Due to a sudden, unexpected passing in the family a few years ago and another more recently and my subsequent (mental) health issues stemming from that, I was unable to download this book in time to review it before it was archived as I did not visit this site for several years after the bereavements. This meant I didn't read or venture onto netgalley for years as not only did it remind me of that person as they shared my passion for reading, but I also struggled to maintain interest in anything due to overwhelming depression. I was therefore unable to download this title in time and so I couldn't give a review as it wasn't successfully acquired before it was archived. The second issue that has happened with some of my other books is that I had them downloaded to one particular device and said device is now defunct, so I have no access to those books anymore, sadly.

This means I can't leave an accurate reflection of my feelings towards the book as I am unable to read it now and so I am leaving a message of explanation instead. I am now back to reading and reviewing full time as once considerable time had passed I have found that books have been helping me significantly in terms of my mindset and mental health - this was after having no interest in anything for quite a number of years after the passings. Anything requested and approved will be read and a review written and posted to Amazon (where I am a Hall of Famer & Top Reviewer), Goodreads (where I have several thousand friends and the same amount who follow my reviews) and Waterstones (or Barnes & Noble if the publisher is American based). Thank you for the opportunity and apologies for the inconvenience.

This is a great look at the history of legal pharmaceutical drugs and how they have harmed people throughout history. I especially appreciated the focus on the different ways society treats people depending on race, class and type of drugs. Quite a history and civics lesson and one we all need to take a closer look at.

Well written book about the opiod crisis we are facing. Very concise and clear. Would read this author again. Thanks to NetGalley, the author and the publisher for the arc of this book in return for my honest review. Receiving this book in this manner had no bearing on this review.

This book details the history of opiate use in the United States, touching on topics of race, socio-economic factors behind drug use, corporate liability and regulation, and harm reduction.
I think the critical approach to the history of opiate use worked well in this book as it provided a more nuanced perspective rather than the perspective of the white, middle-class female drug user, which is one of the classes that history has long protected and uplifted when it comes to drug abuse. I also really enjoyed the inclusion of documents, photographs, and other visual aids to both break up the text and to provide a glimpse into the past - the old drug advertisements were my personal favourite!
This book is written in a somewhat dry writing style, making it more suited to perhaps a textbook or supplementary readings for a class rather than a casual read, but the language is still mostly accessible to the everyday reader (i.e. not much medical or specialized language.) I do not think I would recommend this to a nonfiction beginner or someone that only has a passing interest in drugs and medicine or the opioid crisis, but if you are interested in the origins of the opioid crisis in America and the nuanced history of drug marketing and regulation this could be of interest to you.

If there had been a television in every home around WWI, there would have been a commercial that said “Ask your doctor if Heroin® is right for you.” Because Heroin was a registered, trademarked and readily available prescription drug from Bayer. All throughout the 20th century, drug companies were finding or inventing narcotics to swell their profits. In David Herzberg’s White Market Drugs, the history of legal drugs in America is that of solutions in search of problems, all while addicting and killing customers. If they made it, Americans would take it.

It is a history of failures. Government failed to regulate industry. Industry failed to provide safe products. Regulation caused the explosion of informal markets, where “dope fiends” could purchase illegal drugs from “peddlers”. And along the way, customers became addicts. They overdosed; they became criminals to raise cash for their addictions. The white markets were organized and legal, but they were populated with crooked doctors, crooked pharmacies and crooked manufacturers, making them no better than the black markets, where the working classes got their drugs. Herzberg positions it as three major drug crises, all of which were far worse than the illegal drug trade the government was (and is) constantly trying to stamp out. From opium and morphine, through barbiturates and (back to) opioids, Americans flock to their doctors and pharmacies in the white markets for their addictions. For those who can’t afford it, they flock to prison because of their purchases in the black markets. As Herzberg puts it: “Treating consumers like criminals…had been a self-fulfilling prophecy.”

The book is therefore not about marijuana, cocaine, amphetamines and ecstasy. It is about good, clean, authorized prescription drugs, addicting their users into poverty and death if prison doesn’t grab them first.

All through the book there are some disgusting commonalities. Drugmakers love hairsplitting. It was and is their way of differentiating themselves from the competition and from past failures. We are probably most familiar today with the hairsplitting over addiction. According to the makers of opioids, they are no longer addictive! This has been said repeatedly over the past 150 years, and it is no more true today than it was then, but they keep making this same false claim. And doctors keep falling for it.

The current malaise began in the 1980s, when researchers decided to split hairs over the addictiveness of opioids, in particular for oxycodone, a resurrected opioid from the 1940s. In denying the addictiveness of the drug, their studies instead said things like: “A set of aberrant behaviors marked by drug-craving, efforts to secure its supply, interference with physical health or psychosocial function, and recidivism after detoxification.” (But never addiction.) They called addiction to opioids “Pseudo-addiction” – it was a sign the patient needed more opioids! (But never addiction.)

Incredibly, the medical community bought into this obviously fake news, and doctors all over the country fell for the pitches of the sales reps from the opioid makers. My own dentist assured me it was a non-addictive pain killer when he prescribed oxycodone for me. Even though it didn’t pass the smell test.

This all came from the bizarre and misguided policies the government developed at the turn of the previous century. Opium and morphine were the fashionable drugs of the era. White women in particular sought solace in morphine. It combatted a make-believe illness doctors called neurasthenia – the stress of being a weak, delicate white woman in the Victorian era when women could do pretty much nothing but fret.

Congress and the government moved to split the pills in two; there were medicines and there were drugs. The medicines were to be regulated by the Food and Drug Administration (FDA), while drugs fell under the purview of the Federal Bureau of Narcotics (FBN). Didn’t matter that both compounds had their own medicinal properties, that customers couldn’t tell the difference between drugs and medicines, and that both could be obtained on the street regardless. For legal purposes, two whole bureaucracies were needed to keep them separate.

But in those days, there wasn’t much need of the street anyway. Doctors freely prescribed narcotics for all comers, starting with themselves. Many patients later claimed to have no idea what was in their meds. Even as laws were promulgated to control the distribution, huge prescribers of narcotics and huge purveyors (pharmacies) distributed them. A hundred years later, the USA once again found a Pareto distribution: 20% of the doctors did 80% of the prescribing of opioids, and 20% of pharmacies sold 80% of the pills. Even though they were both required to log their activities and even though they were required to report outsized quantities to the regulators, the money was just too good. Instead of reporting , they upsized to accommodate the demand.

Herzberg points to Demerol, a 1939 opioid that was entirely synthetic – the first of its kind. It was the first opioid not to be derived from opium. Winthrop, the drugmaker, claimed this made the drug non-addictive, and produced and sold massive amounts of it. It fought the government tooth and nail to keep the money pouring in. Its in-house magazine for sales reps touted not the efficacy, but rather the easy money it brought. It was not until 1962 that the FDA got the right to demand proof of efficacy for white market meds.

Although it is a very complex tale that Herzberg tells, there are some threads that flow all the way through. The drugmakers were always pushing to distribute more, without regard to need or harm. They were all over free samples of narcotics, even a hundred years ago. Anything to get someone hooked, starting with the doctor. They continually lied about the properties of the drugs. They fought off any kind of regulation. The drugs themselves were discoveries rather than purposeful. They were solutions in search of a problem. The drugmakers marketed them as the cure for all kinds of conditions that were simply not true. These all-purpose cure-alls went through little or no testing, not even for safety. Nonetheless, doctors bought in, hook, line and sinker.

Herzberg takes readers on a grand tour, explaining the development, marketing and effects of numerous drugs readers might or might not be familiar with. Their names are legion: opium, morphine, Heroin, codeine, Quaaludes, psychotropics, Dilaudid, Valium, Darvon, Demerol, Ritalin, methadone, OxyContin, Percodan, Darvon, Fentanyl and many others that could bring back fond memories for many Americans.

The federal government twisted and contorted itself in its efforts to control narcotics. In 1914 it passed the Harrison Act, which as was a tax law, not a narcotics law. It creatively required healthcare professionals to register and pay a tax on any narcotics they handled. Since only professionals could register, anyone in possession of narcotics who therefore could not have paid the tax was automatically a criminal for tax purposes. There were battles over interpretation, the usual spate of lawsuits, and a constant battering of its objectives and performance from within. Eventually, it seemed to have been simply outcompeted by new laws and agencies the government kept creating. For example, the government developed a bizarre benchmark: if a drug was less addictive than codeine, it would be regulated by the FDA. If it was more addictive than codeine, it would be regulated by the Harrison Act and the FBN. As Herzberg says, the government spent the 20th century arguing whether addiction was a disease or a crime. It was so contorted, the Sheriff of Alma Georgia admitted to taking narcotics, but by prescription, because he said, getting them from peddlers would be illegal.

With such confusion and doubt, gaps and loopholes big enough for caravans of drugs to drive through became the story of legal addiction in the USA.

There has just always been a white market for drugs that kill in the USA. Americans, Herzberg says, are drug-seeking rather than health-seeking. In 1954, barbiturates (for sleeping) were all the rage. They made up one in every six prescriptions (not including illegal otc sales which the FDA estimated brought them u to 50% of total sales). In the 1970s it was Valium, followed by Quaaludes. 5% of men and 10% of women were regularly using Valium in the early 1970s.

The whole business of the “War on Drugs” started by Nixon in the early 70s has been a horrific diversion of funds against a smaller black market, when right in front of everyone, the white markets were killing and continue to kill customers by the tens of thousands. Nixon was following in the steps of Lyndon Johnson, who began the new trail of pursuing illegal dealers and their customers instead of the big drugmakers and the doctors they compromised with their misinformation. “The history of American drug policy offers precious few success stories,” Herzberg says in an understatement worthy of Churchill. More realistically, he later calls it a white market apocalypse.

In a final touch of irony, the drug laws of the United States are so weak they could not stop makers like Purdue Pharma from producing, marketing and cashing in on opioids, fraudulently posing as non-addictive painkillers. Nonetheless, their customers went to prison. Doctors, pharmacists and patients continue to be sentenced to long prison terms for their roles in the disaster. The D.A.R.E. program in schools gets kids to snitch on their parents, putting them in prison and making the kids wards of the state, sent to foster homes where they are drugged to keep them passive. It is a suitably bizarre outcome for a perverse cobweb of rules and regulations targeting the wrong objectives, badly.

David Wineberg

This was a difficult book for me. Mainly because it didn't seem to flow. I was missing : this is how it started, this is how it flowed, this is where it divided, this is where we are now.
I realize this is just the way I like things, but WMD seemed to scatter and tried to touch on those points in every chapter.
I think it's a book that should be read by everyone (love to see doctors read this!).
Policy? Well, there's so much policy. Sometimes, that's the problems. Things are too big to know.
All in all, very well done.

Thank you to the publisher and Netgalley for the opportunity to read and review this book. This was VERY informative on the addiction crisis we are in right now. It is just so amazing how pharmaceuticals are seen as something good, but can lead you down a very bad path.