1879 – Keeley Institute Opens
Mid 1960's – Introduction of Methadone
Early 1800s - Isolation of Morphine
1914 – Harrison Narcotics Tax Act
1970 – Controlled Substances Act
The History of Substance Use Disorder
1987 – Drug Addiction Recognized as a Disease by the American Medical Association
1971 – War on Drugs Begins
Late 1990s– Opioid Epidemic Emerges and Intensifies
1996 – Mental Health Parity Act
2008 – Mental Health Parity and Addiction Equity Act
2000 – Drug Addiction Treatment Act of 2000 (DATA 2000)
2013 -- Rise of Synthetic Opioids
2016 – Comprehensive Addiction and Recovery Act (CARA)
Present Day – Harm Reduction Strategies
2018 – SUPPORT for Patients and Communities Act
2013 - Rise of Synthetic Opioids
Since 2013, overdose deaths have dramatically increased due to the rise of illicit fentanyl, a synthetic opioid 30-40 times more potent than heroin. This surge is being driven by a positive supply shock, meaning it is due to what's available on the street rather than an individual suddenly buying more drugs, as fentanyl is often sold as ‘heroin.’ There is a strong market incentive for its production because it is cheaper to manufacture than heroin. The rise in availability of fentanyl represents a heightened structural risk environment for individuals who buy and use drugs. This shift significantly impacts healthcare access and quality because it puts an increased demand on emergency services. With a surge in fentanyl related overdoses, this puts a strain on responders to quickly identify an overdose and quickly reverse it. Responders must be able to adapt to manage these more potent overdoses, often requiring repeated doses of Naloxone. This impacts health outcomes because there is a higher risk of accidental overdoses because individuals are unknowingly consuming fentanyl which increases the overall drug-related mortality rate. In response, there has been expanded access to medications for opioid use disorder. Medications like methadone and buprenorphine have strong evidence for efficacy, yet disparities in access and biases against medication treatment remain barriers to full coverage. Addressing these structural disparities is essential to reducing overdose mortality and improving outcomes for individuals with substance use disorders.
Ciccarone D. (2021). The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current opinion in psychiatry, 34(4), 344–350. https://doi.org/10.1097/YCO.0000000000000717 Jamie
1996 - Mental Health Parity Act
The Mental Health Parity Act became law on September 26, 1996 and it was a major step in addressing insurance inequalities in receiving care for mental health conditions. Even though it did not specifically address care for substance use disorders, it was still monumental in expanding the understanding of health beyond just physical conditions. This law required that employer-sponsored insurance plans cover mental health and provide the same spending limits for such conditions as they do for medical/surgical conditions. Following the passing of this law, there was an increase of reporting dollars spent on mental health services which shows an increase in access and quality of care for the population this was available to. In addition to not covering substance use disorders, this law had many flaws and limitations. One of which was that employers maintained control over the extent of coverage and could even drop mental health coverage altogether. A second limitation came from insurance companies because this law did not address visit limits, co-pays, and out of pocket cost limits. This allowed insurance companies to still make receiving appropriate care very difficult and expensive for a large amount of the population. This in large part was due to mental health.
Ettner, S. L., M Harwood, J., Thalmayer, A., Ong, M. K., Xu, H., Bresolin, M. J., Wells, K. B., Tseng, C. H., & Azocar, F. (2016). The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among "carve-out" enrollees. Journal of health economics, 50, 131–143. https://doi.org/10.1016/j.jhealeco.2016.09.009 zach
1971 - War on Drugs Begins Under Richard Nixon
On June 17, 1971, Richard Nixon officially declared the War on Drugs, a federal policy prioritizing criminalization to reduce drug use (American Civil Liberties Union of Arizona, n.d.). He described drug abuse as a “national emergency” and “public enemy number one” (American Civil Liberties Union of Arizona, n.d.). This highlighted substance abuse as a criminal issue rather than a public health concern. As a result, billions of dollars each year were directed toward drug enforcement and punishment at the local, state, and federal level. Individuals were more likely to be incarcerated than treated for their substance use disorder (SUD).People with SUDs often have high rates of co-occurring conditions, including psychiatric disorders, infectious diseases, and other chronic health conditions, all of which require consistent medical care. However, this policy significantly reduced healthcare access, as individuals are often deterred from seeking healthcare due to prior negative and stigmatizing experiences with providers. The avoidance of care contributed to increased psychological distress and negative health outcomes. In terms of outcomes, the War on Drugs had everlasting impacts on vulnerable populations, particularly those with SUDs, by subjected millions to incarceration, lifelong criminal records, and disrupting their access to adequate resources and supports to live healthy lives.
Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs impacts social determinants of health beyond the criminal legal system. Annals of medicine, 54(1), 2024–2038. https://doi.org/10.1080/07853890.2022.2100926 https://www.acluaz.org/news/fifty-two-years-fear-and-failure-war-drugs/ Jamie
Late 1990s - Opioid epidemic emerges
This period was characterized by a transition from prescription opioid misuse to increased heroin use and the emergence of highly potent synthetic opioids such as fentanyl. Pharmaceutical companies began introducing new opioid medications, including OxyContin and Vicodin. Drug manufacturers assured healthcare providers that these pain relievers carried a low risk of addiction, which led to a sharp increase in prescribing. However, this widespread use eventually contributed to misuse and diversion, as it became evident that these medications were in fact highly addictive.Changes led to a dramatic rise in overdose deaths and significant gaps in the healthcare system, including limited access to addiction treatment, inadequate mental health support, and disparities in care. Policies aimed at reducing opioid prescribing unintentionally contributed to increased use of illicit substances, demonstrating how healthcare decisions can have complex and sometimes harmful consequences. Stigma continued to act as a barrier, as individuals with substance use disorders often faced judgment and were less likely to seek help. This impacted health outcomes by delaying treatment and increasing the risk of overdose and death. Many people who were already dependent on opioids began turning to heroin, which was cheaper and easier to obtain. Around the same time, more potent synthetic opioids, such as fentanyl, started to appear in the drug supply. Discrimination affected low-income individuals and communities, where access to treatment programs, mental health services, and harm reduction resources was limited. Fear of judgment or legal consequences discouraged individuals from seeking help, increasing risk of overdose and untreated comorbid conditions. The stigma contributed to delays in implementing compassionate care approaches. As the epidemic progressed, there was a gradual shift toward recognizing addiction as a public health issue, leading to expanded access to treatment, increased use of harm reduction strategies, and policy changes aimed at improving outcomes.
Robert, M., Jouanjus, E., Khouri, C., et al. (2023). The opioid epidemic: A worldwide exploratory study using the WHO pharmacovigilance database. Addiction (Abingdon, England), 118(4), 771–775. https://doi.org/10.1111/add.16081 ria
2016 - Comprehensive Addiction and Recovery Act (CARA)
The Comprehensive Addiction and Recovery Act of 2016 (CARA), signed into law by President Barack Obama on July 22, 2016, represented a major federal step in addressing substance use disorders and the opiod crisis in America. This law had six major pillars: prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. In passing this law, more recognition was given to substance use disorders as being a true medical condition, helping to address previous stigmas. This law expanded prevention efforts, primarily through the education of youth and communities on the harms of opioid use, the treatment options available, and the steps of recovery. This included the implementation of evidence based opioid treatment and intervention programs as well as making medication assisted treatments available across the country. Not only were these changes felt in the community, an emphasis was also placed on identifying and treating incarcerated individuals with substance use disorders. In an effort to reduce the distribution of opioids in the country, stricter drug monitoring programs were put into place to track drug diversion as well as drug disposal boxes becoming more readily available across the US. Finally, a focus was placed on the training and availability of naloxone for first responders and law enforcement to reduce the amount of possible overdoses in the country. More treatment options and availability greatly helped in providing opportunities for improvement in people who were willing to seek such treatment. This law helped reduce the amount of overdose deaths by improving the awareness and availability of naloxone.
Cara. CADCA. (2025, June 10). https://www.cadca.org/cara/ zach
Harm Reduction
Harm reduction strategies reduce negative effects of drug use rather than only promoting complete abstinence. This marked a critical turning point in addiction care by recognizing that individuals could still benefit from healthcare services even if they were not ready to stop using substances. Naloxone quickly reverses opioid overdoses. As opioid-related deaths began to rise, it became more available to healthcare professionals and to community members, first responders, and individuals at risk. Needle exchange programs became more common in response to the spread of infections like HIV and hepatitis among people who inject drugs. These programs provide clean needles and safe disposal options, helping to reduce the transmission of disease. Over time, they have expanded to include education, testing, and connections to treatment and social services.These programs provide immediate safety by connecting individuals to healthcare services and resources that address basic needs like housing, food, legal assistance, and job support. Substance use was viewed as criminal behavior, which lead to judgment, discrimination, and limited access to healthcare. Although harm reduction approaches like needle exchange programs or naloxone are meant to keep people safe, they are often misunderstood and judged. Many people, including some healthcare providers, see these strategies as enabling drug use instead of preventing harm. Because of this, individuals with substance use disorders may face discrimination or feel judged when trying to access these services. Over time, this stigma has become deeply rooted not just in society, but also within healthcare systems and policies. This makes it harder for harm reduction programs to expand or be fully supported. Stigma can also be internalized, causing individuals to feel shame or fear being judged, which can stop them from seeking help at all. This directly impacts healthcare access and quality, because if services are available, people may avoid using them. As a result, health outcomes can worsen for vulnerable populations.
Miller, L. W., Murray, K., DayBranch, E., & Thakarar, K. (2024). Use of Syringe Service Programs in Rural vs Urban Maine: A Harm-Reduction Study. Journal of Maine Medical Center, 6(1). https://doi.org/10.46804/2641-2225.1153 Ria
Early 1800s - Isolation of Morphine
Friedrich Wilhelm Adam Serturner isolated a key active ingredient in opium and used it to create morphine. Through trial and error, he discovered lower doses diminished pain, while higher ones caused drowsiness. He found that 15 mg was the "perfect dose" and named the drug Morphium. Serturner himself became addicted, along with many others. This became known as one of the first documented cases of drug addiction. The enhanced potency led to feelings of euphoria, resulting in many facing addictive tendencies. This discovery was a major advancement in healthcare because it allowed for more controlled dosing of morphine, reducing the risk of accidental overdose. The isolation of alkaloid led to the development of other compounds such as codeine, veratrine, and emetine.
Krishnamurti, C., & Rao, S. S. C. (2016). The isolation of morphine by Sertürner. Indian Journal of Anaesthesia, 60(11), 861–862. https://doi.org/10.4103/0019-5049.193696 paige
1914- Harrison Narcotics Tax Act
The Harrison Narcotics Tax Act was the first United States law to regulate drug production and distribution. This US law regulated the distribution of opiates and coca leaves (used for cocaine production). Any person involved in the creation or distribution of these drugs (manufacturers, dealers, and doctors prescribing) had to register with the IRS and pay a specific tax. This law was the first step in controlling narcotic access, but not yet a step towards criminalizing it. This law was aimed towards lessening the accessibility to the narcotics, by enforcing extra costs to lower easy distribution. This was the first major federal drug policy in the United States. This impacted healthcare because many lost access to physican prescribed narcotics and had to turn to illegal dealers to gain access. This also lessened physican'a ability to prescribe for maintenance of SUDs.
Garner, A. (2014, December 17). “FEAR Narcotic Drugs!” The passage of the Harrison Act. New York Academy of Medicine. https://nyamcenterforhistory.org/2014/12/17/fear-narcotic-drugs-the-passage-of-the-harrison-act/ paige
The SUPPORT for Patients & Communities Act of 2018
The SUPPORT for Patients and Communities Act, enacted in 2018 in response to the opioid crisis to improve prevention, treatment, and recovery services for people with substance use disorders. It marked a shift in how addiction is viewed from being treated as a criminal issue to being recognized as a public health problem that requires medical care and support. The law helped expand access to treatment by increasing funding, training more healthcare providers, and improving Medicaid coverage for substance use services. It improved the quality of care by promoting evidence-based treatments like medication-assisted therapy and encouraging better coordination between healthcare and behavioral health services. Makes it easier for those with Medicaid to to get MATs and funds recovery housing and peer support services; however, it lets Medicaid temporarily help pay for short-term residential addiction treatment in large facilities, but it’s optional for states and lasts 5 years. While the Act promotes education and workforce development, stigma among providers can still influence how care is delivered, leading to undertreatment, delayed interventions, or reluctance to prescribe evidence-based therapies. This demonstrates that expanding services alone does not guarantee equitable access or quality care.At a community level, stigma affects whether individuals seek treatment at all. Even with increased availability of services under the Act, fear of judgment, discrimination, or legal consequences may discourage patients from engaging in care, ultimately worsening health outcomes. Therefore, although the policy improves infrastructure and access on a systemic level, its effectiveness is constrained by ongoing stigma and marginalization, which continue to shape patient experiences over time.
Congressional Research Service. (2026). The SUPPORT for Patients and Communities Reauthorization Act. CRS. https://www.congress.gov/crs-product/R48864. ria
2000 – Drug Addiction Treatment Act of 2000
1879- Keeley Institute Opens
The Keeley Institute opened during the rise of the newly born opium epidemic. It looked to treat not only alcholism, but also drug addiction. The institute was known for the "Gold Cure", a promised cure with injections of "gold bichloride". The opening of the Keeley Institute introduced that addiction treatment did not require treatment in aslyums. Like the New York State Inebriate Asylum, this further pushed the idea that addiction was a disease, not a failing. The opening of the Keeley Institute began commercialized addiction help, allowing more access in the population. This access was limited to those that could afford it; a key difference to the state-run aslyum model. This institute showed that addiction could be treated in an outpatient center, further impacting the idea surrounding addiction as an illness.
White, A. (2016, December 14). Inside a nineteenth-century quest to end addiction. JSTOR Daily. https://daily.jstor.org/inside-a-nineteenth-century-quest-to-end-addiction/ paige
2000 - Drug Addiction Treatment Act
The Drug Addiction Treatment Act of 2000 was a bill that amended the Controlled Substance Act by changing the requirements needed for treating opioid use disorder in the United States. It signified a huge shift in the perception of substance use disorders. It allowed for these disorders to be viewed more as a medical condition rather than a criminal issue. It introduced the practice of readily available medication-assisted treatment. Instead of substance abuse clinics being the only source of care, physicians could become qualified to dispense FDA-approved medications now. Prior to this, treatment with medications such as methadone was largely restricted, limiting health care access and reinforcing the marginalization of individuals with substance use disorders. This allowed for treatment to be obtained from a variety of healthcare settings making access to care drastically better. This greatly improved treatment and retention for patients who seeked out care.
GovTrack.us. (2026). H.R. 2634 — 106th Congress: Drug Addiction Treatment Act of 2000. Retrieved from https://www.govtrack.us/congress/bills/106/hr2634 zach
March 2022
WHO releases data showing that the COVID-19 pandemic triggered a 25% increase in anxiety and depression worldwide, with young people and women at the highest risk.
The number of recorded deaths due to COVID-19 reaches 976,229, with more than 79,853,683 total reported cases of the virus in the U.S.
The Mental Health Parity and Addictions Equity Act 2008
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that ensures health insurance plans cannot treat mental health or substance use disorder benefits differently from medical or surgical benefits. If a plan offers coverage for mental health or substance use, it has to provide it at the same level as it would for physical health conditions, without putting stricter limits or restrictions on those services. MHPAEA significantly improved access to care by preventing insurance companies from using more restrictive nonquantitative treatment limits (NQTLs) for mental health and substance use care. These include things like prior authorization, medical management rules, provider network availability, and how out-of-network services are reimbursed. The law also increased accountability by requiring health plans to review data to identify differences in access between mental health/substance use services and medical services. If those differences are found, plans have to take action to fix them. It requires insurance providers to complete comparative analyses to evaluate how their policies impact access to care. This creates more accountability and transparency. The law prohibits the use of biased or discriminatory practices that would unfairly limit access to mental health or substance use treatment.
CMS. (2026). The. Mental Health Parity and Addiction Equity Act. CMSgov. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity. ria
Mid 1960's – Methadone treatment introduced
In the mid 1960s, heroin addiction was running rampant in New York City. Researchers at the Rockefeller Foundation developed a plan of dosing those suffering from heroin addiction with methadone to reduce withdrawals and cravings (National Academies of Sciences, Engingeering, and Medicine (2022). This provided one of the first evidence-based treatments for treating SUD. This long-term treatment plan helped many end their opioid addiction and not relapse. This was the first long-term and on-going treatment plan created. This treatment is still widely used as one of the gold standard treatments for opioid use disorders. This allows many suffering from addiction access to researched medical care (Narcanon, n.d.).
Narconon. (n.d.). Methadone history. https://www.narconon.org/drug-information/methadone/methadone-history.html
National Academies of Sciences, Engineering, and Medicine. (2022). Methadone treatment for opioid use disorder: The history of methadone and barriers to access for different populations. In C. Stroud, S. M. Posey Norris, & L. Bain (Eds.), Methadone treatment for opioid use disorder: Improving access through regulatory and legal change. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK585210 paige
1970 - Controlled Substances Act
The Controlled Substances Act (CSA) is significant because it established a federal system for regulating the manufacture, distribution, import, export, and use of controlled substances in the United States. Enacted in 1970, the CSA shifted towards stricter regulations associated with substance use. It also created a framework for classifying these substances (I–V). Classification is based on a substance’s accepted medical use, potential for abuse or addiction, and level of harmfulness. The CSA significantly influences healthcare by shaping how controlled medications are accessed and prescribed. There are specific prescribing criteria that need to be followed. A controlled substance prescription must be issued by a licensed practitioner for a legitimate medical purpose, and must include the prescriber’s DEA registration number, which is a 9-character code used to verify legitimacy. Pharmacists may never change the patient’s name, drug prescribed, or prescriber’s signature. This helps ensure a safe and high quality prescribing system. In terms of outcomes, the CSA helps reduce misuse and improve patient safety of controlled substances since prescription practices are controlled. While this was intended to be a safeguard to improve safety, it contributed to disparities in access to care. For example, people living in rural or underserved areas may experience delays in obtaining timely prescriptions leading to undertreatment of pain.
Ortiz, N. R., & Preuss, C. V. (2024). Controlled Substances Act. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574544/ Jamie
1987 - Drug Addiction Recognized as Disease by AMA
Addiction is characterized by a problematic pattern of substance use that leads to clinically significant impairment or distress. In 1987, the American Medical Association (AMA) classified addiction as a disease, shifting perspectives from viewing addiction as a moral failure to recognizing it as a complex, chronic condition. This change marked an important shift for public health policy and treatment strategies by promoting a more medicalized understanding of addiction. Despite this important shift, stigma surrounding addiction continued to influence some providers attitudes towards individuals with SUDs.
In terms of healthcare quality, this shift supported more compassionate, patient-centered care and encouraged providers to use individualized treatment plans that address all aspects of addiction. Brain imaging research shows structural and functional differences in the brains of individuals with addiction, furthering supporting the need for individualized treatment plans and ongoing management instead of punishment-based approaches. Studies like these have helped legitimize treatment plans for addiction within the healthcare system. It has also led to contributed to expanded insurance coverage and increased funding for research.
https://www.vfmc.net/blog/is-addiction-a-disease-eca36#:~:text=The%20understanding%20of%20addiction%20has,use%20despite%20significant%20adverse%20consequences. Jamie
The History of Substance Use Disorder
Jamie Donohue
Created on April 14, 2026
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Transcript
1879 – Keeley Institute Opens
Mid 1960's – Introduction of Methadone
Early 1800s - Isolation of Morphine
1914 – Harrison Narcotics Tax Act
1970 – Controlled Substances Act
The History of Substance Use Disorder
1987 – Drug Addiction Recognized as a Disease by the American Medical Association
1971 – War on Drugs Begins
Late 1990s– Opioid Epidemic Emerges and Intensifies
1996 – Mental Health Parity Act
2008 – Mental Health Parity and Addiction Equity Act
2000 – Drug Addiction Treatment Act of 2000 (DATA 2000)
2013 -- Rise of Synthetic Opioids
2016 – Comprehensive Addiction and Recovery Act (CARA)
Present Day – Harm Reduction Strategies
2018 – SUPPORT for Patients and Communities Act
2013 - Rise of Synthetic Opioids
Since 2013, overdose deaths have dramatically increased due to the rise of illicit fentanyl, a synthetic opioid 30-40 times more potent than heroin. This surge is being driven by a positive supply shock, meaning it is due to what's available on the street rather than an individual suddenly buying more drugs, as fentanyl is often sold as ‘heroin.’ There is a strong market incentive for its production because it is cheaper to manufacture than heroin. The rise in availability of fentanyl represents a heightened structural risk environment for individuals who buy and use drugs. This shift significantly impacts healthcare access and quality because it puts an increased demand on emergency services. With a surge in fentanyl related overdoses, this puts a strain on responders to quickly identify an overdose and quickly reverse it. Responders must be able to adapt to manage these more potent overdoses, often requiring repeated doses of Naloxone. This impacts health outcomes because there is a higher risk of accidental overdoses because individuals are unknowingly consuming fentanyl which increases the overall drug-related mortality rate. In response, there has been expanded access to medications for opioid use disorder. Medications like methadone and buprenorphine have strong evidence for efficacy, yet disparities in access and biases against medication treatment remain barriers to full coverage. Addressing these structural disparities is essential to reducing overdose mortality and improving outcomes for individuals with substance use disorders.
Ciccarone D. (2021). The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current opinion in psychiatry, 34(4), 344–350. https://doi.org/10.1097/YCO.0000000000000717 Jamie
1996 - Mental Health Parity Act
The Mental Health Parity Act became law on September 26, 1996 and it was a major step in addressing insurance inequalities in receiving care for mental health conditions. Even though it did not specifically address care for substance use disorders, it was still monumental in expanding the understanding of health beyond just physical conditions. This law required that employer-sponsored insurance plans cover mental health and provide the same spending limits for such conditions as they do for medical/surgical conditions. Following the passing of this law, there was an increase of reporting dollars spent on mental health services which shows an increase in access and quality of care for the population this was available to. In addition to not covering substance use disorders, this law had many flaws and limitations. One of which was that employers maintained control over the extent of coverage and could even drop mental health coverage altogether. A second limitation came from insurance companies because this law did not address visit limits, co-pays, and out of pocket cost limits. This allowed insurance companies to still make receiving appropriate care very difficult and expensive for a large amount of the population. This in large part was due to mental health.
Ettner, S. L., M Harwood, J., Thalmayer, A., Ong, M. K., Xu, H., Bresolin, M. J., Wells, K. B., Tseng, C. H., & Azocar, F. (2016). The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among "carve-out" enrollees. Journal of health economics, 50, 131–143. https://doi.org/10.1016/j.jhealeco.2016.09.009 zach
1971 - War on Drugs Begins Under Richard Nixon
On June 17, 1971, Richard Nixon officially declared the War on Drugs, a federal policy prioritizing criminalization to reduce drug use (American Civil Liberties Union of Arizona, n.d.). He described drug abuse as a “national emergency” and “public enemy number one” (American Civil Liberties Union of Arizona, n.d.). This highlighted substance abuse as a criminal issue rather than a public health concern. As a result, billions of dollars each year were directed toward drug enforcement and punishment at the local, state, and federal level. Individuals were more likely to be incarcerated than treated for their substance use disorder (SUD).People with SUDs often have high rates of co-occurring conditions, including psychiatric disorders, infectious diseases, and other chronic health conditions, all of which require consistent medical care. However, this policy significantly reduced healthcare access, as individuals are often deterred from seeking healthcare due to prior negative and stigmatizing experiences with providers. The avoidance of care contributed to increased psychological distress and negative health outcomes. In terms of outcomes, the War on Drugs had everlasting impacts on vulnerable populations, particularly those with SUDs, by subjected millions to incarceration, lifelong criminal records, and disrupting their access to adequate resources and supports to live healthy lives.
Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs impacts social determinants of health beyond the criminal legal system. Annals of medicine, 54(1), 2024–2038. https://doi.org/10.1080/07853890.2022.2100926 https://www.acluaz.org/news/fifty-two-years-fear-and-failure-war-drugs/ Jamie
Late 1990s - Opioid epidemic emerges
This period was characterized by a transition from prescription opioid misuse to increased heroin use and the emergence of highly potent synthetic opioids such as fentanyl. Pharmaceutical companies began introducing new opioid medications, including OxyContin and Vicodin. Drug manufacturers assured healthcare providers that these pain relievers carried a low risk of addiction, which led to a sharp increase in prescribing. However, this widespread use eventually contributed to misuse and diversion, as it became evident that these medications were in fact highly addictive.Changes led to a dramatic rise in overdose deaths and significant gaps in the healthcare system, including limited access to addiction treatment, inadequate mental health support, and disparities in care. Policies aimed at reducing opioid prescribing unintentionally contributed to increased use of illicit substances, demonstrating how healthcare decisions can have complex and sometimes harmful consequences. Stigma continued to act as a barrier, as individuals with substance use disorders often faced judgment and were less likely to seek help. This impacted health outcomes by delaying treatment and increasing the risk of overdose and death. Many people who were already dependent on opioids began turning to heroin, which was cheaper and easier to obtain. Around the same time, more potent synthetic opioids, such as fentanyl, started to appear in the drug supply. Discrimination affected low-income individuals and communities, where access to treatment programs, mental health services, and harm reduction resources was limited. Fear of judgment or legal consequences discouraged individuals from seeking help, increasing risk of overdose and untreated comorbid conditions. The stigma contributed to delays in implementing compassionate care approaches. As the epidemic progressed, there was a gradual shift toward recognizing addiction as a public health issue, leading to expanded access to treatment, increased use of harm reduction strategies, and policy changes aimed at improving outcomes.
Robert, M., Jouanjus, E., Khouri, C., et al. (2023). The opioid epidemic: A worldwide exploratory study using the WHO pharmacovigilance database. Addiction (Abingdon, England), 118(4), 771–775. https://doi.org/10.1111/add.16081 ria
2016 - Comprehensive Addiction and Recovery Act (CARA)
The Comprehensive Addiction and Recovery Act of 2016 (CARA), signed into law by President Barack Obama on July 22, 2016, represented a major federal step in addressing substance use disorders and the opiod crisis in America. This law had six major pillars: prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. In passing this law, more recognition was given to substance use disorders as being a true medical condition, helping to address previous stigmas. This law expanded prevention efforts, primarily through the education of youth and communities on the harms of opioid use, the treatment options available, and the steps of recovery. This included the implementation of evidence based opioid treatment and intervention programs as well as making medication assisted treatments available across the country. Not only were these changes felt in the community, an emphasis was also placed on identifying and treating incarcerated individuals with substance use disorders. In an effort to reduce the distribution of opioids in the country, stricter drug monitoring programs were put into place to track drug diversion as well as drug disposal boxes becoming more readily available across the US. Finally, a focus was placed on the training and availability of naloxone for first responders and law enforcement to reduce the amount of possible overdoses in the country. More treatment options and availability greatly helped in providing opportunities for improvement in people who were willing to seek such treatment. This law helped reduce the amount of overdose deaths by improving the awareness and availability of naloxone.
Cara. CADCA. (2025, June 10). https://www.cadca.org/cara/ zach
Harm Reduction
Harm reduction strategies reduce negative effects of drug use rather than only promoting complete abstinence. This marked a critical turning point in addiction care by recognizing that individuals could still benefit from healthcare services even if they were not ready to stop using substances. Naloxone quickly reverses opioid overdoses. As opioid-related deaths began to rise, it became more available to healthcare professionals and to community members, first responders, and individuals at risk. Needle exchange programs became more common in response to the spread of infections like HIV and hepatitis among people who inject drugs. These programs provide clean needles and safe disposal options, helping to reduce the transmission of disease. Over time, they have expanded to include education, testing, and connections to treatment and social services.These programs provide immediate safety by connecting individuals to healthcare services and resources that address basic needs like housing, food, legal assistance, and job support. Substance use was viewed as criminal behavior, which lead to judgment, discrimination, and limited access to healthcare. Although harm reduction approaches like needle exchange programs or naloxone are meant to keep people safe, they are often misunderstood and judged. Many people, including some healthcare providers, see these strategies as enabling drug use instead of preventing harm. Because of this, individuals with substance use disorders may face discrimination or feel judged when trying to access these services. Over time, this stigma has become deeply rooted not just in society, but also within healthcare systems and policies. This makes it harder for harm reduction programs to expand or be fully supported. Stigma can also be internalized, causing individuals to feel shame or fear being judged, which can stop them from seeking help at all. This directly impacts healthcare access and quality, because if services are available, people may avoid using them. As a result, health outcomes can worsen for vulnerable populations.
Miller, L. W., Murray, K., DayBranch, E., & Thakarar, K. (2024). Use of Syringe Service Programs in Rural vs Urban Maine: A Harm-Reduction Study. Journal of Maine Medical Center, 6(1). https://doi.org/10.46804/2641-2225.1153 Ria
Early 1800s - Isolation of Morphine
Friedrich Wilhelm Adam Serturner isolated a key active ingredient in opium and used it to create morphine. Through trial and error, he discovered lower doses diminished pain, while higher ones caused drowsiness. He found that 15 mg was the "perfect dose" and named the drug Morphium. Serturner himself became addicted, along with many others. This became known as one of the first documented cases of drug addiction. The enhanced potency led to feelings of euphoria, resulting in many facing addictive tendencies. This discovery was a major advancement in healthcare because it allowed for more controlled dosing of morphine, reducing the risk of accidental overdose. The isolation of alkaloid led to the development of other compounds such as codeine, veratrine, and emetine.
Krishnamurti, C., & Rao, S. S. C. (2016). The isolation of morphine by Sertürner. Indian Journal of Anaesthesia, 60(11), 861–862. https://doi.org/10.4103/0019-5049.193696 paige
1914- Harrison Narcotics Tax Act
The Harrison Narcotics Tax Act was the first United States law to regulate drug production and distribution. This US law regulated the distribution of opiates and coca leaves (used for cocaine production). Any person involved in the creation or distribution of these drugs (manufacturers, dealers, and doctors prescribing) had to register with the IRS and pay a specific tax. This law was the first step in controlling narcotic access, but not yet a step towards criminalizing it. This law was aimed towards lessening the accessibility to the narcotics, by enforcing extra costs to lower easy distribution. This was the first major federal drug policy in the United States. This impacted healthcare because many lost access to physican prescribed narcotics and had to turn to illegal dealers to gain access. This also lessened physican'a ability to prescribe for maintenance of SUDs.
Garner, A. (2014, December 17). “FEAR Narcotic Drugs!” The passage of the Harrison Act. New York Academy of Medicine. https://nyamcenterforhistory.org/2014/12/17/fear-narcotic-drugs-the-passage-of-the-harrison-act/ paige
The SUPPORT for Patients & Communities Act of 2018
The SUPPORT for Patients and Communities Act, enacted in 2018 in response to the opioid crisis to improve prevention, treatment, and recovery services for people with substance use disorders. It marked a shift in how addiction is viewed from being treated as a criminal issue to being recognized as a public health problem that requires medical care and support. The law helped expand access to treatment by increasing funding, training more healthcare providers, and improving Medicaid coverage for substance use services. It improved the quality of care by promoting evidence-based treatments like medication-assisted therapy and encouraging better coordination between healthcare and behavioral health services. Makes it easier for those with Medicaid to to get MATs and funds recovery housing and peer support services; however, it lets Medicaid temporarily help pay for short-term residential addiction treatment in large facilities, but it’s optional for states and lasts 5 years. While the Act promotes education and workforce development, stigma among providers can still influence how care is delivered, leading to undertreatment, delayed interventions, or reluctance to prescribe evidence-based therapies. This demonstrates that expanding services alone does not guarantee equitable access or quality care.At a community level, stigma affects whether individuals seek treatment at all. Even with increased availability of services under the Act, fear of judgment, discrimination, or legal consequences may discourage patients from engaging in care, ultimately worsening health outcomes. Therefore, although the policy improves infrastructure and access on a systemic level, its effectiveness is constrained by ongoing stigma and marginalization, which continue to shape patient experiences over time.
Congressional Research Service. (2026). The SUPPORT for Patients and Communities Reauthorization Act. CRS. https://www.congress.gov/crs-product/R48864. ria
2000 – Drug Addiction Treatment Act of 2000
1879- Keeley Institute Opens
The Keeley Institute opened during the rise of the newly born opium epidemic. It looked to treat not only alcholism, but also drug addiction. The institute was known for the "Gold Cure", a promised cure with injections of "gold bichloride". The opening of the Keeley Institute introduced that addiction treatment did not require treatment in aslyums. Like the New York State Inebriate Asylum, this further pushed the idea that addiction was a disease, not a failing. The opening of the Keeley Institute began commercialized addiction help, allowing more access in the population. This access was limited to those that could afford it; a key difference to the state-run aslyum model. This institute showed that addiction could be treated in an outpatient center, further impacting the idea surrounding addiction as an illness.
White, A. (2016, December 14). Inside a nineteenth-century quest to end addiction. JSTOR Daily. https://daily.jstor.org/inside-a-nineteenth-century-quest-to-end-addiction/ paige
2000 - Drug Addiction Treatment Act
The Drug Addiction Treatment Act of 2000 was a bill that amended the Controlled Substance Act by changing the requirements needed for treating opioid use disorder in the United States. It signified a huge shift in the perception of substance use disorders. It allowed for these disorders to be viewed more as a medical condition rather than a criminal issue. It introduced the practice of readily available medication-assisted treatment. Instead of substance abuse clinics being the only source of care, physicians could become qualified to dispense FDA-approved medications now. Prior to this, treatment with medications such as methadone was largely restricted, limiting health care access and reinforcing the marginalization of individuals with substance use disorders. This allowed for treatment to be obtained from a variety of healthcare settings making access to care drastically better. This greatly improved treatment and retention for patients who seeked out care.
GovTrack.us. (2026). H.R. 2634 — 106th Congress: Drug Addiction Treatment Act of 2000. Retrieved from https://www.govtrack.us/congress/bills/106/hr2634 zach
March 2022
WHO releases data showing that the COVID-19 pandemic triggered a 25% increase in anxiety and depression worldwide, with young people and women at the highest risk. The number of recorded deaths due to COVID-19 reaches 976,229, with more than 79,853,683 total reported cases of the virus in the U.S.
The Mental Health Parity and Addictions Equity Act 2008
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that ensures health insurance plans cannot treat mental health or substance use disorder benefits differently from medical or surgical benefits. If a plan offers coverage for mental health or substance use, it has to provide it at the same level as it would for physical health conditions, without putting stricter limits or restrictions on those services. MHPAEA significantly improved access to care by preventing insurance companies from using more restrictive nonquantitative treatment limits (NQTLs) for mental health and substance use care. These include things like prior authorization, medical management rules, provider network availability, and how out-of-network services are reimbursed. The law also increased accountability by requiring health plans to review data to identify differences in access between mental health/substance use services and medical services. If those differences are found, plans have to take action to fix them. It requires insurance providers to complete comparative analyses to evaluate how their policies impact access to care. This creates more accountability and transparency. The law prohibits the use of biased or discriminatory practices that would unfairly limit access to mental health or substance use treatment.
CMS. (2026). The. Mental Health Parity and Addiction Equity Act. CMSgov. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity. ria
Mid 1960's – Methadone treatment introduced
In the mid 1960s, heroin addiction was running rampant in New York City. Researchers at the Rockefeller Foundation developed a plan of dosing those suffering from heroin addiction with methadone to reduce withdrawals and cravings (National Academies of Sciences, Engingeering, and Medicine (2022). This provided one of the first evidence-based treatments for treating SUD. This long-term treatment plan helped many end their opioid addiction and not relapse. This was the first long-term and on-going treatment plan created. This treatment is still widely used as one of the gold standard treatments for opioid use disorders. This allows many suffering from addiction access to researched medical care (Narcanon, n.d.).
Narconon. (n.d.). Methadone history. https://www.narconon.org/drug-information/methadone/methadone-history.html
National Academies of Sciences, Engineering, and Medicine. (2022). Methadone treatment for opioid use disorder: The history of methadone and barriers to access for different populations. In C. Stroud, S. M. Posey Norris, & L. Bain (Eds.), Methadone treatment for opioid use disorder: Improving access through regulatory and legal change. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK585210 paige
1970 - Controlled Substances Act
The Controlled Substances Act (CSA) is significant because it established a federal system for regulating the manufacture, distribution, import, export, and use of controlled substances in the United States. Enacted in 1970, the CSA shifted towards stricter regulations associated with substance use. It also created a framework for classifying these substances (I–V). Classification is based on a substance’s accepted medical use, potential for abuse or addiction, and level of harmfulness. The CSA significantly influences healthcare by shaping how controlled medications are accessed and prescribed. There are specific prescribing criteria that need to be followed. A controlled substance prescription must be issued by a licensed practitioner for a legitimate medical purpose, and must include the prescriber’s DEA registration number, which is a 9-character code used to verify legitimacy. Pharmacists may never change the patient’s name, drug prescribed, or prescriber’s signature. This helps ensure a safe and high quality prescribing system. In terms of outcomes, the CSA helps reduce misuse and improve patient safety of controlled substances since prescription practices are controlled. While this was intended to be a safeguard to improve safety, it contributed to disparities in access to care. For example, people living in rural or underserved areas may experience delays in obtaining timely prescriptions leading to undertreatment of pain.
Ortiz, N. R., & Preuss, C. V. (2024). Controlled Substances Act. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574544/ Jamie
1987 - Drug Addiction Recognized as Disease by AMA
Addiction is characterized by a problematic pattern of substance use that leads to clinically significant impairment or distress. In 1987, the American Medical Association (AMA) classified addiction as a disease, shifting perspectives from viewing addiction as a moral failure to recognizing it as a complex, chronic condition. This change marked an important shift for public health policy and treatment strategies by promoting a more medicalized understanding of addiction. Despite this important shift, stigma surrounding addiction continued to influence some providers attitudes towards individuals with SUDs.
In terms of healthcare quality, this shift supported more compassionate, patient-centered care and encouraged providers to use individualized treatment plans that address all aspects of addiction. Brain imaging research shows structural and functional differences in the brains of individuals with addiction, furthering supporting the need for individualized treatment plans and ongoing management instead of punishment-based approaches. Studies like these have helped legitimize treatment plans for addiction within the healthcare system. It has also led to contributed to expanded insurance coverage and increased funding for research.
https://www.vfmc.net/blog/is-addiction-a-disease-eca36#:~:text=The%20understanding%20of%20addiction%20has,use%20despite%20significant%20adverse%20consequences. Jamie