Where Did Our Ideas About Substance Health Come From?

We all carry ideas about substances. Which ones seem dangerous. What it means when someone uses them. Who we picture when we hear the word “addiction.” Whether our first instinct is care, concern, anger, judgment or something else.

Most of us could not say exactly where those ideas came from. That is where this story gets interesting.

In the late 1800s, opium was widely used in the United States. When San Francisco began restricting opium smoking, however, the laws did not simply target opium. They targeted the form and setting associated with Chinese immigrants. Other forms of opium used by other Americans were not treated in the same way.

Around the same period, morphine was widely used as a pain medication, including for soldiers injured during the Civil War. Some developed what we would now recognize as substance use disorder. Physicians were already debating how best to care for them, and some provided ongoing medication so their patients could continue working and living their lives.

The substance mattered. But so did the story society told about the person using it. Who we picture has shaped how we respond.

That pattern continued as cannabis became entangled with hostility toward Mexican immigrants. Later, heroin and crack cocaine became strongly associated in public messages and policy with Black Americans and poor communities.

The contrast became especially visible during different periods of opioid use. When people were understood as having developed a substance use disorder after receiving medication for pain, the story could be one of patients who deserved care. People associated with heroin or other illicit drugs were much more likely to be described through the language of crime and personal failure.

Similar health condition. Very different assumptions about the person experiencing it.

Over time, those assumptions did not stay neatly contained in laws or history books. They became part of the culture in which all of us learned what substances supposedly mean.

There is another consequence of this history that is easy to miss.

Many of us grew up surrounded by strong messages about substances without receiving much actual education about substance health. We learned what to fear and not do and we learned what certain kinds of substance use were supposed to say about a person.

What many of us did not learn was how substances affect our bodies, why people use them, how our experiences can change over time, what different kinds of care can do, or even what questions were worth asking.

That helps explain something that might otherwise seem strange: we can have very strong ideas about substances while knowing surprisingly little about substance health.

This is not about blaming ourselves for what we did or did not learn. Most of us did not sit down and deliberately choose our earliest beliefs about substances. We picked them up from families, schools, news stories, movies, public campaigns, healthcare systems and the conversations happening around us.

We inherited a lot of answers before many of us ever had the chance to understand the subject.

Learning this history does not require us to trade one set of assumptions for another. Health risks are real. Substance use disorders are real. Good science matters. What the history gives us is permission to examine what we think we know.

When we hear ourselves thinking, Anyone who does that must... we can wonder what makes us so certain. When we find ourselves responding differently to someone taking a prescribed substance and someone using an illicit one, we can ask how much of that difference is about health. When a new substance becomes the focus of public concern, we can pay attention to both the science and the stories being told about the people who use it.

We have more information available to us now. We can understand substances, our bodies, patterns of use, treatment and care in ways many of us were simply never taught.

And sometimes that begins with a surprisingly useful question:

How do I know what I think I know?

Sometimes the answer will strengthen what we already understand. Sometimes it may complicate it. And every once in a while, we may discover that something we thought was simply true has a history we never knew.

Knowing that gives us the chance to look again.