During the Civil War, military hospitals considered opioids to be essential medicine. Doctors and nurses used opium and morphine to treat soldiers’ pain, stop internal bleeding and mitigate vomiting and diarrhea caused by infectious diseases. However, this led some soldiers to develop opioid addictions, either during the war or afterward when they sought medical treatment for wartime injuries or illnesses.
Opioid use has a long history in the United States. Before the Civil War, doctors commonly prescribed opium pills and laudanum, which was a mixture of opium and alcohol. These opiates, or natural opioids, were available in many drugstores without a prescription. When the war began, both the Union and the Confederacy considered it important to stock their hospitals with the drugs. A Confederate medical handbook advised that “Opium is the one indispensable drug on the battlefield—important to the surgeon, as gunpowder to the ordnance.”
In addition to opium and laudanum, some Union doctors also started using the hypodermic syringe, a relatively new invention, to inject another opioid—morphine—straight into soldiers’ veins.
Notably, Black veterans mostly did not develop opioid addiction, owing to disparities in medical care provided to Black and white men. “Overall, Black soldiers were systematically denied the same quality of medical care that white soldiers were given,” Jones says. Doctors didn’t provide Black soldiers with the same level of opioids as white soldiers, who began to refer to their addiction—seemingly without irony—as “opium slavery.”
When veterans returned home after the war, they continued taking opium and injectable morphine, which became much more accessible in the 1870s.
“By the end of the 1870s, virtually every American physician had a hypodermic syringe,” says David T. Courtwright, a professor emeritus of history at the University of North Florida and author of Dark Paradise: A History of Opiate Addiction in America. “And by all accounts, that was the primary driver of the big increase in opiate addiction in the 1870s, 1880s and early 1890s.”
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