PART II Opiate Addiction as a Social Problem

CHAPTER 12 NEEDED REFORMS

Many writers have assumed that there is only one basic solution to the opium problem, namely, the limitation, by international agreement, of the amount of opium produced to that just sufficient to meet the medical needs of the world. A number of international conferences have been held for this purpose, but all attempts to secure effective international action on this matter have failed. This failure has been due to the fact that those countries with vested economic interests in the production of raw opium have refused to sacrifice these interests. Since the opium poppy is not cultivated in the United States no such vested economic interest exists here and the American representatives found it relatively easy to assume the proper attitudes of moral superiority toward those nations in which the production or trade in opium was an integral part of the economic structure, forgetting perhaps that the lucrative market for illicit drugs in the United States offers the illegal dealer his best chance for large profits. Unfortunately, there has been so much discussion of international control of this problem that less dramatic and more practical things which we can do for ourselves to put our own house in order have been neglected It is these measures which we will now discuss.

The most important basic change which is needed in this country is to reinterpret the Harrison and Jones-Miller acts so that the prescription of drugs to an addict by a physician is defined as being within the field of medicine. This would mean that a physician could legally prescribe drugs to an addict, and it would give addicts a legitimate low-cost source of supply. This is the way in which English drug laws are interpreted. No change in the wording of the Harrison Act, and very few changes in the Jones-Miller Act, would be required. All of the regulations, requirements, and penalties specified in these acts to apply to persons who handle drugs could be left untouched. The only change would be that if a physician wished to prescribe drugs to an addict be could do so with complete legality, provided only that be was registered Under the act and kept the proper records. It is probable that the Harrison Act was intended to function in this manner in the first place, since it does not specifically prohibit the physician from prescribing for an addict, and since such a prohibition might have been interpreted as an unwarranted interference in the practice of a profession.

At first glance it might seem that such a plan would make opiates more available than they now are and lead to a spread of the habit Further consideration reveals, however, that the opposite would be the case. In England, where, as has been indicated doctors do prescribe for addicts, there is much less addiction than in the United States, and there is scarcely any smuggling problem. At present the new addict in this country usually obtains his drugs from illicit sources; under the proposed plan be would have to obtain his supplies from a doctor registered under the Harrison Act. Certainly one would expect medical men to exert more of a restraining influence on the spread of addiction than the underworld peddler does! The reduction or elimination of illegal dealing in opiates would unquestionably remove the greatest source of new addicts now in existence.

August Vollmer, formerly police chief of Berkeley, California, and later professor of police administration at the University of California, and an outstanding authority on police problems, has the following to say about the narcotics problem:

Can the narcotic problem be met intelligently so that it may be controlled and possibly reduced to the point where it need no longer be regarded as a menace to the young men and women of this country, and where drug users will not aggravate the crime conditions, as they do at the present? Stringent laws, spectacular police drives, vigorous prosecution, and imprisonment of addicts and peddlers have proved not only useless and enormously expensive as means of correcting this evil, but they are also unjustifiably and unbelievably cruel in their application to the unfortunate drug victims. Repression has driven this vice underground and produced the narcotic smugglers and supply agents, who have grown wealthy out of this evil practice and who, by devious methods, have stimulated traffic in drugs. Finally, and not the least of the evils associated with repression, the helpless addict has been forced to resort to crime it) order to get money for the drug which is absolutely indispensable for his comfortableexistence.

The first step in any plan to alleviate this dreadful affliction should be the establishment of Federal control and dispensation-at cost of habit-forming drugs. With the profit motive gone, no effort would be made to encourage its use by private dispensers of narcotics, and the drug peddler would disappear. New addicts would be speedily discovered and through early treatment, some of these unfortunate victims might be saved from becoming hopelessly incurable.

Drug addiction, like prostitution and like liquor, is not a police problem; it never has been and never can be solved by policemen. It is first and last a medical problem, and if there is a solution it will be discovered not by policemen, but by scientific and competently trained medicalexperts whose sole objective will be the reduction and possible eradication of this devastating appetite.There should be intelligenttreatment of the incurables in outpatient clinics, hospitalization of those not too far gone to respond to therapeutic measures, and application of the prophylactic principles which medicine applies to all scourges of mankind.(1)

Vollmer's proposal goes further than the plan proposed here, since he proposed federal dispensation at cost, probably under the auspices of the Public Health Service. It is possible that this sort of a plan would be necessary at first, but it is believed that in the long run most of the cases could and should be handled by private practitioners. If every addict in the United States became a doctor's patient the average case load would be increased by less than one per doctor. However, since addicts are at present concentrated in large cities, temporary clinics might have to be set up there to handle the immediate problem. As the addicts secured employment and bettered their economic and social status, these clinics would become less and less necessary, for the drug user would certainly prefer to patronize a private practitioner rather than to attend a public clinic. The net long-run effect would be, we believe, to reduce the visibility of the problem and to bring it under public control through the agency of the Public Health Service and of the medical profession

Under this plan the drug addict would, in effect, be given the same status as the person who drinks alcohol. If the latter does not steal, destroy property, create public disturbances, assault someone, or otherwise violate the laws, be is left to his own private devices. Drinking is regarded as a question of private morality, in spite of the fact that drunken persons are in most respects more dangerous and are much more numerous than drug addicts. The proposal presented here is simply that addiction to drugs should be regarded like addiction to alcohol-as a private vice. If a drug addict steals, kills, or otherwise violates laws be should be arrested and punished, but be should not be punished simply because be uses drugs.

Another advantage of the proposed change would be that the present brutal and unnecessarily cruel methods of handling addicts, to which Vollmer refers, would be eliminated. The addict would be handled by medical men as a patient; not by policemen as a pervert and a criminal. It would no longer be possible or necessary to use drug addicts as informers in order to enforce the law. In taking these steps the United States would not be venturing into an unknown field of dangerous experimentation, for the drug addict in virtually all European countries has been regarded and treated as a patient for many generations. The United States would by these measures conform to generally accepted standards of humanity and decency.

There has been considerable publicity given to the federal hospitals which have been established in the United States by the Public Health Service to handle and study addicts.(2) It is true that they represent a step in advance for this country, but Europeans have Dever attempted to utilize the prison as a means of controlling addiction and have always placed their opiate addicts in the hands of doctors and nurses. The inmates of these hospitals are still prisoners "doing time." In this sense we are still behind European practice.

Under the proposed plan the facilities of the Public Health Service and the Narcotics Bureau would continue to be useful. The narcotics farms could be used as hospitals for addicts or to administer cures to those seeking to free themselves from the habit The Narcotics Bureau could devote itself more fully to checking on the flow Of narcotics through the bands of registered dealers under the Harrison Act. There would also probably be a residual problem involving addicts who were professional criminals who would Dot conform to the new situation. There would also be the cocaine and marihuana problems to which narcotics agents could devote their energies.

One of the effects of the proposed plan which would, in the long run, be of the greatest importance is that as the illegal traffic dwindled and as more and more addicts came to private physicians reliable information would become available concerning the numbers of addicts in each community. New cases would be detected quickly, and measures could be taken to eliminate foci of infection. Under the present system very little reliable information of a statistical character is available and no one knows bow many addicts there are, where they are, or where the new cases come from.

Arthur Woods, formerly New York Police Commissioner and international authority on the opium traffic, appraising the situation in the United States, states:

Since the passing of the Federal Narcotic Act in 1914, actually thousands of addicts and small peddlers have gone into the Federal prisons, while with but few exceptions the "high financiers" of dope smuggling remain at large. In practice this state of affairs amounts to little more than prosecuting the victims of the traffic and permitting those who reap the large monetary benefits to go untouched.(3)

Simple justice requires that this situation be corrected. The American people have had an experience with prohibition and from it they have learned that matters of private morality cannot be settled by legislation. The effects of prohibition on drug addiction are substantially the same as they were upon alcohol addiction. As in the case of the bootleg traffic in alcohol, the high financiers of the dope racket can be eliminated only by doing away with prohibition.

It should, of course, not be assumed that any change in the method of handling the narcotics problem will at once or even ultimately eliminate all problems connected with addiction. Many difficult problems would remain, although the situation as a whole might be greatly improved. For example, if the changes recommended here were made, it is probable that some traffic in drugs would continue in the American underworld and that attempts ,would be made to sell these illicit drugs to addicts to supplement the supplies they were obtaining from medical sources or to enable persons not using the drug to start its use or resume its use. It would, of course, be impossible for illegal dealers to obtain the prices which they now can, and much of the financial incentive would be gone. Nevertheless, there would probably be a problem here and a task for the Narcotics Bureau. Other problems that would remain would be that of attempting to cure as many addicts as possible, and that of guarding against any spread of I the habit.

1. August Vollmer,The Police and Modern Society (Berkeley: University of California Press,1936), pp. 117-1&

2. Howard Wbitman, "One UP on Narcotics," Colliers (Dec. 15, 1945), 1 16: 82, 86, 88--go.

3. ArthurWoods, Dangerous Drugs: The World Fight against illicit Traffic in Narcotics (New Haven, Conn.: Yale University Press,1931), p. 62.