Lecture examines history, science of opioid addiction

The vast majority of drug addiction in American history has occurred in the context of drugs that were legally produced for the medical industry. Addiction rates lean toward pharmaceuticals, but policing and punishment have focused on street drugs, according to UB historian David Herzberg.

“Today’s situation with opioids is not as novel as it might appear,” said Herzberg, one of the speakers at the first of a three-part series, “Confronting the Opioid Epidemic,” presented by the UB Mini Med School, a public service, community education program of the Jacobs School of Medicine and Biomedical Sciences at UB.

The Mini Med School educates the public about the science that underlies medicine and health care by building a curriculum for non-specialists that’s modeled after many aspects of a medical school education. More information about the remaining sessions in the opioid lecture series can be found on the Mini Med School’s website.  The next session on “Prevention and Treatment” will take place on March 22.

“This topic, the topic of the opioid epidemic, is in the newspapers; it’s on the radio; it’s a concern of lawmakers and health care providers,” said Roseanne Berger, director of the Mini Med School and senior associate dean for graduate medical education. “We are presenting this series to further educate the public about this particular issue from an historical perspective, a biological perspective, a patient-care perspective and a judicial and enforcement perspective.”

The unfolding opioid epidemic began in the early 1990s with increased prescriptions, said Kenneth E. Leonard, director of UB’s Research Institute on Addictions.

“The availability of these drugs meant that the people who were at risk had access to them when in previous years they did not,” Leonard said.

The regulatory environment also relaxed around the same time, according to Herzberg, when pharmaceutical companies created new mass markets with direct-to-consumer advertising.

Yet, viewing the opioid epidemic as distinct from similar social problems created by other drugs is flawed, according to Herzberg.

Herzberg, an associate professor in the Department of History, says America has historically viewed drug abuse as a divided problem bordered by street drugs on one side of the issue and pharmaceuticals on the other. Drug policy has mirrored this split, basing its approach on either protecting vulnerable consumers who fell victim to prescription drug addiction or punishing illicit drug users who often were viewed as having created their own problem.

The Pure Food and Drug Act of 1906, the country’s first consumer protection legislation which created the Food and Drug Administration (FDA), was mostly a safety measure that required accurate labeling of drugs. It approached addiction as something similar to accidental poisoning, Herzberg said.

But where the FDA was designed to protect, the subsequent Harrison Anti-Narcotic Act of 1914 evolved into a tool to punish. It worked so well in that role that 30 percent of all federal inmates were incarcerated for narcotics violations only 14 years after its creation.

“From a historical point of view, the best drug policy may have come in the 1970s with the Controlled Substances Act (CSA), when policy makers looked beyond the distinction between street drugs and prescription drugs and managed the problem from a perspective that was quite effective, looking at the full range of drug use,” he said.

In fact, ignoring that distinction is critical to understanding the nature of addiction, noted Peter Thanos, RIA senior research scientist.

“One of the common definitions of addiction revolves around a notion of a cycle,” Thanos said. “We think of addiction as a chronic brain disease characterized by an urge to compulsively use one or more drugs, or engage in compulsive behaviors despite catastrophic consequences.”

The CSA’s effectiveness was, however, short-lived. Even as pharmaceutical regulations were loosened, punitive drug wars ramped up, again creating the impression that drug addicts were a threat rather than a population in need of treatment and protection.

The country continued its pattern of making drug policies both too weak and too strong, with the flaws in both approaches hidden by a determination to see abuse of pharmaceuticals and abuse of street drugs as separate problems.

“The CSA wasn’t perfect, but when you look at a century of repeated failures to protect Americans from the harmful effects of drug abuse, you can’t throw away successes, no matter how partial they were,” says Herzberg.