ABSTRACT

Opioids can effectively treat pain and suffering, can imbue users with a sense of well-being, can increase artistic creativity, and can cause addiction. It is no surprise, then, that throughout their history, opioids have been used for both therapeutic and recreational purposes, and have been associated with varying degrees of disapproval related to their addictive properties. Unfettered opioid use and addiction have tended to be openly tolerated by societies during times of limited supplies, but when increases in supplies have brought addiction into prominence as a pervasive societal problem, politicians have generally felt compelled to introduce controls. In the United States, controls were introduced at the beginning of the 20th century, at a time when the street use of heroin was becoming an obvious source of crime and depravity. Other industrialized nations had similar problems and followed the lead of the United States in introducing controls on opioid use. There was an important difference, however, between the United States and other nations; the therapeutic use of opioids for the maintenance of addiction was not tolerated in the United States, whereas elsewhere it was, at least initially. For example, the British politicians expressed an abhorrence of restricting opioid use: “Heroin addiction in Great Britain is practically unknown and it is difficult to see why administrative action should be allowed to hinder the relief of suffering” (1). The more conservative U.S. politicians felt that: “Drug addiction is an evil” [that should be] “rooted out and destroyed” (2). A 55 years impasse (after Webb vs. the United States under the provisions of the 1914 Harrison Narcotic Drug Act made it illegal for physicians to prescribe opioids for the treatment of opioid addiction) (3) was broken only when the pioneering work of Nyswander, Dole, and Kreek, who demonstrated over years that addicts maintained on opioids can function normally and are less likely to relapse back into crime (4), culminated in the 1974 Narcotics Addict Treatment Act. Now opioids could be prescribed in the United States by certified physicians for the treatment of opioid addiction, but under tight constraints.