From Patent Medicine to Public Enemy: The Twisted History of U.S. Opioid Prohibition
Opioids didn’t become a “crisis” when suburban white America discovered OxyContin. The war on opioids started over a century earlier—when the people using them were Chinese railroad workers, Black laborers, sex workers, and poor women buying laudanum from corner shops.
To understand how we got from open, over-the-counter opium tinctures to mass incarceration and fentanyl-adulterated street drugs, you have to trace a simple story: whenever opioids were profitable for the right people, they were medicine. When they were associated with the “wrong” people, they became a moral emergency.
Evidence? Science? Public health? Those were optional extras. Race, class, fear, and profit drove opioid policy far harder than any concern for actual harm. And we’re still living in the wreckage.
From Everyday Tonic to Convenient Scapegoat
In the 19th century, opioids were everywhere in the United States. Morphine, opium, and later heroin were sold in patent medicines, advertised in newspapers, and poured into children’s cough syrups. You could buy opium-based “soothing syrups” for teething babies and laudanum for “women’s troubles” without a prescription.
Were people getting dependent? Absolutely. Was it treated as a crime? No. The main victims of this era’s opioid dependence were middle-class white women, Civil War veterans, and people self-medicating pain, anxiety, or trauma. The response was largely medical and paternalistic, not criminal.
The “drug menace” narrative didn’t ignite until opioids became politically useful as a tool for social control.
The Racialization of Opium: Chinese Workers and Moral Panic
In the late 1800s, Chinese immigrants were brought in to build railroads and do dangerous, low-paid work. When the economy soured and white workers wanted someone to blame, Chinese communities became targets for every moral panic available, and opium smoking was weaponized as a racial issue.
Opium itself wasn’t new. American and European elites had been drinking opium tinctures for decades. What was new—and politically convenient—was the panic over opium smoking, heavily associated with Chinese communities.
Politicians and newspapers pumped out lurid stories about “opium dens,” where supposedly innocent white women were being lured, drugged, and sexually corrupted by Chinese men. It was classic racist fantasy, wrapped in “protect the women and children” rhetoric that prohibitionists still love today.
The first major U.S. anti-drug laws were not driven by some scientific epiphany that “drugs are bad.” They were explicitly tied to immigration control and racial hierarchy.
San Francisco 1875: The First Opium Law Wasn’t About Health
In 1875, San Francisco passed the first anti-opium ordinance in the United States, banning opium smoking in “opium dens.” Not opium tinctures. Not morphine. Not the stuff white Americans were using. Just the way Chinese workers were using it.
Let’s underline this: the same drug, different mode of administration, different race of user—completely different legal treatment.
The law was explicit about its goal: control and harassment of Chinese communities. Not public health. Not safety. It was a targeted political weapon disguised as morality.
The Harrison Act: When Medicine Became a Crime
Fast-forward to 1914. The U.S. signs onto international narcotics control efforts and passes the Harrison Narcotics Tax Act. On paper, it’s a “tax” and registration law for opium and coca products. In practice, it’s the foundation of federal opioid prohibition and the criminalization of people who use drugs.
The Harrison Act didn’t outright say “it’s illegal to be addicted,” because that would’ve clashed with medical norms and constitutional concerns. Instead, the Treasury Department and the courts reinterpreted it over time to effectively criminalize maintenance treatment—doctors prescribing opioids to people already dependent, to stabilize their lives.
Doctors who continued to treat opioid-dependent patients with small maintenance doses—what we would now call humane harm reduction—were raided, prosecuted, and jailed. Thousands lost their licenses. Clinics that provided maintenance to dependent people were shut down in the 1920s.
Overnight, a treatable condition became a legal status. Simply existing as an opioid user became grounds for surveillance, criminalization, and police harassment.
The Supreme Court: Codifying Cruelty
In cases like Webb v. United States (1919) and United States v. Behrman (1922), the Supreme Court gave the government exactly what it wanted: authority to punish doctors for prescribing opioids to dependent patients under the guise of “not legitimate medical practice.”
Let’s be crystal clear: the Court wasn’t following some evidence base that said maintenance treatment was harmful. Maintenance was already known to stabilize people. The rulings reflected moral panic, professional gatekeeping, and bureaucratic power grabs, not science.
The result was predictable. When legal, regulated access was cut off, people turned to the illegal market. Crime rose, overdose risk increased, and users were pushed further into the margins. This wasn’t an accident; it was the logical outcome of a policy that chose punishment over care.
Heroin, “Junkies,” and the Birth of the Drug War Mythology
Heroin itself started as a pharmaceutical product. Bayer marketed it in the late 1800s as a cough suppressant and a supposedly “less addictive” morphine alternative. (Yes, the same Bayer that now sells you aspirin.) That little mistake tells you all you need to know about corporate “drug expertise.”
By the mid-20th century, heroin use was heavily associated with poor urban neighborhoods, Black and Latino communities, veterans, and people pushed out of mainstream economic life. Cue another moral panic.
Popular media portrayed heroin users as dangerous, depraved, and doomed. Never mind the social conditions—poverty, racism, trauma, lack of healthcare, mental health neglect. It was all flattened into one caricature: the “junkie.”
This caricature functioned perfectly for policy-makers. It justified police crackdowns, aggressive surveillance, and mass criminalization, while ignoring the structural violence that actually shaped people’s lives.
Methadone: Accepted Only When It Fit the Narrative
The 1960s and 70s introduced methadone maintenance treatment—an opioid agonist therapy that dramatically stabilized people’s lives, reduced crime, and cut overdose risk. Evidence piled up that treating opioid use as a health issue worked far better than raids and prison.
Did the U.S. suddenly “see the light” and embrace a health-based approach? Not quite. Methadone programs were tightly controlled, stigmatized, and often framed not as respecting autonomy but as containing a problem population. The same racist and classist logic persisted: we don’t care about your wellbeing; we care if you’re visible, inconvenient, or politically threatening.
Opioid policy never really left the carceral frame—treatment was tolerated only when it didn’t challenge the underlying idea that the state owns your body and can punish you for how you choose to alter your consciousness.
The Controlled Substances Act: Centralizing Power, Not Protecting Health
In 1970, the U.S. passed the Controlled Substances Act (CSA), creating the familiar “schedule” system that classifies drugs from Schedule I (supposedly most dangerous, no medical use) to Schedule V.
Opioids were scattered across different schedules—heroin in Schedule I, morphine and oxycodone in Schedule II, some weak codeine combinations in lower ones. This wasn’t a coherent health-based ranking; it was a mash-up of medical lobbying, political calculation, and international treaty obligations.
The CSA did one thing very effectively: it centralized federal power over what adults can put in their own bodies. The Attorney General and, later, the DEA gained enormous authority to classify, reclassify, and control substances based on elastic notions of “abuse potential” and “accepted medical use.”
Once again, public health was the costume. Control was the plot.
The War on Drugs: Opioids as Enemy, Pharma as Partner
When Nixon declared the “war on drugs” in 1971, his own domestic policy chief later admitted the strategy: associate drugs with anti-war leftists and Black communities and then criminalize both via enforcement. Opioids were part of that toolkit. Heavy policing of heroin in urban Black neighborhoods helped justify aggressive surveillance, militarized tactics, and mass arrests.
But while street heroin was demonized, pharmaceutical opioids were increasingly promoted as safe and modern when dispensed through doctors and corporations. The hypocrisy is so blatant it barely needs explanation: same receptors, same dependence potential, radically different moral framing depending on who profits and who’s using.
The OxyContin Era: Corporate Dealers in Lab Coats
In the 1990s, Purdue Pharma launched OxyContin, aggressively marketing it as a long-acting, low-risk pain medication. The company leaned on pseudo-science, misleading data, and a tiny, misinterpreted 1980 letter about addiction rates to claim their product was rarely addictive when used as prescribed.
Doctors, primed by pharma’s messaging and systemic pressure to “treat pain,” prescribed OxyContin and other opioids liberally. Pharmacies shipped ridiculous quantities to small towns. Wholesalers, distributors, and regulators saw the numbers and looked away—or cashed in.
When overdose deaths began to spike, the moral panic didn’t start with handcuffs for CEOs. It started, again, with people who use drugs.
Instead of facing the obvious—that a corporate-driven over-prescription wave had created widespread dependence and a deeply entrenched market—the political class reverted to its favorite script: crack down, restrict, criminalize.
Cutting the Supply Without Caring About the People
As prescription monitoring tightened and pills became harder to get, people didn’t just stop being dependent. They shifted to cheaper, unregulated street opioids, often heroin. Later, as supply chains evolved, fentanyl and analogues flooded the illicit market because they were easier to smuggle in tiny quantities.
This is Prohibition 101: you restrict a popular substance without providing safe, legal, regulated alternatives or serious, accessible care, and you supercharge the black market. The drug gets more potent, more contaminated, and more deadly.
The overdose crisis didn’t “just happen.” It was engineered by a mix of corporate greed, regulatory complicity, and prohibitionist ideology. You couldn’t design a better system to kill people if you tried.
The Civil Liberties Tab We’re Still Paying
Opioid prohibition hasn’t just made drugs more dangerous; it’s shredded civil liberties in the process. A few hits to the Constitution in the name of “saving people from drugs”:
- Search and seizure creep: “Drug suspicion” has been used to justify car searches, stop-and-frisk, no-knock raids, and mass surveillance, disproportionately targeting Black, Brown, and poor communities.
- Medical privacy erosion: Prescription Drug Monitoring Programs (PDMPs) give law enforcement indirect windows into people’s medical histories under the banner of “diversion control.”
- Criminalizing health conditions: Being opioid-dependent invites policing instead of care—people are arrested for possession, for self-medicating withdrawal, for simply existing in public while visibly unwell.
- Pregnancy policing: Pregnant people who use opioids are reported, criminalized, and have children removed, driving them away from prenatal care and increasing risk for both parent and child.
Prohibition doesn’t just regulate substances. It rewires the relationship between the individual and the state. Your body stops being yours and becomes a legal problem.
The Public Health Carnage of Prohibition
Every major public health disaster around opioids is amplified—or outright created—by prohibitionist policy:
- Overdose deaths: Driven by an unregulated, unpredictable supply (fentanyl, analogues, adulterants) and fear of calling for help due to police involvement.
- Infectious disease: HIV, hepatitis C, and bacterial infections spread when sterile syringes and safe supplies are blocked by law and stigma.
- Treatment barriers: Medications like methadone and buprenorphine are heavily restricted, bureaucratically strangled, and stigmatized, while prison remains wide open and well funded.
- Forced withdrawal in jails: People are thrown into cells and left to withdraw without medical support, a form of state-sanctioned torture dressed up as “detox.”
Meanwhile, in countries that have embraced sane, evidence-based approaches—heroin-assisted treatment in Switzerland, decriminalization and health services in Portugal—overdoses and associated harms have plummeted. Turns out giving people safe supply and support works better than arresting them. Who knew? (Everyone paying attention.)
What an Evidence-Based, Rights-Respecting Opioid Policy Would Actually Look Like
If we stopped worshipping prohibition and started caring about people, opioid policy would look radically different:
- Legal, regulated supply: Adults would have access to pharmaceutical-grade opioids through medical or supervised channels—no mystery powders, no roulette with fentanyl.
- On-demand treatment: Opioid agonist therapies (methadone, buprenorphine, slow-release morphine, even heroin-assisted treatment) available without absurd hoops, waitlists, or moral interrogation.
- Full harm reduction infrastructure: Safe consumption sites, drug checking, syringe services, naloxone everywhere, and no cops hovering around every program.
- Decriminalization of possession and use: No one should be arrested for what they put into their own body. Full stop.
- Respect for bodily autonomy: Treat opioid use as a matter of health, self-determination, and personal risk calculus, not as a pretext for state control.
This isn’t utopian. Versions of this already exist around the world and have been studied to death. They reduce harm, reduce death, and improve quality of life. The main thing they don’t do is feed the carceral machine or deliver huge profits to pharma while scapegoating users. That’s why they’re resisted.
The Real Lesson of Opioid History: It Was Never About the Drug
From 19th-century laudanum to Chinese opium dens, from heroin scares to OxyContin, from “junkies” to “victims of the opioid crisis,” the through-line is painfully simple: the law doesn’t follow the pharmacology. It follows power.
When opioids were quiet companions of white middle-class suffering, they were tolerated. When they were associated with racialized “others,” they became an emergency. When pharmaceutical companies could make billions in pain pills, the system greenlit mass prescribing. When the fallout hit the streets, suddenly the talk turned to “cracking down” and “getting tough.”
Prohibition hasn’t saved people from opioids. It has made opioids more dangerous, empowered violent markets, fueled mass incarceration, and given the state a ready-made excuse to invade people’s lives and bodies.
The lesson isn’t that opioids are uniquely evil. The lesson is that giving governments the power to decide which altered states are acceptable—and who gets punished for them—is a civil liberties disaster dressed up as morality.
Adults deserve honest information, regulated options, and the freedom to make their own choices about their own bodies. We can’t undo the history of opioid prohibition, but we can stop repeating it.
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Tags: drug policy, harm reduction, legalization, antiprohibit, education-history
