Histo rical Milestones of the Opioid Epidemic Pre-1800s & early use Before 1800, pain was often viewed philosophically or existentially; clinicians did not emphasize pharmacologic control of pain. Early on, opioids and cocaine were used liberally for various ailments (toothache, diarrhea) with little regulation. Early 20th century regulation & opiophobia The Harrison Narcotic Control Act (1914) was passed in response to rising heroin abuse and iatrogenic morphine dependency, which began to restrict opioid prescribing. Throughout the early to mid-1900s, many pain complaints, especially non-cancer pain, were met with skepticism, and clinicians often withheld opioids due to fear of addiction. This led to “opiophobia,” an underuse of opioid analgesics even when clinically indicated. Rise of pain advocacy and “pain as the fifth vital sign” In the 1990s, mounting concern about undertreatment of pain led to advocacy positioning pain control...