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‘Cuca’ to Cocaine Anesthetic, a Short History of Addiction

With the United States in the midst of an opioid epidemic and more states easing restrictions on marijuana, the subject of drug abuse and addiction has received an enormous amount of media attention in recent years. Addiction, however, has been with us for a long time. Even late into the 19th century, the problem of addiction to drugs was not fully realized, particularly in Europe and the United States. Drug use was just accepted as part of everyday life. At that time, there was no mention or evidence of “controlled substances,” as we call these drugs today. Morphine and cocaine were readily available to anyone at any time during those early years.

For centuries, cocaine was grown in South America in the Andes Mountains and used readily by the indigenous population, who found that it improved their tolerance to the effects of the high altitude and cold weather. The drug, called “cuca” in the native tongue, was used in its leaf form and chewed. It must be noted that the concentration of the ingested narcotic was far less as a chewed leaf than in the chemical form that was produced years later in Europe. In the 16th century as Spain took over South America, the various explorers discovered cocaine and began using it for their own purposes and exporting it to Europe.

Cocaine became readily available in Europe when chemists found they could extract it from the leaf and convert it into a powder that was much more potent. They further began mixing it with alcohol, particularly wine, enhancing its effects even more. By 1890, a chemist found that cocaine could be mixed with alkaline soda water without using alcohol, forming a drink he called “Coca Cola.” This concoction became the drink of choice for many who found it energizing to the psyche as well as a cure for many pain syndromes. Finally, as time went on and the problems regarding cocaine use became more evident, cocaine was left out of the drink, but the name persisted.

It must be recognized that there were no uniform laws in Europe or the United States prohibiting the use of these narcotic drugs during the 19th century.

A Surgeon/ Cocaine Addict in the 1800s

Cocaine came to the attention of the medical community, not because of its  addictive effects, but because it was discovered to be a powerful local anesthetic when injected under the skin for surgical procedures or dropped into the eye for ophthalmologic procedures that were being performed at the time.

Addiction became more evident in the medical profession through its use by a renowned American general surgeon in the late 1800s by the name of William Halsted. He pioneered a number of surgical procedures including the radical mastectomy for breast cancer, gall bladder surgery and other significant procedures. He also encouraged the use of gowns, gloves and pre-surgical scrubbing to prevent postoperative infections.

His contact with cocaine occurred through his experimentation with the substance as a local anesthetic, finding that cocaine injected in or near a nerve would cause significant anesthesia. In developing this procedure, he often used it on himself as well as directing his surgical residents to experiment with it. Through this use, Halsted became addicted to the drug and fostered addiction in a number of those surgical residents who were involved with his cocaine experimentation.

His colleagues recognized his extraordinary abilities as a surgeon, but every effort to rid him of his cocaine addiction was of no avail. One close friend arranged a lengthy overseas ocean cruise to keep him away from the substance. However, Halsted later relapsed, and it was evident to his colleagues that his extraordinary abilities were being compromised by his addiction.

At this point in his life, he switched to morphine sulfate, another addictive drug that he found he could take in lower doses and still satisfy his dependence, allowing him to continue his surgical practice with the same extraordinary abilities as before he became dependent on cocaine.

Later Halsted became chief of surgery at Johns Hopkins School of Medicine, one of the most prestigious schools of its kind in the United States. He died at age 70 in 1922, having contributed extraordinarily to the practice of surgery, all the while continuing on morphine sulfate.

Sigmund Freud’s Fascination With Cocaine

But there were other physicians who became addicted to these drugs while they used them in treatment of their patients. One of those physicians was Sigmund Freud. He was a heavy cigar smoker and as a consequence developed chronic nasal and oral inflammation causing significant pain that he found he could relieve with cocaine.

Freud became familiar with the drug while treating a number of patients who were addicted to morphine. He found that cocaine could substitute for the morphine but in doses low enough to avoid its negative effects. He wrote extensively on his treatment of morphine addicts. But eventually he became addicted while using the drug as symptomatic relief of his oral/nasal symptoms. However, in spite of his dependence, he continued his work in what today would be called neuropsychiatry, developing the concept of psychoanalysis for which he became so famous, all the while still using cocaine. He may have stopped the drug in 1896, although this is unclear. He died in 1939 at the age of 83 of cancer of the jaw.

The details of narcotic addiction in these well-known physicians are hard to come by.  Even the details surrounding the use of narcotics by Halsted were not fully understood until 1969 at the 80th anniversary of Johns Hopkins when a locked notebook was discovered that revealed the details of his addiction. It had been written by one of his close colleagues.

While today substance abuse appears to be concentrated among the nonmedical citizenry, drugs continue to be misused by health professionals, particularly practicing physicians. The specific reasons are unclear but probably have to do with the extraordinary contact they have with these drugs, as well as the stress that comes with practicing medicine.

By Robert Hersch

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