The Rise and Fall of Heroin: Was it a 1900s Wonder Drug?

INTRODUCTION

The significant advancements in medical therapy over the past century are largely attributable to the rapid progress in chemistry and pharmacology. During this period, countless compounds synthesized in chemical laboratories were evaluated for their pharmacological activity. Those deemed satisfactory subsequently entered commercial production.

The extent of public acceptance and use of any particular drug has typically been determined by the medical profession. Many newly introduced compounds were used only briefly, frequently being superseded by others found to be more effective or less prone to inconvenient side reactions.

The case of “Heroin” (diacetylmorphine) is nearly unprecedented. Initially hailed as a wonder drug, it was embraced with enthusiasm by the medical profession. Inevitably, the detrimental effects of the drug became apparent. Although many physicians ceased prescribing heroin and all cautioned against its careless use, the market for it continued to thrive. As a dangerously addiction-producing substance, curtailing its usage proved challenging.

This paper aims to trace the history of heroin from its discovery and initial enthusiastic reception through to its current precarious status today, examining why it was perceived by some as a 1900s 9th Wonder Of The World in its early days of medical application, before its true dangers were widely known.

HEROIN AS A WONDER DRUG

While diacetylmorphine was not widely prescribed as a medicine much before 1900, its preparation had already been reported in 1874 by C. R. Wright at St. Mary’s Hospital in London. The primary objective of his research was to determine the constitution of certain natural and purified alkaloids. By boiling anhydrous morphine alkaloid for several hours with acetic anhydride, he successfully isolated acetylated morphine derivatives. The prevailing understanding of the morphine molecule at that time was represented by a double empirical formula, which led to rather confusing nomenclature in his article. The extremely acetylated derivative he obtained was termed “Tetra acetyl morphine,” a compound corresponding to diacetylmorphine according to modern nomenclature.

This “Tetra acetyl morphine” was dispatched to F. M. Pierce, Associate at Owens College, London, for biological assessment. Following tests on animals, he reported the following findings to Wright. The observed effects included: “great prostration, fear, sleepiness speedily following the administration, the eyes being sensitive and pupils dilated, considerable salivation being produced in dogs, and slight tendency to vomiting in some cases, but no actual emesis. Respiration was at first quickened, but subsequently reduced, and the heart’s action was diminished and rendered irregular. Marked want of coordinating power over the muscular movements and the loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4°, were the most noticeable effects.”
stonehenge a wonder of the world

Medical interest in this novel morphine derivative remained relatively low for the initial twenty years. In 1890, a German scientist, W. Dankwortt, synthesized diacetylmorphine by heating anhydrous morphine with excess acetylchloride. His work holds significance primarily from a chemical perspective rather than pharmacological. Based on the compounds he successfully isolated, he concluded that the morphine molecule possessed a simple empirical formula, contradicting the prevailing double formula theory.

In the final decade of the 19th century, Dreser and other researchers investigated the physiological effects of diacetylmorphine. The positive reports from these investigators, coupled with the growing interest in the drug within the medical community of that era, prompted the Bayer Company in Eberfeld, Germany, to commence commercial production of the compound in 1898.

Bayer marketed the new compound under the name “Heroin.” (The name is likely derived from “heroisch,” a German medical term signifying large, powerful, extreme, or exhibiting a pronounced effect even in small doses.) This name subsequently became synonymous with the drug.

The new remedy garnered spontaneous and widespread acceptance, comparable to that of drugs like penicillin or cortisone in more recent times. The high prevalence of tuberculosis and other respiratory illnesses had generated significant demand for an effective treatment, and heroin was hoped to fulfill this requirement.

Prescribed for nearly all ailments where codeine or morphine had been utilized, heroin was also considered effective in combating addiction to these two drugs. The enthusiasm for the new drug is best illustrated in the medical literature of the period. While by no means exhaustive, the following excerpts exemplify the common writings of the day.

In 1898, Strube reported findings from studies conducted at the Medical University Clinic of Berlin. Evaluating heroin on 50 patients suffering from phthisis, he found it effective in alleviating their cough and inducing sleep. Although Strube observed no adverse effects, he emphasized the need for further observation to ascertain whether continuous use might be harmful or lead to chronic “heroinism”.

Heroin's Early Clinical Trial Results on Cough Relief and SleepHeroin Effectiveness in Treating Bronchitis, Asthma, and Tuberculosis Patients

At Dreser’s request, Floret conducted experiments with the drug at the Poliklinik der Farbenfabriken in 1898. He concluded it was valuable in treating bronchitis, asthma, and tuberculosis. For instances of dry bronchitis where codeine had proven ineffective, Floret reported that heroin was remarkably prompt and reliable.

These experiments were among those that led to Dreser’s endorsement of heroin at the congress of German Naturalists and Physicians in 1898. Claiming heroin was ten times as effective as codeine for respiratory ailments, he estimated it had only one-tenth of the toxic effects.

H. Leo, reporting frequent success in administering the drug, provided a detailed case history of one of his patients. In 1896, the patient, then 71 years old, developed a severe cough with expectoration and suffered from dyspnea. After being hospitalized in the summers of 1897 and 1898, the patient was finally sent to a sanatorium in November 1898. By this time, his condition had significantly deteriorated. Respiration was rapid and difficult, fat and muscle tissue had wasted, lungs were enlarged, and heart function was poor.

By February 1899, other drugs provided no relief, and the patient was unable to sleep at night. Heroin was then prescribed. The treatment is described as follows:

“February 4. The patient had been given the first dose the evening before. The night was still without sleep, but the cough was looser and effortless. Also the dyspnea was not so pronounced. After he had taken the drug he felt very comfortable and stated that he no longer felt sick. The action of the heart was somewhat more regular. The appetite was better.

“February 5. The patient had obtained some sleep. The sensation of fear that was always with him was gone. The respiratory frequency in the morning was 23. The cough was without difficulty.

“February 6. The patient slept soundly most of the night, in a reclining position. The respiratory frequency in the morning: 20. The action of the heart was regular.

“The heroin was then withdrawn for eight days. The ailments he had suffered before gradually returned. Heroin was again administered and had the same beneficial action as before.”

Manges, who had previously reported on the advantages of heroin over morphine in treating coughs, phthisis, and asthma, reiterated his confidence in the drug in 1900. Reviewing the treatment of 341 respiratory cases by his colleagues, he stated that addiction was noted in less than eight percent, without the negative effects associated with morphine treatment. While most cases in Manges’ report did not show habituation, in two cases, heroin had even been found successful in breaking addiction to morphine.

Prompted by Harnack’s 1899 warning that heroin might be a dangerous poison, Turnauer tested the drug for potential harmful after-effects. After treating 48 cases of phthisis, bronchitis, and dyspnea, Turnauer noted a tolerance to the drug. Administering heroin for extended periods, he found that the dosage needed to be increased. He reported finding “No harmful results, especially as I observed no abstinence symptoms whatever. Generally it appeared that in all cases in which period of time was allowed to elapse the full effect could again be obtained with small doses … It may be concluded that, regarding tolerance to heroin, certain individuals react peculiarly and it is recommended that in the case of old and feeble persons, the initial dose should not be over 0.005 g.”

Horatio C. Wood Jr., in 1899, also observed that dosage had to be increased for the drug to remain effective. He cautioned that experimentation was still insufficient to conclude that heroin was not addiction-producing.
2th wonder of the world

Many other investigators recommended heroin use at the turn of the century. Most failed to mention the danger in its use or implicitly stated that it did not lead to tolerance.

In 1901, Joseph Jacobi, based on using heroin in 85 cases, claimed the drug was superior as a cough-soothing remedy. Although he found it more effective with patients who had never used strong narcotic drugs, he reported that any tendency towards tolerance could be averted if dosage was reduced for several weeks. He also recommended alternating its use with morphine or codeine.

Around this time, the initial enthusiasm for heroin began to diminish. Morel-Lavallée in 1902 cautioned against its habit-forming properties, though he still considered it safer than morphine. Along with many others, Morel-Lavallée advocated heroin treatment for demorphinisation. His practice was criticized by Jarrige in 1902, who claimed physicians would thereby create “heroinists” of their patients. Citing several cases of heroinism, he emphatically contended that heroin withdrawal was significantly more painful than morphine withdrawal. Rather than reducing narcotic use, the advocacy of heroin was responsible for many people becoming drug addicts.

In 1903, Pettey reported that of the last 150 drug addiction cases he treated, eight were heroin users, and of these, three had first become addicts through heroin use. He further reported that the heroin habit was as difficult to cure as the morphine habit.

Sollier, in 1905, deplored the use of heroin in treating morphinism. This practice, he claimed, had resulted in the number of heroin addicts becoming as large as that of morphine addicts. Heroin was extremely toxic, and the severity of poisoning in the heroinists he had observed was far greater than it would have been for the same amount of morphine. Sollier found that the mental and physical deterioration from heroin use was very rapid. He opposed its use in treating both morphinism and respiratory diseases.

In the same year, Atwood reported a case of heroinism in a woman who became addicted after its use in surgery. Although not as vehement as Sollier and Jarrige, Atwood advised caution in prescribing the drug. Atwood believed cases of heroin addiction were rare but pointed out that they would become more common if the medical profession lacked discretion. He was against prescribing it for coughs, recurring headaches, rheumatism, and other chronic diseases.

At that time, however, there was no other drug that could entirely replace heroin for some medical indications, and the medical profession largely remained in its favor despite acknowledging many of its disadvantages.

As J. D. Trawick of Kentucky expressed in 1911: “I feel that bringing charges against heroin is almost like questioning the fidelity of a good friend. I have used it with good results, and I have gotten some bad results, such as a peculiar bandlike feeling around the head, dizziness, etc., but in some cases referred to, it has been almost uniformly satisfactory.”
why is christ the redeemer a wonder of the world

ABUSE OF HEROIN

It took the medical profession a considerable time to fully grasp the danger of heroin addiction. Conversely, very little time elapsed after the drug became readily available before the criminal underworld and smugglers discovered that heroin possessed properties even exceeding those of other narcotics, which have since established it as the primary drug of addiction in many parts of the world. Heroin’s analgesic and euphoric effects per gram are significantly greater than those of morphine. Unlike morphine, it does not cause depression of the alimentary tract. Whereas morphine is typically administered via hypodermic needle, heroin can be inhaled (“sniffed”) into the system. This is a crucial factor, as many people are initially repelled by using a hypodermic needle. However, individuals addicted to heroin soon transition to using it hypodermically, and even intravenously. As the perceived effects diminish with increasing addiction, they resort to larger doses and more drastic self-administration methods, constantly seeking to recapture the initial stimulation of the drug. Heroin’s addiction-forming properties are even more pronounced than morphine’s. It induces a disregard for societal conventions and morals, with these symptoms progressing more rapidly than with other habit-forming drugs. Heroin addiction is the most challenging to cure; sudden withdrawal can lead to cramps, convulsions, and even death from respiratory failure. The post-convalescent treatment, both psychological and physical, is longer and more difficult than with morphine.

Drug addiction is a global issue. However, addicts’ preferences appear to vary considerably by region. In the Far East, opium has been used as a narcotic for centuries, while in the Middle East, hashish has a long history of use. In South America, chewing coca leaves is an ancient practice. Among the so-called “white drugs,” European addicts have typically confined themselves to cocaine and morphine. Three regions stand out where heroin addiction has garnered more attention than any other drug addiction: the United States, particularly the eastern part, Egypt, and China. In other locations, heroin addiction has been more sporadic.

The United States appears to be the first place where heroin addiction became a major problem. New York City was the epicenter of this addiction, with reports indicating that 98 percent of all drug addicts there at the time were heroin addicts.

The Public Health Service Hospitals in the United States discontinued dispensing heroin at their relief stations in 1916. In 1920, the House of Delegates of the American Medical Association at its 71st annual session passed a resolution: “that heroin be eliminated from all medicinal preparations and that it should not be administered, prescribed, nor dispensed; and that the importation, manufacture, and sale of heroin should be prohibited in the United States.”

Several other authorities, especially law enforcement, supported this resolution. The rising crime rate in larger U.S. cities alarmed the public. In 1922, while London reported seventeen murders, New York City saw 260, with heroin addiction blamed for a significant number of the New York murders. Carleton Simon, Special Deputy Police Commissioner in New York, wrote in February 1924: “Ninety-four per cent of the criminal drug addicts arrested in New York City use heroin regularly. Placing the consumers receiving their drugs from the illicit narcotic street venders in New York City at a minimum of 10,000 (based upon statistics of arrests), using at an average of ten grains a day per individual, we have a total of 76,000 ounces as the yearly quantity of heroin used by the narcotic addicts who procure their drugs on the streets in New York City alone.” The total amount of heroin prescribed by the entire medical profession in the State of New York during the same period was estimated at fifty-eight ounces.

These observations led to a congressional law prohibiting the import of crude opium for heroin manufacturing purposes in June 1924.

Pharmaceutical production of heroin ceased within a very short time. As a substitute, factories concentrated their efforts on producing codeine. The quantity of codeine needed to replace heroin for a similar medicinal effect must be approximately two to six times the weight of the original heroin quantity. Since there is little difference in the amounts of heroin and codeine producible from a given quantity of opium, the quantity of opium required for import into the United States had to increase after the law’s enactment. This is the primary reason for the high opium import into the United States shortly after 1924.
is christ the redeemer a wonder of the world

Although legitimate heroin production virtually ended after 1924, addicts’ demand for the drug continued to be met by smugglers. Heroin traffic in the United States peaked in the late 1920s. By 1930-1932, there was a sharp decline in trafficking primarily due to international restrictions. The heroin still circulating in the illicit market was generally adulterated.

With the onset of World War II, stricter border controls and reduced shipping diminished illicit heroin supplies. To stretch available supplies, traffickers resorted to increasing adulteration and dilution of the drug. The heroin finally reaching the addict often contained less than two percent heroin. Many addicts were involuntarily cured, some without even realizing it. Others broke the habit, at least temporarily.

AVERAGE PERCENT OF ADULTERATION OF HEROIN FOUND IN ILLICIT TRAFFIC CALENDAR YEARS 1938, 1939, 1940 and 1941

* By the time the drug reaches the addict, much of it is less than 1% pure.

As one addict stated: “If I could get good heroin or morphine again I would probably go back to using the drugs. As it is, I won’t touch it as it has so much other stuff mixed with it that it is dangerous.”

The following figures show the amount of seized heroin in the United States from 1930 until 1950:

Trends in Heroin Seizures in the United States, 1930-1950

Another region where heroin addiction attracted considerable attention was Egypt. Hashish had been used as a narcotic in this country since ancient times. However, narcotic use did not become such a serious problem until the “white drugs” emerged.

This began in 1916, with cocaine initially being sold non-medically, followed shortly by heroin. The price of the new narcotic was kept low at first, until the vice had spread and ensnared large numbers of victims.

There were even instances where contractors paid their laborers with heroin. The vice permeated every class of Egyptian society, and a new kind of slum formed as a consequence of heroin addiction. Hygienic conditions among addicts were often beyond description, and all manner of illnesses followed in the wake of heroin use. For example, a major epidemic of malignant malaria erupted among addicts in 1928, spread by hypodermic syringes used by multiple individuals without disinfection. The total number of addicts in Egypt by the late 1920s was estimated at half a million. Considering Egypt’s total population at the time was approximately 14 million, the scale of the problem was immense.

Before World War I, Egypt had no strict narcotic regulations. The maximum penalty was 7 days imprisonment or a fine of LE 1. There had been no perceived need for stronger measures. When it became clear that the heroin habit had become a serious issue, a new law was enacted, taking effect in 1925. This law criminalized narcotic trafficking and possession, classifying the offense as a “délit” punishable by up to 1 year’s imprisonment and a LE 100 fine. In the first twelve months after the law’s enactment, 5,600 prosecutions were initiated under it in Cairo alone. Within the year, maximum penalties were increased to 5 years imprisonment and a LE 1,000 fine. The new law made drug trafficking significantly more difficult in Egypt, but wholesale heroin smuggling commenced and intensified until 1929. It is revealing to compare the number of seized heroin samples with other narcotics in Egypt after the 1925 narcotic law. The number of seizures is a good indicator of narcotic traffic. The table suggests that heroin addiction in Egypt peaked in 1929 and subsequently declined rapidly.

Comparison of Narcotic Seizures (Heroin, Opium, Hashish, Cocaine) in Egypt, 1922-1935

This decline after 1929 resulted from two factors. The 1925 Convention on Narcotic Drugs had just come into effect, and international measures quickly curtailed supply from all sources that maintained any pretense of legality. Also, new and stringent legislation was enacted by the Turkish Government, leading to the closure of three large factories in Turkey. Initially, most illegal heroin in Egypt originated from Europe, but stricter controls closed these sources, making Turkey the main supply source. Manufacturers in Turkey relocated their equipment to other countries they believed safer. Much of it went to Bulgaria, where three or four larger factories soon began operations. One Bulgarian factory opened in October 1931 and in its first months produced 1,500 kilograms of heroin, smuggled out in trunks to Germany and France en route to Hamburg for the American market, and to Marseilles for the Egyptian and Far Eastern markets. This new center of heroin production was discussed by the League of Nations Advisory Committee on traffic in opium and other dangerous drugs in 1931, leading the Bulgarian Government to close the factories and render the manufacturers homeless once more.
what is the sixth wonder of the world

TABLE SHOWING THE RESULTS OF ANALYSES AS REPORTED BY THE LEGOMEDICAL OFFICER IN EGYPT

	1922	1923	1924	1925	1926	1927	1928	1929	1930	1931	1932	1933	1934	1935
Hashish	241	500	1016	2465	1853	1260	1865	2935	2534	2789	1759	1214	1173	863
Opium	38	83	162	621	407	669	720	681	756	1433	989	1052	992	938
Morphine	105	105	590	2500	225	347	353	134	115	74	48	39	49	116
Cocaine	119	148	569	1000	226	426	220	122	—	10	5	5	7	1
Heroin	—	11	35	1872	3783	7475	8150	10000	7456	6947	1685	377	261	684

	1936	1937	1938	1939	1940	1941	1942	1943	1944	1945	1946	1947	1948	1949
Hashish	569	609	574	1038	1296	1450	2048	2159	1269	1259	2211	3978	4238	4660
Opium	806	1020	955	2156	2388	2321	1569	1440	1644	2011	2235	3269	3753	3302
Morphine	25	7	14	21	3	—	5	2	6	8	7	17	5	7
Cocaine	1	—	—	—	9	—	—	1	2	8	16	12	7	13
Heroin	802	761	874	1375	594	113	18	1	—	—	29	38	13	30

China subsequently became a hub for heroin production and an epicenter of epidemic spread. This country was already grappling with smoking opium use, and Chinese authorities had attempted to eradicate opium addiction with varying success. Around the beginning of the century, “white drugs” began arriving in China from Europe. Small quantities were legally imported for medical and scientific purposes, but most were smuggled through coastal ports. The greater potency of morphine and heroin was discovered by an increasing number of former opium addicts, particularly in coastal cities. In addition to Western products, Japanese pharmaceutical firms also started manufacturing large quantities of heroin and exporting it to the Chinese market to meet the growing demand of newly created addicts.

Heroin’s cheapness and potency appealed to the Chinese addict. A few cents could buy a dose of heroin or a heroin cigarette. In pill form, consumption was more discreet and less time-consuming than opium smoking. Whenever the Chinese Government periodically enforced the prohibition on smoking opium, consumption of white drugs would increase because the absence of opium odor and the opium pipe made evasion easier. Even when opium smoking was tolerated under registration, white drugs retained popularity, as addicts feared registering lest they become known and the government potentially cut off their supplies at any time. Due to civil war, revolutions, and war with Japan, narcotics laws in China were often inconsistently enforced. The laws concerning white drugs were the strictest China ever attempted to implement. The Provisional Regulations for the Drastic Prohibition of Highpowered Narcotic Drugs were promulgated in May 1934 to address the increasingly severe danger posed by manufactured drugs. According to these regulations, the penalty for manufacturing, transporting, and selling highpowered narcotic drugs containing morphine, cocaine, or heroin was death. The penalty for providing protection to those engaged in such activities was also death.

After January 1, 1937, even uncured addicts faced life imprisonment or execution.

The government’s objective was to suppress addiction within a six-year period. The progress made under the new laws was abruptly halted by the outbreak of war between China and Japan in 1937. In unoccupied China, efforts to suppress drug habits persisted. When the six-year plan for narcotics suppression concluded on January 1, 1941, the Chinese Government circulated a statement throughout Free China warning against any further indulgence in opium. In February 1941, the death penalty was decreed for all persons cultivating poppies, manufacturing opium or narcotics, and for the distribution and sale of narcotics. The same law stipulated that heroin addicts found injecting or smoking heroin pills were to be shot, and opium smokers imprisoned from one to five years.

Before and during World War II, it was widely reported that the Japanese occupying forces protected heroin manufacturing and trade in their territories. This was confirmed after the war when Allied forces discovered large heroin factories.

The Commissioner of Narcotics of the United States reported that in one factory in Seoul, Korea, operated by the militarist Japanese Government at the time, 1,244 kilos of heroin were manufactured in 1938; and in 1939, 1,327 kilos. During these two years, while the Japanese occupied Manchuria, 2,400 kilos of this heroin were consigned to the Manchukuo Monopoly Bureau. The normal annual heroin requirement for China, including Manchuria, prior to 1938 was 15 kilos.

The total world medical needs for heroin for 1938 and 1939 were no more than 1,200 kilos annually. Consequently, the output of this single heroin factory alone exceeded the total world medical requirement for heroin.

INTERNATIONAL CONTROL OF HEROIN

The Hague Opium Convention of 1912 categorized heroin alongside morphine and cocaine. The Convention obligated Contracting Parties to “use their best endeavours” to restrict the manufacture, sale, and use of these drugs exclusively for medical and legitimate purposes. Control was to be established over all individuals manufacturing, importing, selling, distributing, and exporting the drug and its salts. Registers detailing manufactured, imported, and exported quantities were required. Furthermore, international trade dealings with unauthorized individuals were prohibited. All preparations containing more than 0.1% heroin were also subjected to control. However, the Convention provided no specific guidance on how control over production and distribution should be implemented. Each country was free to determine its best method. By the outbreak of World War I, only eleven countries had ratified the Convention, although seven others had indicated their willingness. Peace treaties after the war automatically brought the Hague Convention into effect between the parties to the treaties.

The primary deficiency of the Hague Convention was its failure to create an administrative mechanism for implementing the agreed-upon principles.

The Geneva Convention of 1925 aimed to rectify the shortcomings of the Hague Convention and, regarding heroin, limited manufacture exclusively to licensed establishments and premises. It mandated that all individuals involved in the manufacture, sale, distribution, or export of the drug obtain a license or permit for these operations. It also required such persons to record quantities manufactured, imported, exported, sold, and all other distribution activities in their books. Under the system established by the Convention, exporters were obliged to obtain an export license from their government, which would only be issued upon presentation of a copy of an import certificate provided by the government of the importing country. A copy of the export authorization accompanied the consignment and had to state the import certificate number and date to ensure linkage. Transit through third countries and diversion of consignments were also strictly controlled. These measures facilitated a rigorous check on the international trade in narcotic drugs. The Convention, under the supervision of the Permanent Central Opium Board it established, also abolished the 1912 Hague Convention’s exemption for preparations containing not more than 0.10% of the drug.

The Geneva Convention entered into force on September 28, 1928. The sharp decline in heroin seizures in both the United States and Egypt shortly after the Convention’s enforcement began clearly demonstrates the significant progress made in controlling drug trafficking.

However, the controls implemented under this Convention did not directly limit the quantities of drugs manufactured. When the Egyptian Government reported in 1929 and 1930 on the grave situation caused in the Middle East by uncontrolled factories in Turkey, the tenth Assembly of the League unanimously adopted a resolution supporting a system for limiting the manufacture of dangerous drugs. The limitation system finally incorporated into the Limitation Convention of 1931 is based on estimates that contracting and non-contracting parties are requested to provide regarding drugs needed for the coming year. These estimates are based solely on the medical and scientific requirements of the reporting country and are designed to include:

1. The quantity necessary for use as such for medical and scientific needs, including the quantity required for the manufacture of preparations for the export of which export authorizations are not required, whether such preparations are intended for domestic consumption or for export.
2. The quantity necessary for the purpose of conversion, whether for domestic consumption or for export.
3. The amount of the reserve stocks which it is desired to maintain.
4. The quantity required for the establishment and maintenance of any government stock.

These estimates are reviewed and endorsed by a Supervisory Body established by the Convention. If national estimates appear excessive, the Supervisory Body can make recommendations to the governments concerned for their reduction. If a country fails to provide estimates, Article 2 of the Convention empowers the Supervisory Body to make the estimates itself. Special restrictions were placed on diacetylmorphine and its preparations by Article 10 of the Convention. Exports were prohibited, except upon request from the government of a country not manufacturing diacetylmorphine, accompanied by an import certificate.

LICIT MANUFACTURE AND CONSUMPTION OF DIACETYLMORPHINE

The impact of the 1925 and 1931 Conventions is evident from the production figures below and the graph on page 12 of the original document. The figures show a decrease in acknowledged heroin production from nearly 4,000 kgs in 1930 to approximately 1,100 kgs in 1934 and about 600 kgs in 1935. The Permanent Central Opium Board summarized the progress of international drug control in November 1947:

“In the case of manufactured drugs, the period during which the international control can be described as having been world wide in scope is relatively short, the six years 1931-1936. This fact… was due to events ufelated to the problem itself, which resulted in a number of countries ceasing to furnish the Board with the statistics required. Nevertheless, the Board feels justified in stating even on the basis of the short period for which it has complete statistics, that some of the chief aims of the two conventions on the control of manufactured drugs-namely, a complete account of the supplies available (Geneva Convention of 1925) and the limitation of the manufacture to medical and scientific requirements (Limitation Convention of 1931) have been to a large extent and subject to one exception attained.”

World Manufacture of Diacetylmorphine

World Trends in the Licit Manufacture of Diacetylmorphine

The mentioned exception related to illegal heroin manufacturing in Japan and Korea. It was estimated that from 1934 to 1937, 94 percent of the world supply was accounted for. From August 1, 1946, the work of the Opium Section of the League of Nations was transferred to the Division of Narcotic Drugs of the United Nations.

There have been some changes in the proportion of global output produced by heroin-manufacturing countries between the pre-war and post-war periods.

	Average 1934-1937	1948
Japan	299 kgs.	—
USSR	162 “	—
Germany	60 “	—
United Kingdom	110 “	300 kgs.
Italy	90 “	276 “
Finland	— “	73 “
Other countries	184 “	184 “
	905 kgs.	835 kgs.

It is also noteworthy to observe the pre- and post-war legal consumption of heroin in various countries. While most countries saw a decrease in consumption per million inhabitants, a few others experienced a marked increase.

PRESENT STAGE OF THE HEROIN PROBLEM

(The question of total suppression of heroin as a drug)

Due to the rise in heroin traffic in various parts of the world since World War II, creating conditions that attracted public attention, such as addiction among teenagers in New York and other large cities in the United States, the complete prohibition of heroin is being discussed by international organizations. However, the proposal for worldwide suppression of heroin production is not new. Such a suggestion was first made in 1923 by the Opium Advisory Committee, which recommended that the Council ask Governments for their views on the possibility of totally suppressing heroin manufacture. The replies from Governments showed a division of opinion between those willing to consider total abolition and those who believed heroin was indispensable for medical practice. The proposal for abolition was rejected by the Conference in 1925.

At the 1931 Limitation Conference, a proposal for the total abolition of heroin use was initially moved. This was opposed on grounds that the drug had medical value; that practically none was entering illicit traffic from amounts exported by manufacturing countries based on import certificates; and that, even if heroin were abolished, traffickers could manufacture it from morphine without significant difficulty. Consequently, the legal use of heroin was not forbidden, but special restrictions were placed on it in Article 10 of the Convention. In response to a circular letter sent by the League of Nations to governments in 1934 requesting opinions on the possibility of abolishing or restricting diacetylmorphine use, 12 countries provided reasons why they could not consider abolishing or restricting its use. Four countries responded in favor of restricting diacetylmorphine use, 8 countries stated that the drug’s use was already restricted de jure or de facto in their territories, and 9 countries stated they were in favor of completely abolishing diacetylmorphine use. Finally, 7 countries stated that diacetylmorphine use was, in fact, already prohibited in their territories through various measures.

DIACETYLMORPHINE Consumption per inhabitants during the years 1930 to 1934.

Diacetylmorphine Consumption per Million Inhabitants in Selected Countries, 1930-1934Changes in Diacetylmorphine Consumption per Million Inhabitants, Pre- vs. Post-WWII

The United States Government had already prohibited opium import for heroin manufacture in 1924.

The Bulgarian Government had prohibited the importation, manufacture, and trade in heroin (July 25, 1934).

By decree of August 3, 1933, the Spanish Government had prohibited the manufacture, import, distribution, and consumption of diacetylmorphine.

In Costa Rica, diacetylmorphine use had been entirely prohibited since October 24, 1928.

According to the Mexican Health Code (from 1924), the import, export, preparation, possession, use, and consumption of the drug were prohibited.

In Greece, heroin was excluded from the list of narcotic drugs whose use was permitted by the Greek State Monopoly (1930).

From 1931, the Polish Government prohibited the manufacture, import, and export of diacetylmorphine in its territory.

Heroin’s indispensability from a medical standpoint has significantly decreased since the introduction of dihydrocodeinone, dihydromorphinone, and some newer synthetic analgesics. In response to a similar inquiry by the World Health Organization in 1950, 38 member States replied in favor of dispensing with heroin, while 9 States were in favor of retaining it. The latter, however, include several of the world’s chief manufacturing countries.

REFERENCES

Wright, C. R. A.: On the action of organic acids and their anhydrides on the natural alkaloids, Journal of Chemical Society, 1874, 12, 1031.

Raoult: Annales de Chimie et de Pharmacie, 8, 327 and 2, 72.

Dankwortt, W.: Archiv der Pharmacie, 1890, 228, 572.

Dreser, H.: Pharmacologisches über einige Morphinderivate, Deutsche medizinische Wochenschrift, 1898, 24, Vereins Beilage, 185.

Strube, G.: Mittheilung über therapeutische Versuche mit Heroin, Klinische Wochenschrift, 1898, 38.

Floret: Klinische Versuche über die Wirkung und An-wendung des Heroins, Therapeutische Monatschrifte, 1898, 12.

Dreser: Abstract in Journal of American Medical Association, 1898.

Leo, H.: Über den therapeutischen Wert des Heroins, Deutsche medizinische Wochenschrift, 25, 185.

Manges, M.: New York Medical Journal, November 1898, 26.

Manges, M.: A second report on therapeutics of heroin, New York Medical Journal, 71, 51.

Harnack, E.: Über die Giftigkeit des Heroins, München medizinische Wochenschrift, 1899, 46, 881-884, 1019.

Turnauer, B.: Über Heroinwirkung, Wien medizinische Presse, 40, 457.

Wood, Horatio C. Jr.: The newer substitutes for morphine, peronine, dionine, heroin, Mercks Archiv 1899.

Jacobi, J.: Über die Wirkung des Heroins, Wien. med. Wochenschrift, 51, 1853, 1924, 1963, 2017.

Morel-Lavallée, A.: Les Alcaloides de l’Opium, Morphine, Héroïne, Dionine, Revue de thérapeutique, 1902, 69.

Leynia de la Jarrige, J.: Héroïne, Héroïnomanie, Theses, 1902.

Prettey, G. E.: The heroin habit another curse, Alabama Medical Journal, 1902-03, 15, 174-180.

Sollier, P.: Heroine et héroïnomanie, Presse med., 13, 716.

Atwood, C. E.: A case of heroin habit, Med. Rec., 67, 856.

Trawick, John D.: A case of heroin poisoning, Kentucky Medical Journal, 9, 187.

Report of the Committee of Experts concerning Diacetylmorphine (Heroin) Records of the Conference for the Limitation of the Manufacture of Narcotic Drugs, League of Nations, Geneva, May 27th to July 13th, 1931. Vol. II. 529.

Woods, Arthur: Dangerous Drugs, The World Fight against illicit traffic in Narcotics, New Haven, Yale University Press, 1931, 14.

Payne, E. George: The Menace of Narcotic Drugs, A Discussion of Narcotics and Education, New York, Prentice-Hall, Inc. 1931, 17.

Todd, A. R.: Hashish, Experimentia, Vol. II/2, 1946, 55.

Golden Mortimer, W.: Peru, History of Coca, J. H. Vail & Company, New York, 1901.

Wolff, P.: (a) Die Suchten und ihre Bekämpfung. (Morphinismus, Kokainismus, u.a.) Sonderabdruck aus der “Apotheker-Zeitung 1927, f. 17/20, 3.

(b) Cyril et Berger: La “Coco” Poison moderne, Paris, Ernest Flammarion, 26, rue Racine, 1926.

Foreign Policy Association, Pamphlet No. 24. Series of 1923-1924, 4.

The Journal of the American Medical Association, May 8, 1920, 1318.

Foreign Policy Association, Pamphlet No. 24, Series of 1923-1924, 3.

Foreign Policy Association, Pamphlet No. 24, Series of 1923-1924, 7.

U. S. Treasury Department, Bureau of Narcotics, Regulations No. 2 relating to Importation,… of Opium or Coca Leaves…under the Act of May 26, 1922, as amended by the Act of June 7, 1924, United States Government Printing Office, Washington, 1938.

League of Nations document. No. O.C.23(i)4, May 31, 1926, 24.

U. S. Treasury Department, Bureau of Narcotics. Traffic in Opium and other dangerous Drugs for the year ended December 31, 1940. U. S. Printing Office, Washington, 1941, 19.

(a) Traffic in Opium and other dangerous Drugs for the year ended December 31, 1932. U.S. Government Printing Office, Washington D.C.

(b) League of Nations document. No. C.96 M. 43, 1935 XI, [O.C. 294 (v)], 42.

(c) Traffic in Opium and other dangerous Drugs for the year ended December 31, 1933. U.S. Government Printing Office, Washington D.C.

(d) League of Nations document. No. C. 81. M. 29, 1936, XI. [O.C.S. 294 (z)], 44.

(e) League of Nations Document. No. C. 124, M. 77, 1937, XI. [O.C.S. 300 (c)], 38

(f) League of Nations Document. No. C. 65. M. 27. 1939. XI. [O.C.S. 300 (k)], 38.

(g) Traffic in Opium and other dangerous Drugs for the year ended December 31, 1944. U.S. Government Printing Office, Washington D.C., 1945

(h) League of Nations Document. C. 91. M. 91, 1946, XI, [O.C.S. 300 (2)], 46.

(i) United Nations Document, E/NS 1946/Summary, 3 July 1947, 127.

(k) United Nations Document, E/NS. 1951/Summary 1/Add, 22 March 1951, 18.

(l) Traffic in Opium and other dangerous Drugs for the Year ended December 31, 1950. U.S. Treasury Department, Bureau of Narcotics, U. S. Government Printing Office, Washington: 1951, 18.

Thomas Russel Pasha, Egyptian Service 1902-1946, Butler and Tanner Ltd., Fromeand London 1949, 225.

Ibid, p. 226

Annual Report for the Year 1931, Egyptian Government,Central Narcotics Intelligens Bureau, Cairo, Government Press, 1932, 131.

Thomas Russel Pasha : Egyptian Service 1902-1946, Butler and Tanner Ltd., Frome and London 1949, 224.

Ibid, p. 225.

(a) Egyptian Government, Central Narcotics Intelligens Bureau, Annual Report for the year 1937, Government Press. Bulaq, Cairo, 1938, 114.

(b) Egyptian Government, Central Narcotics Intelligens Bureau, Annual Report for the year 1940, Government Press, Bulaq, Cairo, 1941, 74.

(c) Egyptian Government, Central Narotics Intelligens Bureau, Annual Report for the year 1944, Government Press, Bulaq, Cairo, 1945, 78.

(d) Egyptian Government, Central Narcotics Intelligens Bureau, Annual Report for the year 1949, Government Press, Bulaq, Cairo, 1951, 146

Wolff, P.: Deutsche Medizinische Wochenschrift, f. 37/38, 1931, 7.

Thomas Russel Pasha : Egyptian Service 1902-1946, Butler and Tanner Ltd., Frome and London 1949, 241.

Merril, Frederick T.: Japan and the Opium Menace, Institute of Pacific Relations and the Foreign Policy Association, New York, 1942, 15.

Ibid, p 15.

Ibid, p 16.

Traffic in Opium and Other Dangerous Drugs, Annual Report, 1934, Chinese Government Opium Suppression Commission, Nanking, China, 4.

Merril, Frederick T.: Japan and the Opium Menace, Institute of Pacific Relations and the Foreign Policy Association, New York, 1942, 31.

Ibid, p. 46.

Permanent Central Opium Board, Report of the Work of the Board, United Nations document, Geneva, 21 October 1946, E/OB/1.

International Opium Convention, Signed at The Hague, January 23rd, 1912, Article 14(c). (League of Nations document : O. C. 1 (I). 29)

League of Nations, Second Opium Conference, Signe at Geneva on February 19th, 1925. (League of Nations document: C. 88. M. 44. 1925. XI. (O.D.C. 106 (3); O.D.C. 7 (2); O.D.C. 130 (1).)

International Conciliation, No. 441, 329.

League of Nations, Conference for the Limitation of the Manufacture of Narcotic Drugs. (Geneva, May 27th-July 13th, 1931) (C. 455. M.193. 1931. XI.)

(a) Series of League of Nations Publications XI. Opium and other Dangerous Drugs, 19.

(b) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1932, XI. 6, 8.

(c) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1933, XI, 4, 68.

(d) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1934, 78.

(e) Series of League of Nations Publications XI, Opium and other Dangerous Drugs,1936, XI, 21, 10.

(f) Series of League of Nations Publications XI, Opium and other Dangerous Drugs,1937, XI, 8.

(g) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1938, XI, 5, 14.

(h) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1939, XI, 8, 68.

(i) United Nations Publication, E/OB/5, October 1949, 38.

(j) United Nations Publication, E/OB/7, November 1951, 39.

(k) United Nations Publication, E/OB/7, November 1951, 14.

Permanent Central Opium Board, United Nations, Geneva, November 1947, (E/OB/2), 25.

Permanent Central Opium Board, United Nations, Geneva, October 1949, (E/OB/5), 17.

(a) Permanent Central Opium Board, United Nations, Geneva, November 1950, (E/OB/6) 39.

(b) Permanent Central Opium Board, United Nations, Geneva, November 1951, (E/OB/7) 48.

Anslinger, H. J.: The Facts About our Teen-Age Drug Addicts, The Reader’s Digest, October 1951.

League of Nations, Advisory Committee on Traffic in Opium and other Dangerous Drugs, Minutes of the Fifth Session, (League of Nations Document No. C. 418. M. 184. 1923. XI.), 121 and 205.

League of Nations Document No. C. 760. M. 260. 1924. XI. C. 105.

League of Nations Document No. C. 191.M.136. 1937. XI., 231.

(a) League of Nations Document, No. C. L. 61. 1934. XI.

(b) League of Nations Document, No. C. 178. M. 114. 1936. XI., O.C. 1589(1).

Ordinance No. 766, of June 9th 1934, from the Bulgarian Government. Ann. Report from Bulgaria 1934.

Decret of 3 August 1934, from Spanish Government. League of Nations file, No. 12/8978/427.

Costa Rica: Ley sobre Drogas Estupefacientes, Secretaría de Salubridad Pública y Protección Social, San José de Costa Rica 1930, 4.

League of Nations document C. L. 228. 1938, XI. Annex. O.C. 1743 (1).

United Nations, World Health Organization, Document No. WHO/APD/23 Add.1., 3 December 1950.

CONCLUSION

The history of heroin reveals a stark contrast between its initial perception as a medical marvel, arguably seen by some as a 1900s 9th Wonder Of The World for its perceived therapeutic benefits, and the devastating reality of its addictive potential and societal harm. Developed from morphine in the late 19th century, it was quickly embraced by the medical community for its efficacy in treating respiratory ailments and managing pain. However, the rapid onset of severe addiction and its widespread abuse, particularly in the United States, Egypt, and China, soon overshadowed its medical applications.

International efforts, spearheaded by conventions like The Hague (1912), Geneva (1925), and the Limitation Convention (1931), gradually established stricter controls over its manufacture and distribution. These measures significantly curbed the legal supply and impacted illicit trafficking, although the problem persisted through clandestine production. The legal medical need for heroin has dramatically decreased with the advent of safer alternative analgesics.

Today, while debated for limited medical use in some regions, heroin is overwhelmingly recognized globally as a highly dangerous and illicit substance. Its story serves as a cautionary tale about the unforeseen consequences of medical advancements and the complex interplay between scientific discovery, public health, and international control efforts. Its initial promise faded, replaced by a legacy of addiction and suffering, far removed from any notion of a “wonder”.