In the late 1820s, one of Philadelphia’s most prominent druggists and scientists, George Washington Carpenter, recommended that the United States support the cultivation of opium domestically. Importation from abroad was increasingly uncertain, he warned, and a national supply would better secure medicinal needs while strengthening commercial independence. Carpenter’s proposal was not an eccentric speculation, nor was he alone in calling for growing opium on the home front. In fact, his proposal reflected a broader nineteenth-century effort to align medical practice, agricultural production, and national economic policy around a single, potent commodity. What appears, at first glance, as a discrete national concern—how to secure reliable access to opium—was embedded in a far larger system of coordinated production, distribution, and control. And it is precisely this system, in its global dimensions and long durée, that historian Benjamin Robert Siegel pieces together in Markets of Pain.

Over the course of eight chapters, Siegel eschews the narrow analytical lens of prohibition. While many histories of opium focus on prohibition, addiction, and illicit trade, Siegel’s concern lies elsewhere. He focuses on the largely untold legal side of opium and opioids, which are characterized like oil or grain as managed commodities whose production, pricing, and circulation have long been coordinated through state and corporate intervention. Siegel deliberately situates “the production, marketing, and export of opium” as part of the “consolidation of state power in India, Turkey, and the United States” (p. 7). His central claim, moreover, is innovative and unsettling: the modern opioid economy we recognize today actually emerged from a two-century system linking agricultural production, state power, scientific innovation, and international trade; and the contemporary opioid crisis represents an unraveling of that broader centuries-old system. That is, a well-crafted “single machinery for managing pain” rusted and fractured alongside the crumbling of imperial and colonial foundations themselves (p. 253).

Siegel’s book rests on a wide-ranging and impressive multinational archival base, in addition to national and local reportage in multiple languages. Using these sources, and others, Siegel ably moves from imperial monopolies to twentieth-century regulatory regimes and finally to the integration of opium into modern pharmaceutical production; in doing so, he consistently demonstrates that the boundaries between legality and illegality, medicine and vice, were and are historically produced and persistently unstable. Structurally, the book is divided into three sections, “The First Great Unraveling,” “Building the Twentieth-Century Opium Order,” and “Opium Disassembled.”

Siegel’s narrative is compelling and challenges many long-held assumptions. In Markets of Pain, we learn how the nineteenth century witnessed the establishment of an opium monopoly in India and Turkey. Cultivators were subject to fixed prices, quotas, and inspection regimes, while processed opium was auctioned and exported into global markets—most notably to China or the United States. This was not an informal or illicit economy but a tightly administered commercial system that would later be impacted by pharmacology and pharmaceutical sciences. As an alkaloid revolution gathered pace, pharmaceutical firms such as Merck and Bayer (just to name two companies) isolated morphine and other derivatives—and this effort bound agricultural inputs to industrial chemistry and standardized pharmaceutical products without eliminating dependence on global raw material supply. In the early twentieth century, this system was further formalized through international agreements that introduced quotas, reporting requirements, and regulatory categories distinguishing licit from illicit trade. By mid-century, Cold War pressures further reshaped supply: Turkey reorganized cultivation under international scrutiny, while India retained a central role as a licensed producer. In recounting this history and in charting these shifts, Siegel makes the case effectively that agricultural policy, diplomatic negotiation, and pharmaceutical demand remained tightly integrated.

Indeed, the book’s most significant contribution is its refusal to separate the history of imperial opium from the history of the modern opioid crisis. By tracing connections among cultivation, commerce, manufacturing, and regulation, Siegel demonstrates that these histories are deeply intertwined. He capably reconstructs the institutional continuities linking colonial monopolies, international control regimes, and modern pharmaceutical supply chains, and he reveals how these histories are not parallel but continuous. In this rendering, the opioid crises of the present appear not as a sudden modern development but as part of a much longer and globally braided story. Whether readers ultimately accept every aspect of this interpretation, the book offers a provocative framework for rethinking the relationship between drugs, states, markets, and medicine.

In many ways, the questions that animated George Washington Carpenter in the 1820s—how medicines should be produced, regulated, and distributed—remain with us today. Carpenter imagined opium as a national resource that could be cultivated, managed, and secured for domestic needs. One of Siegel’s signature achievements is in illustrating that such questions were never simply national. They were embedded in a vast international network linking farmers, manufacturers, scientists, merchants, and states.