LAZINESS IS ALWAYS EPIDEMIC:

The first great U.S. opiate-addiction epidemic began much the same way, with medications handed out by well-meaning doctors who embraced a wondrous new class of drugs as the answer to a wide range of aches and pains.

The pharmacologist Nathaniel Chapman, writing in 1817, held up opium as the most useful drug in the physician's arsenal, arguing that there was "scarcely one morbid affection or disordered condition" that would fail to respond to its wonder-working powers. That same year, chemists devised a process for isolating a key alkaloid compound from raw opium: morphine.

Though there's some evidence that opiate dependency had become a problem as early as the 1840s, it wasn't until the 1860s and 1870s that addiction became a widespread phenomenon. The key, according to historian David Courtwright, was the widespread adoption of the hypodermic needle in the 1870s.

Before this innovation, physicians administered opiates orally. During the Civil War, for example, doctors on the Union side administered 10 million opium pills and nearly 3 million ounces of opium powders and tinctures. Though some soldiers undoubtedly became junkies in the process, oral administration had all manner of unpleasant gastric side effects, limiting the appeal to potential addicts.

Hypodermic needles, by contrast, delivered morphine directly into a patient's veins with no side effects, yielding immediate results. As Courtwright notes: "For the first time in the entire history of medicine near-instantaneous, symptomatic relief for a wide range of diseases was possible. A syringe of morphine was, in a very real sense, a magic wand."

An enthusiastic medical profession began injecting morphine on a vast scale for all manner of aches and pains, much the way that a more recent generation of doctors began prescribing Oxycontin and other legal drugs in a reaction against widespread undertreatment of pain.

Wounded veterans became addicts, but so, too, did people suffering from arthritis. Women also became addicts en masse, thanks to the practice of treating menstrual cramps -- or for that matter, any female complaint of pain -- with injections of morphine.

Skeptics in the medical profession warned about the dangers of administering too much morphine. Yet these warnings generally fell on deaf ears. Some of the problem lay with the doctors themselves.

One well-regarded doctor put it this way: "Opium is often the lazy physician's remedy."

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