Chapter 1
The Origins of Heroin

Developed in the 1890s as a supposedly safe alternative to the opiate painkillers of the day, heroin was declared "a heroine in the war against pain" by its manufacturers, and aggressively marketed internationally. The arrival of such a drug was welcome news for a world that had for thousands of years relied on heroin's parent drug, opium, for pain relief and other medicinal purposes. However, opium had destructive properties as well. With the invention of heroin, it seemed that a miracle drug had finally been found that dramatically increased opium's pain-relieving and medicinal properties, while at the same time making its legacy of addiction, overdose, and unpleasant side effects a thing of the past. It soon became evident, however, that instead of alleviating the risks opium use had posed, heroin presented even more dangerous problems of its own.

The First Opium-Using Societies

Opium, a narcotic sap contained within the seedpod of the Asian opium poppy, has been used by humankind since the Stone Age. Since its earliest users had neither the knowledge nor the intricate tools needed to harvest the plant's sap, most of them probably obtained its effects by boiling, steeping, or soaking the plant's seedpods and then drinking the resulting tea. This seedpod tea probably delivered rather weak opium doses, however, since excessive amounts of seedpods and labor would have been required for potent batches. Thus, the drug's pain-relieving and other medicinal benefits, which include soothing respiratory and lower digestive tract ailments, would have been experienced at moderate levels by these earliest users. Likewise, its undesirable side effects, which include flushing and itching of the skin, dry mouth, and occasional nausea and vomiting, would also have been mild, and opium addiction and overdose was probably very uncommon.

The earliest known opium-users were the Sumerians in the highlands of what is now Turkey and Iraq. "The first reference to opium," explains pain relief expert Dr. J.C.D. Wells, "seems to have been an inscription carved on a tablet by members of the Sumerian tribe around 4000 years b.c."¹ The Sumerians were quite fond of the opium poppy, with its delicate white-to-pink or purple petals, and called it hul gil, which meant "joy plant." When the Sumerians migrated from the Middle East into lower Mesopotamia about 3500 b.c., they brought the opium poppy with them, and it became one of the main crops of the flourishing agricultural society that they developed there.

Sumerian poppy farmers in Mesopotamia discovered an even more efficient way to harvest opium. They found that if they cut incisions on the poppy's mature seedpod, which is about the size of a chicken egg, most of the opium would ooze out within twenty-four hours and dry into a latexlike substance that could then be scraped from the outside of the pod. This efficient harvesting technique, which opium poppy farmers employ to the present day, enabled people to eat or drink strong, concentrated doses of opium for the first time in history. The increased dosage strength provided the first significant medicinal pain remedy known to humankind, and led to substantially increased instances of opium addiction and lethal overdose.

The Sumerians passed their knowledge of opium harvesting to other Mesopotamian civilizations, such as Assyria. These poppy-culling practices continued from the Assyrians to the Babylonians, who would in turn pass their knowledge on to the Egyptians. About the time of King Tutankhamen's reign in 1400 b.c., the Egyptians themselves had become extremely productive cultivators of opium, and the sprawling poppy fields of their capital city of Thebes had become internationally renowned.

Opium in Ancient Greece

At the end of the Bronze Age, about 1100 b.c., the Egyptians introduced opium to the ancient Greeks, and opium played a prominent role in their society until they were conquered by the Romans one thousand years later. The image of the poppy seedpod can be found in much of the art of the ancient Greeks, as well as on many of the coins and other artifacts from their society. As with most ancient opium-using societies, opium held supernatural connotations for the Greeks because of its seemingly miraculous pain-relieving properties, and much of their mythology contains references to the drug, including those of their oldest surviving poem, Homer's Iliad.

Opium also appears in the medical chronicles of ancient Greece, where it was praised by their earliest physicians, many of whom mistakenly assumed that it cured diseases because it removed the painful symptoms associated with them. The physician Hippocrates, for example, who is widely known as the father of medicine, praised opium's usefulness as a pain reliever and remedy for internal diseases, though he dismissed the widespread notion that it possessed magical attributes. Opium eventually received similarly high praise from some of the great physicians of the Roman Empire, including Galen, who prepared opium remedies for several Roman emperors.

Despite opium's powerful pain-relieving and euphoric properties, however, some ancient Roman physicians and scholars—most notably the well-known scholar Pliny the Elder—recognized its dangers and classified it as a poison, and considered it useful only for performing euthanasia on the terminally ill. They had seen opium cause crippling dependency and even lethal overdose in many of its users, and felt that its risks outweighed its medical benefits. In spite of such warnings, however, widespread opium use continued for the duration of the Roman Empire and made addicts of such historic figures as Marcus Aurelius, the emperor of Rome from a.d. 161 to 180.

Opium use spread throughout much of the world during the early centuries of the second millennium. Opium from the Egyptian fields at Thebes, for example, was introduced to Persia, India, and China by Arab traders, and its use was common in the Middle and Far East by a.d. 1000. High-profile opium casualties occurred in these places as well, including the accidental overdose death in 1037 of the great Arabic physician Avicenna. Avicenna had been an advocate of the healing power of opium during much of his lifetime, having praised it as "the most powerful of stupefacients."²

Increasing the Strength of Opium

Despite opium's known dangers, people continued to seek ways of increasing its intoxicating properties for both medicinal and recreational uses as the centuries passed. During the 1500s, after traders and explorers brought tobacco and the tobacco pipe to Europe from the Caribbean, European opium users experimented with opium smoking, and found that it provided far stronger and more immediate effects than did either eating or drinking the drug. However, smoking increased the risk of overdose and addiction, as well as the severity of the drug's undesirable effects. Addiction to opium smoking quickly spread throughout Europe and the Middle East, and by the 1700s it had a tremendous impact in the Far East. Though the eating and drinking of opium had not been as popular in China as elsewhere, the practice of opium smoking for both recreational and medicinal purposes quickly caught on there (and would continue to cause addiction of truly epidemic proportions until 1949, when the Communist Revolution in China brought a halt to the country's opium trade).

Unlike their counterparts in the Middle East, European physicians and surgeons of the 1500s did not generally prescribe opium smoking to their patients. Potency among the batches of opium that were imported from the Middle East widely varied, making it impossible for Western physicians and surgeons to dispense safe and measured opium dosages through this method. Instead, they continued to dispense opium in the same way that had been used for centuries. They provided their patients with a moderately useful "sleeping sponge" soaked in water and opium. The sponge was placed on patients' tongues or over their nostrils for extended pain relief and surgical anesthesia.

The Opium War Between England and China

The Opium War is a particularly dark chapter in opium's long history. It began in 1839, after Chinese officials detained British opium smugglers who were employed by the British East India Company, and confiscated millions of dollars worth of illegal opium in an effort to curtail the staggering opium epidemic that was crippling China. The British East India Company had netted the British Crown a fortune during its four-decade monopoly on the illegal but highly lucrative opium trade in China. In response to Chinese efforts to end the trade, the British government declared war on China.

After the Chinese were overwhelmingly defeated by the British in 1842, the Treaty of Nanking, which the Chinese would call the "unequal treaty," forced them to permit England's opium trade in their country indefinitely, to give Hong Kong to Britain as a colony until July 1, 1997, and to pay for England's war expenses, as well as for the opium seizure that had touched off the war. China's opium epidemic continued into the early twentieth century.

In 1527, however, a Swiss physician and alchemist named Paracelsus created a more measurable (yet potent) form of medicinal opium than had previously been known. He dissolved a measured amount of powdered opium in wine and then added citrus juice and a trace of gold powder. Paracelsus found that opium retains far more of its potency when it is dissolved in alcohol than when it is in water. The resulting concoction, which he called "laudanum," either could be bottled as a tincture, or the black, gummy pulp that remained after the alcohol evaporated could be fashioned into pills of relatively uniform size and potency. He dubbed these pills "stones of immortality."

Though a very primitive surgical anesthetic by modern standards, laudanum was a breakthrough for sixteenth-century surgeons who were accustomed to operating on patients who were conscious and physically restrained. Modern-day anesthesiologist Michael A.E. Ramsay explains that before the advent of laudanum, "surgeons became very adept at performing fast operations. . . . 'Pitilessness' was expounded as an essential characteristic of a surgeon. Pain was considered a symptom of importance only in differential diagnosis, not as a problem related to surgical procedures."³ Laudanum became the primary surgical anesthetic and pain reliever in European medicine, as well as the most common method of opium abuse in the West, for over three centuries.

Morphine Is Invented

Although opium had undergone increasingly effective methods of harnessing the drug's beneficial as well as destructive properties, a scientific discovery made in 1803 marked a turning point in the drug's history. Friedrich Sertuerner, a German scientist, discovered that dissolving opium in acid and then neutralizing it with ammonia isolated the drug's most intoxicating ingredient from the rest. Just as the ancient Sumerians had learned to isolate the poppy's sap from the rest of the plant, Sertuerner had found a way to further isolate the active ingredient of opium. This discovery made it possible to greatly increase the potential dosage strength of the drug. Sertuerner named this component "morphine," after Morpheus, the Greek god of dreams. To this day, morphine is believed to be by far the most intoxicating of the estimated fifty chemical components, called "alkaloids," that make up opium.

Morphine was immediately embraced by physicians as an important medical breakthrough, and was widely prescribed. This powdered drug, which patients took orally, not only provided stronger pain relief than that of raw opium, but its soothing effects on the respiratory and lower digestive tracts were considerably stronger as well. However, the most significant advantage of morphine over raw opium was that it allowed precise dosages. Though with morphine's increased potency came a proportional increase in addictiveness, physicians at the time considered morphine addiction a non-life-threatening vice that was well worth the drug's benefits. Morphine also produced stronger allergic reactions than opium, but doctors also considered these increased side effects to be worth the drug's medicinal benefits.

International Efforts to Regulate the Opiate Drug Industry

Widespread addiction to heroin was by no means limited to the United States; the drug was marketed throughout the world, and in numerous countries levels of addiction were comparable to those in the United States. Though concerns about the market-driven expansion of opiate drug abuse had existed in various countries before the marketing of heroin in 1896, the ravages of heroin addiction sparked an international effort during the early twentieth century to regulate the opiate drug industry. The Harrison Narcotic Act, passed in the United States in 1914, taxed the importation and sale of heroin and all opium drugs, restricted the amount of heroin or other opiates permitted in patented medicines, and required a doctor's prescription for the use of such drugs. Similar legislative reforms were implemented in dozens of countries around the world between 1909 and 1925. Most—but not all—of these countries also eventually decided that heroin had no legitimate medical uses, and made the drug's use illegal altogether.

The power of morphine, and further, the overall quality of medical treatment in the nineteenth century, made a tremendous advance in 1856 with the advent of the hypodermic needle. Two American doctors first experimented with the use of the hypodermic needle to inject morphine directly into the bloodstream through a vein, and found that injected morphine yielded much stronger results in less time, and lasted much longer than morphine that was administered orally. Further, since the human liver does not destroy most of an injected dose of morphine, as it does with an oral dose, far less morphine is required for an injected dose. Sir William Osler, a distinguished British physician of his day, coined the widely used expression "God's own medicine" for morphine injections. This term reflected the common sentiment among physicians around the world concerning their newfound ability to bring extremely strong and rapid pain relief to patients for the first time in the history of medicine. Once again, the increased opiate dosage strength was accompanied by high addiction and opiate-related side effects, but as they had in the past, physicians considered these drawbacks to be greatly outweighed by the drug's power to relieve pain.

Opiate Drug Use in the United States

At the time of the advent of the morphine injection in 1856, raw opium had already been widely used for medical and nonmedical purposes in the United States for well over a century. Both opium smoking and laudanum drinking had been popular among colonists before the Revolutionary War, and patented, nonprescription medicines containing raw opium had been available and widely used since the late 1700s. The use of raw opium did not subside with the advent of morphine injections and morphine-based nonprescription medicines. Instead, raw opium was featured in a growing number of patented nonprescription medicines, including such general remedies as "Dr. Barton's Brown Mixture," and "Dover's Powder," as well as the very popular "Mrs. Winslow's Soothing Syrup," for teething babies.

Various opium-based concoctions that promised to cure alcoholism were very popular, as were the many alcohol-based concoctions that promised to cure the opium addiction that resulted. In reality, however, many so-called remedies for opium addiction actually contained opium as a main ingredient—a fact that went unnoticed by users because the listing of product contents on labels was not yet required by U.S. law. Also contributing to opium addiction in America during the last quarter of the century was the fact that laudanum drinking had become highly fashionable among men, and opium smoking had grown increasingly popular among women, since society considered alcohol use to be improper for them.

The Civil War had also contributed significantly to the widespread use of raw opium in the United States. Between 1861 and 1865, an estimated 10 million opium pills and an additional 2 million ounces of raw opiates were distributed to Union forces alone, with a roughly equivalent amount going to the Confederate forces. Consequently, thousands of wounded and traumatized soldiers from both sides began to suffer from opium addiction—a condition then referred to as "army disease" or "soldier's disease." Also, the war provided America with ample opportunity to use the new morphine injection, and it was highly effective in treating the pain and dysentery that were a constant on the battlefield. Off the battlefield, morphine injections were used as treatment for the opium withdrawal experienced by soldiers, as well as for the emotional trauma experienced by the families of disabled and killed soldiers. Of course, these treatments only served to compound the nation's growing opium problem, and addiction to injected morphine quickly rivaled that of raw opium. "After the war," author Charles F. Levinthal writes, "thousands of ex-soldiers continued to use [morphine] for these purposes, and they recommended it to friends and relatives. The United States Pension Bureau had difficulties with large numbers of veterans suffering from the 'army disease' . . . until well into the twentieth century."⁴

Predictably, the demand for patented medicines containing morphine rose after the war, and physicians recommended these medicines not only to veterans of the war, but also to the general public as a cure-all for the wide variety of ailments for which there were not yet legitimate medical treatments. "A popular medical textbook in 1880 listed fifty-four diseases that could be treated with morphine injections," notes Levinthal, "ranging from anemia and angina pectoris through diabetes, nymphomania, and ovarian neuralgia, to tetanus, vaginismus, and morning sickness."⁵

Not all doctors sanctioned the use of morphine as a panacea, however, including John Witherspoon, a noted physician who eventually became the president of the American Medical Association. "Ah, Brothers!" Witherspoon cautions his colleagues, "we, the representatives of the grandest and noblest profession in the world . . . must . . . warn and save our people from the clutches of this hydra-headed monster. . . . The morphine habit is growing at an alarming rate, and we can not shift the responsibility, but must acknowledge that we are culpable in too often giving this seductive siren until the will power is gone."⁶

Diacetylmorphine (Heroin) Is Invented

By the 1890s, the various forms of opium and morphine use had led to very real addiction problems in the United States and abroad, and it became evident to the international medical community that something had to be done about it. "Finally recognizing the seriousness of the addiction problem," explains author Alfred W. McCoy, "medical science devoted considerable pharmacological research to finding a non-addicting pain killer."⁷ Aware of the tremendous market for such a drug, Bayer Pharmaceutical Company of Germany embarked on its own large-scale research program. One of Bayer's research chemists, Heinrich Dreser, recalled having read about a drug that had been invented twenty years before by C.R. Wright, a researcher in England. Wright, he recalled, had found that boiling morphine and a common industrial acid called acetic anhydride together over a stove for several hours produced a drug that was at least ten times more powerful than ordinary medical morphine, and that it reached the brain far more quickly as well. Wright had concluded, however, that the resulting drug, which he named "diacetylmorphine," possessed too many negative effects to be a practical painkiller, and he discontinued his experiments with it.

With the race heating up among major pharmaceutical companies to find a nonaddictive opiate drug, Dreser, who also invented aspirin for Bayer, decided to reevaluate Wright's conclusions about diacetylmorphine. Upon tinkering with Wright's recipe, Dreser created a form of diacetylmorphine that upon injection, was immediately metabolized by the body into a morphine dose approximately twenty-five times stronger than a morphine injection of the same size. Further, Dreser and his research team found that since less of this powerful diacetylmorphine was needed, fewer of opium's undesirable allergen-related side effects were caused. Based on these encouraging results, Dreser assumed that diacetylmorphine was also largely free of the addictive properties present in other opiate drugs, and thus, that diacetylmorphine would enable opiate drug addicts to break their addiction by simply switching to it for a brief time and then discontinuing its use whenever they chose to.

The Marketing of Heroin

Dreser felt that his new drug was not only nonaddictive but also an effective treatment for respiratory illnesses such as bronchitis, chronic coughing, asthma, and tuberculosis. However, other researchers at Bayer disagreed. These skeptics suspected that diacetylmorphine, and all opiate drugs, have a depressant effect on the central nervous system and the respiratory system, thereby slowing and lessening the body's breathing impulse. Although diacetylmorphine seemed to improve respiratory conditions, they suggested, it merely suppressed the body's urge to cough—a masking of symptoms.

Despite the doubts of some of its chemists, Bayer deferred to Dreser's optimistic assessment of diacetylmorphine, and announced to the world in 1898 that it had invented a revolutionary new drug that was a nonaddictive painkiller and cure for opium and morphine addiction, as well as an effective treatment for all breathing ailments and a soother of digestive disorders. They chose the brand name "heroin" for diacetylmorphine, and launched an aggressive international advertising campaign in a dozen different languages, touting the drug as "a heroine in the war against pain." Heroin, like morphine before it, and opium before morphine, was hailed as a miracle drug by physicians, and was widely prescribed as a nonaddictive cure for practically every ailment.

Details of Poppy Growing

Opium poppies grow from a very small, round seed to reach a height of between two and five feet. In less than six weeks the young plant has grown four large leaves and resembles a small cabbage in appearance. The plant then flowers, and its four petals can be white, pink, reddish purple, or crimson red in color. The petals last for two to four days and then drop to reveal a small, round, green seedpod, which continues to grow until it is about the size of a chicken egg. The plant's opium sap is produced within the walls of the seedpod, and it secretes more than 95 percent of its opium when it is scored with a knife. The entire growth cycle for opium poppies is about 120 days, during which the plant flowers and bears seedpods only once.

One of those many ailments was addiction to morphine. Physicians quickly administered heroin injections to intravenous (in the vein) morphine addicts, expecting it would soon free these patients from their crippling addictions. The philanthropic Saint James Society launched a campaign in which free heroin was supplied through the mail to morphine addicts who were trying to give up their habits. Bayer also marketed heroin as an over-the-counter drug, and it soon became one of the most popular patented medicines of any sort on the market. Since there were an estimated 1 million opiate drug addicts in America by 1900, heroin was big business as these users switched to this new drug en masse. Heroin's popularity was a worldwide phenomenon; between 1899 and 1913, Bayer exported over one ton of the drug annually to over twenty-three countries.

The Impact of Heroin

There was no immediate evidence that heroin could successfully treat respiratory ailments, since patients with terminal respiratory illnesses, such as tuberculosis, continued to die in spite of their heroin treatments. Heroin did seem to be a truly superior cough suppressant for these patients, however, and thereby enabled them to die without the tortuous coughing and pain that they would otherwise have experienced. The debate over whether heroin provided legitimate treatment for respiratory ailments, or simply depressed respiratory functions, continued for a full decade after the drug's introduction into the marketplace, and spawned over 180 clinical studies and reports on its use in over ten thousand patients. By 1910, the evidence had overwhelmingly demonstrated that heroin merely had a depressant effect on the respiratory system. Dreser, like his predecessors in ancient opium-using societies, had naively assumed that since the drug removed the symptoms of diseases, it therefore cured them.

Though the vast majority of the medical studies conducted during the first decade of heroin's legal use were focused on the drug's effects on the respiratory system, additional questions arose within the medical community concerning the claim that the drug was nonaddictive. Patients across the country reported experiencing withdrawal symptoms, including violent muscular aches and spasms, chills, and sweating, that were worse than those encountered with serious morphine addiction. By 1903 medical journals were rightly suggesting that heroin's uniqueness lay not only in the degree to which it killed pain, but also in the degree to which it created crippling physical dependency.

The addictiveness of heroin became obvious as reports of addiction continued to mount at an alarming rate between 1903 and 1906. By 1906 the medical community had reached the overwhelming consensus that heroin was at least twice as addictive as morphine. The U.S. government responded to pressure from the medical community by passing the 1906 Pure Food and Drug Act, which required warnings of the potential for addiction on the labels of all opiate products.

Despite the continuing concerns of both the medical and law enforcement communities regarding both heroin and the other opiates present in society, however, the U.S. government was slow to take further action. Though in 1914 Congress did pass the Harrison Act, which required a prescription for heroin use, set limits on the amount of heroin permitted in patented preparations, and taxed the sale and manufacture of heroin, it did not pass legislation outlawing the importation, manufacture, sale, and use of heroin until 1924.

The immediate impact of heroin use in the United States was a fiercer addiction for hundreds of thousands of already suffering addicts, as well as the creation of many new addicts. The long-term result has been the permanent presence in society of an intensely addictive and deadly opiate drug that continues to inflict tremendous suffering on its many users and, by association, their friends, families, and communities. Some medical experts today do still consider heroin to have a narrow range of legitimate and unique medical uses—most notably its ability to comfort the terminally ill with its unmatched pain-relieving powers. However, there is little argument that the consequences of heroin use for other medical purposes have far outweighed its benefits—that the drug has fallen well short of its intended role as a "heroine in the war against pain." Rather, by pushing opium's powers of destruction to their ultimate extreme, heroin can be said to have played something more akin to the role of saboteur in such a war.