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Gradually, at times imperceptibly, in the years.after World War I, use of narcotics in the United States declined. The nadir was reached during World War II; not only had usage gone down prior to those hostilities, but it declined even further as the disruption of international transportation cut down on supplies. From being easily available and commonly used, heroin, morphine and cocaine almost faded out of nonmedical situations: when someone was caught with drugs, the event elicited headlines and comment. Once commonplace, narcotics use waned into little more than rumors about this physician or that movie star. Personal knowledge of a "dope fiend" was unusual for the vast majority of Americans by the 1950s.
The consensus on drugs—intolerance toward the use or advocacy of narcotics—was well-setablished by the mid- or late 1920s. As a result, members of the generation born in the 1920s grew to maturity with diminishing direct knowledge of, but a great deal of animosity toward, the substances. Their parents had lived through the drawn-out, intense experience with drugs that marked the nation's first wave of narcotics use, peaking around the turn of the century. It was an experience not unlike that we have endured over the last twenty years. Not only could the parents convey their fear of drugs, but they had the advantage of direct knowledge, which sustained their conviction and helped instill it in their children. The next generation, the grandchildren or great-grandchildren of those who knew about drugs, carried into the 1960s no direct knowledge of narcotics but had heard exaggerations about them that were in fact minatory rather than informative. Indeed, new generations not only lacked information gained firsthand sixty years earlier, but by and large had little awareness that there had been an earlier, extensive experience with morphine, heroin, and cocaine.
As documented in earlier chapters, it was when drug intolerance increased that laws such as the Harrison Act (1914) were enacted and the Supreme Court outlawed addiction maintenance ( 1919). The public continued to support vigorous law enforcement against addicts and physicians, among others, and the laws themselves were made increasingly severe. During that climate of growing intolerance, the Marihuana Tax Act was easily passed in 1937 because the substance was linked to other alarming drugs such as cocaine and heroin. In contrast, when cocaine surfaced again in the mid-1970s, at a peak of drug ( especially marihuana) toleration, it was easily assimilated with the drive to legalize or at least "decriminalize" marihuana, and the decriminalization of cocaine was widely discussed.
Anti-drug laws increased in severity from the 1930s well into the 1950s. The peak was reached in 1956 when the death penalty was applied to the sale of heroin to minors. Draconian penalties against narcotics faced little opposition during this era of drug intolerance and growing unfamiliarity with the direct effects of drugs. The Federal Bureau of Narcotics had meagre resources, and the research effort on the scientific front was modest. The bulwark against drug use was popular imagery—the more fearful the better. Not much should be said, but what was said should depict drugs as so revolting and dangerous that no youngster would try a narcotic even once.
The portrayal of narcotics in motion pictures had been banned under the Production Code of the Motion Picture Association ( 1934 ) so that no major studio would touch the subject until a slight relaxation in 1948 allowed filming of To the Ends of the Earth, a dramatization of the worldwide efforts of the Federal Bureau of Narcotics ( FBN ) to stop drug smuggling into thé United States.1 In 1955 the film Man with the Golden Arm broke Hollywood's silence shortly before the death sentence for selling heroin to minors became law. Both the film and the law, the so-called Little Boggs Act, had been prompted by the first stirrings of a renewed heroin wave in the United States ( see p. 23off )
When I interviewed former Narcotics Commissioner Harry J. Anslinger in 1972, he described his astonishment at the explosion of drug use in the 196os. He felt the FBN had reduced the level of addiction to a minimum, and the rise of heroin and marihuana usage in the late 1960 s was a phenomenon he had never seen before nor expected.2 Anslinger had counted on stiff mandatory sentences, negative drug imagery, and the consensus of national institutions against drug tolerance. The 1960s broke through that brittle shell of defense, behind which lay an ignorance of drugs, perceptions so extreme as to be laughable to the new drug users, and a prison system that would be overwhelmed by a small fraction of those breaking the drug laws. The renewed popularity of drugs, about a lifetime after the previous surge of interest and consumption, arrived in an atmosphere that indeed was unfamiliar to Anslinger and others of his generation who had devoted their lives to reinforcing the intolerance toward drugs that had emerged by the beginning of this century.
I am reminded of a conversation I had with a narcotics officer while researching the original edition of this book. He offered whatever help he could, for, he said, he was very troubled by the change in public attitude toward his job: "Years ago, when I started arresting possessors of narcotics, I was a hero; now the public thinks I'm a rat. Yet, I'm doing exactly the same thing I have always been doing. I don't understand it."
Almost three decades have passed since the 1960s began, and we have moved from a peak of toleration during the Carter administration to an opposition to drug use echoing, although not yet matching in severity, those decades of intolerance. The recent years have given us experiences that allow us to understand both points of view and to appreciate the recurrent quandary drug use presents to Americans.
RESPONSE TO THE RISE IN DRUG USE, 1968-1973
The use of illegal drugs increased astoundingly in the 1960s. Drugs thought safely interred with the past, marihuana and heroin, rapidly resurfaced at the same time that new drugs such as LSD materialized and attained tremendous popularity among young people. This rapid turnaround occurred amid massive changes in American society, which we must appreciate in order to understand the reactions drug use evoked.
The entire decade was a period of enormous growth in the wealth of the United States. The gross national product doubled from 1960 through 1970. Funds were available not only to wage a war in Vietnam but also to fight the War on Poverty. All this productivity and money created an unparalleled market for consumer goods and anything else that promised to make a person feel comfortable, including drugs.
At the same time, the generation of "baby boomers" entered that period of their lifespan in which they were most susceptible to drug use, violence, and crime—ages 15 through 24. Within the decade this age group had increased by 11 million, an astounding gain of nearly 50 percent and over twice the increase that would take place in the next 10 years.3
Furthermore, these many young people were stressed by the war in Vietnam, which relied on military draft for manpower, and were encouraged to attack traditional culture by such older, charismatic figures as Dr. Timothy Leary, who urged youth to "turn on, tune in, and drop out." Increasingly, young people gathered to celebrate their own culture, as at Woodstock in August 1969, or to protest the war, as in the march on Washington in November 1969; and drugs, particularly marihuana, pervaded the crowds. Older Americans, viewing these gatherings through the media, saw drug use as a symbol of rejection of traditional values and patriotism and a prime illustration of the frequently bemoaned generation gap.
We can gauge the response to marihuana use by the increase in arrests at the state level for marihuana possession, which rose from 18,000 in 1965 to 188,000 in 1970.4 A national survey in 1971 estimated that 24 million Americans over the age of i11had used marihuana at least once. The highest incidence was among 18- to 21- year-olds, of whom 40 percent had tried marihuana.5 A reflection of the rise in drug use, chiefly heroin, by needle injection can be seen in the rapid rise in narcotic-related hepatitis cases from about 4,000 in 1966 to about 36,000 in 1971.6 Never easy to estimate, the number of heroin users rose from about 50,000 in 1960 to roughly a half-million in 1970. This wave of drug use alarmed most of the public and their representatives in Congress.
In November 1968, when drug use and its social damage Were both rapidly increasing, Richard Nixon was elected President on a platform of restoring law and order. No President has equalled Nixon's antagonism to drug abuse, and he took an active role in organizing the federal and state governments to fight the onslaught of substance abuse.
THE NIXON WAR ON DRUGS
One year prior to President Nixon's inauguration in January 1969, the drug enforcement agency in the Department of Health, Education, and Welfare (HEW) and the FBN had been united as the Bureau of Narcotics and Dangerous Drugs (BNDD). Within the National Institute of Mental Health ( NIMH) a small Center for Studies of Narcotic and Drug Abuse had been established. The Customs Bureau chiefly guarded the border, and the BNDD dealt with domestic and foreign matters (although the division of responsibility had overlapping elements, which frustrated both agencies). The drug budget for fiscal year ( FY ) 1969 was $86 million and in FY 1970, the last Johnson budget, $101 million.7
Treatment for those with drug problems ranged from outpatient care based on traditional psychotherapy or counseling to inpatient care for detoxification from addictive drugs such as heroin or extended drug-free care in a therapeutic community such as Phoenix House in New York City. The appearance of methadone stimulated the creation of outpatient facilities where that drug, and nothing else in many instances, could be obtained. After an initial optimistic report in 1966, methadone's popularity quickly spread; it was hailed as one of the first new ideas to combat heroin addiction, the most feared form of drug abuse at the time. Methadone, a long-acting opioid taken by mouth, could substitute for shorter-acting heroin taken by needle. It thereby reduced the danger of needle-transmitted diseases such as hepatitis, gave the patient a better chance for employment, and ended the need to commit crimes to maintain the addiction. Curiously, though, for some years it seemed as if methadone was seen by the public as a cure for addiction, more like penicillin for pneumonia than like insulin for diabetes.
Methadone's appeal was in no small measure due to its reputed effectiveness in cutting into the crime attributed to drug use, especially heroin addiction.8 The initial medical or therapeutic response to the rise in drug abuse was accelerated by methadone's reputation for achieving results. For decades critics of the law enforcement approach had pleaded for a more humane solution to dangenfus drug use. Not only did methadone seem to answer that call, but it was a big step toward sanctioning the most extreme anti-enforcement style, the provision of heroin itself to heroin addicts.
Lifting restrictions on individual choice—even to permit the unhindered use of drugs most Americans considered dangerous—harmonized with broader efforts at social reform in the 196os. Barriers to individual opportunity were under attack at every level of American life, and it should not be surprising that some observers would see drug use as an expression of personal choice that no other person or social institution had a right to obstruct. Advocates of drug use, such as Dr. Leary, specifically hailed drugs for promoting individual fulfillment. Commentators on youth described drug experimentation as an ordinary element in adolescent life—a natural, not a fearful, phenomenon.
Although the government did not legalize heroin maintenance, arguments to do so on libertarian grounds and as a practical mechanism to cut down on thefts performed to maintain illegal addiction were part of a growing toleration around 1970 for unrestricted drug availability.9 In this context, methadone maintenance in the Nixon anti-drug program can be seen as a compromise between simple toleration of drug use and the public's demand that crime associated with heroin be curbed. Addicts got something to assuage their drug cravings, but not their first choice.
The final component of the Nixon administration's "war on drugs" was greater emphasis on law enforcement, although the budgetary support for treatment programs was even larger. The twin goals were to cut off the foreign supply of heroin and at the same time to increase drug treatment programs massively so that those in trouble with drugs could find help if they wanted it. Drug availability and consumer demand for drugs were to be attacked simultaneously.
CURBING TURKISH OPIUM PRODUCTION
To facilitate enforcement Nixon took the lead in demanding that the influx of drugs from Turkey be stopped in one way or another." The federal government estimated that 80 percent of heroin reaching the United States came from Turkey. The significance of the president's determination lay in the almost invariable rule that the drug problem is a secondary concern to American foreign policy goals. As bad as drug trafficking might appear to Americans, when a decision involves dealing effectively with a drug-producing or -exporting nation while maintaining national security interests through friendly relations with that country, national security and good relations nearly always win out over the important but less crucial issue of drugs. This makes Nixon's personal insistence regarding Turkish opium unusual in the history of American drug policy.
While making strong diplomatic representations and threatening to cut off aid if Turkey did not squash the export of drugs to the United States, the Nixon administration also promised to reimburse Turkey for subsequent losses resulting from reduced poppy cultivation. Turkey did in fact cease being a significant source of heroin on American streets. Accounts generally agree that the drug was more scarce in 1972 and 1973, although the degree to which the Turkish ban was responsible has been debated. At about this time a smuggling ring that transported morphine base from Turkey to France (where it was changed into heroin and sent on to America) was broken up.11 Also, from 1971-73 methadone and other treatment centers aimed at reducing demand for heroin increased enormously. Whatever the reason, it is generally agreed that the heroin problem was briefly reduced. Soon, however, the slack in supply was taken up by Mexican production and other supplies from Southeast Asia's Golden Triangle, Afghanistan, Pakistan, and so on. Turkey resumed growing poppies in 1975 using a method of harvest that appears to make diversion from licit production much less likely.12 However, because estimates are that the U.S. demand for heroin can be met by the amount of opium poppies growing on a ten- to twenty-square-mile patch of land, ending one country's excessive production does not eliminate the supply.13
In retrospect, one lesson of the Turkish opium ban is that the political determination to take such an action and the circumstances that give the United States sufficient leverage with the producing nations are rare. Dramatic reduction in total foreign production is not to be expected soon or broadly. Decreased domestic demand for drugs, such as occurred in the United States after World War I, appears the more likely course for improving the drug problem.
In addition to addressing the Turkish supply and the "French connection," the Nixon program rapidly expanded law enforcement agencies such as BNDD. The budget for enforcement rose in FY 1970 from $43 million to $292 million in FY 1974.14 In January 1972 the Office of Drug Abuse Law Enforcement ( ODALE ) was established. A domestic strike-force operation employing the "no-knock" provisions that federal law had authorized in 1970, it garnered bad publicity with its assaults on some innocent families.15 ODALE had been criticized as an election-year gambit to go after local drug offenders with great fanfare. John Ingersoll, Director of the BNDD, had refused White House pressure to become deeply involved with small-scale operations, preferring to concentrate on major dealers and international interdiction. This lack of cooperation led eventually to his leaving the government when ODALE was melded into the BNDD with the creation of the Drug Enforcement Administration (DEA) in 1973.16 Shortly before, Myles J. Ambrose, head of ODALE and a former customs commissioner who was widely assumed to be the administration's choice to head DEA, also resigned.17
DEMAND REDUCTION
The other prong of the Nixon strategy was drug abuse prevention, which included research, education, training, rehabilitation, and treatment—efforts to reduce demand for drugs among the American public. Here the monies authorized by the federal government rose from $59 million in FY 1970 to $462 million in FY 1974.18 Nixon established the Special Action Office for Drug Abuse Prevention ( SAODAP ) to coordinate the many government programs linked to the drug problem but especially to give leadership to a crash program of treatment services. To head this unparalleled elevation of drug abuse issues to national prominence, Nixon chose Dr. Jerome H. Jaffe, an academic researcher who was familiar with treatment programs, especially methadone maintenance. Dr. Jaffe, who came to be known as the "drug czar," was urged by the President to knock heads together to achieve the high priority of curbing the drug menace.19
VIETNAM AND HEROIN
Dr. Jaffe faced an urgent problem, all the more troublesome because of its connection with the unpopular Vietnam War. This was the imminent return of American servicemen, many of whom had been frequent users of marihuana and heroin. Estimates for the number of men using heroin were as large as 25 percent.20 Would these drug users spur the domestic drug problem to an even higher level of social disorganization and violence? The similarity to the fear of returning veterans following World War I is evident.
Dr. Jaffe organized a urine-testing program that allowed those with negative tests to return to the United States without interference; those who tested positive for opiates would be remanded for a brief period of detoxification and further treatment, if necessary. One of the most interesting aspects of returning veterans who had tested positive for heroin was that very few continued using it once back home.21 This suggested that the easy availability of heroin in South Vietnam led to increased use and also that different settings had a profound effect on the desire to use drugs. Dr. Jaffe was so impressed by the efficacy of urine testing for drugs that he thought it might eventually be considered in the same light as chest X-rays for tuberculosis.22
EXPANSION OF TREATMENT PROGRAMS
The early 1970s brought an explosion in treatment facilities. SAODAP stimulated an increase in the number of cities with federally funded programs from 54 to 214 in the first 18 months of operation. From 20,000 clients in these programs in October 1971, the number climbed to over 60,000 by December 1972. Programs for methadone clients, either funded federally or otherwise, were enrolling 80,000 persons by October 1973, just over two years after SAODAP's
creation.23
While methadone treatment expanded, some communities grew suspicious that those administering the federal program had insidious motives and that the drug was actually extremely dangerous.24 Over the years, methadone has not been found to have any significant long-term negative effects; but at the same time the public's hope and expectation that methadone would solve the drug problem has faded. Methadone has been useful for some clients, particularly when assisted by the client's motivation and expert clinical support.25
Drug-free clinics and inpatient programs have paralleled the rise of methadone clinics. In the early 1970s, adherents of these differing approaches often carried on antagonistic public debates. Drug-free proponents argued that only completely getting away from drugs would result in a curative outcome. To take methadone, according to this way of thinking, was to be still dependent on a drug. The methadone advocates argued that some of those addicted to opiates had created for themselves a lifelong need that required an opiate to feel normal. Yet another position was that methadone was required for a while, perhaps a year or two, for an addict to reestablish a stable life and employment. Once this productivity had been set on a solid foundation, the client could be detoxified from methadone.
Whatever their persuasion, most people have acknowledged that withdrawing from methadone might be as hard or harder than ending a dependence on heroin, but that the advantages of stopping the use of needles and involvement with illicit drugs outweighed the disadvantages. As the years have passed, the two ways of dealing with opiate addiction have learned to live in better harmony, although in the 1980s drug-free treatment more closely matches the public's growing desire for a drug-free society. Abusers of other drugs—marihuana, alcohol, LSD, and so on—have so far no substitutes like methadone for heroin or morphine available, and so drug-free therapy for them is less controversial.
RANKING DANGEROUS DRUGS
Dr. Jaffe and other experts called into government service to handle the rapid rise in drug use faced the intriguing problem of how to list drugs in order of dangerousness. The history of drug laws in the United States shows that the degree to which a drug has been outlawed or curbed has no direct relation to its inherent danger. With the prospect of billions to spend on fighting drug abuse, the federal policymakers tried to reorient anti-drug thinking so that it reflected actual dangerousness. They were burdened by the fact that negative characterizations that had developed during the concluding, intolerant phase of the previous wave of drug use were so extreme. Left over from the 1930s, for example, was an image of marihuana far worse than its acknowledged adverse health effects.
Establishing actual dangerousness sounds reasonable, but the process had its difficulties. If the dangers of drugs were to be ranked according to deaths linked to their use, tobacco and alcohol would head the list. These substances, however, had powerful economic and political interests behind them and moreover were not part of the public's fear over the drug crisis, which had led to the Nixon response. How could these be included in the anti-drug campaign? If not included, how credible would this new scientific approach toward drugs' dangers be?
The first Federal Strategy for Drug Abuse and Drug Traffic Prevention ( 1973) granted the problems caused by alcohol and tobacco but argued that the federal anti-drug effort was primarily intended to attack illicit drugs and, furthermore, that alcohol and tobacco are deeply ingrained in American "social rituals and customs." Chief responsibility for the two familiar drugs lay with the National Institute on Alcohol Abuse and Alcoholism and the "overall mission of the Department of Health, Education and Welfare."26 As the years have passed, tobacco and alcohol increasingly have been perceived by the American people as dangerous drugs.
COMPREHENSIVE DRUG ABUSE AND CONTROL ACT (1970)
An attempt to rank drugs by a common standard of dangerousness was written into legislation in 1970. Specific drugs could be assigned to categories with appropriate restrictions. Britain had tried this way of differentiating among drugs of varying danger through its Pharmacy Act of 1868. The system permitted changes among the categories by an administrative process, should a drug be shown to be more or less dangerous than its first assignment.27 Generally, laws had been enacted to deal with one dangerous drug at a time: in 1909, smoking opium; in 1914, cocaine and the opiates; in 1924, heroin; in 1937, marihuana. Obviously, the attitude a drug provoked at the time of its restriction could be frozen into the law, and changes were difficult later on, for every change required another law formulated in a political atmosphere.
In1970 the earlier laws were combined in the Comprehensive Drug Abuse Prevention and Control Act (Public Law 91-513) with the establishment of five schedules for drugs, depending on the potential for abuse and dependency and the accepted medical use of each drug. Schedule One is reserved for drugs that are not permitted to be used in medical practice, such as heroin and LSD. Schedule Two contains the most dangerous prescribable drugs, such as morphine and cocaine; Schedule Three is for those less dangerous, including most barbiturates; Schedule Four, for chloral hydrate and meprobamate; and Schedule Five, for mixtures of low levels of narcotics such as codeine in a cough syrup. Different degrees of control are applied to manufacturers, distributors, and prescribers, depending on the schedule in which a drug has been placed.
This law represents a transition between reliance on law enforcement with severe penalties and a therapeutic approach—even a tolerance for at lease some previously forbidden drug use. It established no minimum sentences. It did provide that someone charged with a first offense for possessing a small amount of marihuana be placed on probation for one year or less with the possibility that the record would be expunged if no further offense occurred during probation. Still, law enforcement was strengthened in an extraordinary manner by allowing "no-knock" searches of premises at any time of day or night.
COMMISSION ON MARIHUANA AND DRUG ABUSE ( 1972-1973)
Uncertainty in this period of rising drug use, and conflicts between the philosophy of enforcement and that of treatment or toleration, were indicated by the establishment of a Commission on Marihuana and Drug Abuse ( NCMDA ). The Commission was composed of thirteen persons chosen by the President, Speaker of the House, and president pro tem of the Senate. Its first task was to report in a year on marihuana, descriptions of which were the most upsetting example of older, disgusting images from the 1930s colliding with youthful enthusiasm and praise for the drug in 1970. The Commission was ordered to report in two years on drug abuse in general.
Composed largely of traditionally minded members, the Commission had a powerful effect on the movement to tolerate marihuana use when it concluded in its first report that possession of small amounts of marihuana should be "decriminalized"; that is, possession for personal use could be a finable offense, like a parking ticket, but should no longer subject the possessor to jail. Dealing for profit in large amounts would still be a felony.28 The public did not always understand decriminalization in the way the Commission intended, but it did realize that it meant relaxation, not more severe penalties. President Nixon also understood the drift of the Commission and refused to receive the report in public from former Pennsylvania Governor Raymond Shafer, the Commission's chairman. The President made it clear that marihuana would not be decriminalized while he was in office.29
The final report appeared in March 1973 and reconfirmed its original recommendation about marihuana. In addition, the report called for a single federal agency to combine all drug efforts—enforcement, research, and treatment—for a period of several years. Possession laws should be interpreted as providing an opportunity not to punish but rather to direct users to treatment. The report suggested a moratorium on drug education efforts, including curricula, movies, and posters being spun off in all directions with a wide variety of warnings, philosophies, and other bits of information. Sentiment had been growing among drug experts that these efforts were a waste of federal money.30 Both the first and the final report stressed the greater problems posed for American society by alcohol and tobacco and urged that action be taken against them as well as the more conventionally perceived "bad" drugs.
THE NATIONAL INSTITUTE ON DRUG ABUSE ( 1973 )
Although no single federal agency has so far combined all antidrug efforts, in 1973 many programs were consolidated into the DEA and the National Institute on Drug Abuse ( NIDA ). Most prevention programs funded by the government were gathered under NIDA, which also became the center for drug research.31 The goal, however, was to decentralize programs into the states, and a first step toward that goal was the establishment of Single State Agencies. These would oversee treatment efforts and guide federal monies into local projects. SAODAP was mandated by law to end in mid-1975, and its central planning role was taken over by groups within the White House such as the Office of Drug Abuse Policy ( ODAP ) in the Carter administration. Over the course of several administrations, ODAP and similar groups enjoyed varying public visibility and influence with presidents who were also advised by even more obscure bureaucrats in the Office of Management and Budget, where great power is wielded over the funding of government programs.
THE FORD ADMINISTRATION, 1974-1977
The departure of President Nixon in August 1974 brought to the White House a man much more relaxed about recreational drug use. President Ford simply did not share Nixon's intense anger at drug users. Ford's attitude facilitated creation of a federal policy that openly acknowledged that drug abuse was here to stay and that hopes of elimination were illusory. His formal recognition of the limits of even the enormous federal effort during the Nixon years was contained in the White Paper on Drug Abuse, prepared by the Domestic Council Drug Abuse Task Force and published in September 1975, a year after Ford assumed the presidency. In a wide-ranging review of the anti-drug effort starting in 1969 ( which managed never to mention the name of President Nixon), the White Paper drew conclusions marking official recognition of a painful truth: "Total elimination of drug abuse is unlikely, but governmental actions can contain the problem and limit its adverse effects." The White Paper also made a clear statement on the ranking of anti-drug priorities: "All drugs are not equally dangerous, and all drug use is not equally destructive." When a choice must be made, "priority in both supply and demand reduction should be directed toward those drugs which inherently pose a greater risk - heroin, amphetamines ( particularly when used intravenously) and mixed barbiturates."32
MARIHUANA AND COCAINE
In the summary of this report, the words "marihuana" and "cocaine" do not appear in any of the seventy-seven specific recommendations covering the entire spectrum of federal drug activities. Both ommisions are significant. Only five years earlier, Congress had insisted that the Commission on Marihuana and Drug Abuse give highest priority to a report on marihuana. The result was unfavorable to the Nixon attitude but more congenial to the experts he had assembled and who were freer to express their own opinions after his departure. Americans were increasingly using marihuana, and the belief that smoking it regularly was dangerous was rapidly fading. In 1975 only 43 percent of high school seniors thought so, and that figure continued to fall until it reached its lowest point in 1978 when only 35 percent would hold that cautious view. At the same time the use of marihuana by high school seniors rose steeply. In 1975,15 percent reported use in the last 30 days; at its peak, in 1978 24 percent similarly reported.33 Clearly, a momentum was gaining in 1975 toward the acceptance of marihuana.
Cocaine, in contrast, was just coming into wide use. The final report of the NCMDA ( 1973 ) had suggested that the federal government might well end production of licit cocaine after a study to determine whether any need existed that could not be met by some other drug.34 Then, just as had happened in the mid-1880s cocaine gathered adherents who deemed it a remarkable drug, a tonic promoting cheerfulness and industry with no negative after effects—at least not with "moderate consumption," to quote an advocate from 1877.35
As in the nineteenth century, initial experiences with cocaine were so positive that some experts wondered whether the severe penalties for its use were not parallel to what they saw as those stemming from the misguided fear of marihuana. A prominent drug expert, Dr. Peter G. Boume, wrote in August 1974: "Cocaine . . . is probably the most benign of illicit drugs currently in widespread use. At least as strong a case could be made for legalizing it as for legalizing marijuana. Short acting—about 15 minutes—not physically addicting, and acutely pleasurable, cocaine has found increasing favor at all socioeconomic levels in the last year." 36
During a period of drug intolerance in the 1930s, marihuana was quickly outlawed when it was compared, among other dangerous drugs, to cocaine. In the mid-1970s, at the peak of recent drug tolerance, the effect of comparing the two was to imply that possibly both should be legalized.37 In each era a consensus developed on the way to handle new drug issues, a response any apparently reasonable person would accept. The problem with cocaine, demonstrated in the 1890s and again in the 198os, is that the most severe effects do not become obvious and eventually notorious until the drug has been used for an extended period of time by many people. Then praise for a tonic changes to fear of a poison, and society desperately seeks ways to repress the substance.
The Ford administration faced a resurgence of heroin addiction, which was attributed to establishment of Mexican poppy fields and heroin coming now from the South rather than from Turkey.38 The previous drop in heroin availability had led President Nixon to announce on 11 September 1973 that "we have turned the corner on drug addiction in the United States."39 That heroin should now re-emerge as a problem was discouraging and convinced policymakers that they were dealing with a much longer time-line than they had hoped was the case. Perhaps drugs would escalate indefinitely; perhaps drugs such as marihuana, cocaine, and even heroin should simply be legalized so as to end the enormous government expenditures of money and time on a problem that only seemed to bring profits to drug dealers and elicit contempt for the law from an ever-growing body of drug users. The presidential election of 1976 would carry this tolerant attitude to its peak.
PRESIDENT CARTER AND DRUG TOLERATION
President Carter's image combined disparate elements. A stranger to Washington politics, he could accomplish great things in government; a fervent Christian, he also appeared to tolerate drug use, particularly marihuana. As Governor of Georgia he had appointed Dr. Bourne as an advisor and to head the state's drug program. In 1972 Boume took a high post in SAODAP but left two years later to become a major figure in Carter's campaign. Carter's narrow victory in 1976 gave hope to those who wanted a more unequivocally tolerant approach to drugs, much as Nixon's close victory in 1968 buoyed those who wanted an assertion of "law and order." Boume was promptly named Special Assistant for Health Issues to the President and began to reorganize the drug policy of the federal government. His direct and easy access to the President and his intimate familiarity with drugs and drug policy made him the government's highest ranking and most influential drug authority in the nation's history.
Carter favored decriminalizing the possession of a small amount of marihuana. One ounce was chosen as that small amount. Civil penalties—for example, a small fine—might still be imposed, but criminal sanctions, such as a jail sentence, would be removed. Oregon had decriminalized marihuana in 1973, and studies credible to Bourne and other advocates of decriminalization indicated no dire consequences.40
In March 1977, less than two months after Carter's inaugu'ration and forty years after the Marihuana Tax Act Hearings, Bourne and high officials from DEA, the State Department, NIDA, NIMH, the Customs Service, and the Justice Department appeared before the House Select Committee on Narcotics Abuse and Control to argue for the decriminalization of marihuana. Boume, acknowledging that marihuana could pose some of the same dangers as alcohol does when, for example, a driver is intoxicated by either drug, explained that marihuana "is not physically addicting and in infrequent or moderate use, probably does not pose an immediate substantial health hazard to the individual." He recommended that federal law be amended in this area so that the states would have the option to determine what penalty to apply to the possession of small amounts. He noted that federal law "is now rarely enforced with regard to simple possession." Legalization, Boume argued, "would only serve to encourage the use of the drug when we seek to deter it," and furthermore, "legalization would violate the 1961 Single Convention of which the United States is a signatory."41
Five months later, President Carter followed up this campaign with his own message to Congress on drug abuse. The President repeated a familiar theme: "Penalties against possession of a drug should not be more damaging to an individual than the use of the drug itself; and where they are, they should be changed. Nowhere is this more clear than in the laws against possession of marihuana in private for personal use."42 He called for decriminalization and asked that this1972 NCMDA conclusion be implemented.
In February 1978, Boume addressed the United Nations Commission on Narcotic Drugs regarding United States drug policy. He did not specifically mention decriminalization, a process that some nations either had difficulty understanding or frankly opposed, but he called attention to the fact that priority of attention would be given to those drugs that caused the greatest threat to life. Barbiturates, implicated in nearly 2,000 deaths in the United States in 1977, ranked high on the list. Both heroin and marihuana, he reported, were being investigated objectively for their possible therapeutic value regardless of their historic reputations.43
Boume highlighted to this U.N. commission a success story in the drug war that would paradoxically lead to the end of his government career. The Carter administration was sensitive to charges that it was soft on drugs and looked to improvements in the heroin problem, as both a refutation and as a real achievement. After Nixon ended the Turkish supply, heroin slumped in the United States but then rose again during Ford's administration when it started arriving from Mexico. Bourne reported that heroin-related deaths were now at the lowest level since they had begun to be officially reported in 1973. Furthermore, heroin purity at the retail level also had fallen. The decline in heroin-related deaths had begun precipitously over the last year of the Ford administration, from a rate of about 2,000 per year to 800, but the low point did not come until Carter was in office and Boume was heading the anti-drug effort.44 Boume and other Carter drug experts felt that this important claim for success in the war against heroin was the result of Mexico's spraying of opium poppy fields with the herbicide 2-4-D, after Mexico had been urged as well as provided with financial aid by the United States to do so.45
Mexico's actual priority was to eradicate marihuana, which it saw as its major domestic drug problem, not opium poppies. Clearly, the Carter administration had worried less about Mexican marihuana entering the United States than about Mexican heroin. Subsequently, though, Mexican marihuana created a big problem for Carter and Boume because the herbicide used by Mexico for this part of the eradication program was paraquat. As news of this spread, so did the fear that paraquat-laced marihuana was entering the United States and endangering the health of millions of marihuana smokers, a fear that was excitedly fanned by the National Organization for the Reform of Marijuana Laws (NORML) and its sympathizers. Pro-marihuana forces were outraged: here was their favorite administration contaminating marihuana with a deadly poison. They insisted that it had to stop.46
Boume was now in a strange position. If he discouraged Mexico from spraying with paraquat by reducing aid, Mexico would still maintain its priority of spraying marihuana before poppies and the effect on the paraquat problem would be minimal. Furthermore, no one could ( or ever has) come up with a single verified instance of a marihuana smoker who had been injured by the paraquat spraying, although the Center for Disease Control had been ordered to look everywhere for potential victims. Still, the furor over paraquat continued unabated. On 12 March 1978, the Secretary of HEW announced in a press release that a "preliminary report" indicated that if an individual smoked "three to five heavily contaminated marijuana cigarettes each day for several months, irreversible lung damage will result." Senator Charles Percy announced in May that he was considering an amendment to the Foreign Assistance Act that would curb eradication programs such as the spraying of paraquat on marihuana plants. All the while, Keith Stroup, founder of NORML in 1971 ( and still its Executive Director) kept up a steady drumbeat of fear and anger directed especially against Boume and the White House drug policy staff over the spraying of marihuana with paraquat.
THE DEPARTURE OF DR. BOURNE
Stroup's opportunity to end Bourne's White House career came suddenly.47 In July Boume wrote a prescription for fifteen methaqualone tablets for an aide who complained of nervousness and difficulty in sleeping. He wrote the prescription for a fictitious name in order, he said, to be sure she would have nothing in her record to indicate an emotional problem. Such cover for prominent persons is said not to be uncommon in Washington, but because of a series of surprising coincidences, within days of the attempt to fill the prescription, the issue had become a national scandal. Bourne therefore decided to take a leave of absence in order to deal with the controversy. Then, at the height of the commotion, Stroup conveyed to a Washington Post reporter that an allegation was true that Dr. Boume had snorted cocaine at a party marking NORML's annual meeting the previous December.48 When this was reported on television the morning of 20 July 1978, Bourne decided he had no choice but to resign from the government. Earlier in the Carter administration, allegations of financial irregularities against Bert Lance, Director of the Office of Management and Budget, had dragged on an embarrassingly long time. Boume felt that the administration should be spared a repetition.
From the short-term perspective, the focusing of NORML's Executive Director on the paraquat issue had rid the government of the most influential person defending paraquat spraying. Soon Congress adopted the Percy amendment, which required an environmental impact statement for any U.S. funds that might support such activities as herbicide spraying in a foreign country.49 Meanwhile, the proposal to decriminalize an ounce of marihuana for personal use was still wending its way through Congress.
This state of affairs appeared quite satisfactory for the goals of NORML and of others who favored a more tolerant attitude toward drug use, but eventually a strategic error revealed itself. After Bourne's departure, government agencies, which he had been able to coordinate through his personal style and the authority he enjoyed as a personal friend of the President, returned to their own agendas and business as usual. Furthermore, because of the context of Bourne's departure ( the chief drug adviser writing a fictitious prescription and accused of taking cocaine at a party), the Carter White House was in no position to appear soft on the drug issue. No longer did presidential messages urge Congress to decriminalize marihuana. It may not have been apparent at the time, but the tide of toleration, which had been rising since the 1960s, had reached its high-water mark in government and public opinion and was set to recede. In terms of the goals NORML espoused, the departure of Dr. Bourne was a disaster. For all opposed to any use of marihuana and other drugs, particularly those in what would become the parents' movement, 1978 was the dawn of a better day.
THE REVIVAL OF ABSTINENCE: THE PARENTS' MOVEMENT
The year 1978 was a watershed in American attitudes toward drugs and drug use. As after the peaking of the first great wave of drug toleration a lifetime earlier, approval of drug use has declined gradually since 1978, and change in public toleration has been difficult to perceive in any one year. It is most easily seen in attitudes toward marihuana, the drug that led the demand for toleration.
Among high school seniors, the perception that smoking marihuana regularly is harmful hit a low point of 35 percent in 1978, rising steadily to 70 percent in the class of 1985.50 That near-reversal of attitude indicators within seven years reflects an increased wariness over the effects of marihuana. These figures are reinforced by those for seniors using marihuana within the past month: hitting their peak in 1978 at 37 percent, the figures dropped to 23 percent for the class of 1986.51 It is important to note that the decline in reported marihuana use has been accompanied by a parallel increase in concern over its effects. Decline in the use of drugs again appears to be associated, as it was in the 1920S and 1930s, not with indifference but with a positive antagonism to drugs, their ',effects, and ( to some degree) those who use them. The extent to which current antagonism, often described as "intolerance" by opponents to drug use, will continue affecting public attitudes and policies will be of great interest. It has not yet reached the settled condemnation that marked national attitudes in the 1930s and 1940s.
Illustrating both the change in attitude itself and the social and political forces that have fought for that change from the earlier tolerance of drug use are the parents' groups, whose origin can be traced back to the years of peak acceptance. The parents' groups also illustrate how drugs are perceived by those who must deal with their effects on young users and their effects on the family. Regardless of studies that could not find anything seriously troublesome about the "moderate" use of marihuana, the parents' groups carried forth into battle an absolute conviction about the danger of drug tolerance based on their own experiences as parents. The targets of their outrage included the sophisticated notion that "some" drug use was all right: they insisted that not only children but all members of society were endangered by drugs, including alcohol.
Parental concern over childrens' drug use was widespread, but the energy and organizational skills needed to gather parents into an effective political force emanated from a much smaller number of persons who give similar accounts of how they were drawn into actively opposing drug tolerance. Their initial experiences have in common a sudden revelation that the drug culture had invaded deeply their world, followed by outrage and stern determination to fight this unexpected, intrusive menace.52 A Silver Spring, Maryland, housewife named Joyce Nalepka, who later presided over the National Federation of Parents for Drug-Free Youth, attended a rock concert in 1978 with her two young children and discovered rampant drug use all around them. Her anger, shared by others she contacted, apparently was a major factor in the defeat of her Congressman, Newton Steers, who had co-sponsored a bill favoring the decriminalization of an ounce of marihuana. That a broad base of parents were antagonistic to drugs, and that they were now organizing their political power, had been demonstrated.
In Atlanta, Georgia, Marsha Manatt had discovered in 1977 that parties for young teenagers were starting to become drug parties. After ,organizing parents there, she came into contact with drug-abuse professionals but found them to be often hostile to her 49concerns and perceptions. She did receive encouragement from some experts, however, particularly Dr. Robert L. DuPont, then Director of NIDA, and her message spread. Under commission from NIDA she wrote a handbook for parents' organizations, Parents, Peers and Pot, of which a million copies were distributed after it appeared in 1979.53 DuPont had previously been an advocate for decriminalization but changed his mind, and by the time of his departure from government in 1978, he firmly opposed marihuana and its decriminalization. He later stated that "it was parent power that changed my mind on marijuana." Marsha Manatt had pooled her efforts with those of other activist parents to form PRIDE (Parent Resources Institute on Drug Education) in 1978. Two years later they formed a national umbrella for these parents' groups, the National Federation of Parents for Drug-free Youth ( NFP ).
Another parent, Otto Moulton, was shocked to discover in 1977 that a local newspaper shop in Massachusetts was displaying High Times next to the children's magazine Sesame Street. He and other parents decided in the late 1970s that they had had enough. In particular, they were unimpressed by the received wisdom of the experts, who assured them that marihuana was not harmful unless used to excess. As Mr. Moulton told a Senate committee on the health consequences of marihuana use in January 1980, "For the past 18 years I have coached youngsters in Little League and youth hockey. I don't have to be a doctor or scientist to note over the years the change in these youngsters."54
It is instructive to compare these examples of outrage and organizing zeal with another equally energetic outpouring of righteous indignation in the late 196os: that of the pro-marihuana campaign, which culminated in the establishment of NORML in 1970. In the 196os marihuana users were also outraged—by the lengthy prison sentences meted out to possessors of small amounts of marihuana, the dangers of which were grossly misunderstood by the enforcers of state and federal laws. Keith Stroup led a forceful drive to help those imprisoned for marihuana use which ranked in anger and zeal with the parents' movement a decade later. The parents' disdain for the "experts" who told them not to worry about marihuana was comparable to the pro-marihuana activists' contempt for official descriptions of the drug, which implied that it inevitably drove users mad or to violent crime.
One of the goals of drug experts around 1970 was to replace exaggerated descriptions of marihuana in official literature with more accurate information. As the White Paper of 1975 put it, "Federal media efforts [should] provide basic information about drugs . . . rather than using scare tactics."55 In a parallel effort, parents groups around 1980 began to monitor federal publications with the goal of weeding out comments favorable to drug muse. As one high-ranking NIDA official put it, "The NFP has reviewed most, if not all, of the NIDA publications in order to spot ambiguous messages that could be interpreted as being anything other than firmly against drug use. As a result of these efforts, several NIDA publications have been revised or removed from circulation."56
Just as those who favored a more relaxed attitude toward drugs by and large had encountered a congenial administration with the election of Carter in 1976, supporters of the parents' movement were delighted with the election of Ronald Reagan four years later. This group and others like it were warmly received by the Reagan administration, which was headed by a President who had grown to maturity during the last era of drug intolerance.
Nancy Reagan began a personal campaign against drugs by speaking to student groups, visiting drug treatment centers, drawing media to oppose drug use, and otherwise rousing public sentiment against drug use in any form. Her message was simple and dramatic: "Each of us has a responsibility to be intolerant of drug use anywhere, any time, by anybody. . . . We must create an atmosphere of intolerance for drug use in this country."57 Meanwhile, the Reagan administration's attitude toward drug use was uncompromising. To the important post of Administrator of the Alcohol, Drug Abuse and Mental Health Administration, the President appointed a Florida pediatrician who had been an outspoken member of the parents' movement, Dr. Ian MacDonald. Eventually, MacDonald rose to become the top spokesman on drug issues for the administration.
During the Reagan years, law enforcement received larger appropriations, but until 1986, funds for treatment and research fell in constant dollars. Many factors played a part in this decreased funding, including attempts to shift payments to third-party payers such as health insurance companies and to reduce the budget generally. Although interdiction was the most adequately funded federal effort, the street availability of interdicted drugs such as marihuana, cocaine, and heroin was not reduced. In 1986 a reawakened concern about drugs led to administration announcements that a new approach was to be taken against the drug menace: demand reduction.58 As is evident from the history of the last twenty years, this is hardly a new approach, but the statement does indicate that the Reagan administration saw itself as having emphasized enforcement—the reduction of availability—rather than treatment and education about the danger of drugs.
For Ronald Reagan and his wife, to be against drugs was as natural a reaction as tolerance would be for some of the young Carter supporters who had battled against draconian laws and scare tactics in the 196os. Influential elements on each side had a vision of America where every person could achieve his or her maximum potential, but one saw drugs as helping people enhance life, while the other saw ultimate personal achievement only reduced by drug use. Each side translated its vision for the nation into a political movement that profoundly affected elected representatives, laws, and policy regarding drugs.
COCAINE, "CRACK," AND AIDS
As during the last wave of cocaine use in America, from the 188os to World War I, the perception of cocaine has changed from that of an apparently harmless, perhaps ideal, tonic for one's spirits or to get more work done, to that of a fearful substance whose seductiveness in its early stages of ingestion only heightens the necessity of denouncing it. The calm with which experts until the early 198os viewed cocaine consumption was one more bit of evidence, to those alarmed by cocaine, that the authority of "experts" should not prevail against the evidence of a citizen's eyes and ears. Examples of tolerant statements in a standard psychiatry textbook published in 1980 have been cited: "Used no more than two or three times a weeks, cocaine creates no serious problems. . . . At present, chronic cocaine use does not usually present as a medical problem."59
In 1985 the appearance in several areas of the United States of "crack," a smokable form of cocaine, created a wave of fear that resulted in enormous media and public attention to the drug problem. Crack has several characteristics that make it appealing to users and frightening to observers. It is cheap: a single dose might cost only $lo or $15. It does not require needle injection, thereby avoiding a major route for hepatitis or AIDS infections. It also bypasses the danger of flammable liquids such as ether used to prepare another smokable form of cocaine, "freebase." Finally, smoking crack allows a large amount of cocaine to enter directly into the blood stream from the lungs and then to reach the brain quickly. ( Snorting powdered cocaine through the nose limits its impact because cocaine constricts small blood vessels and slows absorption.) Thus, crack combines low cost with high absorption of the drug. Users often find this appeal irresistible and are unable to control their use. Violence and crimes, including murder, have been attributed to crack smoking, and thus an image of cocaine has been created that is close to the image common in the first decade of this century.
In the autumn of 1986, at the height of public furor over cocaine, Congress and the President vied with one another to show their hatred of drugs and to state how much money they were willing to pit against the drug issue. Shortly before the national elections that November, the President signed into law the Anti-Drug Abuse Act of 1986, which authorized nearly $4 billion for an intensified battle against drugs, most of which was destined for law enforcement activities.60
The law also promised some additional support for drug abuse research. Funding of research at NIDA has had ups and downs, which has created a field with an uncertain future in spite of advances in the knowledge about addiction over the past two decades."61 Perhaps the most important discoveries have been that the brain has specialized receptors for opiates, and that the body itself produces opiate-like substances, enkephalins and endorphins, which appear to provide pain relief and pleasure.62 Related to these findings is the discovery of a new opiate-antagonist, naltrexone, which blocks brain receptor sites and thereby nullifies the effects of opiates such as heroin.63 A sign of the immense significance of opiate-receptor studies—widely thought to be of the Nobel Prize class—is a heated controversy among several claimants to the discovery of the receptors.64 Other valuable advances include the finding that the drug clonidine, previously employed as an antihypertensive remedy, can relieve much of the distress of opiate withdrawal.65 Unraveling the mechanism of cocaine's effect on the brain may also lead to drugs that relieve craving or block the effects of cocaine.
Acquired Immune Deficiency Syndrome ( AIDS ), a fatal disease that can be transmitted by contaminated needles used to inject drugs into the body, was described in 1981. Since then, the number of persons exposed to the virus and the percentage of those who then have contracted AIDS have rapidly increased. The intimate association of AIDS with drug users who share contaminated needles adds to the general and powerful disapproval of drug users, for they promote the spread of AIDS into the rest of the community. The specter of AIDS in fact has scared some casual as well as habitual needle users into quitting intravenous drug use. Some have switched to smoking crack, and others have entered methadone or drug-free treatment programs.
This growing intolerance now resembles in many ways the intolerance early in this century, which was associated with a reduction in drug use until the 196os. Perhaps the explosion of fear regarding cocaine will lead the broad anti-drug effort as it apparently did in the first decade of this century. Some other anti-drug movements, though, such as the vigorous one against tobacco, may in the end form the model on which abstinence advocates will once again achieve substantial success.
People opposed to the use of dangerous substances have a new instrument in their arsenal: sensitive drug tests that are relatively cheap and capable of mass usage. Earlier we noted that urine tests were administered to returning Vietnam service personnel. The practical value of urine testing in this instance led observers to speculate that these drug tests would become a part of routine physical examinations—but that was in the 1970s, an era of drug tolerance and assumption of a right to bodily privacy with regard to drugs. In such an atmosphere, the tests did not become common. During the fifteen years since the Vietnam drug surveys, tests have been devised to be more accurate and feasible for even larger numbers. In the mid-1980s, with the dramatic alarm over crack and other forms of cocaine and the accompanying decline in drug tolerance, testing gained acceptance as a good way to discover drug use. The armed services used drug testing beginning in the late 1970s as part of an anti-drug program and have claimed considerable success in reducing the level of drug use.66
When President Reagan asked in 1986 that the workplace and schools be made "drug-free" and that government workers in crucial occupations be required to take random urine tests, the issue of drug testing aroused intensive debate across the nation. Several groups, including unions and the American Civil Liberties Union, have attacked drug testing as an unwarranted invasion of privacy for a person exhibiting no difficulty in school or work that would make testing reasonable.67 Severe criticism has also been leveled at the accuracy of the tests and the ignorance that some who administer them show about the need to confirm results after a positive screening test.68 Drug tests may be seen as an anti-drug program in themselves, without provision for treatment or counseling and where a positive test means dismissal, not referral to an employee assistance program. Taking the long view, those wielding this new instrument in an era of increasing drug intolerance might seek out drug users with a righteousness and vigor last witnessed in the 1920s and 1930s, without appreciating the likelihood of error and possible damage to lives and livelihoods. The legal limits of drug-testing programs are still vague and their future course unclear, although it appears that the evolution will occur in an environment favorable to drug testing as a method to root out drug users.
An additional factor that might ease the way for drug testing is the fear of AIDS, which could lead to general blood testing for antibodies to the AIDS virus. AIDS is so frightening that it makes extreme control measures seem reasonable. Under the umbrella of measures taken to combat this menace, testing for drugs might fit in easily.
Reflecting on the earlier wave of drug intolerance, one cannot help but be concerned that the fear of drugs will again translate into a simple fear of the drug user and will be accompanied by draconian sentences and specious links between certain drugs and distrusted groups within society, as was the case with cocaine and Southern blacks in the first decade of this century. Is there some sort of inherent symmetry between excessive praise of drugs in the phase of rising tolerance, and zealous and at times prejudiced denunciation of users in the decline phase? That aside, knowing about our earlier wave of drug use at the turn of the century offers us some assurance that the problem can recede; and perhaps this knowledge will allow a decline in consumption to proceed with a minimum of distortion. We are, however, an impatient people.
NOTES
1 T. Ramsaye, ed., 1947-1948 International Motion Picture Almanac ( New York: Quigley Publications, 1947), pp. 737-44.
2 Interview of 30 May 1970 at Hollidaysburg, Pennsylvania.
3 Bureau of the Census, Statistical Abstract of the United States, 1981 ( GPO, 1981), p. 31.
4 National Commission on Marihuana and Drug Abuse, Marihuana: A Signal of Misunderstanding (GPO, 1972), p. io6.
5 Op. cit., pp. 32-33.
6 Domestic Council Drug Abuse Task Force, White Paper on Drug Abuse ( GPO, 1975), p. 15. Hepatitis has no direct relationship to the number of heroin users, but at the time, the rise in this disease was associated with spread of needle-injected drugs, a common mode of hepatitis transmission.
7 Drug Abuse Council, The Facts about "Drug Abuse' ( New York: Free Press, 1980), p. 29. Budget figures for drug abuse cannot be precise because of overlap with other federal activities but are a useful guide to chdnges in emphasis and overall effort.
8 Vincent P. Dole and Marie Nyswander, "Rehabilitation of heroin addicts after blockade with methadone," N.Y. State J. Med. 66 : 2011-17 (1966 ).
9 N.Y. Times, 9 Apr. 1972.
10 Drug Abuse Council, Facts, pp. 37 if. and 79 ff.
11 Sibyl Cline, Turkish Opium in Perspective ( Washington, D.C.: Drug Abuse, Council, 1974).
12 Drug Abuse Council, Facts, p. 29.
13 John F. Holahan, "Economics of Heroin," in Drug Abuse Survey Project, Dealing with Drug Abuse, A Report to the Ford Foundation ( New York: Praeger, 1972), p. 263.
14 Drug Abuse Council, Facts, p. 57.
15 See, for instance, the editorial in the N.Y. Times, "Police Terror," 2 July 1973. Also see the important series of articles on ODALE raids by Andrew H. Malcolm in the N.Y. Times during 1973.
16 N.Y. Times, 30 June 1973.
17 N.Y. Times, 22 May 1973.
18 Drug Abuse Council, Facts, p. 57.
19 Richard Nixon, "Rremarks on Signing the Drug Abuse Office and Treatment Act of 1972," 21 Mar. 1972, Public Papers of the Presidents of the United States: Richard Nixon: Containing the Public Messages, Speeches, and Statements of the President, 1972 (GPO, 1974), pp. 451-57.
20 H. Wayne Morgan, Drugs in America, A Social History, /800-1980 ( Syracuse, N.Y.: Syracuse Univ. Press, 1981), p. 154.
21 Lee N. Robins, A Follow-up of Vietnam Drug Users, SAODAP monograph series A, no. j ( GPO, 1973).
22 Jerome H. Jaffe, "The Pitfalls of Promulgating Policy," Pharmacologist 15 53-59 ( 1973 ).
23 Strategy Council on Drug Abuse, Federal Strategy for Drug Abuse and Drug Traffic Prevention, 1973 ( GPO, 1973), pp. 75-76, 83.
24 See, for example, John N. Chappel, "Methadone and Chemotherapy in Drug Addiction—Genocidal or Lifesaving?" J. Amer. Med. Assoc. 228 : 725-28 ( 1974 ).
25 For a review of methadone's value and limits, see Joyce H. Lowinson, "Methadone Maintenance in Perspective," ch. 26 in Joyce H. Lowinson and Pedro Ruiz, eds., Substance Abuse, Clinical Problems and Perspectives (Baltimore, Md.: Williams & Wilkins, 1981), pp. 344-54.
26 Strategy Council on Drug Abuse, Federal Strategy, pp. 6o, 62.
27 Virginia Berridge and Griffith Edwards, Opium and the People, Opium Use in Nineteenth-Century England ( New York: St. Martin's Press, 1981 ), p. 113 ff.
28 National Commission on Marihuana and Drug Abuse, Marihuana: Signal of Misunderstanding, p. 151
29 N.Y. Times, 25 Mar, 1972.
30 National Commission on Marihuana and Drug Abuse, Drug Use in America: Problem in Perspective (GPO, 1973), pp. 462-81.
31 Drug Abuse Council, Facts, p. 45 ff.
32 Domestic Council Drug Abuse Task Force, White Paper, pp. 97-98.
33 Lloyd D. Johnston, Patrick M. O'Malley, and Jerald G. Bachman, Drug Use Among American High School Students, College Students, and Other Young Adults: National Trends through 1986 (GPO, 1986), PP. 47, 114.
34 National Commission in Marihuana and Drug Abuse, Drug Use in America, pp. 218-19.
35 Ch. 1, n. 17, p. 401.
36 Peter G. Boume, "The Great Cocaine Myth," Drugs and Drug Abuse Education Newsletter 5 : 5 (1974).
37 Taxation of Marihuana, hearings before the Committee on Ways and Means, House, 27-30 Apr. and 4 May 1937, 75th Cong., ist Sess. ( GPO, 1937), p. 36.
38 United States General Accounting Office, Report: Gains Made in Control of Illegal Drugs, Yet the Drug Trade Flourishes (GPO, 1979), p. 17.
39 Richard Nixon, "Remarks at the First National Treatment Alternatives to Street Crime Conference," 11 Sept. 1973, in Public Papers of the Presidents: Richard Nixon: Containing the Public Messages, Speeches, and Statements of the Presidents, 1973 ( GPO, 1975), p. 788.
40 See, for instance, Office of Legislative Research, State of Oregon, Effects of the Oregon Laws Decriminalizing Possession and Use of Small Quantities of Marijuana, 31 Dec. 1974.
41 Decriminalization of Marihuana, hearings before the Select Committee on Narcotics Abuse and Control, 14-16 Mar. 1977, House, 95th Cong., ist Sess. (GPO, 1977) p. 5.
42 "President's Message to the Congress on Drug Abuse," in Strategy Council on Drug Abuse, Federal Strategy for Drug Abuse and Drug Traffic Prevention, 1979 (GPO, 1979), pp. 66-67.
43 Peter G. Bourne, "Statement before the Fifth Special Session of the United Nations Commission on Narcotic Drugs," press release, White House Press Office, 14 Feb. 1978.
44 Heroin Indicators Task Force, NIDA, Heroin Indicators Trend Report—An Update (GPO, 1979), p. 5.
45 Strategy Council on Drug Abuse, Federal Strategy 1979, p. 4o.
46 Patrick Anderson, High in America: The True Story behind NORML and the Politics of Marijuana (New York: Viking Press, 1981 ), p. 190 ff.
47 Op. cit., p. 274 ff.
48 Ron Shaffer, "The Cocaine Incident," Washington Post, 21 July 1978.
49 Later nullified by PL 97-113, sect. 502 ( 29 Dec. 1981 ).
50 L. D. Johnston et al. Drug Use, p. "4. •
51 L. D. Johnston, P. M. O'Malley, and J. G. Bachman, "Drug Use Among American High School Students," press release, University of Michigan, 23 Feb. 1987, p. 8.
52 Peggy Mann, Marijuana Alert ( New York: McGraw-Hill, 1985), pp. 411-55.
53 Marsha Manatt, Parents, Peers and Pot, NIDA ( GPO, 1979).
54 Health Consequences of Marihuana Use, hearings before the Subcommittee on Criminal Justice of the Committee on the Judiciary, Senate, 16-17 Jan. 1980 (GPO, 198o ), p. 199.
55 Dpmestic Council Drug Abuse Task Force, White Paper, 1975, p. 101.
56 ' R. A. Lindblad, "A Review of the Concerned Parent Movement," Bulletin on Narcotics 35 : 41-52, p. 48.
57 Nancy Reagan, "We Must be Intolerant of Drug Use," USA Today, 8 Aug. 1986.
58 N.Y. Times, to Aug. 1986.
59 Lester Grinspoon and James B. Bakalar, "Drug Dependence: Non-Narcotic Agents," in H. I. Kaplan, A. M. Freedman, and B. J. Sadock, eds., Comprehensive Textbook of Psychiatry, 3rd ed. ( Baltimore, Md.: William & Wilkins, 1980 ), pp. 1621-22.
6o The fate of the law remains uncertain. In January 1987 the Reagan Administration reduced in its proposed budget the funds requested, and the monies ultimately to be appropriated remain to be decided by Congress and the President.
61 Board on Mental Health and Behavioral Medicine, Institute of Medicine, Research on Mental Illness and Addictive Disorders: Progress and Prospects ( Washington, D.D.: National Academy Press, 1984), p. 47 ff.
62 Eric J. Simon, "Recent Developments in the Biology of Opiates: Possible Relevance to Addiction," in J. Lowinson and P. Ruiz, Substance Abuse, PP. 45-56.
63 Charles P. O'Brien and Robert A. Greenstein, "Treatment Approaches: Opiate Antagonists," in J. Lowinson and P. Ruiz, Substance Abuse, pp. 403_07.
64 Eugene Garfield, "Controversies over Opiate Receptor Research Typify Problems Facing Award Committees," Current Contents, no. zo, 14 May 1979, pp. 5-18.
65 M. S. Gold, D. E. Redmond, Jr., and H. D. Kleber, "Clonidine in Opiate Withdrawal," Lancet i : 929 ( 1978 ).
66 R. M. Bray et al., Worldwide Survey of Alcohol and Non-medical Drug Use Among Military Personnel: 1985 ( Research Triangle Park, N.C.: Research Triangle Institute, 1986).
67 "ACLU Denounces Drug Testing Recommendations of President's Commission on Organized Crime," ACLU News, 4 Mar. 1986.
68 Hugh J. Hansen, Samuel P. Caudill, and Joe Boone, "Crisis in Drug Testing, Results of CDC Blind Study," J. Amer. Med. Assoc. 253 : 2382-87 (1985).
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