Peter Chow: Drugs in Sault Ste. Marie – How We Got Here

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Opioids have been used therapeutically and recreationally for thousands of years, starting with Persian poppy-derived Opium that both Hippocrates and Galen praised for its healing effects.

Even famed Canadian-born physician William Osler (1849-1919) – no lover of pharmaceuticals – hailed Opium as “God’s own medicine.”
Before 1800, physicians regarded pain as an existential phenomenon, a consequence of aging.
There was no regulation on the use of Cocaine and Opioids, resulting in widespread use for many ailments ranging from diarrhea to cough to toothache.
In Victorian England it was possible to walk into a chemist’s shop and buy without prescription Laudanum (a tincture of Opium mixed with alcohol), or Cocaine.
Indigenous peoples of South America have chewed the leaves of Erythroxylon coca — a plant that contains vital nutrients as well as numerous alkaloids, including cocaine — for over a thousand years.
 
The Spanish brought it to Europe in 1569.
The recreational use of Opiates and Cocaine was popular particularly with Victorian artists and writers.
Samuel Taylor Coleridge, Lord Byron, John Keats, and Percy Shelley, took Laudanum for medicinal and inspirational and recreational uses.
Lord Byron’s daughter, Ada Lovelace (1815-1852), a mathematical genius and the world’s first computer programmer, became addicted to Laudanum having been prescribed it for asthma.
Mirroring his times, Sherlock Holmes, who has long since transcended the literary and creative realm to the point where he is no longer merely a fictional character, but practically one of flesh and blood, would regularly inject himself with a 7% solution of Cocaine to “stimulate” his brain when he wasn’t famously applying it to a case.
Charles Dickens immortalised the Opium dens in east London, “Dark England”, as part of the fabric of Victorian London.
Angelo Mariani, a French chemist, created a wine called Vin Mariani in 1863 made from Bordeaux wine with 6 mg of Cocaine per fluid ounce of wine, which was marketed for its ability to increase energy, appetite and mood, promoted as a performance enhancer for creatives and athletes alike, and was endorsed by many notable people of its time.
Pope Leo XIII and later Pope Saint Pius X were both Vin Mariani drinkers and advocates.
Pope Leo appeared on a poster endorsing the wine and awarded a Vatican gold medal to Mariani for creating it.
Thomas Edison used it to help him stay awake longer and as a power-aid.

A proper “dose” was two to three glassfuls per day, taken before or after meals (halved for children!).  

The delicious concoction promised to heal whatever ailed you and provide the energy boost needed by actresses, inventors and workingmen alike.

Vin Mariani was a massive hit. 

Mariani’s wine and coca tonic took his home city of Paris by storm, and then, the rest of Europe and the U.S.  

While Mariani’s ads claimed that thousands of doctors endorsed the product, it was the celebrity endorsers who really pushed the elixir. 

The ads he ran in newspapers and magazines featured countless politicians, actors, writers and religious leaders, all extolling the many virtues of Vin Mariani. 

The list of celebrities included three popes, sixteen kings and queens, and six presidents of the French Republic.

There were also painters, sculptors, composers, actors, politicians, generals, bishops, physicians, and respected scientists.

Devotees of the drink included Alexander Dumas, Emile Zola, Presidents William McKinley and Ulysses S. Grant, and countless monarchs including Queen Victoria of England.

In addition, actress Sarah Bernhardt and Pope Leo XIII (who gave Mariani a Gold Medal!) were among the many who actually appeared in advertisements.

Another ad revealed that the Pope was a true believer in the product:

“His Holiness THE POPE writes that he has fully appreciated the beneficiary effects of this Tonic Wine and has forwarded to Monsieur Mariani as a token of his gratitude a gold medal bearing his august effigy.”

Vin Mariani was the inspiration for John S. Pemberton’s 1885 development of a caffeinated, carbonated, non-alcoholic version containing Cocaine from cola leave extract which he called Coca- Cola.

 
Coca-Cola once contained 9 milligrams of Cocaine per glass.
For comparison, a typical dose or “line” of Cocaine is 50–75 mg. 
 
In 1903, it was removed.
 

Today, Cocaine is the second most popular illegal recreational drug in Europe behind Cannabis.

 
Morphine was isolated in 1803 from the opium poppy, the first isolation of an active ingredient from a plant, named after the Greek god of dreams, Morpheus.
Merck began marketing it commercially in 1827.

Morphine was more widely used after the invention of the hypodermic syringe in 1853.

Physicians used Morphine as a new-fangled wonder drug.

It is on the World Health Organization’s List of Essential Medicines.

Injected with a hypodermic syringe, the medication relieved pain, asthma, headaches, alcoholics’ delirium tremens, gastrointestinal diseases and menstrual cramps.
The Civil War helped set off America’s Opiate epidemic.
The Union Army alone issued nearly 10 million Opium pills to its soldiers, plus 2.8 million ounces of Opium powders and tinctures.
By 1895, Cocaine, Morphine and Opium powders, like OxyContin and other prescription Opioids of today, had led to an addiction epidemic that affected roughly 1 in 200 Americans.
Before 1900, the typical Opiate addict in America was an upper-class or middle-class White woman.
Today, doctors are re-learning lessons their predecessors learned more than a lifetime ago.
The Harrison Narcotic Control Act of 1914, passed in response to the sudden emergence of street Heroin abuse and Morphine dependence, shaped the thinking of both physician and patient alike to avoid Opiates for most of the 20th century..
Cancer patients through the 1950s were encouraged to wean themselves off Opioid painkillers until their lives “could be measured in weeks.”
This attitude persisted well into the latter half of the 20th century  –  a general world-wide “Opiophobia.”
Then, several developments served to raise awareness of pain under-treatment.
A 1973 manuscript in the Annals of Internal Medicine decried the failure to treat patients in severe pain with adequate doses of Opioid analgesics, invoking the conventional wisdom of the day that “therapeutic use of Opiates for actual severe pain rarely results in addiction.”
The World Health Organization addressed the under-treatment of postoperative and cancer pain in 1986 with their Cancer Pain Monograph.
This further prompted a number of publications in the 1990s that questioned the state of pain under-treatment.
Notably, an article in Scientific American questioned why Opioids were reserved solely for cancer pain and avoided entirely in chronic non-cancer pain states.
Cancer and non-cancer pain quickly became equated.
Opioids became the primary modality of Chronic Non-Cancer Pain treatment.
Alongside this Opioid evolution, the American Pain Society launched their influential “Pain as the Fifth Vital Sign” campaign in 1995, with intent to encourage proper, standardized evaluation and treatment of pain symptoms.
Henceforth the evaluation of pain became a requirement of proper patient care as important and basic as the assessment and management of temperature, blood pressure, respiratory rate, and heart rate.
The US Drug Enforcement Agency (DEA) also issued statements promising less regulatory scrutiny over Opioid prescribers, thereby assuaging physician reluctance to prescribe more liberal amounts of Opioid analgesics.
Physicians were now mandated to provide adequate pain control, resulting in a heavy reliance on Opioid medications.
Pharmaceutical companies heavily pushed the use of Opioids as a humane treatment option, often using paid physician consultants to expound on the safety and benefits of Opioids use.
Not prescribing Opioids for a patient with pain risked being labelled as inhumane, often even to the extent of litigation for the under-treatment of pain.
Pharmaceutical companies began releasing slow-release formulations of a number of the drugs in the 1990s and early 2000s, which doctors began embracing for the treatment of chronic pain, among them the Fentanyl patch, Hydromorphone, MS Contin and OxyContin.
On its release in 1995 by Purdue Pharma, OxyContin was hailed as a medical breakthrough, a long-lasting Opioid that could help patients suffering from moderate to severe pain with no fear of dependence or addiction.
The drug became a blockbuster, and generated some US$35 billion in revenue for Purdue.
Purdue Pharma aggressively marketed its product to practising physicians and medical school students as a highly effective painkiller “without unacceptable side-effects” – including addiction.
From 1997 to 2002, OxyContin prescriptions increased from 670,000 to 6.2 million per year in the USA..
Overall Opioid consumption continued to climb throughout the 2000s in the USA, rising from 46,946 kg consumed in the year 2000 to a peak of 165,525 kg in 2012.
Prescription numbers soared – in Canada, the U.S. and elsewhere – as did growing reports of addictions and overdose deaths.
Then in 2007, the truth about OxyContin was revealed when Purdue and three of its top executives settled U.S. criminal and civil charges for the company’s deceptive promotion of the medication.
Purdue was accused of intentionally downplaying the risk of addiction posed by OxyContin and misleading both physicians and the healthcare industry as a whole by overstating the benefits and minimising the harm of Opioids for chronic pain.
Purdue agreed to pay a total of $634.5 million to resolve Justice Department investigations, as well as a $19.5 million settlement to 26 states  –  small change when OxyContin sales totaled more than $2.4 billion in 2007 alone.
Purdue Pharma, which is owned by the Sackler family, made billions selling the prescription painkiller OxyContin that is widely seen as a catalyst to the crisis that claimed hundreds of thousands of lives.
Purdue Pharma filed for Chapter 11 bankruptcy in 2019 and proposed a settlement in the U.S. worth up to $12 billion US.
Canadians remain the second highest per-capita consumers of Opioids in the world, after Americans.
Canadians are the world’s highest per capita users of Codeine, which our bodies metabolise to Morphine (Buffy Sainte Marie had a song about Codeine).
Beginning in the 1990s and particularly with the advent of Oxycontin in 1995, doctors “specialising” in pain management for “Chronic Pain Syndromes” popped up all across the US and Canada.
Of the people who died of opioid overdose in 2020, that were employed at the time they died, 30% were construction workers, more prevalent in this industry than any other.
The nature of the industry can lead its workers down the path of addiction.
With workplace injuries not uncommon, prescription painkillers like Oxycontin often led to drug dependence.
A lot of injured workers were treated for chronic pain with Opiates in Sault Ste Marie.
By 2010, a large bulk of the prescription Opioids on Queen St. could be traced back to a handful of doctors who were disciples of the scripture of Purdue.
Eventually, the College of Physicians and Surgeons intervened and the pill factories operated by Dr. Feelgood were ordered to cease and desist.
Then the trouble really started, when the doctor cut off the prescriptions.
The addicted worker couldn’t get their prescription pain killers anymore and that’s when they go to the street for illicit drugs increasingly laced with Fentanyl or its even more lethal analog, Carfentanil.
Sault Ste Marie is particularly vulnerable due to a large portion of its workforce being employed in industries susceptible to workplace injury.
Doctors and nurses and healthcare workers account for one of the highest rates of addiction in the workforce, second to construction workers.
What sets doctors and nurses apart from other professionals is their accessibility to highly sought-after drugs — because it’s easier for them to get the drugs, it’s easier to create or feed an addiction.
According to Journal of Clinical Nursing, approximately 20% of all nurses struggle with an addiction to drugs or alcohol.
Healthcare is one of the largest employers in this city.
Addiction is often a disease of despair.
In the 1960s, Sault Ste Marie offered numerous well-paying industrial jobs at Algoma Steel, the tube mill and St. Mary’s Pulp and Paper, spawning a large and prosperous middle class.
The relative isolation of the local economy created a captive market for retail goods and services, as well as a cozy business environment dependent on a few key industries in a company town.
In the early 1960s, Sault Ste Marie had the second highest per capita income in Canada year after year, trailing only Oakville.
That golden age faded.
Economic growth remains arrested.
It was projected in 1970 that the Sault would grow to 125,000 by 2020.
Obviously, that never happened.
At present, Sault Ste Marie has a population of 73,368 people, a drop from 84,000 in the earky 1990s.
We should have become Traverse City on the  St. Mary’s.
We didn’t.
Sault Ste Marie sustained multiple self-inflicted wounds that have resulted in economic stagnation and decline.
What has happened mirrors the U.S. Rust Belt, where economic trauma has fuelled populism and negative attitudes.
In the Sault, increasing economic polarization, mental-health and addiction problems and a decaying social fabric marked by drugs, a ridiculous level of crime and an increased use of shelters and food banks, have become a fact of life.
Deaths of despair from alcoholism, drug overdose and suicide have risen, especially in the pandemic.
The Opioid Crisis is complicated by the exploding use of Crystal Meth in the Sault, mirroring what is happening everywhere across Canada.
In 2011, 19% of opioid drug users said that they also used Crystal Meth;  by 2020 that number had grown to 80%.
Crystal Meth is Methamphetamine, what we called “Speed” fifty years ago.
The refrain in 1968 was “Speed kills!”
The availability and use of Crystal Meth is still increasing rapidly because Meth is so cheap, and people get such a quick and powerful rush of euphoria that can last for 12 hours or more  –  “Hillbilly Coke.”
One user:  “I tried it and I was hooked from the first hit  –  It was an explosion of the senses.  It was the biggest high I’d ever experienced.”
A “hit” with what is almost 100% pure Meth can cost as little as $10.
In the past few years, Crystal Meth hit with full force and crime rates — primarily thefts of items people were selling to feed their addiction — increased dramatically.
No bicycle is safe in Sault Ste Marie.
Opiates and Fentanyl are a community health crisis;  Crystal Meth is a crime and safety issue.
A Meth abuser will go to all ends, literally steal from their own grandmother, to feed their Meth addiction.
The community of substance abusers in the Sault is a made-to-order market for Crystal Meth.
Crystal Meth makes treatment a lot more complicated and difficult.
Unlike Opioid addiction which can be treated with Suboxone or Methadone or Naltrexone, there are no well-developed pharmaceutical therapeutics for addiction to Crystal Meth.
Which, sadly, is where we are in Sault Ste Marie today.
 
 
REFERENCES
 
https://en.wikipedia.org/wiki/Cocaine
https://en.wikipedia.org/wiki/Heroin
https://en.wikipedia.org/wiki/Vin_Mariani
https://en.wikipedia.org/wiki/Coca-Cola
https://en.wikipedia.org/wiki/Morphine
https://en.wikipedia.org/wiki/Oxycodone
https://en.wikipedia.org/wiki/Purdue_Pharma
https://en.wikipedia.org/wiki/Methamphetamine#Recreational

3 COMMENTS

  1. You forgot to mention reefer madness, remember the experts published all kinds of pamphlets there was even a video, so we all knew what the symptoms where. It was a terrible “disease”, and even to this day the public would still prefer believing this is a problem caused by drugs.

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