Prof. David Courtwright Recounts History of Opioid Epidemics in Trial against Makers, Distributors

Physicians ignored century-old lessons learned during America’s post-Civil War opioid crisis by overprescribing powerful opioid drugs in the 1990s and 2000s, a medical historian testified Wednesday in Central Islip.

University of North Florida professor emeritus David Courtwright, an expert in the history of drug use and drug policy, was the first of what could be hundreds of witnesses called in the landmark lawsuit filed by Nassau, Suffolk and New York Attorney General Letitia James against opioid manufacturers and distributors.

Courtwright said the "narcotic conservatism" that prevented widespread addiction from prescription opioids from the turn of the 20th century until the 1980s had crumbled by the '90s, fueling the opioid epidemic that has killed thousands of Long Island residents in recent years.

"We have been here before. This country was burned badly by the opioid epidemic of the late 1800s. We learned lessons from that," Courtwright said under direct examination by Hunter Shkolnik, an attorney for Nassau County.

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While opioids had been used -- and abused -- throughout much of American history, Courtwright said America’s first "medical opioid epidemic " was sparked by doctors who aggressively prescribed powerful pain medications in the 1870s and 1880s to treat everyday aches and ailments, including premenstrual cramps. The importation of opioids tripled during those years -- and 70% of those who became addicted were women.

Patent medicines -- concoctions made from secret formulas and sold over the counter to address specific ailments -- also often contained opioids, Courtwright said. The use of morphine spiked, he said, as the use of hypodermic needles became more common.

Doctors and public health experts realized patients were becoming addicted to the drugs they had been prescribed, Courtwright said. Medical journals, textbooks and other periodicals soon contained warnings about the dangers of opioid drugs and addiction. By the 1890s, Courtwright said, opioid addiction caused by inappropriate prescriptions began to decline.

Lawmakers also took notice, passing legislation intended to prevent drug abuse and addiction. Those laws included the U.S. Pure Food and Drug Act, which required manufacturers to list ingredients on labels, and the Harrison Narcotics Act of 1914, which regulated and taxed the importation of opioid products. The Controlled Substances Act of 1970, meanwhile, codified on a national scale how opioids are manufactured, distributed and prescribed.