This talk argues that medical maintenance of opiate addicts was an important element in the effective response to America’s first opioid epidemic in the late 19th and early 20th centuries. Physicians were relatively free to prescribe morphine to addicts despite federal authorities’ effort to stop them, because surveillance and policing were weak and state Medical Boards were often protective. Maintenance was clandestine and informal, however, and depended on addicts’ gaining sympathy and/or trust from individual physicians on a case-by-case basis. This restricted its reach along the familiar lines of American social prejudices, favoring addicts who could claim to be (as one described himself) “nice people in good standing.” This early and limited form of harm reduction did not ultimately serve as a model for future drug policy because of its secrecy and because of the racially-charged assumption that good addicts—rather than good policy—had helped bring an end to the opioid epidemic.
A Dorothy Bernstein Lecture in the History of Psychiatry