top of page

Opioid Abuse in the USA

Updated: Jul 1, 2021

By Emily Duchenne - Geography Student @ Brasenose College, Oxford


The opioid epidemic across the US has been described as a “uniquely American problem”, taking the lives of almost 400,000 people from 1998 to 2017. The term opioid refers to all compounds that bind to the opiate receptors on nerve cells, with natural compounds such as heroin and morphine known as opiates. Opiates have been used for millennia due to its analgesic (painkilling) qualities, with heroin being cultivated from poppy seeds over five-thousand years ago in Mesopotamia, yet today’s long-term administration of an opioid for the treatment of chronic non-cancer pain continues to be controversial due to concerns related to effectiveness, safety, and abuse liability through addiction. The confluence of pharmaceutical lobbyist agendas, a culture of overmedicalisation, failure to recognise the epidemic due to racialised and classist stereotypes of drug users, all reflect the importance of what Arjun Appadurai (1986) terms ‘the social life of things’, where opioids have become loaded with histories and contemporary investments that sit in contrast to their innocuous pill form.

America’s history with opioids over the 19th and 20th centuries is one of infatuation followed by revolt. Following scientific developments in Europe during the 19th century, the extraction and administration of the active ingredient morphine to relieve patients of severe pain not only presented opioid use as a breakthrough for successful treatment, but recognised pain as a debilitating and destructive condition. In the American context, morphine appeared a godsend for soldiers severely injured during the Civil War in the 1850s; however, the liberal use of the drug to sooth patients meant many soldiers came home from field hospitals addicted to the analgesia experience. Throughout the 19th century, the overzealousness of doctors who prescribed opiates to upper-middle-class women for everything from menstrual cramps to hysteria resulted in a “tally of wrecked middle-class families and lives”.

The synthesisation of the more powerful heroin towards the end of the century entrenched opioids as part of the pharmacist’s counter, marketed as a cough suppressant and even an aid to help infants cope with teething. By 1895, morphine and opium powders had led to an epidemic that affected roughly 1 in 200 Americans, with the typical opiate addict being an upper-class or middle-class white woman. Due to the demographic, however, the situation was treated more as a scandal than a crime, and it was not until advances in medicine, public health, and sanitation, as well as the debut of pain relievers such as aspirin in 1899, did doctors begin to slow and reverse the overuse of opiates. Conceptualising pain as a medical condition became criticised, with