I was thinking about the opioid epidemic recently. I did some research and found that heroin was used in the late 1800s in the US as a medical treatment, and that morphine was used medicinally before that. Was it widespread, though? Could Appalachians get ahold of that stuff?
I've done my own research on medicine in the region, and I know that most Appalachians used folk medicine and herbs for day to day ailments, but I don't know if harder stuff was accessible or even available. If it was, was opioid addiction a thing in the 1800s? Did soldiers come home addicted to morphine? If opioids weren't widespread, was there some other addiction? Or was it just liquor/moonshine?
I've searched the r/AskHistorians back catalogue but I didn't see anything. Maybe I'm phrasing things wrong?
I'm not an expert on Appalachian history so my answer is only limited to the drug aspect of the question. Hopefully someone else can answer the interesting historical context to this question.
However, the evidence for the opioid epidemic particular in Appalachia is very recent. Most of the statistics show that the rate of opioid deaths spiked in the last 10 years. While there was readily available morphine and some other opioids since the 1800s, it is only in the last 20-30 years that their use became epidemic across the US and especially in Appalachia.
But why did this happen in Appalachia so significantly? There are a lot of important considerations. Throughout most of the 20th century, opioid addiction was restricted by the expense of drugs such as heroin. But in the 1970s and 1980s, there became a push by prescription drug companies to create and prescribe more powerful opioids. This marketing removed much of the stigma from prescribing these drugs and increased their availability across the US. This was based on some misconstrued evidence that suggested that opioids were not addictive when treating pain, which is completely false.
This led to the approval of even more powerful prescription opioids, with the most notable being extended release oxycodone (OxyContin) in 1995. When used properly, the idea was that oxycodone would be released over 12 hours and slowly treat pain. However, it was very easy to defeat this and take the entire dose at one time, which is why it became so popular for recreational drug.
Appalachia was a prime area for this increased prescriptions because there is a high percentage of individuals with work-related disabilities along with poverty, and covered by Medicaid and other governmental programs. Thus it was easy to get a prescription for opioids in the late 1990s. This combined with the ability to sell these drugs greatly increased the supply and set the stage for the opioid crisis.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648074/ - is a good overview of the particular issues in Appalachia and some of the sociological factors related to this.
I also recommend American Pain by John Temple, a great journalistic account of how Florida pill mills pushed opioids in Appalachia long after the government tried to clamp down on prescriptions in WV and KY.