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Drug Epidemics, Past and Present – The New York Times



A late-19th-century drug advertisement.CreditCreditLibrary of Congress

By Sam Kean

How Plants, Powders, and Pills Have Shaped the History of Medicine
By Thomas Hager

Synthetic opioids — drugs far more potent than anything that’s come before — are flooding America’s streets. New users start up daily, while old users fall deeper into cycles of despair. And as officials bicker about whether addiction is a medical problem or a criminal one, thousands upon thousands of people are dying.

That may sound like a contemporary account, but as Thomas Hager, a historian of medicine and science, explains in his absorbing new book, “Ten Drugs,” it also describes America’s first, forgotten opioid epidemic a century ago. The culprit back then was morphine, a compound isolated from poppy sap. And as Hager makes clear, we’re just as helpless treating addicts today as we were in the early 1900s.

The 10 titular drugs aren’t necessarily the most important ones ever; neither penicillin nor aspirin makes the cut. Instead, Hager writes, he picked each for its “historical importance plus its entertainment value.” (The first public demonstration of a treatment for erectile dysfunction — onstage at a medical conference — is especially memorable.) But above all, Hager explores the fraught human relationship with drugs: “Are they good for you? Often. Are they dangerous? Always. Can they perform miracles? They can. Can they enslave us? Some do.”

One chapter covers chlorpromazine, which awakened thousands of catatonic mental patients in the 1950s. Many were able to leave their asylums for the first time in decades — only to find an alien world, with their careers obsolete and their spouses remarried. Other drugs were selected less for their medicinal value than for the groundbreaking way they were discovered: through high-tech, systematic screening rather than blind groping.

Hager also dissects how the rise of giant drug companies has changed medicine. His critique is no screed: He acknowledges, rightly, what they do well. As late as the 1930s, doctors had just a dozen drugs in their armory to fight diseases; today, they have thousands. He even admits a grudging admiration for drug marketing, which is extraordinarily effective.

At the same time, he recognizes the bad. Companies scare patients into taking drugs with marginal benefits, or conjure up wholly new ailments (e.g., social anxiety), which then require pricey drugs to “cure.” He also highlights the chicanery of companies that trumpet flattering research while burying negative studies.

But the core of “Ten Drugs,” the subject of three separate chapters, is opioids. Human beings have been cultivating opium for more than 10,000 years — “before towns,” Hager writes, “before agriculture, before science, before history.” And opioids do kill pain, no question. The problem is, they’re frighteningly addictive, and chemists since the 1800s have had no luck creating new opioids that dull pain without creating dependency.

This work has not only failed, it’s also backfired spectacularly. Like the monster in a horror-movie franchise, each sequel — morphine, heroin, OxyContin, fentanyl — grows more terrifying. Fentanyl, which killed Tom Petty and Prince, is 50 times stronger than heroin, which itself is roughly twice as potent as morphine. Still more powerful drugs await government approval.

For various reasons — wealth, a broken health care system, a determination to self-medicate — the United States has suffered more from opioids than other nations. Although just 4.4 percent of the world’s population, Americans consume a staggering 80 percent of all opioids. “Opioid overdoses,” Hager notes, “kill more Americans than car accidents and gun homicides put together.”

Time and again throughout history, our mastery of new pharmaceuticals gave us a feeling of omnipotence at first, until we realized just how little control we had over them. But maybe that ambiguity is an intrinsic part of their nature. As Hager aptly sums up: “No drug is good. No drug is bad. Every drug is both.”

Sam Kean’s newest book, “The Bastard Brigade,” will be published in July.

How Plants, Powders, and Pills Have Shaped the History of Medicine
By Thomas Hager
296 pp. Abrams Press. $26.

A version of this article appears in print on , on Page 21 of the Sunday Book Review with the headline: Drug Epidemics, Past and Present. Order Reprints | Today’s Paper | Subscribe

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