Opium

Opium appears in the book as a substance with a history far longer and more complicated than any single modern drug crisis: it could relieve pain or produce intoxication, sustain vast commercial fortunes, and provoke conflict. Its changing status—from familiar medicine to a regulated drug associated with criminality—also exposes how societies have assigned blame for dependence differently across eras and groups.

A medicine with a long history

The book traces opium’s use back to ancient people who learned to dry and smoke the juice of the poppy, whether to feel its effects or to seek relief. In the nineteenth century, opium was a major ingredient in laudanum, an alcohol-based tincture used for a wide range of conditions, from fever and cholera to headaches and general pain. After Alexander Hamilton was wounded in a duel in 1804, doctors administered laudanum to ease his pain. The same substance thus belonged both to ordinary medical practice and to a much older history of intoxicating use.

That dual role extended into international politics and private wealth. Britain and China fought two nineteenth-century wars over opium. In the 1820s, a Boston merchant organized an opium-smuggling operation off the Cantonese coast; the resulting wealth enriched Boston families and later helped finance railroads, mines, and factories. Opium was not merely a medicine or a personal habit. It was also a commodity whose circulation connected distant markets to the building of American industry.

From opium to morphine

Around the same period, the German apothecary Friedrich Sertürner isolated opium’s active ingredient and named it morphium, after Morpheus, the Greek god of dreams. The discovery made possible a more powerful compound, but Sertürner also recognized its dangers. He observed a progression from euphoria to depression and nausea, and saw severe after-effects in animals given the drug. The book connects this withdrawal to the condition historically called yen and to later language for the distress of dependence. In 1810, Sertürner warned that attention to the new substance’s harmful effects might avert calamity.

By the 1870s, morphine injections were widely accepted among upper-class users in Europe and the United States. Doctors employed them for complaints including menstrual pain and eye inflammation, while minimal oversight left opium and morphine products readily available at drugstore counters without prescriptions. Even injected morphine could be considered acceptable if a doctor had initially approved its use. Daily reliance did not necessarily carry public disgrace: when dependence followed medical treatment, it could be understood as a consequence of care rather than a moral failing.

Medical dependence and changing scrutiny

That broad acceptance was not uncontested. In 1884, the Virginia General Assembly considered regulating over-the-counter opium and morphine. A local newspaper opposed the proposal, while Richmond physician W. G. Rogers argued that the drugs could leave people dependent after they had first been prescribed. His appeal identified a contradiction within the prevailing system: patients could be harmed by medicines supplied through legitimate care, yet regulation was dismissed as an attack on ordinary commerce.

Other physicians began challenging routine prescribing. In 1895, a Brooklyn doctor warned the New York Academy of Medicine that leaving morphine and syringes with patients for use whenever pain returned could lead to dependence after only a few doses. By 1900, more than 250,000 Americans were addicted to painkillers derived from opium. The figures and warnings complicate any account that treats dependence as a problem brought into medicine from outside: doctors’ decisions and the easy availability of drugs were part of the history too.

From familiar use to criminalization

The book places the later history of heroin within this same pattern of medical enthusiasm and delayed alarm. Bayer promoted heroin as a safe, nonaddictive treatment and distributed samples to physicians; by 1899, the company was producing a ton a year and selling the drug in twenty-three countries. Heroin appeared in cough drops and baby-soothing syrups, while some consumers remained functioning, doctor-approved users whose habits could stay hidden as long as their supply continued. These developments concerned a derivative and not opium itself, but they carried forward the older confidence that a drug could be presented as a reliable remedy before its risks were fully understood.

Over time, public and legal classifications shifted. The Harrison Narcotics Act of 1914 severely restricted the sale and possession of heroin and other narcotics, and heroin manufacture was outlawed in 1924. By the 1930s, the book describes a changed image of the typical heroin user: working-class people, including children of immigrants, as well as musicians and other creative workers. Those who remained dependent were increasingly identified as criminals rather than patients. The earlier figure of the physician-dependent user, common even in small towns, receded from public memory as addiction became associated with inner-city poverty and illicit drug networks.

The legacy of stigma

The book uses the history of Opium to show that the social meaning of drug dependence is not fixed by a substance alone. Earlier users of opium and morphine could be regarded as respectable when doctors had authorized their use; later users of related drugs were more readily marked as deviant or criminal. That distinction matters to the modern story of Roanoke, Virginia, where heroin had long been treated as an invisible inner-city problem before the epidemic reached suburban families. The book also describes how people of color received painkillers at lower rates than white patients, while drug enforcement and imprisonment fell disproportionately on Black and Hispanic people. These are not interchangeable histories of Opium and modern opioids, but they reveal a recurring divide in how medical risk, addiction, and blame are distributed.

The through-line is not that every period understood the drugs in the same way. It is that claims of safety, patterns of prescribing, rules governing supply, and public judgments about users repeatedly changed together. Opium’s history therefore serves as a warning against treating addiction as either an isolated individual failing or a new, unprecedented crisis: its consequences have long been entangled with medicine, commerce, regulation, and stigma.