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Eh maybe. But then still, why an opioid epidemic now? Opium and derivatives have also been around for a very long time. Is it just that much more appealing in pill form and prescribed by your doctor than in smokeable or snortable form?
It is prescribed by a doctor, imparting legitimacy. And in pill form you can pop a couple in a quiet moment to yourself anywhere, something you can't do with a syringe or opium pipe. And the pharmaceutical companies only figured out in the fifties and sixties how to mass produce doses that would leave people mostly functional while still taking their pain away. Before that those drugs were prohibitively expensive and so people just drank themselves to death.
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There certainly was an opium epidemic in the 19th century US, but most addicts were middle class or wealthy, predominantly women; the poor could afford neither the drug nor the doctor to introduce it to them (you could buy it over the counter, but the poor then were very poor indeed), and it was primarily injected by said physician. There was a population of civil war veteran addicts too. It was estimated that 0.5% of the population were opium addicts, a much larger percentage presumably used opioids occasionally. Apparently there are about 2.1 million opioid addicts in the US (estimated number with ‘opioid misuse disorder’) today, which is approximately 0.6% of the population. This doesn’t seem like a huge difference.
Opium smoking only became a major issue at the very end of the 19th century, and was primarily a feature of Chinatown opium dens which were necessarily not fully geographically distributed across the whole country but concentrated in major cities. As soon as opium addiction became recognized as a major problem in the 1890s it was restricted and then banned pretty quickly, physicians were shamed for prescribing it (both within and beyond the profession) and so it was never even introduced to many working and underclass communities. There were also horror stories from Western travellers in China describing the opioid epidemic there (eg half of all young men wasting away in the opium dens of major Chinese cities) such that politicians acted relatively quickly.
Today opioids are much easier to produce synthetically, much easier to sell (eg on the dark web) and ship, global trade offers far more places to hide large volume illicit imports, and a decline in communal identity means that social pressure (around almost everything) is less than it was in 1890.
So I don't really dispute any of that, but it feels like this conversation is getting a little shifted or circular, I suppose as a consequence of it being with so many people. What I'm really arguing against is ulyssessword's point that "the 'opioid epidemic' is an appropriate reaction to the chronic pain epidemic". I find it pretty hard to buy into, humans have been doing manual labor for millennia, opium has been around for millennia at varying levels of availability, but only now somehow is blue-collar manual labor so strenuous that using opiates to dull the pain is an appropriate response.
It seems more likely to me to be something like the point that sarker and TheDag are making, that the pain is actually a symptom of broader cultural disease, not a natural consequence of manual labor.
Uh, I'm pretty sure that the laboring classes who had access to a lot of drugs have proceeded to do a lot of drugs for all of recorded history. "They drink way too much" is a pretty universal blue collar stereotype, because that's a nearly universally available drug that's priced at blue-collar affordable levels in most societies.
Opium may have existed in 1890, but it wasn't widely available in the US the way it often is now. Booze was the drug of choice for construction workers and miners suffering from nonstop pain; when we decided it was a medical issue doctors of course can't say "have you considered needing some AA?" and so prescribed oxycodone instead. I suspect that the issue will fade with the normalization of medical marijuana.
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I think it’s much more available now and at much greater purity. If you have a script, you can pop into any pharmacy and have 100 pills in minutes. You don’t even need to get out of the car. Unless you lived in a big city, you probably had a harder time getting patent medicines simply because it required a trip to those cities, and it came as a bottle of a couple of ounces mixed with all kinds of stuff. Modern medical insurance covers a lot of the cost of modern opioid drugs where the older patent medicines were comparatively expensive. Cheap easy pills that you can get in large quantities without leaving your car are probably going to be a bigger addiction risk than something that’s expensive and sold in small quantities.
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