Opioids' Long Shadow

2020 is not the only time the world has seen opioids ruining the lives of thousands. This article discusses 3 historical episodes in which the need to relieve pain was challenged by the need to prevent and control opioid addiction: the era of iatrogenic addiction in the early 20th century before and after the passage of the Harrison Act of 1914; the shift in attitudes toward and treatment of pain from the 1950s to the 1970s; and the current opioid epidemic, fueled by opioid overprescription and overuse, from the late 1990s to the present. These episodes illustrate the tensions between pain relief and risk reduction and between clinical practice guidelines and modern corporate health care, as well as the stigmatization of chronic illness in American culture and society.