Shakespeare once wrote that "what’s past is prologue." This familiar phrase means that what happened in the past provides a context for, and can help to understand and predict, the future. To the extent that the past is prologue, the history of drug use provides a sobering lesson: Drug use has been common since ancient times and has been common in almost every society. As a recent book on drug policy states, “People have used chemicals to alter their state of mind since before there were written records” (Kleiman, Caulkins, & Hawken 2011: xviii). If past is indeed prologue, then it is no surprise that drug use remains common in contemporary nations despite considerable efforts to reduce it.
One manifestation of the long history of drug use is that humans have used mind-altering plants since prehistoric times: “Early humans discovered that eating some plants gave a feeling of relaxation, happiness, drowsiness, or peace,” one scholar writes. “Some gave a feeling of increased energy, alertness, and stamina. And some caused strange sensations, terrifying visions, or a profoundly different awareness” (Gahlinger 2004: 5).
Documented examples of drug use thousands of years ago abound (Escohotado 2010; Faupel, Horowitz, & Weaver 2010; Goodman, Sherratt, & Lovejoy 2007). Mead, an alcoholic drink made from fermented honey, was first used about 8000 BCE, and beer and berry wines were first used about 6000 BCE. The ancient Sumerians used opium starting about 5000 BCE. Ancient Egypt used alcohol in 3500 BCE, while ancient China used cannabis (the source of marijuana) around 3000 BCE. Ancient people in what is now Switzerland ate poppy seeds (the source of opium) in 2500 BCE. Coca leaves (the source of cocaine) have been chewed for thousands of years. Folk medicines made from plants and herbs have also been used since ancient times. People in ancient Palestine drank wine in 350 BCE. Ancient Greeks drank poppy juice in 300 BCE. In about the same period, South American tribes used a hallucinogen called cohoba, made from mimosa beans. The Chinese and other Asians were using opium regularly by 1000 CE. Native Americans used tobacco before being 'discovered' by Columbus in 1492. The use of various drugs has also been common in the many societies that anthropologists have studied (Durant & Thakker 2003; Page & Singer 2010).
Sociologist Erich Goode (2008: 176) summarizes the history of drug use as follows: “Humans have been ingesting drugs for thousands of years. And throughout recorded time, significant numbers of nearly every society on earth have used one or more drugs to achieve certain desired physical or mental states. Drug use comes close to being a universal, both worldwide and throughout history.” Thus, the US is no outlier when it comes to drug use. However, as we'll see, the nation may be an outlier among rich democracies regarding drug policy – how it's handled drug use and punished drug users. We focus on the US context of drug use next.
Drug Use in US History
During the colonial era, tobacco was a major crop in Virginia and other colonies thanks to slave labor. After being processed, it was commonly used by colonists and also exported to Europe in great quantities (Gately 2001). From the earliest colonial days, alcohol was another drug used in great quantities, as “Americans were drinkers right from the start” (Genzlinger 2011: C1). The Mayflower, the ship that brought the first Puritans to what eventually became the US, was filled with barrels of beer. In colonial New England, rum manufacturing was a major industry, and rum drinking was common. During the early 1770s, New England had more than 140 rum distilleries, and rum consumption in the colonies averaged 7.5 million gallons annually. This massive drinking has led one author to call rum “the real spirit of 1776” (Williams 2006). Rum was also a major export to Europe and elsewhere. In addition to rum, colonists routinely drank beer and hard cider. Alcohol remained a popular drug, and use of this drug during the 1800s was probably greater than during colonial America (Faupel et al. 2010).
During the nineteenth century, Americans began to use drugs other than alcohol in great quantities. One popular drug was coffee (yes, coffee counts). Before the Civil War, Americans who drank coffee had to buy green (unroasted) coffee beans in bulk and roast their own coffee. Then in 1865, John Arbuckle, a Pittsburgh grocer, began selling roasted coffee inside a new invention: The paper bag. His bagged coffee was an instant hit across the nation, other coffee manufacturers followed suit, and coffee use by Americans greatly increased.
Three other popular drugs in this era were opium, cocaine, and cannabis. Use of these drugs was so common that nineteenth-century America has been called a “dope fiend’s paradise” (Brecher 1973). A brief discussion of these drugs’ histories will underscore the widespread use of drugs in the American past and also racial issues that arose when laws were passed to ban these drugs (Musto 1999).
Opium
During the decades before and after the Civil War, the use of opium was extremely common (Goode 2012). Beyond making people feel good, opium is an effective painkiller and cough suppressant. Accordingly, it was a staple in many patent medicines, elixirs, and tonics, and was sold in apothecaries, general stores, and other venues. Large numbers of people from all social backgrounds used these opium-laced medicines for problems such as depression, headaches, menstrual cramps, and toothaches. It is not much of an exaggeration to say that the US was a nation of opium users during this period: An estimated 500,000 Americans were addicted to opium by the end of the century. As anthropologist Robert B. Edgerton (1976: 57-58) summarizes the situation, “The use of opium was widespread in all segments of American society. Children were calmed with opium derivatives, women used many popular patent medicines which were liberally larded with opiates, and ‘opium dens’ were probably present in all cities and most towns as well.”
Opium was a common ingredient in nineteenth-century tonics and elixirs that were sold widely to the public.
© Thinkstock
Attendance at opium dens (the equivalent of today’s bar or tavern, with opium the drug of choice rather than alcohol) was a popular activity for Chinese immigrants who began coming to the US during the 1850s to help build the nation’s railroads and perform other jobs. White workers feared their growing numbers as a threat to their jobs, and racial prejudice and discrimination against Chinese immigrants soared. Politicians, labor unions, and other parties began to target the smoking opium at opium dens and warned that Chinese immigrants were kidnapping little white children, taking them to the opium dens, and turning them into “opium fiends.” This campaign had two effects: It further increased prejudice and discrimination against the Chinese, and it increased public concern about opium. This rising concern led San Francisco in 1875 to become the first locality to ban opium dens. Other California cities did the same, and the state itself banned opium dens in 1881. Three decades later, the federal government banned the manufacture, sale, and use of opium (except for use with a physician’s prescription) when it passed the Harrison Narcotics Act in 1914.
Cocaine
Cocaine was another drug that was popular in the nineteenth century, beginning in the 1880s, thanks in part to enthusiastic claims by Sigmund Freud and American physicians that cocaine could help relieve asthma, depression, hay fever, sexual impotence, toothache pain, and a host of other problems. Like opium, cocaine was a popular ingredient in the many patent medicines that people bought at various stores, and the US Army Surgeon-General advocated its medical use. It was a major ingredient in a new beverage introduced in 1886, Coca-Cola, which became an instant hit because people naturally felt so good when they drank Coke! During the next two decades, however, concern grew about cocaine’s effects. Some of this concern was fueled by the absurd belief that African Americans who used cocaine became extra strong, dangerous, and even invulnerable to bullets. Cocaine was heavily taxed by the 1914 Harrison Narcotics Act and later banned.
Cannabis
A third legal drug during the late nineteenth century was cannabis. It joined opium and cocaine in being a common ingredient in patent medicines, and it was a popular drug for problems like migraine headaches, menstrual cramps, and toothache pain. After the Mexican Revolution of 1910, Mexicans moved to the US in increased numbers and some brought with them a habit of cannabis use. Whites feared that Mexicans would take their jobs, and, similar to what happened with opium and Chinese immigrants during the 1870s, began to charge that Mexicans who used 'marijuana' would become violent and more likely to rape and murder innocent white victims. This racially prejudiced claim increased concern about cannabis and helped lead to the federal Marijuana Tax Act of 1937 that banned its use. Note that the use of 'marijuana' was strategic – to tie cannabis use to Mexican people.
This brief history shows that drug use has been part of the American culture ever since the nation began. If past is prologue, it should come as no surprise that drugs remain part of American culture today, and it should also come as no surprise that efforts to reduce or eliminate drug use often meet with much resistance and little success. As we have seen, the history of drug regulation in the US is racialized. Moreover, it is a racist history. As we try to frame drug policy and as the US continues to try to deal with drug use, these basic facts must not be forgotten.
Defining Drugs and Drug Use
A drug may be defined as any substance other than food that, when taken into the body, affects the structure and/or functioning of the body. Defined this way, many common substances contain drugs or are drugs: Coffee and other products to keep us alert, aspirin and other pain relievers, Tums and other products that reduce heartburn, Sudafed and other cold medicines, and so forth. Prescription drugs also certainly exist: Prozac and other antidepressants, Valium and other tranquilizers, Yaz and other birth control pills, Viagra and other erectile dysfunction products, and so forth. Sales of these prescription drugs amount to tens of billions of dollars annually. If you have ever used one of these products, you are technically a drug user, however silly that might sound.
The following substances are more likely to be identified as 'drugs': Alcohol, molly, cocaine, heroin, cannabis, LSD, meth, PCP, and tobacco. Much has been written about these drugs, and we will discuss them further in the chapter. But note that two of these drugs, alcohol and tobacco, are legal after a certain age, while the remaining drugs are typically illegal.
Substances that we commonly consider 'drugs' interact with our bodies in different ways. Drugs are often grouped by the kinds of physical effects they have. Some drugs, called depressants, slow down the central nervous system. Hallucinogens cause people to hallucinate, to see, hear, or experience things that are not physically real. Narcotics, derived from natural or synthetic ingredients, are effective at relieving pain, but they depress the nervous system. They are also highly physically addictive. Stimulants speed up the nervous system, potentially causing alertness, euphoria, or anxiety. Finally, cannabis may create euphoria, hunger, and relaxation and dull the sense of time and space. Some of these drugs are legal, often through prescriptions, whereas others are illegal. Even with prescriptions, however, a drug may be misused, meaning that it is being used in a way other than prescribed.
A concern in deciding how to think about and deal with drugs is the distinction between legal drugs and illegal drugs. It makes sense to assume that illegal drugs should be the ones that are the most dangerous and cause the most physical and social harm, but research shows this is not the case.
Rather, alcohol and tobacco cause the most harm even though they are legal. As Kleiman and his research team (2011: xviii) note about alcohol, "When we read that one in twelve adults suffers from a substance abuse disorder or that eight million children are living with an addicted parent, it is important to remember that alcohol abuse drives those numbers to a much greater extent than does dependence on illegal drugs."
According to the CDC, cigarette smoking kills 480,000 people due to complications from smoking or secondhand smoke (CDC 2022). Alcohol use prematurely kills 140,000 people per year in the US. These deaths are caused by physical damage related to long-term use. They are also caused by drinking too much alcohol in a short period of time. DUI fatalities are one example of this premature death. The rate of premature death is much higher for legal drugs than illegal ones.
We return to the issue of the relative harm of legal and illegal drugs toward the end of the chapter when we discuss drug policy. In the meantime, keep in mind two related facts: All drugs can be dangerous and some drugs are much more dangerous than others. Two aspirins are safe to take, but a bottle of aspirin can kill someone. Two cups of coffee a day are fine, but drinking many cups a day can cause anxiety, insomnia, and headaches. One drink of alcohol is safe to take, but several drinks in a short time amount to binge drinking, and long-term use of alcohol can kill someone. One snort of cocaine is usually safe, but even one snort can result in a sudden fatal heart attack, and long-term use often has serious health consequences.
There are competing ways to construct drug use as a social problem, but important distinctions exist between drug use and harmful drug use, including misuse, abuse, and addiction or disorders. These are not mutually exclusive, but they differ from each other in significant ways. Whereas drug use is simply the intake of a substance that produces a change in your body, this can happen without addiction or physical dependence but may lead to those outcomes. There is nothing inherently wrong with drug use, and some people may consider any use a problem whereas many do not. What matters from a sociological perspective is how harmful the drug use will be for users and for their family, friends, and community. Harmful drug use occurs when it negatively impacts a person’s health, livelihood, family, community, freedom, or other important aspects of their life.
Addiction is the chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences (National Institute on Drug Abuse 2020). Addiction is often associated with a mental health diagnosis such as substance use disorder. However, rather than using the diagnosis of 'addiction,' health professionals now use the language of substance use disorder (SUD), which is the diagnosis of a condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s), such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day-to-day life becomes impaired (Saxon 2023). Physical dependence is the bodily experience, in that the body has built up a tolerance to the drug and that one must take the substance in order to not feel ill.
But it’s not just harmful drug use that is a social problem. The unequal impact of drug use on families and communities is a social problem, as well as how certain social groups have been targeted in drug policy. For instance, the opioid epidemic impacts everyone, from individuals to families, hospitals, workplaces, communities, and governments. It goes beyond the experience of one individual. Further, the war on drugs disproportionately harms Black (and Brown) people, as we discussed with racialized social control in the Crime, Immigration, and Social Control chapter.
A Sociological Perspective
One of the dominant approaches to understanding SUDs or addiction involves looking solely at how a person’s brain is affected by drug use. Another popular approach focuses on the psychology of the user and the chemical traits of the substance. Both approaches ignore social issues such as poverty, racism, and classism that increase the harmfulness of drug use for certain individuals, populations, and neighborhoods. Incarceration, disease (such as HIV), other negative health impacts, job loss, and family disruption are examples of harms associated with drug use that are more or less likely to occur depending on one’s social location including their class, race, gender, sexuality, and more.
The sociological perspective focuses on the social determinants of harmful drug use. This perspective avoids blaming the individual and making them responsible for getting the proper treatment and resources to fix issues caused by social inequality and oppression. A sociological lens can help us see how social structures of oppression can change the outcomes of harmful drug use depending on the social location of an individual (Friedman 2002).
This social-ecological model framework of the opioid crisis is a complex model which examines individual, interpersonal, community, and societal factors for the opioid crisis. We can use this model to examine harmful drug use in general. Sociologists look at this problem at all levels, particularly focusing on how social location, social determinants of health, laws, policies, and practices influence drug use, misuse, and related health outcomes.
“The Social Ecological Framework of the Opioid Crisis” from “The opioid crisis: a contextual, social-ecological framework” by Mohammad S. Jalali, Michael Botticelli, Rachael C. Hwang, Howard K. Koh & R. Kathryn McHugh, Health Research Policy and Systems is licensed under CC BY 4.0
Social scientists point out that a person’s social class may impact whether they can continue to work or go to school while using substances (Friedman 2002; Singer and Page 2014; Zinberg 1984). For example, white middle-class users of opioids, like heroin, are less likely to get arrested or go to jail. Therefore they can more often keep their jobs and still earn money.
Racism in our society creates differences in how white people and people of color are treated when they use drugs. White people are more likely to be seen as people experiencing a medical condition. Therefore, they need drug treatment to recover. Black, Brown, and Indigenous people are more likely to be seen as criminals. They are more likely to be arrested and put in jail than receive treatment. This chapter will discuss how racist social structures shape the experiences of problematic drug use.
In this chapter, we will also see social construction at work. You may notice that we use the word cannabis to describe the drug that is commonly known as marijuana or weed. The common word marijuana reflects a racist past. As mentioned above, the US experienced an increase in Mexican immigration after the 1910 Mexican War of Independence. Some immigrants used the herb mariguano for casual smoking. Although the immigrants were important in providing needed agricultural labor, the increase in immigration raised xenophobic fears.
Mexican immigrants were often blamed for property crimes and sexual misconduct. White people in power conveniently blamed the use of 'marijuana' for this. For instance, "One Texas state legislator proclaimed on the senate floor: 'All Mexicans are crazy and this stuff [cannabis] is what makes them crazy.'" In 1937, Harry Ainsliger, head of the Federal Bureau of Narcotics testified before Congress saying, "marihuana is an addictive drug which produces insanity, criminality, and death" (Ghelani 2020: 7-8). Associating the use of cannabis with Mexican immigrants by naming it 'marijuana' was a way to assert power and control over a particular ethnic group. This is using language as a social construction. To resist this oppression, we will use the word cannabis instead of the word marijuana in this chapter, except when we are quoting from other people.
In addition, we remember that a social problem arises when groups of people experience inequality. This point is particularly important when we discuss drug use and harmful drug use. Generally, people of all races use drugs at similar rates. However, people of color are likely to be arrested and jailed for drug offenses. White people are more likely to be seen as needing medical intervention, and therefore they are more likely to receive treatment. More specifically, "Although Black Americans are no more likely than Whites to use illicit drugs, they are 6-10 times more likely to be incarcerated for drug offenses" (Netherland and Hansen 2017). This racialized response to harmful drug use is a deep source of inequality, a key component of a social problem.
