Shocking though this sounds, given our general perception that pharmaceutical companies work to create lifesaving, not life taking, drugs, this isn’t the first time unfettered greed created an opioid epidemic. In fact, a century ago the same thing happened thanks to the “opium trade.”
At that time, an extraordinary American woman named Ellen N. La Motte launched an international anti-opium campaign to stop it. Her long-forgotten critique of the opium epidemic then ravaging Asia offers surprising and intriguing parallels to our own opioid crisis. By exposing the profiteers and creating public outrage, La Motte aimed to halt the opium trade, a strategy that just might pay dividends today.
La Motte’s name may not be familiar in 2019, but she was one of the most highly accomplished people of her era. Born in 1873 into the extended duPont family, she was a trained nurse and pathbreaking public health administrator, who had volunteered during World War I as a nurse on the Western Front. By the time she turned her formidable talents to fighting the opium trade in Asia, she had already published two books and served as the first woman to head a division of Baltimore’s health department. La Motte was also a bold trailblazer in other notable ways, as a suffragist, socialist, self-proclaimed anarchist and lesbian.
During a year spent traveling throughout Asia in the mid-1910s with her partner, Emily Crane Chadbourne (an American heiress and art collector), La Motte became deeply concerned about the pernicious effects of the opium trade. She investigated the issue in every country she visited and was horrified to discover what she later described as a “complete, systematic arrangement, by which the foreign government[s] profited at the expense of the subject peoples under [their] rule.”
She came to realize that the trade in opium was an ugly form of imperialism, in which England and other colonial powers fostered, and even forced, the cultivation, manufacture and sale of addictive, deadly opium in their colonies, even as they severely restricted its use at home because of the inherent dangers.
La Motte came home determined to eradicate the opium trade. In 1919 she published two new books: “Peking Dust,” a collection of her letters from China that resoundingly condemned the opium trade, and the ironically titled “Civilization: Tales of the Orient,” a collection of stories that underscored the hypocrisy of Western imperialism, especially with regard to opium.
Over the following decade, she continued to write prolifically about opium, including three more books and dozens of articles for publications such as the Atlantic.
She also met with politicians in London and Washington (including Eleanor Roosevelt at the White House), regularly attended the meetings of the Opium Committee of the League of Nations, joined advisory boards and lectured on college campuses. In 1928, an American congressman labeled La Motte “the best informed woman in the world on the opium question.”
Among those determined to address the opium crisis, La Motte was revered, but she butted heads with those who benefited from opium’s cultivation, manufacture and trade, namely colonial powers. Five such countries — Britain, Holland, France, Switzerland and Germany — dominated the League of Nations Opium Committee and banded together to prevent any meaningful attempts to eliminate or restrict the opium traffic. “The most powerful countries in the world,” La Motte fumed in the New York American in 1928, “[were] engaged in the most lucrative traffic — that of poisoning people in the five continents and the seven seas! The whole opium question can be summed up in two words: Bad faith.”
Elsewhere, she quoted an official report published by England’s House of Commons in 1907 that explained England had over 650,000 acres under poppy cultivation in India, producing nearly $22 million (roughly $5.35 billion in today’s dollars) of revenue for the British treasury during a single year.
La Motte hoped that by revealing England’s rapaciousness, the opium trade could be ended. “The public is watching,” she wrote in 1924, “something which has not happened before. . . . The moral opinion of the world will no longer stand for it.” But despite laboring until she retired in the mid-1930s, LaMotte was stymied by the powerful opium profiteers. As she conceded, “The drug traffic dies hard. Vast financial interests both of nations and of individuals, are at stake.”
There are clear parallels between La Motte’s fight and the challenges facing us today. In both eras, money ruled over the common good. Our current opioid epidemic stems from the mass overprescribing of addictive opioid drugs, most infamously OxyContin. But the fault belongs to more than just Big Pharma. Unscrupulous pharmaceutical distributors and pharmacies, corrupt doctors running pill mills and bottom-line driven insurance companies have also profited from pushing highly addictive drugs on Americans.
Nowhere is this clearer than West Virginia, which has the highest rate of opioid related deaths in the United States. In 2017, the age-adjusted rate of deaths because of drug overdoses in West Virginia was 57.8 per 100,000, up from only 1.8 per 100,000 in 1999.
In the intervening years, however, West Virginia was flooded with prescription drugs. In one especially egregious example, two pharmacies in Williamson, a town with just 3,000 residents, dispensed more than 20 million prescriptions for opioids from 2006 to 2016.
Just as the colonial powers put profit ahead of people, so too the opioid trade of our day allowed the Sackler family and others to put profit ahead of patients. The result was the vast over-prescription of opioids, which led to widespread addiction and our current opioid epidemic. To echo La Motte, the whole opioid crisis today can be summed up in two words: bad faith.
But the resurrection of La Motte’s tactics offers hope that we can conquer the epidemic. By exposing the profiteers, La Motte hoped to spark a moral reckoning that would end the opium trade. We are now witnessing just such a reckoning. Virtually overnight, the Sackler family’s donations to prominent arts and cultural institutions went from coveted to rejected. (There is a Sackler Wing at the Metropolitan Museum and the Louvre, a Sackler Gallery in Washington and numerous other Sackler named-places everywhere from Harvard University to Peking University.)
Our government, long in the pocket of Big Pharma, also is finally awaking from its long stupor and beginning to charge the criminals and adjudicate the damages.
The next steps, La Motte would tell us, are to curtail the circulation of opioids and give those already addicted “intensive and humane treatment, under scientific direction, and so give them every chance for rehabilitation."
But we really never should have arrived here at all. In La Motte’s era, as in our own, monumental greed resulted in a completely avoidable epidemic.