An Overlooked Crisis: Morphinism and the National Homes, 1880-1916

Over the past 250 years, America’s Veterans have faced challenges that are persistent, yet unique to each generation. Substance abuse and addiction are examples of challenges that have long affected Veteran communities.

America’s first opioid crisis is widely considered to have started during the Civil War, and it severely impacted Civil War Veterans. Many developed an addiction known as morphinism, which is today diagnosed as opioid use disorder. The National Home for Disabled Volunteer Soldiers (National Homes) was founded in 1867 to care for Union Civil War Veterans living with disabilities and conditions connected to their service, including addiction.

Given that the National Homes treated Veteran substance abuse, and that Veterans of the Civil War were the largest group living at the National Home for most of its history, one might guess they received the bulk of opioid addiction treatment during this period. While it is true that the largest increase in opioid treatment at the National Homes happened when Civil War Veterans were the majority of residents, the highest number of opioid cases actually occurred when fewer Civil War Veterans were living at the Home than ever before¹.

This suggests that Veterans who served between the Spanish-American War and World War I likely faced America’s second opioid crisis.

Where did National Home Veterans serve?

Between 1880 and 1916, the National Homes cared for Veterans of seven different conflicts. These include the War of 1812, the Mexican War, the Civil War, conflicts collectively called “The Indian Wars,” the Spanish-American War, the Philippine-AmericanWar, and the “Foreign Service” (service in China, Alaska, or the Philippines after 1902). For the sake of comparison, they can be grouped into Veterans of the Civil War, Continental Wars (North American conflicts other than the Civil War), and Overseas Wars.

The proportion of these groups in the National Home changed over time. Veterans of Overseas Wars were first admitted in 1901 and quickly grew to 10 percent of the National Home’s membership by 1912. At the same time, the proportion of aging Civil War Veterans at the National Home shrank from 98 percent to 89 percent.

How was addiction treated at the Home?

Addiction to drugs and alcohol was considered part of a Veteran’s disability as early as 1871. Numbers of Veterans treated for morphinism and those who died from overdose were published in annual reports beginning in 1880. Many at the time considered addiction a moral failing, but the National Homes instead treated addiction as a medical condition. For example, the Surgeon at the Central Branch filled over 500 prescriptions in 1875 “chiefly for alcoholism ¹.”

The names of specific medications used at the National Homes are not fully known. However, one example was seen in a display of historical objects found at the Dayton VA Medical Center, formerly the Central Branch of the National Home. Trional is the name of a medication recommended in an 1893 publication on the treatment of opioid withdrawal, alongside the use of a mild electrical current in an early example of electrotherapy. These methods treated withdrawal symptoms such as insomnia and chronic pain. While the National Home did not describe specific addiction treatments in its reports, the presence of the bottle indicates they were likely familiar with its use.

When did case numbers change?

Between 1880 and 1916, National Home’s leadership reported that 2,319 residents received treatment for opioid addiction. Additionally, 92 deaths were reported as a result of morphinism or poisoning due to opium and morphine, respectively. Today, these deaths would likely be described as a form of overdose. However, the frequency of case numbers and deaths was not consistent and changed frequently over time, as illustrated by the graph in Figure 2.

The largest annual increase of case numbers was reported between 1886 and 1896. That decade, the number of opioid cases treated at the National Homes increased 32 percent each year. That decade, five times more Veterans received addiction treatment than 10 years earlier, even though there were fewer overall cases compared to later decades. Fewer Veterans died from overdose in the first decade compared to later periods. However, the death toll did still triple by the end of the decade. This could be related to the relatively lower risk of overdose, but still widespread availability of opium, morphine, and laudanum, the most common opioid drugs at the time. Between 1897 and 1906, case numbers more than doubled, resulting in a quarter of total opioid cases treated at the National Homes. In the same period, nearly half of all opioid deaths at the Home occurred during this short period. Overdose deaths increased by an average 64 percent each year and nearly tripled by 1906.

Between 1907 and 1916, overall case numbers were twice as high as the previous decade, accounting for more than half (59 percent) of all opioid cases ever reported at the National Homes. Despite higher cases overall, 20 percent fewer opioid deaths were reported this decade, perhaps related to increased treatment and changes in drug regulation. To put it another way, between 1880 and 1907, the National Homes never reported more than 100 Veterans treated for opioid addiction in a single year. However, at least 100 cases were reported every year from 1909 until the end of reporting.

What factors affected the crisis?

Released commercially in 1898, heroin became a popular remedy for many diseases treated at the Homes. At this time, heroin and other opioid-based medicines were considered safer and less addictive than morphine. Opioids were commonly found in over-the-counter medicines, usually sold without any indication of the harmful effects of its ingredients. Many of these medicines were specifically targeted to Veterans, putting them at risk of exposure to addictive ingredients. In 1906, the Pure Food and Drug Act made it unlawful to sell medicinal products without listing their ingredients. However, over the counter opioids were just one facet of this many-sided crisis. Foreshadowing modern opioid crises, heroin itself was prescribed widely. It was even recommended to treat morphinism, meaning Veterans living with addiction could have been prescribed heroin as a remedy.² Widespread availability of the drug may have influenced the frequency of overdose. In fact, more than three-quarters of all opioid deaths reported at the Home occurred after the drug’s development.

It is unclear exactly how overseas conflict contributed to opioid use among Veterans. However, when the proportion of Overseas Veterans grew from less than 1 percent of total National Home membership in 1901 to 21 percent of total membership by 1916, opioid cases at the homes increased threefold.

 In 1904, the Philippine Commission studied opium use and sought to make recommendations for drug policy reform.³ They found that colonial policy in the Philippines promoted opium production and likely increased smuggling operations in and out of the country. Contemporary reporting lends support to these findings. In 1899, a ship arrived in San Francisco carrying $500,000 worth of opium, alongside hundreds of bags of mail from American servicemen in Manila. The Commission interviewed Filipino officials regarding the use of opium and only two reported seeing Americans smoking opium during the occupation. When asked if there had been an increase in overall opium use since the Americans arrived, more than half said yes.³ The Commission did not consider the risk of American servicemen becoming addicted and ultimately did not recommend government regulation of medicinal opioids, focusing instead on the recreational use of opium.

Civil War Veterans continued to manage addiction long after their service while heroin at home and overseas opium fueled a perfect storm for Veterans returning from Southeast Asia at the turn of the century. Historical analysis demonstrates the scale of the issue and provides clues for how the National Homes responded to America’s second opioid crisis.

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1. National Home for Disabled Volunteer Soldiers Board of Managers. Report of the Board of Managers, National Home for Disabled Volunteer Soldiers (1871-1916): National VA History Center.
2. Mattison, Jensen Beemer. “The Mattison Method in Morphinism”. The Universal Medical Journal (1893): 1-15, National Library of Medicine Digital Collections, https://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-101756636-bk.
3. United Nations Office on Drugs and Crime. “History of Heroin”. Bulletin on Narcotics (1953): Issue 2: 3-16, https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1953-01-01_2_page004.html.
4. U.S. Congress. Senate. Use of opium and traffic therein. Message from the President of the United States, transmitting the report of the committee appointed by the Philippine Commission to investigate the use of opium and the traffic therein… March 12, 1906. — Read; referred to the Committee on the Philippines and ordered to be printed, with two illustrations. 59th Cong., 1st sess., 1906.  59-265.  https://www.govinfo.gov/app/details/SERIALSET-04914_00_00-017-0265-0000.