June 23, 2021 –  The alarming parallels between the 19th- and 21st-century opioid crises in the United States are not limited to iatrogenesis. Both crises exhibit a history of troubling racial inequalities in access to opioids as well. Addiction was far more common among White Civil War veterans than among Black veterans, who lacked equitable access to opiates. This pattern presaged the opioid underprescribing experienced by Black Americans in recent decades.1 Thus, the history of the Civil War–era opiate addiction epidemic not only reveals the deep historical origins of iatrogenic opioid addiction in the United States, but also underscores how Black Americans have experienced long-standing racial inequalities in access to opioid medicines.



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