Brooks Hudson

Opioids, Overdose, Abstinence—A Historically Deadly Combination

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

We have told ourselves the “opioid crisis” is an exception to past drug scares. In the past century, the narrative goes, we relied on law enforcement and punishment to curb widescale drug use, but our country now has turned over a new leaf—one centered on public health and compassion. Had it not been for Purdue Pharma, a uniquely bad actor, the spread of addiction and overdose deaths would have never occurred.

None of this is true. Rhetorically, yes, smart politicians now deemphasize the punishment aspect in public speeches. But law enforcement plays a greater role than ever before in regulating the use of drugs—from the zealous policing of some people who use illegal drugs to expansive prescription monitoring programs and from the detailed cataloging of the dosage of Americans’ medications to DEA to threats to doctors who fail to obey their dictates. Such strict and exacting regulations often leave elderly patients and patients with chronic pain out in the cold unable to secure necessary drugs. Yet, at the same time, prohibitionist drug control measures have also done little to stop the proliferation of black-market drugs.

Far from being a deviation, this has long been the norm and with often devastating results. Regardless of your thoughts about current events, this post will let us look back and travel to the past to try to clarify why overdose deaths continue to increase now despite a dramatic recent decrease in opioid prescriptions. And why this situation unlikely to change under current conditions. For about the last century, the United States government has abided by a philosophy that seems to prioritize drug abstinence and the strict policing of drug use at the expense of saving lives. To investigate this continuity, I will briefly examine two episodes: a 1930s critique of an early version of the war on drugs and the government’s opposition to needle exchanges during the AIDS epidemic of the 1980s.

Points Hudson Title Card Opioids
Left: A 10 milligram OxyContin pill. Source: Wikimedia Foundation.

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Profiting for Prescription: Medicinal Alcohol During Prohibition

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

James E. Pepper Whiskey Ad
James E. Pepper Whisky ad from the late nineteenth century. Source: James E. Pepper Distilling Company.

Whenever Prohibition reenters the zeitgeist through pop culture like the recent cable TV series Boardwalk Empire or through a historical anniversary, it seems inevitable that someone will produce an “isn’t this ridiculous” style article about the “bizarre” practice of prescribing medicinal alcohol. On the surface, the entire debate about prescription alcohol often seems illegitimate and merely a loophole that doctors and patients used to skirt enforcement of the Volstead Act.

As medical historians have pointed out, though, prescription alcohol is not merely arcane trivia.  It represented an early skirmish between an aggressive government and the collective efforts of the American Medical Association to assert its rights to distance medicine from politics.  

In reality, the status of medicinal alcohol resulted from negotiations between the state and organized medicine over the power to prescribe. Medicine already had enough prestige to weaponize laws against rival professions. Even critics of the AMA like pharmacist Henry Rowland Strong understood that it was seen “as a graceless and indelicate thing to criticize the medical profession,” and, he argued, the “political schemers in the high places of organized medicine” were always “quick to take advantage of this sentiment.” Strong feared that medicine would overtake pharmacy, and he warned:

“No sooner is [the doctor] attacked for his greed for power and his unscrupulous methods of attaining it than he hastens to hide behind the skirts of the profession at large—the sentimental and picturesque ideal of the profession that the public cherishes in its heart—waxing eloquent about the sacredness of the calling, reciting its long list of honorable men and achievements, and setting forth its noble and disinterested aims.”

Critics feared that giving organized medicine the power to decide what medicines people could use would, in the words of Strong, “be tantamount to the establishment of a State system of medicine.”

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Cocaine in 1980s America: Fine for the Wealthy & Well-Educated; Bad for the Poor

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

Crack is Wack Keith Haring
New York City “Crack is Wack” mural first painted in 1986 by artist Keith Haring. Image courtesy of cookiespi on Flickr.

The years directly preceding the American “crack epidemic” of the 1980s are worth re-examining. Cocaine was by no means new, and people had been using and sometimes smoking, or freebasing, the drug for years. In the early eighties, however, many cocaine users were well-educated white professionals, wealthy celebrities, or captains of industry. By about 1986, though, dealers began condensing cocaine into “crack” that people could smoke instead of snort. As the perception of people who used cocaine changed from white and wealthy to Black and poor, every aspect of reporting changed, too. We can see this unfold in real time, by tracking news coverage in the New York Times archive.

Hollywood Cocaine

Robert Lindsey’s front-page story “Pervasive Use of Cocaine Is Reported in Hollywood” appeared in the Times on October 30, 1982. It described how drug use had become so widespread that companies insuring movies had begun to amend their policies to reflect drug-related risks. Lindsey quoted an unpublished survey of stuntwomen that claimed more than half of the women asked actively used drugs or knew someone who did.

NYT Headline Cocaine1
New York Times, October 30, 1982.

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Review: “Drug Use For Grown-Ups: Chasing Liberty in the Land of Fear”

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

Cover of Drug Use For Grown Ups

Dr. Carl Hart’s timely Drugs for Grown-ups: Chasing Liberty in the Land of Fear attempts to ignite a shift in our collective consciousness—much like the psychoactive substances he chronicles. Credentialed academics and other elites tend to deny using drugs, or, if they want to pass as authentic for political reasons, they might admit to a few youthful indiscretions (e.g., then-candidate Barack Obama’s “inhaling was the point” comment in 2007).

Defying this taboo, Hart, Chair of the Department of Psychology at Columbia University, owns up to his affection for an expansive medicine chest. He reveals dabbling in amphetamines, discloses his use of the unfairly-maligned drug heroin, and discusses sampling 1990s club drug—and soon-to-be FDA approved medication—MDMA, along with other more obscure compounds like 2C-B, which was popularized by virtuoso, chemist, and psychonaut Alexander Shulgin.

Hart’s self-doctoring is reminiscent of nineteenth-century medical ethics, embodied by such titans of the time as William Halstead and Sigmund Freud. His self-prescribing bridges the gap between his knowledge and his experience, which helps him better understand subjects visiting his Columbia University lab. Drugs also filtered into his other extracurricular activities, figuring into adventures with his wife and enhancing their relationship and strengthening their marriage.

Who Are Drug Users?

Hart considers himself the rule not the exception in terms of drug use. Drug users are not zombies, he emphasizes; they are not the flesh-eating monsters sometimes depicted on highway billboards accompanied by inane anti-drug slogans. Drug users are not unwashed psychos or crime aficionados who inexplicably love doing evil. No, most drug users are typical, normal, average Americans, gainfully employed and living undetected—maybe you or your neighbor. And that’s okay.

Generally speaking, Hart’s ideas are easy to understand, and he gives primacy to the crucial observation that most people’s experiences with drugs are positive. Drugs offer insight, increase euphoria, and provide pleasure. Drugs act as social lubricants, making social interactions easier to bear or more enjoyable; and drugs break down barriers, allowing some individuals to be more vulnerable than they otherwise would be. People use drugs to soften the edge after a stressful day working a job they hate, and, conversely, drugs can help those who love their jobs be more productive and work long evening hours.

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Biden’s Opioid Plan: Punishment Disguised as Treatment

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

Last summer, Joe Biden attended a ritzy fundraiser at the Carlyle Hotel for New York donors, where he promised the ultrarich “nothing would fundamentally change.” Since then, his decisions have reflected this sentiment, honoring past administrations’ allegiance to revolving-door-politics, handing out cabinet seats to a who’s who of corporate America, and plucking various candidates from private equity, the arms industry and K-Street. Even his continuation of Trump’s herd immunity, open-everything-up strategy for coronavirus indicates he will keep that promise of “nothing will fundamentally change,” apparently content to preside over the country’s long-term decline.

Throughout the election, media outlets largely avoided scrutinizing Biden’s record, especially as it related to drug policy, with reporters acting much closer to campaign surrogates than journalists, often playing defense for the Biden team. The Washington Post, Vox, Politico, and the New York Times all made the preposterous assertion that Biden apologized for his cruel, single-minded focus on prison and punishment during his time in the Senate. But apart from giving a couple half-hearted non-apology apologies that sounded reminiscent of “mistakes were made,” Biden has never fully taken responsibility for the lives he destroyed, or the incalculable harms he inflicted on millions of Americans.

Equally unwarranted was the positive attention that Biden’s opioid proposal received. Outlets falsely claimed Biden views “addiction” as a health issue and no longer wants to pursue punitive approaches to drugs. German Lopez, senior reporter for Vox, even went as far as labeling Biden’s opioid plan as “ambitious.” To be clear, Biden’s agenda doesn’t guarantee treatment, doesn’t end punishment, and doesn’t include the most effective evidence-based methods for reducing overdose deaths. His plan isn’t ambitious; it’s not even good.

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Defunding the (Drug) Police

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

Defunding the police triumphed at the polls, even if we do not call it that. And it was bipartisan. By defunding, I mean Washington D.C. voting to decriminalize psilocybin, Oregon voters approving two landmark reform measures—Measure 109, which legalized psilocybin therapies, and Measure 110, decriminalizing personal possession of all drugs–as well as the four states that legalize recreational cannabis (New Jersey, Arizona, South Dakota, and Montana, along with Mississippi which passed medical cannabis). These are significant reforms and reveal a couple of things.

First, the Oregon measure recognizes a fundamental reality in American life: drug use is already decriminalized and legal for wealthy people. Second, there is no separation between recreational and medical drug use, other than more affluent, whiter segments of the population receive prescriptions from doctors, and poor people do not. Finally, one interpretation is that voters are coming to understand arresting people for drug possession does not help individuals, improve public safety, or provide obvious benefits to anyone. Instead, it controls poor people in a society that, unlike its peer nations, fails to provide essential services, whether it is healthcare, housing, medical care, paid leave. The only service the poor receive comes through the criminal punishment system. Let’s touch on all these points.

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Drug Reform in a Biden Administration?

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

In August, the DNC Convention depicted Joe Biden as “Uncle Joe,” an empathetic figure who faced adversity, experienced personal tragedy and is generally kind of a goofball, an elderly gentleman telling rambling stories about how movie popcorn tasted better in the 1950s. In late September—in another moment of empathy—the only part of the presidential debate that received positive press coverage came when the former Vice President defended his son and said, “My son, like a lot of people at home, had a drug problem. He’s overtaking it. He’s fixed it. He’s working on it. And I’m proud of him; I’m proud of my son.” Jonathan Reiss, writing for Rolling Stone, was one among many in the press who thought this moment might potentially signal a sea change for drug policy:

“Having the son of the president represent the recovery community is a new paradigm. This wouldn’t be the president’s distant kin quietly slipping into a million-dollar rehab for 28 days. This would be the president’s son acknowledging that he is in recovery, that he has smoked crack and come out the other end of that indelibly narrow glass tunnel. Merely acknowledging the problem is profoundly meaningful — the first of the twelve steps.

“Addiction is a realm where reform often comes from those who have been through it. If Hunter continues to wear the label of ‘addict’ without shame, lending his experience and the experience of others in recovery to pertinent policy discussions, this could be a ray of optimism during bleak times for those in recovery. Especially now, when so many people are confronting one of the bleakest times in modern history.”

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Listen to Science? Since When?

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Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

Every day, on television or doom-scrolling through Twitter, some Democratic Party official rails against Trump for ignoring “science” and putting the country at risk by his failure to “listen to the scientists.” It is true. Though, to be fair, Trump has never claimed to respect science or made any pretense that it would influence his policy decisions. Conversely, since the coronavirus outbreak, Biden has really hammered home the “public health” message. His campaign’s website, in a bullet point filler section, pledges that, if elected, the Biden administration will “ensure public health decisions are made by public health professions and not politicians.” Don’t take this seriously. 

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