Habitual drug use in the United States is at least as old as the nation itself. Elizabeth Kelly Gray's book Habit Forming: Drug Addiction in America, 1776-1914 (Oxford UP, 2023) traces the history of unregulated drug use and dependency before 1914, when the Harrison Narcotic Tax Act limited sales of opiates and cocaine under US law. Many Americans used opiates and other drugs medically and became addicted. Some tried ‘Hasheesh Candy’, injected morphine, or visited opium dens, but neither use nor addiction was linked to crime, due to the dearth of restrictive laws. After the Civil War, American presses published extensively about domestic addiction. Later in the nineteenth century, many people used cocaine and heroin as medicine.

As addiction became a major public health issue, commentators typically sympathized with white, middle-class drug users, while criticizing such use by poor or working-class people and people of color. When habituation was associated with middle-class morphine users, few advocated for restricted drug access. By the 1910s, as use was increasingly associated with poor young men, support for regulations increased. In outlawing users' access to habit-forming drugs at the national level, a public health problem became a larger legal and social problem, one with an enduring influence on American drug laws and their enforcement.

Rachel Pagones is an acupuncturist, educator, and author based in Cambridge, England. She was chair of the doctoral program in acupuncture and Chinese medicine at Pacific College of Health and Science in San Diego before moving to the UK.

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