20. Heroin on the youth drug scene - and in Vietnam

During 1970 and 1971, the mass media carried news of two new and distressing opiate trends. A growing number of white, middle-class young people, in suburbs as well as inner cities, were said to be mainlining heroin. And United States military personnel-primarily in Vietnam, but also at duty stations in the United States and throughout the world-were similarly said to be sniffing, smoking, or mainlining heroin in substantial numbers.

It was still much too early, as this Consumers Union Report was nearing completion, to evaluate these two new phenomena in detail, to ascertain their causes with precision, or to put forward specific policies for handling them. A few central points, however, can be established with reasonable confidence. Let us review the two new patterns of heroin use in turn.

Heroin use among middle-class white young people. How common is heroin use in comfortable residential areas and suburbs? Nobody knows. *

* President Nixon's Message to Congress, June 17, 1971, stated: "Even now, there are no precise national statistics on drug use and drug addiction in the United States, the rate at which drug use is increasing, or where and how this increase is taking place. Most of what we think we know is extrapolated from those few states and cities where the dimensions of the problem have forced closer attention, including the maintenance of statistics."

Anecdotal evidence indicated that by 1971, heroin had become the most popular illicit drug (except for marijuana) among young people in at least a few suburbs. How many suburbs? Which suburbs? No one knew or could find out. Indeed, the only reliable source of information concerning heroin on the youth drug scene came from the free clinics and other indigenous institutions (see Chapter 65)--- institutions to which youthful heroin users naturally turned when they realized that they were "hooked." These institutions could report only that heroin addiction was rapidly rising in certain neighborhoods.

One very distressing aspect of heroin's spread to the suburbs was that it seemed to signal a crumbling of the longstanding dividing line between heroin and the other drugs, licit and illicit. That line had been recognized and accepted by almost all middle-class white young people through all the years from 1914 till late in the 1960s. Young people might risk alcohol, nicotine, marijuana, hashish, LSD, and a variety of other drugs-but heroin? Certainly not--- except, of course, for some poverty stricken denizens of inner cities and a few others.

This breakdown of the barrier against heroin use was at least in part, it should now be apparent, the natural and inevitable result of the official United States antidrug stance, which linked many illicit drugs--- even marijuana--- to heroin in antidrug pronouncements. Thus, marijuana was defined as a narcotic in many laws. The same penalties were decreed against the possession or sale of marijuana as against the possession or sale of heroin. Authorities mistakenly spoke of "marijuana addicts." The often repeated slogan, "Marijuana leads to heroin," further obscured the distinction between the two drugs. At the same time, the distinction between injecting a drug and swallowing, sniffing, or smoking it was also blurred; antidrug propaganda concealed the fact that sniffing, swallowing, or smoking a drug is much safer than mainlining it. As a result, the indigenous institutions report, many naive young people eventually responded to the propaganda and accepted the view that heroin mainlining must not be very different from marijuana-smoking, or "acid-dropping," or other accepted forms of illicit drug use.

Most people who begin to experiment with an addicting drug assume that they are going to be exceptions--- they are not going to get hooked. The antidrug campaigns to which young people were exposed during the 1960s gave them a further assurance: even if they did get hooked on heroin, the propaganda insisted, there were highly effective therapeutic communities and other treatment facilities where they could be cured, rehabilitated." For some young people the message received was, why worry about getting booked? Addiction is only temporary.

There was no reason for young people to doubt these officially sponsored assurances that heroin addiction is curable. If even the schools, with their known hostility toward drugs and especially toward heroin, were interrupting classes for assemblies at which "ex-addicts," after a few months of abstinence, assured young people that they had been able to quit with a little help, why should the message be doubted? What possible reason could adults have to mislead young people in this respect?

What possible reason indeed? Surely when the history of the drug crisis of the 1960s is ultimately written, the story of the parade of young exaddicts brought to school assemblies to demonstrate that heroin addiction is curable will rank among the most bizarre of the decade's drug phenomena.

After the public was informed, during the summer of 1971, of widespread heroin addiction among the United States armed forces in Vietnam and elsewhere, the same reassurances were reiterated. Public officials from the President of the United States down announced that everything possible would be done to "rehabilitate" (which to most people meant "cure") addicts in uniform. * Once again, the mistaken view that heroin addiction is really a short-term problem, treatable by public institutions, was publicized to the entire country.

* President Nixon's Message to Congress on June 17, 1971, for example, contained such statements as these:

"Rehabilitation: A New Priority.... I am asking the Congress for a total of $105 million in addition to funds already contained in my 1972 budget to be used solely for the treatment and rehabilitation of drug-addicted individuals.... The nature of drug addiction, and the peculiar aspects of the present problem as it involves veterans [of the Vietnam war], make it imperative that rehabilitation procedures be undertaken immediately. . . . In order to expedite the rehabilitation program of Vietnam veterans, I have ordered the immediate establishment of ... immediate rehabilitation efforts to be taken in Vietnam.... The Department of Defense will provide rehabilitation programs to all servicemen being returned for discharge who want this help, and we will be requesting legislation to permit the military services to retain for treatment any individual due for discharge who is a narcotic addict. All of our servicemen must be accorded the right to rehabilitation."

Perhaps these three errors of public policy--- the repeated equating of marijuana and other popular drugs with heroin, the failure to explain the difference between eating, sniffing, or smoking a drug and mainlining it, and the insistence that heroin addiction is temporary and curable--- do not constitute an exhaustive explanation of why the long-effective barrier against heroin in middle-class white communities crumbled late in the 1960s. A few years hence, perhaps, in retrospect, it may be possible to identify additional ways in which official drug policies and other factors breached the barrier that formerly separated heroin from other drugs.

Marijuana laws and policies, like heroin laws and policies, also appear to have contributed in several ways to increased use of heroin (see Part VIII).

First, laws and law-enforcement policies tended to force marijuana into underground channels of distribution--- including some of the same channels which were distributing heroin.

Second, by making marijuana scarce at particular times in particular places, law-enforcement drives caused marijuana smokers to look around for substitute drugs. Sometimes the substitute they found was heroin (see table on Page 442).

Third, the illegal status of marijuana caused students and other young people to set up their own informal channels of marijuana distribution. These same informal channels were at least occasionally used also for the distribution of low-cost heroin after 1969, and perhaps earlier. Half a dozen youthful users, for example, might send one of their number down to Mexico, where heroin is cheap, for a month's or two-months' supply. Or cheap, highly potent Mexican heroin might be picked up on the American side of the border in California, Arizona, or Texas. Again, very potent heroin was coming in from Vietnam and from other points in Asia through "informal channels"; this low-priced Asian heroin, too, was being informally distributed at a fraction of the price charged by the traditional black market.

The availability of low-priced heroin through informal channels extending into middle-class white communities had a series of effects. Since the pioneer suburban heroin users were getting their drug at moderate cost, they did not suffer the degradation typical of traditional "junkies." Often they continued in school or in their usual patterns of life. They themselves and their friends thus became convinced that it is possible to take heroin without experiencing the pauperization and criminalization typical of inner-city junkies. In short, they were on their "heroin honeymoon"--- at cut rates. The relative innocuousness of heroin under these circumstances confirmed the view stressed by official drug propaganda that heroin and marijuana hazards are pretty much the same. As for the risk of getting "hooked," they could readily (they thought) get cured or rehabilitated if that happened. That, as noted above, was what even the President of the United States was assuring them. It is hardly surprising, under these circumstances, that heroin use spread. Indeed, it is surprising that use did not explode on an even grander scale.

But the honeymoon did not last. Informal channels of distribution work for marijuana; since it is not addicting, a temporary local marijuana famine is at worst an inconvenience. The unreliability of informal heroin channels--- an unreliability that became more acute as law-enforcement agencies gradually learned how to harry these new suppliersproved a much more serious matter. Young addicts found themselves undergoing withdrawal when their informal supplies were cut off--- with no place to turn for heroin but to the established, traditional, high-priced "jugglers" or "pushers." When their funds were exhausted, they turned to the free clinics and other indigenous institutions to which they had been accustomed to turn for help with their nonheroin problems (see Part IX).

The Haight-Asbbury Medical Clinic in San Francisco has documented this trend. It opened a special section for heroin addicts in November 1967, and by November 1969 it had seen nearly 1,000 heroin users, almost all of whom were addicted. (Since national drug styles tend to be set first in the Haight-Ashbury, the increased use of heroin surfaced there a little earlier than in most other communities.) Of the addicts served by the clinic, about 25 percent (classed as "old-style junkies") had first used heroin before January 1964; about 20 percent (classed as "transitional junkies") first used heroin between then and January 1967; and the remaining 55 percent or so were "new junkies," who began to use heroin after January 1967.

The preponderance of "new junkies," of course, was influenced largely by the fact that the Haight-Ashbury Medical Clinic was familiar to and trusted by this newly addicted group; old-style junkies were less likely to register there for help. Hence the figures tend to exaggerate the ratio of new-style to old-style addicts. But neither the figures nor Figure 9 below exaggerates the extent to which heroin addiction is a relatively new phenomenon among the young, predominantly white population served by the Haight-Asbbury Medical Clinic.

Staff members at the Haight-Ashbury Medical Clinic hoped at first that the 11 new junkies," since they differed from the "old-style junkies" in age, race, education, duration of addiction, and many other characteristics, would prove easier to cure. But, as noted in Chapter 10, this hope has not to date been fulfilled. "New junkies" offered detoxification and other clinic services relapsed at roughly the same high rate as "old-style junkies."

FIGURE 9. First Use of Heroin by Addicts Attending Haight-Ashbury
Medical Clinic in the Years 1967-1969

In 1970, accordingly, California's clinics serving the youthful drug using population applied for permission to try methadone maintenance with these "new junkies." Approval was delayed by state authorities; it was not until 1971 that methadone maintenance became available in California on more than a trivial scale--- and it is therefore --- still too early to determine whether methadone maintenance works as well with the "new junkies" as it has been working elsewhere with the "old-style junkies."

Heroin addiction in the armed forces. During the spring of 1971, the mass media carried the unwelcome news that heroin addiction was rife among American enlisted men in Vietnam, and perhaps also at other United States military bases at home and overseas. "The figure on heroin users most often heard here," one newspaper reported from Saigon in May 1971, "is about 10 to 15 percent of the lower-ranking enlisted men ... as many as 37,000 men. Some officers working in the drug suppression field, however, say that their estimates go as high as 25 percent, or more than 60,000 enlisted men." Later reports put the rate of heroin addiction at about 14 percent of the servicemen in South Vietnam; if true, this represented one of the highest addiction rates in the history of the opiate drugs. It was probable, however, that the high figures included servicemen who had only used heroin a few times and who were not yet addicted, ** or that the figures were inflated in other ways. Subsequent estimates placed the addiction rate as low as 4.5 percent. Even so, there could be no doubt that the country faced a major problem of heroin addiction among American military personnel.

** Among 1,000 returnees passing through the Oakland (California) Army Terminal for release from service, for example, 930 voluntarily filled out an anonymous questionnaire concerning drug use. Of the 930, 16 percent admitted having used heroin at least once during the preceding 30 days; just under 10 percent said they had used it 11 or more times during that period, and 4.2 percent reported having used it 30 times or more during the month.

Since American forces in Vietnam were subjected, before going overseas, to the same antidrug propaganda as other young civilians, it is probable that this propaganda played the same role in breaking down the taboo against heroin among them as among young civilians back home. In addition, military drug policy on marijuana in Vietnam unwittingly triggered the shift from marijuana (which GI's had been smoking earlier) to heroin after July 1970. This is made clear in two reports by Dr. Norman E. Zinberg, a psychoanalyst and professor of education at Clark University, who toured Vietnam in September 1971 on a fact-finding mission for the United States Department of Defense and the Drug Abuse Council--- the latter a private agency set up to encourage reason and common sense in United States drug laws, policies, and attitudes.

. . . The Army itself is universally credited with causing the swing to heroin through its own blunder: the campaign against marijuana," Dr. Zinberg states. Military officials in Vietnam discovered the wide use of marijuana among their troops in 1968.

True to the American activist tradition, as soon as a problem was identified, a full-fledged assault to stamp it out got under way. Radio and TV spots proclaimed the evils of marijuana and indicated that a smoker could . . . damage ... [his] brain and become psychotic...... Drug-education lectures," repeating the scare stories about grass [marijuana], became compulsory. In an all-out drive, the Army repeatedly searched billets, sent out officers to sniff for the weed in barracks and secluded fields, and even trained marijuana-sensitive dogs. . . .

It was a very efficient campaign. Marijuana is relatively bulky, and the smoke is detectable by smell. In one week there were 1,000 arrests for possession. Much official satisfaction was expressed in press releases which indicated that "the" drug problem in Vietnam was being brought tinder control. The Army had not yet learned, and has not yet learned, that you don't get something for nothing.

The aftermath of the army's antimarijuana campaign, Dr. Zinberg continues, was disastrous: "Human ingenuity being what it is--- and the desire for an intoxicant in Vietnam being what it was--- many soldiers simply switched [to heroin]. Once it appeared, medical officials and commanding officers realized that they had acquired a far more serious problem." One commanding officer told Dr. Zinberg: "If it would get them to give tip the hard stuff, I would buy all the marijuana and hashish in the Delta as a present."

That an antimarijuana campaign can increase the use of heroin, documented by Dr. Zinberg in Vietnam, is of course relevant also to United States civilian antimarijuana campaigns. This is a topic to which we shall return in Part VIII.

The military response to the new drug peril was readily predictable. "The Army is presently engaged in the same type of all-out campaign against heroin despite the results of the marijuana campaign Dr. Zinberg reported in December 1971. "Its hard-sell education program again presents false information and exaggerated facts that contradict what the men know from their own experience. The very intensity of the campaign rouses their suspicions. ('What do they really want?' was a question I heard again and again .... )"

The army's all-out campaign against Vietnam heroin failed to curtail the supply of heroin, of course, just as similar civilian law-enforcement campaigns have failed in the United States. What law enforcement achieved, in Vietnam as in the United States, was an increase in the price of heroin. Gloria Emerson explained why, in a dispatch from Camp Crescenz, South Vietnam, appearing in the New York Times for September 12, 1971. Heroin had been cheap and plentiful for a battalion stationed there, Miss Emerson reported, until a new commander, Major John O'Brien, took over. Major O'Brien found on his arrival that he himself could buy heroin all around at a trivial price--- $2 or $3 for a whole vial (250 milligrams). In a series of raids he confiscated 409 vials of heroin, 40 syringes, three water pipes for smoking heroin, and two boxes of morphine. He built new barbed-wire fences around the base to keep out smugglers, arrested traffickers, sought helicopter coverage of the base at night to discourage smuggling, and tightened security in numerous other ways. Major O'Brien himself told Miss Emerson the result: "The price has gone up now because it's harder to get." Vials formerly available at $2 or $3 were now priced at $12. (They would cost about $125 at New York City street prices.)

It was natural, of course, for Major O'Brien and others to conclude that the key to the heroin outbreak was the low cost and ready availability of heroin in Vietnam--- but this was far too simplistic an analysis. In Thailand, which he also visited, Dr. Zinberg found very little heroin used by GI's--- "although the supply is even more abundant and cheaper than in Vietnam." A drug which attracts one clientele under one set of circumstances may attract a quite different clientele--- or none at all under different circumstances.

Once the results of the antimarijuana drive in Vietnam--- the switch to heroin--- became apparent, Dr. Zinberg notes, "the campaign against marijuana relaxed so that it is now on the market and much used by GI's once again." But by then it was too late; "the social barrier" against heroin, in Dr. Zinberg's phrase, had been broken--- and for users actually addicted to heroin, of course, marijuana was no longer an acceptable alternative.

The early United States military experience with heroin in Vietnam confirms ir several other respects the view of heroin expressed in this Consumers Union Report. For example, we have scrupulously refrained from attributing heroin use to personality defects or to the moral shortcomings of heroin users. We have ignored reports suggesting that the American civilian heroin addict has the kind of personality that "cannot function in society at all. He is an anti-social, bitter, 'loner.' "

Dr. Zinberg comments on this point: "Some of the heroin users in Vietnam follow this pattern, but the larger group is made up of men who are like everybody's next-door neighbors They come from small towns in the midwest or south; their personalities are not unusual; they have had slight previous experience with drugs; they are in good physical condition; they represent all ethnic and educational groups about equally."

Dr. Zinberg also asks the question: if the army's antiheroin drive were to succeed, and heroin were to become unavailable to GI's, to what drug would they next turn? The evidence reviewed in Chapter 10 above suggests that for many, perhaps most, heroin users, skid-row alcoholism would be the ultimate outcome.

We noted above that most nineteenth-century opiate addicts either took their drug by mouth, or smoked them; mainlining heroin became the dominant form of narcotic use only when repressive measures and the resulting high prices made less damaging routes of administration too costly. Dr. Zinberg and others report precisely the same phenomenon in Vietnam. With high-quality heroin exceedingly cheap before the army's antiheroin drive, some 90 to 95 percent of all GI users sniffed ("snorted") the drug or inserted a little in a cigarette and smoked it. Some even took it orally; "I saw one young man who had just returned to base after 13 days in the field pour a vial of heroin (approximately 250 milligrams) into a large shot of vodka and drink it," Dr. Zinberg reports. After the army's antiheroin campaign raised prices, however, such prodigality was no longer economically feasible; mainlining therefore increased in popularity. "The increase in intravenous use," Dr. Zinberg comments, "suggests that perhaps as a result of the Army's righteous efforts to stamp out heroin entirely, the drug scene has turned nastier, with potentially unpleasant consequences. When a widely used drug suddenly becomes difficult to obtain, users will conserve their supplies for the greatest effect." In sum, the United States military in Vietnam reenacted on a more modest scale in 1970 and 1971 the changes in opiate use (described earlier) which the United States as a whole had experienced following passage of the Harrison Narcotic Act in 1914.

Much anxiety was expressed, when the facts about military heroin addiction became publicly known in mid-1971, concerning the fate of GI heroin addicts when they returned to the United States--- and concerning the effect of their return on the civilian drug scene. The popular reaction to the problem was prompt and unequivocal: We must cure them, rehabilitate them. In response to this demand, and to the realities of the situation, the Nixon administration announced a variety of measures rehabilitation centers in Vietnam and at other military bases, an expanded Veterans Administration addict-rehabilitation program, expanded federal assistance for civilian treatment centers to which addicted veterans could go after discharge, and so on. We have reviewed in Chapter 10 the failure of such programs throughout the past century.

Even if the government's new treatment programs should prove somewhat more successful than the old ones, moreover, they could hardly be expected to prove 100 percent effective--- and few people, in the fall of 1971, were looking far enough ahead to face the question on the horizon: what is going to happen to the addicted Vietnam, and other, veterans who go through the new rehabilitation programs and don't get cured? Are they to be arrested and imprisoned for the possession of heroin, for the possession of hypodermic needles and other injection paraphernalia, for sharing heroin with one another, and for other heroin-associated crimes? Are they to be left at the mercy of the American heroin black market? Are they to be forced to pay $20 for a nickel's worth of heroin with all of the human suffering and deterioration that that price level entails?

A British visitor in 1999, it will be recalled, commented in amazement on how "in the United States of America a drug addict is regarded as a malefactor"--- even in the case of addicted "soldiers who were gassed and otherwise maimed in the Great War [World War I]" and whose addiction arose as a result. Whether, after subjecting them to unsuccessful cures or "rehabilitation programs," the country will make the same tragic and cruel mistake with uncured Vietnam veterans that it made half a century earlier with addicted World War I veterans remained in doubt at the end of 1971.

Fortunately, there was an alternative: methadone maintenance.

Footnotes
Chapter 20

1. C. W. Sheppard, G. R. Gay, and D. E. Smith, "The Changing Patterns of Heroin Addiction in the Haight-Ashbury Subculture," Journal of Psychedelic Drugs, 3 (Spring, 1971): 22-31.

2. Ibid., Table, p. 28.

3. Ibid., Chart, p. 23.

4. New York Times, May 16,1971.

5. Major Eric Nelson, Letterman General Hospital, San Francisco, quoted in Medical World News, September 3, 1971, p. 17.

6. Norman E. Zinberg, in New York Times Magazine, December 5, 1971, pp. 37, 112-124; and in New York Law Journal, December 6, 1971, p. 43.

7. Zinberg, New York Times Magazine, December 5,1971, P. 120.

8. Ibid.

9. Zinberg, New York Law Journal, December 6, 1971, p. 43.

10. Gloria Emerson, reporting in New York Times, September 12, 1971.

11. Zinberg, New York Times Magazine, December 5,1971, p. 123.

12. Ibid., p. 120.

13. Ibid.

14. Zinberg, New York Law Journal, December 6, 1971, p. 43.

15. Ibid.

16. House Report No. 92-298, Union Calendar No. 124, 92nd Cong., 1st Sess., 1971, p. 3.

17. Zinberg, New York Times Magazine, December 5,1971, p. 122.

18. Ibid., p. 116.

19. Harry Campbell, "The Pathology and Treatment of Morphia Addiction," British Journal of Inebriety, 20 (1922-23): 147.