Is morphine a molecule or a metaphor for American life?

Sam Quinones, the author of Dreamland, isn’t content to write about the inherent drama of opiate addiction and its consequences. He tries to sell readers on the idea that opiate use and American culture intersect in unique ways. Opium has a long history:

Opium was likely our first drug as agricultural civilizations formed near rivers. Mesopotamians grew the poppy at the Tigris and Euphrates. The Assyrians invented the method, still widely used today, of slicing and draining the poppy’s pod of the goo containing opium. “The Sumerians, the world’s first civilization and agriculturists, used the ideograms hul and gil for the poppy, translating it as the ‘joy plant,’” wrote Martin Booth, in his classic Opium: A History.

The ancient Egyptians first produced opium as a drug. Thebaine, an opium derivative, is named for Thebes, the Egyptian city that was the first great center of opium-poppy production. Indians also grew the poppy and used opium. So did the Greeks. Homer and Virgil mention opium, and potions derived from it. The expanding Arab empire and later the Venetians, both inveterate traders, helped spread the drug.

In the early 1800s, a German pharmacist’s apprentice named Friedrich Sertürner isolated the sleep-inducing element in opium and named it morphine for Morpheus, the Greek god of sleep and dreams. Morphine was more potent than simple opium and killed more pain.

War spread the morphine molecule through the nineteenth century. More than 330 wars broke out, forcing countries to learn to produce morphine. The U.S. Civil War prompted the planting of opium poppies in Virginia, Georgia, and South Carolina for the first time, and bequeathed the country thousands of morphine-addicted soldiers. Two nineteenth-century wars were over the morphine molecule itself, and whether China could prevent the sale on her own soil of India-grown opium.

In 1853, meanwhile, an Edinburgh doctor named Alexander Wood invented the hypodermic needle, a delivery system superior to both eating the pills and the then-popular anal suppositories. Needles allowed more accurate dosing. Wood and other doctors also believed needles would literally remove the patient’s appetite for the drug, which no longer had to be eaten. This proved incorrect. Wood’s wife became the first recorded overdose death from an injected opiate.

In London in 1874, Dr. Alder Wright was attempting to find a nonaddictive form of morphine when he synthesized a drug that he called diacetylmorphine—a terrific painkiller. In 1898, a Bayer Laboratory chemist in Germany, Heinrich Dreser, reproduced Wright’s diacetylmorphine and called it heroin—for heroisch, German for “heroic,” the word that Bayer workers used to describe how it made them feel when Dreser tested it on them.

What makes Americans particularly susceptible to opiate addiction? The author describes how Americans who want to be drug addicts can get monthly cash and free pills via Medicaid. He doesn’t mention that any legal U.S. resident who refrains from work can also get a free house (possibly after a long wait) and taxpayer-funded food (food stamps or SNAP), plus an Obamaphone to call the drug retailers, licit or illicit (see Book Review: The Redistribution Recession). Ancient Egyptians and Greeks could have spent all day every day using opium, but there was no welfare state to sustain them. Isn’t that sufficient to explain why addiction is more common in today’s U.S.? Quinones doesn’t think so:

In heroin addicts, I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain. But man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior. In fact, the United States achieved something like this state of affairs in the period this book is about: the last decade of the twentieth century and the first decade of the twenty-first century. When I returned home from Mexico during those years, I noticed a scary obesity emerging. It wasn’t just the people. Everything seemed obese and excessive. Massive Hummers and SUVs were cars on steroids. In some of the Southern California suburbs near where I grew up, on plots laid out with three-bedroom houses in the 1950s, seven-thousand-square-foot mansions barely squeezed between the lot lines, leaving no place for yards in which to enjoy the California sun. In Northern California’s Humboldt and Mendocino Counties, 1960s hippies became the last great American pioneers by escaping their parents’ artificial world. They lived in tepees without electricity and funded the venture by growing pot. Now their children and grandchildren, like mad scientists, were using chemicals and thousand-watt bulbs, in railroad cars buried to avoid detection, to forge hyperpotent strains of pot. Their weed rippled like the muscles of bodybuilders, and growing this stuff helped destroy the natural world that their parents once sought. Excess contaminated the best of America. Caltech churned out brilliant students, yet too many of them now went not to science but to Wall Street to create financial gimmicks that paid off handsomely and produced nothing. Exorbitant salaries, meanwhile, were paid to Wall Street and corporate executives, no matter how poorly they did. Banks packaged rolls of bad mortgages and we believed Standard & Poor’s when they called them AAA. Well-off parents no longer asked their children to work when they became teenagers.

[the Mexican immigrant dealers’] greatest innovations was figuring out that a mother lode of heroin demand was now waiting to be mined in these neighborhoods if they’d only offer convenience. The Happy Meal of dope, he called it. Marketed like fast food—to young people. “‘We want what we want when we want it and thus we are entitled to get it,’” he said. “This drug is following the same marketing [strategy] of every other product out there. ‘I’ll give you good heroin at a great price. You don’t have to go to the bad neighborhoods. I’ll deliver it for you.’” In a culture that demanded comfort, he thought, heroin was the final convenience.

[at running a university hospital pain center] Tauben took over for Cahana in 2013. Cahana’s five years at the center immersed him in America’s pain culture wars. The experience had made him something of a philosopher of pain and happiness. Cahana believed that what insurance companies reimbursed for distilled many unfortunate values of the country. “We overtest, perform surgery, stick needles; these people are worse off,” he said. “If we work on their nutrition, diet, sleep habits, smoke habits, helping [them] find work—then they improve. You have to be accountable. If you give a treatment that kills people or makes people worse, you gotta stop. You can’t continue making money on stuff that doesn’t work.

“All of a sudden, we can’t go to college without Adderall; you can’t do athletics without testosterone; you can’t have intimacy without Viagra. We’re all the time focused on the stuff and not on the people. I tell pain patients, ‘Forget all that; the treatment is you. Take charge of your life and be healthy and do what you love and love what you do.’” And he ignored that very advice. Cahana came to Seattle at 260 pounds, and gained forty-five more over the next five years as, stressed and overworked, he battled to rebuild the historic clinic. The clinic won numerous awards, was highlighted as a model. He was on CNN and in People magazine, gave a TED talk, and testified before the U.S. Senate on overprescribing in medicine. He grew fatter all the while. He was taking medications for hypertension, cholesterol, and then more for the side effects from the medication—nine pills a day, fifteen hundred dollars a month in co-pays. “I couldn’t walk two flights of stairs without huffing and puffing,” he said

Readers: What do you think? Are Americans addicts because we don’t need to work or is it something deeper?

More: read Dreamland.