Just how common were these drugs used? How much heroin and cocaine were available in these products? Why were they eventually banned? Why was heroin made illegal when morphine is still legal? Aren't they basically the same thing once inside the body?
One of the things that makes this a hard set of questions to answer satisfactorily is that it requires an understanding of drug-related societal problems, addiction, and statistical evidence that's just not likely to exist beyond suggestive anecdotal evidence.
To a modern eye, it seems clear. Patient buys a drug with heroin in it, patient becomes an addict showing signs of heroin addiction, patient engages in problematic behavior that gets recorded in a way that allows for later study.
But when dealing with an era that predates mandatory labelling of drug ingredients, teasing out what behavior was related to addiction and what behavior had roots in other issues gets tricky. Was the habitual thief and vagrant in a given record an addict? A drunk? Suffering from mental illness? Just unlucky? It's possible that not even the individuals involved would have been able to tease that out.
And even when we can pinpoint the use of a specific medicine that we know utilized a specific drug, there's still a great deal of uncertainty. Was the long-suffering patient in a given record going through cycles of addiction and withdrawal? Or was that person chronically ill with a disease that would manifest in similar ways today?
That said, we do have evidence that, during the 19th century, opiate use in medicines was associated by at least some part of the population with societal problems. This understanding was often based on a poor understanding of the drugs and was often inaccurate (for example, it tended to overemphasize opiate abuse among the poor while under-representing it amongst the middle-class and wealthy). But there was at least a current of unease.
This unease mounted as more and more Americans began associating these drugs, opium in particular, with the backlash against Chinese immigration of the later 19th century. One of our nation's first laws regulating/banning opium (in San Francisco) was as much about anti-Chinese sentiment as it was about the opium itself. The drugs weren't necessarily linked directly to specific crime, in the way that they would be today (unless it was also linked to Chinese immigration, in which case it was also tied to tricking white women into prostitution). But they were increasingly associated with poverty and questionable morality as the 19th century came to an end.
Here's a cartoon and a little write-up from HarpWeek that gives a quick sense of what I'm getting at.
After medicine manufacturers were obligated to disclose their ingredients in 1906, medicinal use of these drugs was still legal, but by this time there was a general awareness that they probably weren't good for you and were less and less desirable amongst middle-class users who associated these drugs with poverty.
Hello everyone,
Unfortunately, we have already had to remove a number of poor quality responses in this thread, including many asking about the deleted comments, which merely compound the issue. In this thread, there have been a large number of incorrect, speculative, or otherwise disallowed comments, and as such, they were removed by the mod-team. Please, before you attempt answer the question, keep in mind our rules concerning in-depth and comprehensive responses. Answers that do not meet the standards we ask for will be removed.
Additionally, it is unfair to the OP to further derail this thread with off topic conversation, so if anyone has further questions or concerns, I would ask that they be directed to modmail, or a META thread. Thank you!
Asking a somewhat related question: I recently watched the Ken Burns documentary on prohibition in America, and he makes it sound like that due to a variety of reasons alcoholism (and other drug use/addiction, I would imagine) reached a level that sounds difficult to imagine in comparison to what we would see in America today, to the point that a sizeable amount of the nation wanted to completely ban alcohol. How true exactly is that sentiment, did America really have a drinking/drug problem that was that bad?
Professor Charles Whitebread gave an excellent speech the first part of which touches on this topic. Here's a couple salient quotes from the section on 1900:
Depending upon whose judgment, or whose assessment, you accept there were between two and five percent of the entire adult population of the United States addicted to drugs in 1900.
In terms of statistical groups, who was most likely to be addicted to drugs at the turn of the century? A rural living, middle-aged white woman. The use of morphine in medical operations does not explain the much higher incidence of drug addiction among women. What does is the second cause of the high level of addiction at the turn of the century -- the growth and development of what we now call the "patent medicine" industry.
He doesn't go in to detail about the social ills caused by these addictions, except to say they were similar to a character in a Eugene O'Neil play.
In the late 1800's and early 1900's, opiates were everywhere, and they were easy to obtain. Quack medical 'cures' often loaded their products with opiates to cover for the fact that they were absolute quackery. Opiate based drugs were available over the counter at druggists/pharmacies in a wide variety of preparations. There were cough drops, cough medicines, 'calming' supplements for rowdy children (so basically every young child). Importing, possession and use of smoking opium was not outlawed until 1909, three years after the Pure Food and Drug Act (the act that created the FDA). It did NOT bad the use of opiates in medicine. In 1914 the Harrison Act required all of those importing and dispensing heroin to register with the government, but medicinal opiates were still permitted. This law was challenged by successfully upheld by the Supreme Court in 1919. It was not until 1924 that the use of heroin, even for medicinal uses, was outright banned.
The free access of opiates was a significant problem, because it was viewed as medicine and thus did not carry the stigma of alcohol use. Moreover, it was not until 1938 that medicines and cosmetics were required to list their ingredients, so many people using opiate based drugs in earlier decades often had no idea that they were consuming opiates. By contrast, pharmacies started to list who purchased pest control poisons (arsenic, strychnine) much, much earlier, after having recognized that these agents (often flypapers) were sometimes used to poison humans, thus earning the nickname 'The Inheritor's Powder."
Cocaine was used much less frequently, mainly due to price. It is a complicated process to manufacture cocaine, and thus it was a drug of the well to do. You could find small amounts in wine or other beverages, but the direct usage of cocaine was decidedly less common, this having less of an impact than opiates and alcohol. But like heroin, it was misunderstood. Many doctors - most notably Sigmund Freud- viewed cocaine as a cure all, and the solution to an individual's heroin addiction. This is mind-boggling to us now, but at the time it seemed to make sense.
Eventually, narcotic use was made illegal, but quack doctors quickly moved on to a new fad - radiation. Radium treatments, despite being extremely deleterious to one's health, were all the rage. It wasn't until the death of the wealthy industrialist [Eben Myers]z9https://en.wikipedia.org/wiki/Eben_Byers] and the successful litigation of the so called Radium Girls that the US finally recognized that radiation was not helpful to ones health, but extremely deleterious.
Heroin and morphine are two separate chemicals. Morphine is still in use because it has effects that are useful for medical treatment. Heroin, the 'parent' drug of morphine, is just not as useful in medical treatment. It's only common use is as a street drug. (I'm not a biochemist, so I can't tell you exactly what makes morphine medically useful and not heroin, hopefully the above link will help and the comment by /u/denshi will help.)
Other opiate derivatives also used in medical treatment - each one has a particular advantage. I personally was given dilaudid directly in a pain pump for pain relief during my first childbirth. I was given the powerful fentanyl in an epidural (in my spine) during my second labor. Dilaudid use was only possible because my first baby was stillborn - a living child could be born addicted to opiates if exposed during labor. I have been given oxycodone and hydrocodone as postoperative pain relief, to be administered at home. I have no idea why these opiate-based drugs were used the way they were, but it wasn't random, there was a reason for each situation.
Edit: Thank you to /u/denshi my biochemistry. And for those who replied stating that Heroin is used as anesthetic in other parts of the world, the OP was specifically asking about usage in the US so I addressed that. Other countries have vastly different policies on the usage of opiates in medicine and in general.