"Those who cannot remember the past are condemned to repeat it."

    These will both be hard to believe.

Epidemic #1
     In 1853, Sir Alexander Wood used the newly developed hypodermic syringe to treat neuralgia by injection of morphine. 
     Interest in this new method of of pain treatment spread rapidly in the United States during the Civil War.   
     Until 1875, the vast majority of reports about morphine were enthusiastic about its ability to relieve symptoms of multiple diseases. 
     But in the mid-1870s, the work of Eduard Levinstein (published in 1878 as "Morbid Craving for Morphia: a Monograph Based on Personal Observation") initiated a vast literature on the dangers of morphine addiction.  Over the next 10-15 years, the literature shifted from the wonders of morphine to concerns about morphine addiction.

Epidemic #2
     In 1897, Felix Hoffmann of the precursor company of Bayer Pharmaceuticals synthesized heroin, which was released in 1898.  Heroin was marketed from 1898 to 1910 as a non-addictive substitute for morphine and codeine.  Like morphine forty years earlier, heroin was received with great enthusiasm, and its use expanded rapidly.  In 1902 heroin was recommended as a means of treating those addicted to morphine.
     But even by 1903, articles in the medical literature began to express concern about heroin addiction.  But this was a minority view.
     In 1910 Bellevue Hospital admitted its first heroin addict; in 1915 Bellevue admitted 425 addicts.  The handwriting was on the wall, and heroin production in the United States was banned altogether in 1924.  

Lessons from these two epidemics and the current epidemic. 
     (1) In each case, there was something about the new opioid that held out the promise that the new opioid would not result in addiction.
          In the morphine epidemic, the hypodermic needle promised the absence of addiction.
          In the first heroin epidemic, the new drug had all the benefits and none of the drawbacks of morphine.
          In the current epidemic, the promise was that extended-release opioids would not have the multiple cycles of withdrawal which would lead to addiction.  In addition, there was the belief that previous generations of doctors had vastly overestimated the dangers of prescription opioids.
    (2) Each epidemic started with tremendous enthusiasm about the positive effects of opioids.  Prescription of the opioids escalated rapidly. 
         Opioids can be extremely effective. 
         It took considerable time in each epidemic for the reality of widespread addiction to manifest itself. This involved a gradual shift from enthusiasm to awareness of the dangers of the drug and a collapse of the enthusiasm that greeted its development. 

     How many more people will have to die before we get it?