In the past few years, opioids have seen an increase in media attention, as the country grapples with what has been called an opioid epidemic. However, opioid addiction is not just a plague of recent decades; the phenomenon of widespread opioid addiction dates back to the 19th century when the Civil War sparked the United States’ first opiate addiction epidemic among ailing veterans. Nineteenth-century opiate addiction cases usually originated in doctors’ prescriptions, a disturbing parallel with today’s ongoing opioid crisis resulting from opioid overprescribing during the 1990s.
The alarming parallels between the 19th- and 21st-century opioid crises in the United States are not limited to iatrogenesis. Both crises exhibit a history of troubling racial inequalities in access to opioids as well. Addiction was far more common among White Civil War veterans than among Black veterans, who lacked equitable access to opiates. This pattern presaged the opioid underprescribing experienced by Black Americans in recent decades.
Racial disparities in access to essential opioid medicines has been a persistent feature in American health care, both during the Civil War era and in recent decades. Amidst the ongoing opioid crisis, multiple studies have found that Black Americans are less likely to suffer from prescription opioid addiction than White Americans. Like Black Civil War veterans in the late 19th century, African Americans today have less access to prescription opioid painkillers than White Americans. Persistent racial disparities in opioid prescribing rates have been so extreme that, until recently, White Americans were about twice as likely to die from prescription opioid overdose as African Americans.
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