The use of opiates rose gradually in the United States during the 19th century, hitting a peak in the 1890s. Cocaine became popular after 1884, and its use peaked in the first decade of the 20th century. These early waves of drug use eventually passed by the general public but continued to swirl around persons on the fringe of society. These users were burdened with the image of what Caroline Jean Acker calls the "heroin-addicted male urban hustler." Easy access to habit-forming drugs did not encourage members of American society to accept them, but rather prompted them to demand that cities, then states, and finally the federal government crack down on suppliers, including those in the medical profession. Indeed, physicians were widely believed to be responsible for at least half of American addicts. These events - a keen source of public concern at the time - have mostly been forgotten, as has any connection to the drug epidemic that began in the 1960s. Acker, an associate professor of history at Carnegie Mellon University, has resurveyed this crucial era in the formulation of drug policy in the United States, when official positions were established against any nonmedical use of habit-forming drugs: policies were established for closely monitoring health professionals, for guarding against optimistic expectations for the recovery of addicted users, and for severely punishing possessors or sellers of illicit drugs. In her detailed study, Acker argues that a distinctive American approach molded the negative picture of the drug user, giving rise "to an image of deviance that has shaped American drug policy ever since and helped reinforce the moral underpinnings of the war on drugs."

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