27 – The First Opiate Epidemic

The United States is in the midst of an epidemic of addiction and overdose deaths due to opiate painkillers. Its causes are varied, but there’s no question that physicians share a large part of the blame. Little discussed is that this is actually the second time this has happened. Almost a century ago, a remarkably similar epidemic struck the country. In this episode, called “The First Opiate Epidemic,” I discuss what happened, the parallels to today, and the lessons we can learn from our forebearers. Learn about all this and a new #AdamAnswers in this month’s Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!

Sources:

• Courtwright DT. Dark Paradise: A History of Opiate Addiction in America. Harvard University Press, 2001.
• Meldrum ML, “The ongoing opiod prescription epidemic: historical context,” Am J Public Health. 2016 August; 106(8): 1365–1366.
• Courtwright DT, “Preventing and treating narcotic addiction -- a century of federal drug control,” N Engl J Med 2015; 373:2095-2097.
• Adams JFA, “Substitutes for opium in chronic diseases,” Boston Med Surg J 1889; 121:351-356.
• Macht DI, “The history of opium and some of its preparations and alkaloids,” JAMA. 1915;LXIV(6):477-481.
• Hamilton GR and Baskett TF, “In the arms of Morpheus: the development of morphine for postoperative pain relief,” Can J Anesth. 2000;47:4, 367-374.
• Weiner JP, “A shortage of physicians or a surplus of assumptions?” Health Aff January 2002 vol. 21 no. 1 160-162.
• Gudbranson BA et al, Reassessing the Data on Whether a Physician Shortage Exists. JAMA. 2017;317(19):1945-1946.
• Kirch DG and Petelle K, Addressing the Physician Shortage: The Peril of Ignoring Demography. JAMA. 2017;317(19):1947-1948.