In 1884, American physicians discovered the anaesthetic value of cocaine and over the next three decades, the substance derived from the coca plant became so popular that it became, ironically, a public health problem. Demand exceeded supply; abuse proliferated. The black market produced a legendary underground of "cocaine fiends". As attempts at regulation failed, cocaine was banned outright and America launched a war against now illegal drugs. Challenging traditional thinking about both the "rise" and "fall" of drug problems - which makes legal prohibition the pivotal point in the story - Spillane examines phenomena that he believes have eluded earlier students of drug history. He explores the role of American buisness in fostering consumer interest in cocaine during the years when no law proscribed its use, the ways in which authorities and social agents tried nonetheless to establish informal controls on the substance, and the mixed results they achieved.
Arguing that the underground drug culture had origins other than in federal prohibition, he concludes with some thoughts on what the US's early experience with legalization and prohibition can reveal as the America faces questions about contemporary drug policy.