"A mature addict with a legal supply of clean drugs may well be a nice neighbor," was a thought I had put in a column that appeared in The Washington Post early in 1984. It had been written partly with Milton Polansky in mind, but I was also thinking of other drug addicts I had met since the early 70s, many of whom were decent people. Drugs, I had found, were morally irrelevant. Some people who take narcotic drugs behave immorally in other ways but not because of the drugs. Some people who are absolutely drug free are also free of any mor-als. The truly important issues for me have become not so much whether people take drugs but rather how they treat those to whom they should be showing love and care. All of those thoughts were behind that sentence....

Milton thought of himself as a heroin addict, nothing to hide, chin out, them's the conditions that prevail. "Who am I hurting?" he asked me defiantly one day over lunch. We both luiew that, despite the views of many drug abuse experts, there was no scientific evidence that the narcotics caused any significant organic harm to his body. Yet there was sound medical research documenting the harm caused by persistent injecting of the skin, includ-ing abscesses and the many diseases that may be transmitted by dirty needles, such as hepatitis. Accordingly, I asked him if he was not hurting himself by the constant injections since 1940 when he started using heroin as a soldier. The look of disbelief that came over his face suggested that he viewed any person who did not use proper procedures in injecting as a fool. Once, during "the war" in about 1943, "I was at a long party with a jazz band and we shared a needle, in New Orleans, and I ended up in the hospital with hepatitis for a while," but that was the last time he remembered suffering from injections.

However, it would be misleading to portray Milton Polansky as simply a sweet old grandfather, a helpless victim of the drug laws, although that is how he appeared at the tragic end. He was also part devil, a scheming and successful manipulator of doctors and the drug laws and the prescription system. One of his fellow addicts, with long years of experience, told me that Milton was virtually without peer in his ability to "make" doctors, to convince them to "write" for him. In some cases, this was accomplished by pitiful appeals to the doctor's sympathetic nature; in others, by appeals to the physician's pocketbook. Milton would then fill these prescriptions, using some of the drugs and selling the rest to a small circle of fellow addicts. During recent years, it is likely that he took in tens of thousands of dollars every year in drug sales. Of course, when his supply ran low, he would spend roughly the same amounts to buy drugs for himself, often from within that same small circle of addicts. On some occasions, however, this would require venturing onto the mean streets of Baltimore, into rough neighborhoods such as one no-torious area known as "the block." Unlike the multitude of innocent organically ill people who need analgesic medicines every year in America and in many other countries, Milton Polansky, doting father and grandfather, was a criminal narcotic addict.

It is important that his status as a criminal be recognized because that status puts him in the same category, speaking in broad terms, as some of the most destructive inhabitants of America. The man-ner in which we react to people who are both addicts and criminals is important. They are a challenge to our sense of ethics. Each of them presents unique problems and opportunities. If we can understand how we threw away the human opportunity in this case, if we can see the cruelty that we as a nation imposed on this one "criminal" addict, Milton Polansky, late of Baltimore, Mary-land, there is some hope that we can commence evolving a more humane and effective approach to all of our unfortunate neighbors whom personal stupidity, fate, biology, or bad luck, separately or together, have pulled into addiction and some degree of related crime.

Milton's behavior as a criminal addict did not preclude his functioning in many ways as a decent human being. As far as can be discovered, he never committed a violent act or a burglary or a theft to obtain his drugs, which were not difficult for him to obtain for most of his addicted years. He was virtually unknown to police blotters, at least for serious offenses; the man did seem to get stopped often by the police for driving without a license. During much of his life, which commenced on Nov. 19, 1918, Mr. Polansky was a successful Balti-more businessman, engaged in such fields as building renovation and real estate. He was a regu-lar contributor to many charities. While he was not greatly successful in his marriages, he adored his children and grandchildren and I am told that they felt the same way about him. In most respects, he was a nice neighbor.

As the years passed, Milton Polansky developed a number of serious organic and painful diseases. None of them, to my knowledge, were attributable to his use of narcotics. Thus, like many addicts I have encountered, he was soon taking powerful narcotics as a form of self-medication to deal both with his addiction and his organic diseases. Also in line with the patterns of many of these dependent users, there were drugs he preferred and then there were those he found acceptable. In Milton's case, as with many addicts, his drug of choice was heroin and the acceptable substitute was Dilaudid, that legal synthetic opiate which may be several times more potent, dose for dose, even than heroin. He took methadone as a last resort but in general looked with disdain on the favorite drug of the addiction treatment experts of America. There you have him, warts and all, a far from perfect being.

That flawed human package walked into the office of Seymour H. Rubin, M.D., in a Jewish neighborhood in the north of Baltimore, on Oct. 20, 1982. Dr. Rubin knew a great deal about Milton and his family, having treated his brother who had died 17 years previously from diabetes and heart disease. He had not seen Milton since those days, and wrote in his notes, "I am shocked by his horrible and changed appearance. He looks 30 years older than his stated age." The patient, then aged 62, shuffled along haltingly and needed a cane. A medical examination revealed an even more shocking list of organic ailments. Dr. Rubin was especially concerned about the impending gangrene of both legs. Other serious conditions of the patient included diabetes, kidney failure, recurrent transient strokes, heart disease, and high blood pressure with congestive heart failure. Any one of these conditions, along with allied complications, could have rapidly fatal results, Dr. Rubin knew, especially if they were not treated properly. And, of course, those potentially terminal organic illnesses were being ignored by the patient because he was finding it increasingly difficult to find a steady source, legal or illegal, of medicines to treat his diseases — and thus his energies focused on an obsessive search for drugs to feed his addiction.

Seymour Rubin, a native of Baltimore and five years younger than Milton, is a graduate of the University of Maryland Medical School and board certified in internal medicine. He has little experience, expertise, or interest in treating drug addicts. Yet, through a series of unrelated events, he has come to strongly disagree with the current medical-legal approach to them. While a frontline infantryman in World War II, he saw at a newly liberated concentration camp how harsh deprivation of basic needs can reduce decent, proud human beings to sniveling, conniving beggars. Later, at medical school in the late 40s, he heard Harry Anslinger of the old FBN tell the students in a guest lecture how to think about addicts: they are basically evil people; they'll do anything to get drugs; if they don't commit themselves to the Lexington Hospital for detoxification, they should be put in jail and the key should be thrown away. "I feel that our medical profession is still guided by that attitude," Dr. Rubin now declares. "And yet I have found out that drug addicts are not all evil people. Many of them are pathetic people who have to be helped, to be led.... If, though, we treat any group of people badly enough, like what I saw at Dachau, we can turn them into whining puppy dogs.... If you just kick them out of the door, you may be protecting yourself as a doctor but you are not doing anything for the patient.... You're being a rotten doctor."

To avoid the common failing of being a rotten doctor in regard to a known drug addict, Dr. Rubin wanted to act rationally on his objective clinical assessment of Milton Polansky. That extensive evaluation concluded that the major threats to his health, indeed to his life, came from his multiple organic medical ailments and not from his incidental though "very repugnant" problem of drug addiction. He decided to provide periodic prescriptions of Dialudid and then to seek to persuade his patient to go into a local hospital for treatment of his other major medical conditions. Milton refused to go into the hospital because he feared that the doctors there would attempt to detoxify him from Dilaudid and also perhaps put him on methadone, "which would tear me apart." He had been through 15 to 20 drug treatment programs within the previous quarter century and none had worked for him; he did not want to risk another attempt even if it was a prelude to easing his organic conditions. "I'll die of withdrawal!" he cried.

Seymour Rubin knew that every prescription of Diluadid he wrote for this known addict put his entire career at risk, and he knew also that the risk would continue even if his patient were to be hospitalized. It was all very chancy though. Very often, doctors were not bothered by the medical or legal authorities; in other cases, they were and their careers destroyed. He called a leading state drug enforcement official who said he believed Mr. Polansky should be prescribed narcotic drugs, as had other law enforcement officials over the years, according to Milton. But the physician was worried about his medical colleagues. Dr. Rubin told me that he wanted to be able to say, "Milton, I don't want any bullshit from you! You'll get Dilaudid but you must cooperate in this program of treatment." At that point, the doctor would have practically dragged his patient into a treatrnent slot he had ready at Baltimore's Sinai Hospital, especially for his limbs which were becoming gangrenous. But Dr. Rubin knew that he could not assure his patient of a steady supply of Dilaudid, which he was then taking in dosages of about 40 milligrams per day (down from a high in the past of 240 mgs.) After several months of treating this difficult patient and agonizing over the case, Dr. Rubin finally concluded that he had to protect himself somewhat, and he called the head of the medical committee that polices doctors for the state medical society: Stephen A. Hirsch, M.D., Chairman, Committee on Drugs, Medical and Chirurgical Faculty of the State of Maryland.

Dr. Rubin's case notes for December 28, 1982 relate that in response to his call, Dr. Hirsch had emphatically declared "that Milton is well-known to his committee, that he has manipulated many physicians, and that I should not prescribe Dilaudid for him. I will comply with his wishes." Those wishes were communicated in writing a few days later, along with barely concealed threats: "Our very strong advice to you is that you not prescribe any controlled substances for Mr. Polansky, although you of course may treat him for conditions other than his addiction.... Mr. Polansky has been advised of the availability of drug treatment programs in the community and that he should obtain treatment there for his addiction. Again, we appreciate your timely call. You have probably avoided much future difficulty."

Seymour Rubin was indeed out of difficulty with the medical powers who could obliterate his right to practice his profession but not with his own conscience. He could not sleep well for weeks because he felt so ashamed at his weak compliance with the inhumane and ignorant decisions of the appointed state medical drug experts. There was no way to separate Milton's organic diseases from his addiction — and certainly no drug treatment program of Dr. Rubin's knowledge that could cure his addiction. It was at about this time I called Dr. Rubin at Milton's urging, and while he agreed to talk with me, he asked that his name not be used because of his personal sense of shame. Since then, his sense of outrage has taken over.

"Even though I will prescribe no more Dilaudid, there is considerable conflict with what I consider the reasoned and compassionate practice of medicine," Dr. Rubin's notes stated. "Has Milton manipulated doctors, perhaps including me, because he is basically an evil person? No, he has done so because that is the only way available to him to obtain relief from his pains and agonies. Yes, he is at fault for having started his atrocious habit many years ago but do we treat chronic smokers and alcoholics in the same manner?... He is incurably addicted and more Dilaudid pills will do him no harm.... If we can take care of his other problems, his significant renal disease, his uncontrolled diabetes, etc., then we might make an attempt at treating his addiction. He is in far greater danger of the former than the latter, and is more likely to die of them." Operating on his own sense of medical science and ethics, Seymour Rubin had arrived at roughly the same humane point as had the Rolleston Committee some 56 years previously. Yet, he found himself unable to act on his convictions.

Dr. Rubin periodically responded to crisis visits and calls from his patient, to whom he would prescribe no more narcotics. He saw him deteriorate further before his eyes. On March 13, 1984, Milton showed up without an appointment at the doctor's office in a state of collapse. Dr. Rubin pleaded with him to enter the hospital immediately for treatment of all his conditions. Milton refused for all of his usual reasons. He was in enormous pain and shouted that he would lie on the examining table until Dr. Rubin gave him a prescription for Dilaudid. Even though he could barely walk be-cause of the impending gangrene, he threatened to go out and rob a drug store if the doctor did not relent. The doctor did not. The elderly grandfather cursed and shouted and raved that Seymour Rubin was "just like the rest of the fucking asshole doctors."

After that incident, Dr. Rubin lost touch with Mr. Polansky. "I had heard rumors that these were agonizing times for him," Dr. Rubin told me. Almost a year passed. Milton somehow carried on although his doctor later observed, "It was a sur-prise he lasted a.s long as he did."

Milton Polansky, heroin addict, was pronounced dead by the medical examiner on March 8, 1985, at 3:50 p.m. Apparently, the old man died alone, perhaps in pain. His body laid undiscovered on the floor of his apartment for some time — since the medical examiner estimated on the death certificate that the date of death was March 3. The immediate cause of death was listed as "Arterio-sclerotic Cardiovascular Disease." A contributing condition was listed as "Diabetes Mellitus." There was no mention of narcotic use or overdose:

Dr. Seymour Rubin shot off an angry letter to Dr. Stephen Hirsch and the state drug committee containing rare words of professional condemnation: "Your committee's concern with his drug addiction...was disproportionate and tangential. I thought it was more derived from sanctified dogma and bogus fears rather than from any true feelings about the quality of life or even the life itself."

Sitting in his office, alone with me on a quiet day during the holiday season at the end of 1985, Dr. Rubin was still ashamed and bitter: "In essence, I felt that we in the medical profession had pronounced his death sentence. If he had any chance of living, we took it away."

Arnold S. Trebach, The Great Drug War, p. 271.