American concern with narcotics is more than a medical or legal problem—it is in the fullest sense a political problem. The energy that has given impetus to drug control and prohibition came from profound tensions among socio-economic groups, ethnic minorities, and generations—as well as the psychological attraction of certain drugs. The form of this control has been shaped by the gradual evolution of constitutional law and the lessening limitation of federal police powers. The bad results of drug use and the number of drug users have often been exaggerated for partisan advantage. Public demand for action against drug abuse has led to regulative decisions that lack a true regard for the reality of drug use. Relations with foreign nations, often the sources of the drugs, have been a theme in the domestic scene from the beginning of the American antinarcotic movement. Narcotics addiction has proven to be one of the most intractable medical inquiries ever faced by American clinicians and scientists. Disentangling the powerful factors which create the political issue of drug abuse may help put the problem in better perspective.

Fear of narcotics has grown with the awareness of their use. Dr. Holmes in 1860 and Dr. Beard in the 1870s and '80s warned that narcotics abuse was increasing. They based their attacks not only on direct observation but on the open record of import statistics. By 1900 restrictive laws on the state level had been enacted, and reformers began to look to the federal government for effective national regulation. Reform-minded leaders of the health professions agreed on the need to eliminate the nonmedical use of narcotics.

Those seeking strict narcotic controls believed that either the need for money to buy drugs or a direct physiological incitement to violence led to crime and immoral behavior, Inordinate pleasure caused by drugs, moreover, was seen to provide youth with a poor foundation for character development, and a resulting loss of independence and productivity.

The most passionate support for legal prohibition of narcotics has been associated with fear of a given drug's effect on a specific minority. Certain drugs were dreaded because they seemed to undermine essential social restrictions which kept these groups under control: cocaine was supposed to enable blacks to withstand bullets which would kill normal persons and to stimulate sexual assault. Fear that smoking opium facilitated sexual contact between Chinese and white Americans was also a factor in its total prohibition. Chicanos in the Southwest were believed to be incited to violence by smoking marihuana. Heroin was linked in the 1920s with a turbulent age-group: adolescents in reckless and promiscuous urban gangs. Alcohol was associated with immigrants crowding into large and corrupt cities. In each instance, use of a particular drug was attributed to an identifiable and threatening minority group.

The occasion for legal prohibition of drugs for nonmedical purposes appears to come at a time of social crisis between the drug-linked group and the rest of American society. At the turn of this century, when the battle for political control of freed blacks reached a peak ( as shown by the extent of disenfranchisement, lynchings, and the success of segregation policies ), cocaine, a drug popular among whites and blacks and in the North as well as the South, was associated with expression of black hostility toward whites. Chinese and opium smoking became linked in the depressions of the late 19th century, when Chinese were low-paid competitors for employment, and this connection intensified during the bitter discrimination shown Orientals in the first decade of this century. The attack on marihuana occurred in the 1930s when Chicanos became a distinct and visible unemployed minority. Heroin, claimed to be an important factor in the "crime wave" which followed World War I, was implicated in the 1950s as part of the Communist conspiracy against the United States. A youth culture which attacked traditional values became closely connected with marihuana smoking and the use of other psychedelics. Customary use of a certain drug came to symbolize the difference between that group and the rest of society; eliminating the drug might alleviate social disharmony and preserve old order.

The belief that drug use threatened to disrupt American social structures militated against moves toward drug toleration, such as legalizing drug use for adults, or permitting wide latitude in the prescribing practice of physicians. Even if informed students of drugs such as Dr. Lawrence Kolb, Sr., in the 1920s argued that heroin does not stimulate violence, guardians of public safety did not act upon that information. The convenience of believing that heroin stimulated violence made the conviction hard to abandon. Public response to these minority-linked drugs differed radically from attitudes toward other drugs with similar potential for harm, such as the barbiturates.

Narcotics are assumed to cause a large percentage of crime, but the political convenience of this allegation and the surrounding imagery suggest the fear of certain minorities, and make one suspicious of this popular assumption. During the last seventy-five years responsible officials have stated that narcotics caused between fifty and seventy-five percent of all crimes, especially in large cities like New York. Narcotics have been blamed for a variety of America's ills, from crime waves to social disharmony. Their bad effects have been given as the excuse for repressing certain minorities, as evidence for stopping legal heroin maintenance in 1919, and as evidence for starting legal heroin maintenance in 1972.

Like the speculated percentage of crimes caused by narcotic use and sales, the number of addicts estimated for the nation appears often to have been exaggerated. Peaks of overestimation have come before or at the time of the most repressive measures against narcotic use, as in 1919 when a million or more addicts and five million Parlor Reds were said to threaten the United States. Both groups were the object of severe penalties, although in retrospect both figures appear to have been enormously inflated. Still, the substantial number of addicts in the United States has presented one of the most enduringly difficult aspects of any proposed control program. The size of this population has made control of misuse in maintenance programs difficult. There has been a fair amount of diversion of drugs to the illicit market and some registration of non-addicts.

In America, control of narcotics could take only a limited number of legislative forms. The lack of broad federal police powers inhibited the restriction of drug transactions. The division of federal and state powers in effect permitted widespread and unscrupulous dissemination of untested products and unsafe drugs. When the danger of narcotics came to the attention of popular reform movements and after carefully phrased federal legislation was at last enacted in 1914, it took the Supreme Court five years to overcome the apparent obstacle of states' rights. In 1919 the court permitted the federal government almost prohibitory power for prevention of most addiction maintenance. The court's majority affirmed the reformers' belief that simple addiction maintenance was intolerable.

Nevertheless, after 1919, severe constitutional strictures continued to mold enforcement of the Harrison Act. Because all professionals (unless convicted of a violation) had to be treated equally under a revenue statute, the federal government could not discriminate against careless or unscrupulous physicians and druggists by refusing them a tax stamp or by employing some other fair form of flexible administrative punishment. This lack of legal accommodation to circumstances, the small number of agents, and a bureaucratic reward system which favored a large number of prosecutions led to harassment and intimidation as a prominent mode of regulation. Because government agents feared that precedents might prevent indictment of "dope doctors," exceptions to the no-maintenance rule were few. The mutual suspicion which grew up between agents and physicians inhibited reasonable enforcement of the law. The manner of closing the Shreveport clinic illustrates the combination of suspicion and inflexibility.

The federal narcotic authorities never forgot that theirs was a narrow path between federal and states' rights. As late as 1937 the Treasury Department chose to prohibit marihuana by a separate law because it feared an attack on the constitutionality of the Harrison Act. in spite of organized medicine's opposition in the 1920s, and despite several close Supreme Court decisions, the extreme interpretation placed on the Harrison Act in 1919 continued to prevail. Why did the Supreme Court agree that a federal statute could outlaw narcotics, when the Constitution itself had to be amended to outlaw alcohol? One answer to this may be that in the case of narcotics the consensus was almost absolute; everyone appeared to agree on the evils of these drugs. For alcohol, there was no such agreement.

Foreign nations have played important roles in the American perception of its national drug problem. World War I is the watershed in national self-consciousness vis-à-vis foreign powers, dividing respectable opinion on the relative importance of domestic and international causes of narcotics use in the United States. In the prewar years the United States displayed confidence in traditional diplomatic methods and the efficacy of international treaties. Prior to the war and the immediate postwar security crisis, the usual explanation for the American drug appetite rested on characteristics of American culture—the pace of life, the effect of civilization, wealth which permitted indulgence, and inadequate state and federal laws which did not protect citizens from dangerous nostrums and incompetent health professionals.

After World War I, open official criticism of America's defects was no longer common. Whereas Hamilton Wright saw international control of narcotics as a solution to America's indigenous problem and recognized that this nation would benefit more than others from international altruism, Representative Porter in the 1920s denied any unusual appetite for narcotics in the United States, blaming our problem on the perfidy and greed of other nations. Richmond Hobson, equally as patriotic, claimed the country had an immense number of heroin addicts and consequent crime waves due to the evil influence of other nations. Hobson viewed America as surrounded by other dangerous continents—South America sent in cocaine; Europe contributed drugs like heroin and morphine; Asia was the source of crude opium and smoking opium; Africa produced hashish. Porter and Hobson sounded one theme: the American problem was caused by foreign nations. The spirit of national isolation which excluded participation in the League of Nations extended easily to international narcotic control. Americans were encouraged to condemn diplomacy as zealously as they had once sought conferences and commissions.

Projection of blame on foreign nations for domestic evils harmonized with the ascription of drug use to ethnic minorities. Both the external cause and the internal locus could be dismissed as un-American. This kind of analysis avoids the painful and awkward realization that the use of dangerous drugs may be an integral part of American society. Putting the blame on others also permits 'more punitive measures to be taken against certain of the culprits.

The history of American narcotic usage and control does not encourage belief in a simple solution to the long-standing problem. Reasonable regulation of drug use requires knowledge of physiological and psychological effects, an understanding of social causes of drug popularity, and an appreciation of how legal sanctions will actually effect the use and harmful results of drug ingestion. In the construction of such a policy, recognition of accidental and irrational factors in past drug legislation is essential, although no ideal program can be simply extrapolated from an historical study.

Political judgment and values have been paramount in the establishment of national drug policies. The commonsense conclusions reached by legislators, high-ranking government bureaucrats, and influential public figures, without any special or technical knowledge of drug abuse, are likely to gain acceptance from other national social and political institutions. Political judgments made in harmony with popular demands for narcotic control ( or release from liquor control) have a proven longevity. Resisting insistent popular demands is unusual among public officials; considerable political acumen is required to modify prevailing fear and anger into constructive programs.

As the pressure for political action reaches a climax, policy options are almost imperceptibly reduced to the few which have current political viability. The rapid crystallization of public policy in 1919— 20 illustrates how quickly this last stage of policy formulation may pass. Dissidents like Rep. Volk and Dr. Bishop continued to protest, to little effect. Once the national mood had been settled, any attempt to reopen the painful question met strong resistance. The 1919 formulation defined a broad range of issues in narcotic control, and yet the battle was waged on curiously narrow lines. In the medical profession, for example, both those for and against the "disease" concept of addiction carried on their dispute over the question of whether antibodies or antitoxins were produced by morphine administration. The lack of such substances seemed to prove that addiction must be a mere habit, and that those who held out for the "disease" concept had unworthy motives. In that period of crisis over narcotic policies fifty years ago each side was unwilling to compromise and sought to sweep the adversary from the field.

Today an issue like methadone maintenance may form the model on which a consensus is reached. This might lead toward simple toleration, or to prohibition of natural and synthetic opiates for nonmedical purposes ( which would include "mere addiction"). As new generations confront the narcotic question, the same old fundamental issues continue to arise. Current debates over heroin maintenance focus on such basic questions as the effect of heroin on the body and personality. One almost hears the voice of Dr. Bishop arguing that if an addict is in heroin balance he is a normal person as regards the effect of the drug, and Captain Hobson warning that heroin use gradually destroys the brain's higher centers. After more than half a century since the Harrison Act's passage one of the few statements about narcotics on which there is general agreement is that there is no treatment of hardcore addiction which leads to abstinence in more than a fraction of attempts. The lack of agreement on other crucial questions and their relative importance is almost total.

Although social and cultural influences are essential elements in the creation of the American drug problem, it is quite possible to provide a viable political response to public outcry and at the same time avoid an objective examination of critical issues: the nature of American society; the psychological vulnerability of addicts; the physiological effects of drugs; the social impact of drug use. Our society's blindness to alcohol's destructive effects is an example of how denial of reality is compatible with a politically comfortable resolution of a controversial drug problem.

We are now at a time when the credibility of previous solutions is sufficiently low so that some of the unresolved questions can be raised and again discussed. Gradually; and not necessarily as the result of formal decisions, the scientific and political alternatives regarding drug abuse may, as they have in the past, diminish. As a new workable political solution evolves the controversy tends to narrow to a few issues. Ideally, public pressure for elimination of the drug problem should not be met with fewer options. Rather the effective translation of knowledge, scientific and historical, should enable the public to avoid oversimplification, and to exert influence based on more rational understanding. But only the most determined efforts can prevent closure on drug policy by those two most powerful forces: fatigue and frustration.