms was just the opposite. These “Narc” parties are nothing more than opiate users understanding the conditions on the ground and attempting to prevent bad things from happen to people they care about. Which is the very definition of harm reduction. They know no one is going to stop doing heroin, even when it might be spiked or adulterated with a substance that could kill them.

This point was so well defended, that opiates don’t turn people into zombies, people actually started to understand individuals with physical addiction and a fear/aversion to withdrawal exist. They were looking out for each other, and will continue to do so. I got to see some excellent harm reduction advice dispensed by a forensic toxicologist, so I wanted to share it with y’all, in case this stuff was useful for you:

  • Don’t use alone. Use a buddy system, to have someone who can call 911 ( and give Narcan) in case you stop breathing.
  • Learn how to use Narcan if you plan on using street heroin.
  • Even if you know how to use Narcan, test your drugs.
  • Do the same for another addict.
  • Don’t inject at the same time. Stagger your injection times.

These seem like no-brainers to most of us, but sometimes it’s easy to forget. Phillip Seymour Hoffman forgot. So did Prince. We live in an age where adulterants are far more dangerous than even some of the most problematic recreational drugs. And users are recognizing that, leading them to consume with others, and to learn how to reverse overdoses. That sounds like progress to me. Not something to be afraid of, and certainly not a reason to remove Narcan from the hands of those that consume opiates. Let the people save each other, since the powers that be don’t seem all that concerned about saving them.