Traffic in Dope: Medical Problem
For forty years the United States has tried in vain to control the problem of drug addiction by prohibition and police suppresslon. The disastrous consequences of turning over to the police what is an essentially medical problem are steadily becoming more apparent as narcotlc arrests rise each year to new records and the habit continues to spread, especially among young persons. Control by prohibition has failed, but the proposed remedies for this failure consist mainly of more of the same measures which have already proved futile
The number of heroin and morphine addicts (the use of marijuana, cocaine and other drugs is a separate problem not included in this discussion) is conservatively estimated by Mr. Harry J. Anslinger, head of the Federal Narcotics Bureau, at 60,000. This figure is a guess; its main virtue is that it is the lowest offered. Even so, the contrast with European countries is spectacular. For example, the English government reports slightly more than 308 addicts, known to the authorities in all of Brltaln, with a population of over 50,000,000. There are probably more addicts in the United States than in all of the other Western nations combined, and more juvenile users in New York Clty than in the whoIe oi Europe. Almost all English addicts are reported to be over thirty years old, while close to half of ours are under twenty-five. What is even more significant, European users appear to add to the crime problem in only a minor way, and the illicit traffic there is feeble compared to ours. The American market is the hub of the drug traffic in the Western hemisphere.
In recent years there has been a growing interest in the English system of control. General Sessions Judge J. J. Goldstein of New York meptioned it recently in connection with his advocacy of,a system of controlled legal distribution of drugs to users. Dr. Hubert S. Howe of New York has also long urged such a plan, adopted by the New York Academy of Medicine, and has made reference to the apparent success of the English system. Since about 1940, the writer himself has periodically suggested that an adaptation of the Brltlsh idea be tried in this country.
The crucial difference between the American and Brltish control systems is that the English physician is permitted to prescribe drugs regularly for the morphine addlct whlle the American doctor is not. The decision as to whether or not regular prescriptions are to be given to the English user is left to the doctor, usually after consultation with another medical man. He does not have to report on the addicts under his care; but records must be kept both by him aqd by the druggists who fill the prescriptions; Through these sources the British Home Office and the police can secure information about addicts and keep close watch on them. Addicts are arrested for obtaining supplies from illicit sources or from two medical sources simultaneously. The addict cannot be coerced into taking a cure, but there is pressure on the doctor to do everything in his power to persuade the user to quit the habit.
The British addict under medical care is included in the doctor's panel of cases under the National Health Act. Apart from the taxes he pays under this act along with the rest of the populatron, the addict's expenses for maintaining his habit consist only in the shilling (14 cents) paid for each prescription. It is therefore unnecessary for him to engage in criminal activities to get his drug. The black market is small, limited primarily to London and a few other large cities, and caters to users who either don't know that they can place themselves under a doctor's care or don't wish to do so. Sometimes an addict will refuse medical care because he is afraid his addiction will become known, or because he does not want to try to cure himself of the habit. All black market activities are, of course, prohibited by law, and the addict who patronizes peddlers risks arrest and punishment. In 1954 about thirty addicts were arrested, most of them for forging prescriptions or obtaining supplies froin two doctors at once, and the majority were punished with fines up to a maximum sf $280. The smoking of opium and the possession and use of marihuana are completely prohibited.
The obvious advantages of this system are that it removes the major motives for peddling narcotics and for the creation of new users, puts pressure on the addict to seek medical care and removes his incentive to engage in crime. And even though the addict is not treated as a criminal, addiction has not spread. The plan, in fact, has the opposite effect by making the doctor rather than the peddler the prime source of drugs. Another of the great advantages of the system is that a mantle of decent privacy is thrown over the unhappy details.
In this country the history of opiate-drug control has been very different. Because American patent medicines io the nineteenth century often contained opiate derivatives which were not controlled, relatively large numbers of addicts were created who were not, however, generalIy regarded or treated as criminals. The problem then was in no way as serious as now. Criminal addicts were few, the illicit traffic minor in nature and addiction was largely confined to adults (about two thirds of them women). Because drugs were legally available at low cost the user did not have to become a criminal to support his habit. Even so, an increasing concern with the dangers impllcit In the unlimited availability of drugs led to the trial of measures of control late in the nineteenth century and in the first decade of the twentieth. Given time, this experimentation, guided by growing medical knowledge of the opiate drugs, might well have led to the establishment here of something like the English system. This did not happen because of the intervention of federal authorities imbued with the Prohibition mentality.
The present system of drug control began with the passage of the Harrison Act late in 1914. This act made no mention of addicts nor did it in any way indicate how they were to be treated. It was a revenue measure designed to bring the flow of dangerous habit-forming drugs into the open through the exercise of the government's taxing powers. All persons and firms handling such drugs were required to obtain Iicenses and to keep records of supplies received and dispensed. Penalties were provided for violations. An exemption was made for the prescribing of drugs "to a patient by a physician...in the course of hls professional practice only." The interpretation of this part of the law became crucial in the early years of enforcement because on it hinged the whole matter of whether the addict was to be placed under the care of the physiclan or turned over to the police.
Between 1919 and 1925 a number of test cases—the Webb, Jim Fuey Moy, Behrman and Linder cases—were brought before the Supreme Court. The first three involved doctors who had flagrantly violated medical ethics by dispensing large quantities of drugs at high prices to addicts. Rufus King has pointed out in the April, 1953 issue of the Yale Law Journal that these cases were in effect rigged by the government. The prosecutlon wanted a court ruling which would prevent addicts from obtaining drugs from doctors. They evidently hoped that the unprofesslonal action of the doctors in these three cases would influence the court to declde against them, which it did. From the language of the indictments the government was then in a position to argue that these rulings had established that any administration of drugs to acldlcts by medical men, even when done in good faith to achieve a cure, was illegal.
The Linder case was designed to cllnch the government's position. Unlike the three earlier ones, it involved a doctor who bad prescribed small quantities of drugs to a slngle addict in good faith and in what was clearly a professional manner. The government attorneys asked the court for a ruling against the doctor on the basis of the precedent allegedly established by the earlier decisions. In this case, however, the court reversed itself by ruling against the government. Despite this reversal, federal narcotics .authorities have continued to operate under a Treasury Department regulation which states that "a prescription issued to an addict. . . to keep him comfortable by maintaining his customary use, is not a prescription with the meaning or intent of the act; and the person filling such an order, as well as the person issuing it, may be charged with violation of law." Threatened with criminal prosecution, the majority of doctors naturally ceased to treat addicts; the minority found themselves in trouble with the narcotics agents, and in many instances were sent to prison.
In 1920 a radical change in the government's attitude toward addicts became apparent after the enforcement of the drug laws was turned over to a newly formed unit in the Bureau of PnternaI Revenue which was also charged with liquor law enforcement under the Volstead Act. From 1915 through 1919, the annual reports of the Collector of Internal Revenue included expressions of sympathy for the drug user and concern over the fact that previously respectable addicts were being turned into criminals by the operation of the law. The 1919 report notes that various local health authorities had been encouraged to consider the possibiIity of setting up clinics in which drugs could be dispensed legally to such persons. The 1920 report, however, reversed this stand. It deplored the fact that forty-four local clinics had already been set up and announced that they were to be closed down. Neither the 1920 report nor any subsequent one expressed concern with the fate of the once-respectable user who was being forced to the underworld to maintain his supplies.
It is a current myth that the clinics which operated between 1919 a d 1923 demonstrated once and for all the perniciousness of any legal system of drug distribution and that they were closed solely because they faded. The facts are quite otherwise and more complex. It is true that the New York City clinic was generally admitted to have failed, but its failure was guaranteed in advance by the manner in which it was set up and operated. The stories of the other clinics vary. There is considerable reliable informatmn extant about the clinic in Shreveport, Louisiana, established under Dr. W. P. Butler, which Is discussed in some detail by Drs. C. E. Terry and M. Pellens in their book, The Opium Problem, a monumental and authoritative study. This clinic was originally set up by the Louisiana State Board of Health in 1919. In 1921 the board, after consultation with federal narcotics authorities, withdrew its support and the institunon was continued under the authority of the Shreveport City Council. In the same year it was unanimously endorsed by the Shreveport Medical Society; other medical groups and I the local police also expressed their support. However, in 1923 the clinic was finally closed by order of federal authorities in Washington. Dr. Butler reluctantly agreed to the closing after a conference with federal narcotics agents who said they had been sent to shut down the clinic "because it was the only one left in the United States." When a Los Angeles clinic had been similarly closed in 1921, Dr. L.M. Powers, then health commissioner of the city, had remarked, "I have not been able to realize the actual purpose of the closing of our clinic for there has been some unseen motive prompting much opposition to clinics which I have not been able to comprehend."
The disappearance of the clinics marked the final triumph of the "prohibition" idea and the complete removal of the control issue from the medical domain. The drug problem is what it is today as the result of these moves by the government. The huge illicit traffic, directed for profit by non-addicted lords of the underworld, has become the focal point of new infection. These men are rarely apprehended or punished; it is the user, exploited by the system, who suffers the major portion of the heavy penalties that are imposed. Pollce suppression, by increasing the danger of distribution and reducing supplies, keeps up prices and profits.
It is a popular mlsconception that the increase of drug use among young people is entmely a postwar phenomenon. As early as 1921, Dr. E. Bishop. a noted authority on drug addiction, commented on the trend toward juvenile addiction and ascribed it to the "prohibition" control technique. Statistical evidence of the trend itself can be, found in Uniform Crime Report of the FBI over the last twenty-four years. In 1932, for instance, only 15 per cent of narcotic law violdtors were under twenty-five years of age; in 1940, the figure had reached 26 per cent; today is a little under 50 per cent.
In 1950, drug-law enforcement was separated from 'liquor-law' enforcement with the establishment, within the Treasury Department, of the Federal Bureau of Narcotics. Federal narcotics officials, both before 1930 and since, have combined their policing functions with an active and effective campaign in support of the punitive conception of drug control. The expression, of dissident opinion was discouraged. How well their campaign has succeeded in mobilizing legislative and public sentiment is indicated by the fact that Congress, in 1951, passed laws that more than doubled the average prison sentence of federal narcotics offenders. In January of this year a preliminary report of a Senate subcommittee indicated that the present Congress will again be asked to increase penalties, enlarge the budget of the Federal Bureau of Narcotics and generally add to the punitive nature of the existing program., The reeort, expressed sympathy for the addict but makes no distinction between him and the peddler. It admitted that the real culprits, the big profiteers of the trafic, are rarely caught, and proposed to deal with them by legalizing wiretapping. Although the report explicitly stated that the number of addicts in this country probably exceeds the sum total of those in all other Western countries combined, no reference appeared in it to the control systems adopted abroad.
The treatment and cure of opiate drug addiction under the best of circumstances is very difficult. The main hope of control must be based on preventton. The punitive program now in operation neither prevents nor cures and it actually nullifies the rehabilitative measures that are being attempted The addict belongs in the hospital, not in the prison. If we recognize that punishment cannot cure disease, if we want to take the profit out of the illicit traffic, we need to return the drug user to the care of the medical profession—the only profession equipped to deal with him.