Heroin and the Creation of Junkies

BRIAN: We’re back. Earlier, we talked about how doctors were the source of opiate addiction in the late 19th century. As we mentioned, this was before there was a clear understanding of the physiology of addiction, and that’s reflected in the language of the time. Addicts simply had opium or morphine “habits.”

ED: But that changed in the early 20th century, when addiction became criminalized over fears of recreational drug use. People once thought to have “habits” now became known as “junkies.”

NATHAN: In the 1920s, a Philadelphia hospital opened a narcotics ward for recovering addicts. The patients were monitored while they suffered through withdrawal from morphine and other drugs. Once those symptoms stopped, the addicts were pronounced cured and sent home.

Historian Caroline Jean Acker reconstructed the lives of several hundred of these patients. One of them was a fellow she calls James Martin. He was a working-class white man who lived in New York City near Chinatown. In 1908, the then 21-year-old Martin went on a double date that changed his life.

CAROLINE JEAN ACKER: He wanted to impress the people he was with, and so he said, I know where there’s an opium den. Let’s go smoke some. And he found it made him feel really good, so he started going back, and back.

ED: But in 1909, just a year after Martin developed his habit, the federal government banned the importation of what it called “smoking opium.” The law deliberately targeted recreational use of the drug. It did not ban opium or morphine used in medicine.

CAROLINE JEAN ACKER: So for someone like James Martin, he had become addicted to opium, and suddenly, he had no access to it. But guess what was pretty easy to get on the street in those days? At pharmacies, still completely legally sold, except in a few localities? Heroin. So he began sniffing heroin as a substitute for the opium. James Martin changed his drug use behavior in specific response to the passage of legislation.

NATHAN: Heroin, an opioid derived from morphine, didn’t start out as a street drug. It started out as a pharmaceutical drug. The German company Bayer developed heroin in the 1890s and sold it over-the-counter as a cough suppressant. The American Medical Association approved heroin for general use in 1986, and urged doctors to prescribe it instead of morphine, believing it to be less addictive. Physicians gave it to both children and adults.

CAROLINE JEAN ACKER: Remembering that this is a time when tuberculosis was still the leading cause of death, coughing was an important prevalent symptom, a distressing one, and it seemed like a drug that would calm that would be useful. And it certainly made people feel better. But you didn’t have to have a cough to feel better from heroin.

NATHAN: Right.

ED: Pharmaceutical heroin was twice as powerful as morphine. And though Bayer promoted it as a safer, non-addictive substitute for morphine, heroin was even more addictive. And the drug’s easy availability produced a thriving black market for recreational users, especially after the federal government banned smoking opium.

CAROLINE JEAN ACKER: And so for example, teenage boys in pool halls were snorting heroin. Sniffing it up into the nose and into the bloodstream, and quite quickly into the brain, and produce a wonderful feeling. A kind of a rush, and a feeling of utter, utter calmness. So this pattern of use was spreading, it was popular, it was causing alarm.

NATHAN: And Congress responded to that alarm with a landmark law known as the Harrison Narcotic Act of 1914.

CAROLINE JEAN ACKER: And this act outlawed the non-medical use of a set of drugs, including morphine, heroin, and cocaine. And again, this was targeted specifically at use associated with entertainment districts, and largely working-class neighborhoods. Optimists believed that you simply keep the drugs from being imported and no one can get them, and the drug use problem will disappear. We’ve banned this, the problem’s going to go away. But it quickly became evident that the problem wasn’t in fact going away.

NATHAN: In the 1920s, a physician named Lawrence Kolb tried to figure out why banning drugs didn’t seem to eliminate drug use. He classified addicts into two types.

CAROLINE JEAN ACKER: And the main distinction was, people– he really used the term “innocent.” People who accidentally became addicted because they had chronic pain, their physician was prescribing it for them, and they were becoming addicted. And Kolb had complete sympathy for them, and felt they just deserved support, and maybe even it made sense for them to have a doctor-managed continuing supply of morphine.

NATHAN: In other words, medical addicts. So that’s type 1.

CAROLINE JEAN ACKER: But the main category he singled out was what he called type 2, and these were people who started using the drug for pleasure and became addicted. It was never any medical issue at all, as far as he was concerned, that drove them to the use. But he believed that the people who became heroin addicts were born with a certain kind of vulnerability that made them susceptible to having a much more powerful response when they encountered heroin, and then sliding into addiction.

NATHAN: So given Kolb’s categories, you might say that James Martin is more of a type 2 user?

CAROLINE JEAN ACKER: Absolutely. Exactly right. He engaged in this bad behavior, which became criminal once the Harrison Narcotics Act was passed. There was serious classism built into Kolb’s definition. His class background was modest, and he typified the addict who became this conundrum over the course of the middle decades of the 20th century. How do we deal with this?

ED: Kolb’s views on addiction shaped public health policy for decades. His understanding of type 2 addiction also provided the intellectual underpinnings for the War on Drugs, federal drug laws that criminalized addicts like James Martin. Acker says that Martin went through detox and withdraw several times, and struggled with his addiction for at least 15 years. We don’t know what happened to him after that, but we do know that he represents a new kind of addict in the American imagination, a “junkie.”

CAROLINE JEAN ACKER: What happened was that heroin became referred to as “junk,” and that partly reflected the kind– I mean, some of these patients I studied had a real sense of self disgust at what had happened to them, and that their sense had just become enslaved to this drug. It was so associated with the addicts that it became a label for them. And the “junkie” became a profound symbol of deviance to mainstream conventional Americans.

BRIAN: So the way in which the junkie is being targeted as a kind of side of regulation, does that provide any kind of reveal about the nature of addiction itself?

CAROLINE JEAN ACKER: I think it reveals more about the nature of American society, and to some extent, societies in general. And that is the need to find some explanation for problems. So we have this recurring pattern of a panic about a drug, overreaction, and perhaps not as much social learning as would be good for us.

ED: US drug policy has always drawn a hard and fast line between pharmaceutical and recreational users. Between legal and illegal drugs. But given what we know about the physiological nature of addiction, a 19th-century morphine addict isn’t all that different from a 20th-century heroin addict.

BRIAN: Acker says at least some people are starting to understand this. In addition to her academic work, she spent many years working with heroin addicts, and she sees some hopeful signs.

CAROLINE JEAN ACKER: I think that we’ve had an amazing breakthrough in the understanding of drug use behaviors and how to respond to them. In the context of the crisis of AIDS, and the recognition that HIV could be transmitted through sharing syringes, activists sprang up to set up syringe distribution programs to ensure a sterile supply of syringes to injectors. And some people thought this was the craziest thing in the world.

What? You know they’re just going to use them to shoot up heroin. But from a public health point of view, it made perfect sense. Because it was interrupting the transmission of a pathogen from one body to another body.

BRIAN: AIDS activists carried out this work, even when it was against the law.

CAROLINE JEAN ACKER: In this context, they developed relationships with drug users. Trusting relationships. People who had– junkies, injectors, who had been treated terribly by the medical establishment, by social service organizations. Who didn’t want to work with anyone, who was an active drug user.

And so we’re learning that there’s this disdain of the user, and the refusal to work with them until they stop using is counterproductive. That you really can construct productive relationships and help people get better for them.

BRIAN: Carolyn Jean Acker is Professor Emerita of History at Carnegie Mellon University, and author of Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control.

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