Prescription drugs

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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The Pharmacological Era

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

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Stanton Peele

Psychologist Stanton Peele refers to the time we’re living in as a “pharmacological era,” one where “drug use, both approved and unapproved, is widespread, almost universal.” Currently, it’s dealt with through regulation and prohibition. Dr. Peele argues: “Instead, we need to accept drug use as socially and psychologically regulatable behavior to be incorporated into modern life.”

In some ways, we’re already there. It’s near universal, just two-tiered. A Vice News headline summed it up perfectly: “America’s Rich and Powerful have permission slips to get high.” We don’t have to look far to see these inequities in action. Recently, Elon Musk—of Tesla fame—smoked a blunt on the Joe Rogan Experience. Had it been a Tesla employee, they would’ve been fired. Ivy League students swallow smart pills to study just like their future selves, the businessmen burning the midnight oil. And a white woman popping a Xanax found in the seabed of her Hermès bag, totally normal too. But a black man smoking a joint—whoa, wait a minute, that’s unacceptable. So, yeah, like I said universal but two-tiered—same dynamic in Washington. Recall Dr. Ronnie Jackson, Trump’s (failed) nominee for Veteran Affairs Secretary. Apart from his stunning lack of qualifications and experience, we learned during his time as Physician to the President he regularly doled out Schedule II drugs for recreational purposes. As Politico reported:

Nearly a dozen current and former officials — including some who were treated by Jackson while working in the Obama White House — say Jackson is being unfairly labeled as a “candy man” and that casual use of some prescription drugs is an established fact of life at the highest echelons of government. “Not everyone wants it. But anyone who does gets it,” said a former Trump administration official who traveled extensively with Jackson and the president.

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Fiction Points: Eileen Cronin

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CRONINEileen Cronin is a writer and clinical psychologist. Her book Mermaid: A Memoir of Resilience (2014) centers on her search for the truth about her body and the role that the drug thalidomide played in its shape, her childhood in a large Catholic family, her mother’s mental illness, her marriage, and her own struggles with alcohol. In addition to nonfiction, Cronin writes poetry and fiction. Her work has appeared in The Washington Post, Bellevue Literary Review, Los Angeles Times, Third Coast,  and Best American Essays, among other venues. She also writes for The Huffington Post. Mermaid appeared on O, The Oprah Magazine‘s Best Memoirs of 2014 list and Pop Sugar‘s “Must Reads of 2014.” In 2008, Cronin won the Washington Writing Prize for Short Fiction. Her nonfiction has earned her a Pushcart Prize nomination, and her two novels were finalists for the Pirate’s Alley Faulkner Award for Novels-in-Progress. Cronin serves as an assistant editor for Narrative Magazine and lives in Los Angeles. 

Two nuns and a penguin approach you at a bar, and you tell them you’re a writer. When they ask you what you write about, how do you answer?

I can’t help but to notice the resemblance between these folks at the bar. But I don’t ask about that, nor do I tell them that I have written about a nun who looked like a penguin when she ran. Instead I tell them what I have in common with them. I write about Catholics, sort of like Alice McDermott but with a bit more of an edge.

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Will I Be A Dope Doctor When I Grow Up?

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EDITOR’S NOTE: Points is delighted to welcome Kim Sue, a previous contributor (check out her earlier posts here and here), medical anthropologist, and dual degree MD/PhD candidate at Harvard University. On the heels of Points’ recent posts about the difficulties of reconciling clinical and scholarly perspectives on addiction treatment and the media frenzy about the recent prescription opioid epidemic, Sue offers a historical and ethical reflection on having the power to dispense prescriptions.

I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.

Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.

But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.

Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”

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Laudanum (image via Science & Society Picture Library/Getty Images)

 

Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.

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Old Ideas for a New Era: On Reading Sam Quinones

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Sam Quinones and I share an affinity for this startling fact: more Americans now die of drug overdoes than car crashes. I often say this when I am trying to convince someone that it’s important to study the drug wars; Quinones last week used the tidbit in the first paragraph of his New York Times opinion piece titled “Serving All Your Heroin Needs.”

In this article—and probably elaborated in his new book Dreamland: The True Tale of America’s Opiate Epidemic—the L.A.-based journalist writes about a new breed of Mexican heroin dealers who deliver drugs “like pizza” in cities across the Midwest. He uses a nickname for the dealers coined by a cop he knows: Xalisco Boys, for the poppy-growing region from whence they come to the United States looking for a fast buck.

Sam Quinones, Dreamland (Bloomsbury Press, 2015)
Sam Quinones, Dreamland (Bloomsbury Press, 2015)

I have no doubt the system of low-violence, customer-service-oriented drug dealing that Quinones has studied for several years is real. But the old chestnuts he hauls out in talking about the public health problems caused by the increased availability of heroin in smaller cities deserve comment. 

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Pharma Gamesmanship in the Booming Business of Addiction Therapeutics: the Case of Suboxone

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Editor’s Note: Points welcomes another new guest blogger to the ranks today. Kimberly Sue is an M.D.-Ph.D. candidate in medical anthropology at Harvard, doing ethnographic fieldwork with opiate-addicted women. Below, Kim details some very recent developments in the ways pharma companies invoke societal values around drugs in order to manage their market share, and discusses how the outcomes are likely to affect people in treatment.

Pharmaceutical companies and opiates have a complicated, intertwined history. Analgesia was and continues to be a big business as well as an ongoing medical conundrum. Opiates, as we know, are wildly popular analgesics. Yet when did opiates specifically indicated for treating addiction become such a big business, a lucrative niche market inciting pharmaceutical companies to aggressive industry maneuvers? As Penn professors John Kimberly and Thomas McLellan wrote in a 2006 article on the substance abuse treatment industry, “Pharmaceutical companies that, not long ago, refused to allow the use of even their discarded medications for clinical research in addiction now invest hundreds of millions of dollars in the marketing and sales of approved addiction medications.”

Mum, mustard, and maintenance. ( Reckitt Benckiser annual report, 2011).
Mum, mustard, and maintenance. (Reckitt Benckiser annual report, 2011)

Does this say something about the changing cultural attitudes towards addiction—that pharmaceutical companies are no longer afraid of being branded as making drugs for drug addicts—or does it simply speak to the enormous profits to be had?

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Weekend Reads: Lance Armstrong Edition

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Viewed from the outside, many proponents of the War on Drugs seem intransigent in their views simply because they find it difficult to allow any new argumentation or evidence to affect what they’ve deemed a moral issue. Much as temperance was in the 1920s, those who support the American government’s battle to retain strict drug laws with severe punishments are undoubtedly engaged in a symbolic crusade (to borrow a term from Joseph Gusfield). Essentially, their support exists in the name of continuing counterproductive and often irrational public policies because, to many, such laws and strictures symbolize something more, something deeper. Many Americans don’t see the loosening of drug laws as a utilitarian means of harm reduction, but as a retreat from the “traditional” values from a morally cohesive age that never really existed.

To be fair, moral crusades regarding drug use are far too complex to be simply be reduced to the simplistic regressive, anti-modernist picture I just provided without heavy qualification. While it is true that the struggle over the meaning of drug laws remains largely politically partisan in American society, one need only look to the news to see how the issue of drugs, government oversight, and moralism can be reframed in a much more complex way. With the recent investigations of Lance Armstrong’s doping and illegal prescription drug muling coming to a close this week, one finds no clear political delineation among the cyclist’s supporters and opponents. Positions on drugs within the Livestrong Industrial Complex vary, as liberals, libertarians, conservatives, and independents struggle to disentangle the implications of L’affair Armstrong.

For those not yet aware, the Plano, Texas-born Armstrong is perhaps the most celebrated road cyclist in history, having famously won the Tour De France seven times, six times after having contracted cancer in his testicles, lungs, abdomen, and brain. Armstrong parlayed his seemingly superhuman ability to perform astounding athletic feats whilst struggling with a life-threatening illness into the multi-billion dollar Livestrong charity, which works as an awareness-raising (though not really a money-raising) foundation on behalf of cancer research. As one might expect, Lance’s combination of non-partisan do-goodery and athletic acumen – not to mention his celebrity romancing – made him an enormously popular and powerful fellow in the worlds of cycling and politics.

Because it seems counterintuitive that someone should not only recover from cancer to win a prestigious endurance race, but should do so without the use of performance enhancing drugs (PEDs) within a sport rife with said drug use, Armstrong has also spent much of his adult life under suspicion. He is undoubtedly the most famous and divisive longtime target of both national and international anti-doping agencies. Despite numerous allegations and investigations, however, Armstrong has never (publicly) tested positive for PEDs and has vigorously defended, in both the courts and the press, his personal reputation as a “clean” racer. Nonetheless, fans and journalists have continued to widely (and openly) suspect Armstrong’s use of non-detectable PEDs, including “The Clear.” 

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The Points Interview: Dominique Tobbell

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Editor’s Note: We’re more than a quarter of the way to one hundred Points Interview features today!  We dry out from our recent spate of alcohol histories to pop a few pills with Dominique Tobbell, our twenty-sixth interview subject and author of Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and Its Consequences (California, 2012).

Describe your book in terms your mother (or the average mother-in-the-street) could understand.

My book explains the complex relationships between drug companies, physicians, and academic researchers. During the 1960s and 1970s the American drug industry confronted a reform movement that sought to reduce prescription drug prices by securing legislation that would increase the government’s control over drug development, distribution, and therapeutic practice. This reform movement brought together congressional Democrats committed to protecting the economic interests of consumers and organizations dedicated to increasing Americans’ access to affordable health care. It also included state welfare agencies and hospital groups struggling to balance their budgets amidst rising costs, and a growing number of physicians who accused drug firms of spending far more on misleading and excessive marketing than on research, needlessly driving up the costs of prescription drugs. My book describes this reform effort and the historical emergence of a politically powerful pharmaceutical industry in opposition to it. In the decades following World War II, the industry developed extensive networks with academic researchers, medical schools, and government officials. These relationships underpinned innovation and growth in the U.S. pharmaceutical sector and formed the basis of the industry’s political support after the war. I argue that the shared interests among academic researchers and the drug industry and the industry’s responsiveness to the needs of the biomedical community led the drug industry, organized medicine, and leading academic physicians to join forces against reformers in the 1960s and 1970s. My book demonstrates the economic and intellectual influence of drug industry interests on research universities and medical schools in the second half of the twentieth century.

What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?

Because of its focus on pharmaceutical politics, my book explores the dynamic process by which drug companies, physicians, patients, and regulators debated, contested, and defined the regulatory framework for prescription drugs in the U.S. after World War II. As drug and alcohol historians have shown, this regulatory framework has necessarily had a determinative role in defining the legal status of specific of drugs, at the same time that these same groups—drug companies, physicians, patients, and regulators—have been the central actors in demarcating, maintaining, and contesting the boundaries between licit and illicit drug use. My book, I hope, will thus provide drug and alcohol historians with valuable context for understanding the political and politicized history of drugs in American society in the second half of the 20th century.

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