How Civil War Medicine Led to America’s First Opioid Crisis4 min read
During the Civil War, military hospitals considered opioids to be essential medicine. Doctors and nurses used opium and morphine to treat soldiers’ pain, stop internal bleeding and mitigate vomiting and diarrhea caused by infectious diseases. However, this led some soldiers to develop opioid addictions, either during the war or afterward when they sought medical treatment for wartime injuries or illnesses.
For many Civil War veterans, opioid addictions were life-ruining. Veterans’ dependency made them fatigued and emaciated, and could lead to a fatal overdose. In some cases, opioid addiction could threaten a veteran’s ability to receive a pension. In 1895, a Union veteran named Charles L. Williams stated in an application to a soldiers’ home that he was “totally unable to earn a living” since he had “contracted [the] opium habit during war.”
By the time Williams applied to the soldiers’ home, the scope of the problem had grown beyond veterans: America was in the midst of its first major opioid crisis, fueled by the rise of injectable morphine that some doctors had begun administering during the Civil War. The specific plight of veterans helped draw attention to the issue, raising awareness among doctors and the general public about the dangers of opioid addiction.
Opioids as Wartime Medicine
Opioid use has a long history in the United States. Before the Civil War, doctors commonly prescribed opium pills and laudanum, which was a mixture of opium and alcohol. These opiates, or natural opioids, were available in many drugstores without a prescription. When the war began, both the Union and the Confederacy considered it important to stock their hospitals with the drugs. A Confederate medical handbook advised that “Opium is the one indispensable drug on the battlefield—important to the surgeon, as gunpowder to the ordnance.”
In addition to opium and laudanum, some Union doctors also started using the hypodermic syringe, a relatively new invention, to inject another opioid—morphine—straight into soldiers’ veins.
These doctors “realized that this invention that hadn’t really been used very widely in the U.S. could now be a godsend in hospitals, because it delivers morphine immediately,” says Jonathan S. Jones, a history professor at Virginia Military Institute and author of the forthcoming Opium Slavery: The Civil War Veterans and America’s First Opioid Crisis. Injectable morphine provided quicker relief than opium pills and laudanum, but was also more likely to lead to addiction.
In addition to soldiers, Civil War doctors took opioids themselves to treat infectious diseases and deal with the stress of working in army hospitals, leading them to develop addictions before and after the war. A Union surgeon named J.M. Richards would later recall how he had developed chronic diarrhea during the war and “at last resorted to frequent doses of morphine as the only certain means of controlling the difficulty.”
Notably, Black veterans mostly did not develop opioid addiction, owing to disparities in medical care provided to Black and white men. “Overall, Black soldiers were systematically denied the same quality of medical care that white soldiers were given,” Jones says. Doctors didn’t provide Black soldiers with the same level of opioids as white soldiers, who began to refer to their addiction—seemingly without irony—as “opium slavery.”
Veterans Struggle to Quit Opioids After the War
When veterans returned home after the war, they continued taking opium and injectable morphine, which became much more accessible in the 1870s.
“By the end of the 1870s, virtually every American physician had a hypodermic syringe,” says David T. Courtwright, a professor emeritus of history at the University of North Florida and author of Dark Paradise: A History of Opiate Addiction in America. “And by all accounts, that was the primary driver of the big increase in opiate addiction in the 1870s, 1880s and early 1890s.”
Jones argues that the Civil War helped “mainstream” the use of the hypodermic syringe. Doctors who used it during the war taught their colleagues about injectable morphine, which led more doctors to prescribe it for veterans and other patients after the war. Companies took notice, and began selling injectable morphine straight to consumers.
“You can get syringes and morphine easily; you could even buy them through the mail at Sears and Roebuck, the department store,” Jones says (later, the Sears and Roebuck catalogue also sold heroin). The availability of injectable morphine led to a full-fledged opioid addiction crisis by the 1880s, and one of the groups that helped highlight this crisis were Civil War veterans, who had now been addicted for decades.
In the early 1880s, the doctor and prominent opioid expert Thomas Davison Crothers met with an unnamed Union veteran with an opium addiction who had started taking the drug to treat chronic diarrhea he developed during the war. He told Crothers that after two months, he recovered from the disease, but continued taking opium on and off for the next two decades.
Crothers observed that this man had found it difficult to stop taking opioids because he had developed an addiction. Stories like these helped inform medical thinking about opioid addiction as a public health issue—one that the U.S. continues to struggle with today.