Drug Addiction, Crime or Disease?

Interim and Final Reports of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs.

INTERIM REPORT

For the last half-century public authorities in the United States have been wrestling with the problem of controlling addiction to narcotic drugs. Since the twenties, legislation and enforcement policies have aimed at total repression, with criminal sanctions of notable severity attaching to every transaction connected with the non-medical use of drugs. Drug-law enforcement has become a major police activity of federal, state and local governments; the threat of long imprisonment, even of death penalties, hangs over not only the smuggler and the peddler, but the addict-victim of the illicit traffic.

Addiction to narcotic substances has been recognized as a health problem for a long time and in many different countries. It has also in our times and in our national community, emerged as a criminal law problem of distressing magnitude and persistency. The fields of medicine and law are thus equally affected, and the Joint Committee which offers this report has undertaken its assignment with enthusiasm at the prospect of uniting its parent organizations in a common effort centered in an area where the concerns of each overlap and largely coincide. If the Joint Committee can contribute something towards mutual enlightenment and ultimate agreement between the medical and legal professions regarding the drug problem, it may clear the way for desirable reforms. But regardless of the final outcome, its work to date has been highly gratifying to those engaged in it simply by virtue of its resounding success as an experiment in close cooperation between the American Medical Association and the American Bar Association.

The Joint Committee warmly acknowledges the participation of another cooperating partner, the Russell Sage Foundation, which contributed substantial material aid to finance the Joint Committee's work. We wish particularly to express our appreciation to Dr. Donald Young and Dr.

Leonard S. Cottrell, Jr., of the Foundation, who have followed the Joint Committee's work closely, contributing invaluably from their broad wisdom and experience in the field of social science research.

BACKGROUND

The medical profession in this country was widely concerned about the use and abuse of opiate preparations at least as long ago as the Civil War era. The American Medical Association supported the enactment of regulatory legislation before the Harrison Act (1914) became law, and its House of Delegates gave active consideration to the development of the federal regulatory pattern in the formulative period 1919-23. A Special Committee on the Narcotic Drug Situation in the United States, appointed pursuant to a resolution of the A. M. A. House of Delegates in June, 1919, studied the situation and submitted an edifying report the following year. A standing Committee on Narcotic Drugs, of the A. M. A. Council on Health and Public Instruction, served actively thereafter. But except for expressing its position on various matters of administrative detail, the A. M. A. has taken no formal position with regard to the operation of the country's narcotics laws since the adoption, in June, 1924, of a resolution on so-called ambulatory treatment proposed by its Committee on Narcotic Drugs.

In 1954, interest was reawakened by the submission of a proposal from the New York State Medical Society for the legalization of the distribution of narcotics to addicts. The proposal was referred by the A. M. A. House of Delegates to its Council on Pharmacy and Chemistry and Council on Mental Health, and in April, 1955, the latter body appointed a special Committee on Narcotic Addiction, charged with the responsibility of making a thorough study of the matter. Dr. Felix, an A. M. A. member of the Joint Committee, served as chairman of the special committee, which has recently completed its work with a report concluding that the advisability of free distribution cannot be settled on the basis of objective facts at hand, recommending further study and research, and suggesting that the 1924 resolution of the House of Delegates should be revised.

The American Bar Association first concerned itself with narcotic drug laws when its Commission on Organized Crime considered (and disapproved) the mandatory minimum sentences and minimum penalties provided in the first Boggs Act, endorsed by the Kefauver Committee, which became law in '952. As a result of interest developed in its consideration of these provisions, the A. B. A.'s Section of Criminal Law created a standing Committee on Narcotics and Alcohol. The latter committee, after a survey of federal and state legislation on the subject, proposed a three-part resolution which was passed by the A. B. A. House of Delegates in February, 1955: "Resolved, That the Section of Criminal Law, through its Chairman or other such appropriate representative as he may appoint, be and it is hereby authorized: (1) To explore with the American Medical Association the possibilities of a jointly conducted study of the narcotic drug traffic and related problems, by and on behalf of the organizations through their own research facilities or in collaboration with other interested persons or organizations.

(2) To investigate through the American Bar Foundation the availability of funds from sources outside the Association in aid of the study described in the preceding paragraph, and with the approval of the American Bar Foundation to utilize such funds as may be found to be available for that purpose.

(3) To urge the Congress of the United States to undertake a re-examination of the Harrison Act, its amendments and related enforcement and treatment policies and problems." It is of interest to note with respect to part (3) of the A. B. A. resolution that the adoption of Senate Resolution 67, authorizing the Daniels Committee study, followed it within a month (84th Congress, Ist Session, March 18, 1955).

Overtures to the American Medical Association through the A. B. A.'s Section of Criminal Law evoked a cordial response, and the project became a truly joint undertaking from the outset. The original appointees to the Joint Committee, Drs. Felix and Starr and Mr. Stetler for the A. M. A., Judge Dimock and Messrs. Fortas and King for the A. B. A., have continued to serve. In the matters of seeking resources for research and organizing its program, the American Bar Foundation, while not participating directly because the subject matter includes non-legal areas, has given the Joint Committee valued guidance and assistance.

WORK OF THE JOINT COMMITTEE

At its first meeting (Washington, March, 1956) the Joint Committee established as its ultimate purpose "to determine whether the two Associations can or should agree upon common principles or a common course of action" with respect to the subject of narcotic drugs. It was decided that the barbiturates, though similar to opiates in some respects, should not be included in the studies at this time. The Joint Committee outlined a number of areas and problems about which factual data seemed lacking, and noted that a considerable amount of research might be required before final conclusions could safely be reached. During the Summer of 1956, a number of research foundations were approached in quest of advice and support with respect to the Joint Committee's studies. Without exception the responses were approbative, but it was suggested that before seeking any substantial grant of funds, the areas of inquiry ought to be carefully analyzed and reduced to proposals for specific research activity in each case; in the convincing words of one foundation spokesman, "We cannot finance problems--only projects." Thus it was decided to commence on a modest scale with a survey of existing data, an analysis of present conditions and the preparation of one or more specific "project designs." For assistance in making this start, the Joint Committee was most fortunate in being able to reach an agreement with the Russell Sage Foundation of New York.

The Russell Sage Foundation is dedicated to "the improvement of social and living conditions in the United States," differing from many of its counterparts in that it maintains its own research staff and participates directly in many of the undertakings it supports. Its work in recent years has many times entailed cooperation with professional groups, particularly in law, medicine, psychology and psychiatry. Its own general program is currently aimed at increasing the utilization of the social sciences in professional practice.

In October, 1956 a formal application was made to the Russell Sage Foundation for a grant of $15,000 to be used in study of existing data and the preparation of one or more project designs. This application was approved, and the grant made, on November 8, 1956. The Foundation offered the cooperation of its staff, offered to provide office space for the Joint Committee at its headquarters, and undertook to handle all administrative details.

With approval from the A. M. A. Board of Directors and the American Bar Foundation, the Joint Committee accepted these arrangements. At its next meeting (Washington, December, 1956) a representative of the Russell Sage Foundation assisted in reviewing the areas to be studied in preparation of the project designs, and the details of procedure were worked out. The Joint Committee next addressed itself to the task of finding a qualified director-- a task most fortunately concluded when Judge Morris Ploscowe, formerly director of the A. B. A. Commission on Organized Crime and well known for his studies in the field of crime and criminal law administration, agreed to serve. An important factor in the Joint Committee's selection of Judge Ploscowe was that the Report of the A. M. A. Council on Mental Health on Narcotic Addiction, then just submitted, contained so much excellent material on the medical aspects of addiction that the need for medical research appeared limited and a larger part of the Joint Committee's own work could, it believed, be concentrated on legal, administrative and sociological aspects. The Joint Committee met again (Philadelphia, March, 1957) With Judge Ploscowe to discuss his undertaking, and at this time, partly in view of the A. M. A. report mentioned above, it was suggested that in some aspects, at least, enough reliable data might be found already available to enable him to reach conclusions in the course of his analysis. Agreement was reached that the work would thus keep three aims in view: (1) To survey existing sources to find out how much already existing material was available and could be relied upon; (2) To determine what experiments and research projects ought to be sponsored by the Joint Committee to remedy deficiencies in present knowledge of the field; and (3) To draw conclusions, where possible from existing sources, as to any areas which appeared capable of accurate analysis without further study.

REPORTS AND RECOMMENDATIONS

With the foregoing aims in view, a study of the drug addiction problem has gone forward, making use of all available sources and resulting in the report, by Judge Ploscowe, "Some Basic Problems in Drug Addiction and Suggestions for Research," appended hereto as Appendix A. We commend the thoughtful, realistic appraisal of the problems of drug addiction and the critical analysis of present policies toward drug addicts contained in Judge Ploscowe's report. He has clearly spelled out the need for a revision of present attitudes toward and present approaches to drug addicts and drug addiction.

In July-August, 1957, the drug laws and enforcement policies of England and certain European countries were examined, for comparative purposes, by Rufus King, resulting in the report appended hereto as Appendix B.

At its most recent meeting (Washington, November 18, '957) the Joint Committee considered the aforementioned reports. It approved the substance of the report of Judge Ploscowe without formally adopting its language or specific appraisals. It agreed to go forward with the preparation of projects in the five specific areas suggested therein, namely: (1) An Outpatient Experimental Clinic for the Treatment of Drug Addicts (Appendix A, p. 103) Although it is clear, as the report sets forth, that the so-called clinic approach to drug addiction is the subject of much controversy, the Joint Committee feels that the possibilities of trying some such outpatient facility, on a controlled experimental basis, should be explored, since it can make an invaluable contribution to our knowledge of how to deal with drug addicts in a community, rather than on an institutional basis. It has been suggested that the District of Columbia, being an exclusively federal jurisdiction and immediately accessible to both law-enforcement and public health agencies, might be an advantageous locus for this experiment.

(2) A Study of Relapse and Causative Factors (Appendix A, p. 108) It is not possible to fully measure the worth of treatment and rehabilitation measures without more data than has yet been accumulated on the rate of relapse, and on the causative factors underlying both addiction and successful rehabilitation. The Joint Committee feels that large scale research in this area (complementing several limited studies which are already under way) would be highly desirable. Such research is absolutely indispensable to any thorough-going evaluation of present policies in dealing with narcotic addiction, as well as to the formulation of new approaches in dealing with this difficult problem.

(3) Educational and Preventative Research (Appendix A, p. 109) The dissemination of accurate information about narcotic addiction has been neglected and even discouraged by some enforcement authorities. The Joint Committee feels that this matter should be studied critically, to determine whether a campaign of enlightenment might not produce good results. The Joint Committee also feels that other preventative techniques can be devised which can aid materially in lowering the incidence of drug addiction. (4) Legal Research (Appendix A, p. 113) There is uncertainty at present both in the ambiguous provisions of some of our narcotic drug statutes and in the court decisions through which they have been applied. There is also doubt as to whether the premises on which our present narcotic laws rest are sound and validly conceived. A critical study in this area would make possible a thorough evaluation of present legal approaches to narcotic addiction. It should result in the formulation of better methods for dealing with the addict and more realistic and sounder means for controlling the illicit drug traffic.

(5) Research in the Administration of Present Laws (Appendix A, p. 115) There is considerable uncertainty and confusion in the enforcement of existing drug laws. This may be inherent in the nature of the laws, procedures or administrative and judicial machinery which seeks to enforce them. A careful study of how existing laws are operating should provide invaluable guides for a rational drug control program in this country.

THE PROGRAM AHEAD

The five areas described above are those in which the Joint Committee intends to develop specific project designs for its research. This step, to be taken next, is still within the compass of the Russell Sage Foundation grant, and will occupy the Joint Committee's director and cooperating staff until completed. When the designs are complete, additional funds will be sought to carry them out. In some cases, they may appropriately be turned over to other organizations and agencies; for example, it is contemplated that the resources of the American Bar Foundation could be utilized for the legal-research projects.

It is anticipated that another work of value will be completed while the research projects are being developed: a selected bibliography of current material on narcotic drugs has been collected for the Joint Committee and this, plus a carefully edited set of selected readings, will be submitted for publication, if approved, by the Russell Sage Foundation.

The Joint Committee still holds its basic aim, namely, to determine whether the two Associations can agree upon common principles, or a common course of action, with respect to the narcotic drug problem. Its final report will contain its conclusions on this subject as well as its statement of principles and recommended action. But until more is learned about the narcotic problem--until at least some of the proposed research is completed--the Joint Committee believes it should proceed slowly. No final conclusions are therefore offered at this time and no time-table of future progress is attempted. Unless otherwise directed, the Joint Committee will carry on at its present pace until it is satisfied that the assignment given to it has been fully carried out.

RUFUS KING, Chairman

JUDGE EDWARD J. DIMOCK

ABE FORTAS

DR. ROBERT H. FELIX

DR. ISAAC STARR

C. JOSEPH STETLER