By Lea Williams, PhD
In his 2014 State of the State address, Vermont Governor Peter Shumlin devoted significant attention to the growing epidemic of opioid addiction in his state where the number of deaths from heroin overdoses doubled between 2012 and 2013 with a 770% increase in treatment for opiate addiction from 2000-2013. This situation continues to play out across the country with numerous news stories highlighting the contemporary heroin problem.
The current opioid epidemic echoes that faced by Americans almost a century ago and identified presciently by nurse Ellen N. La Motte, a 1902 graduate of the Johns Hopkins Training School for Nurses. At the end of World War I, La Motte, a public health expert and the author of books and articles about tuberculosis and war nursing, turned her attention to the contemporary opium trade. Building on her travels in Asia, La Motte became an expert on the issue developing sound theories on the exact source of the problem.
La Motte’s 1919 book, Peking Dust, offered pointed criticism of Westerners who asserted that the Chinese were corrupt, yet ignored those who corrupted them, specifically Westerners. She asserted that, “The structure of civilization that Europe has erected for itself is imposing and beautiful. We in America are confronted with the façade of this great building, and beheld from our side of the Atlantic it looks magnificent and superb…. But…there are outbuildings, slums, and alleys not visible from the front. …the rear view of the structure of European civilization, seen from the Orient, is not imposing at all. The sweepings and refuse of Western civilization and Western morality are dumped out upon the Orient, where they do not show.” 
The “refuse” that the West, England in particular, dumped in Asia was opium. Historian Carl Trocki, chronicles how England organized the production of opium, much of it in India where it could be farmed on inexpensive land with a cheap labor force, collected and processed under the control of the central authority, first of the East India Company and then the British Crown. It was later sold in markets in Asia, most importantly, in China, guaranteeing that the government had a steady stream of revenue. 
The Crown regulated the import of opium to England, in obvious recognition of the dangers posed by its consumption, yet, the incentives to sell opium to non-white citizens of the empire and beyond was irresistible. In her 1920 study, The Opium Monopoly, La Motte examined this hypocritical practice, raising questions of racism. “Is it because the white race is worth preserving, worth protecting, and because subject nations are fair game for exploitation of any kind?”  Her challenge was to demonstrate to citizens protected by laws regulating opium production and consumption that they too faced imminent dangers posed by the drug trade. The “refuse” that countries like England “dumped” on China posed a local threat once smuggled into the United States. La Motte faced the reality of addiction in her work as data collector for the New York City Health Department’s Clinic for Drug Addicts in April 1919. She connected the rates of drug addiction in New York City to the manufacture of opium in India and China, and linked it to the immoral practices of the government of Great Britain, which profited immensely from the overproduction of opium. In her 1924 study, The Ethics of Opium, La Motte urged Americans to see these connections as a way to incite interest in and sentiment against the international trade as a remedy for local problems. “Considerations of public health, of building up a stable, sober community, have never entered in… opium has been called upon to waste this human life, by destroying its value and efficiency, in order that Europeans might prosper.” 
For a dozen years La Motte observed and wrote updates, most frequently in the pages of The Nation, about the progress of combating the illegal drug trade at League of Nations meetings in Geneva, Switzerland and Great Britain’s attempts to evade the restrictions of The Hague Opium Convention of 1912 and the Geneva Convention of 1924. She saw the impotence of the League of Nations in the face of Britain’s power and influence but urged her readers to understand that “The only remedy for this grave situation which exists, not only in our own country but throughout the world, is an enlightened public opinion, for the problem, like the danger, is international.” 
In 1930, La Motte received the Lin Tse Hsu Memorial Medal from China for her anti-opium campaigning, yet she knew more work remained to combat the international drug trade and to treat drug addiction as a public health threat. She would have approved of Governor Shumlin’s and others’ concerns in a country where deaths from drug overdoses have gone up 137%–this figure includes a 200% increase in the number of deaths that involve opioids—since 2000.  The approaches to rising rates of drug addiction that La Motte advocated almost a hundred years ago—a multifaceted approach that recognizes drug addiction as a public health issue while addressing the international drug trade and the enormous profits made from over-prescribing pain medication resonate with relevance today and may go far in alleviating this most serious threat to the public’s health today.
 La Motte, Ellen N. Peking Dust. (New York: Century, 1919), 27-28
 Trocki, Carl. Opium, Empire, and the Global Political Economy. (New York, Routledge, 1999), 32
 La Motte, Ellen N. The Opium Monopoly. (New York: Macmillan, 1920), 74.
 La Motte, Ellen N. The Ethics of Opium. (New York: Century, 1924), 13.
 La Motte, Ellen N. American Journal of Nursing 29.7 (1929): 791-794.
 Rudd, Rose A., et al. “Increases in Drug and Opioid Overdose Deaths — United States, 2000-2014.” MMWR: Morbidity & Mortality Weekly Report 64.50/51 (2016): 1378-1382. CINAHL with Full Text. Web. 10 April 2016.
Lea M. Williams is an associate professor in the Department of English and Communications at Norwich University in Northfield, Vermont. She is currently working on a book-length biography of La Motte, while researching women’s writings about World War One.
Pingback: Nursing Clio Sunday Morning Medicine
Thank you so much for your time in writing the posts for all of us to learn about.