Drug Abuse

IN THE MIDST of all this, a day and a half were set aside by the Daniel Subcommittee to give critics and dissenters a hearing. Although most of the witnesses came from Washington, this session was held in New York, because congressional hearings held out of the capital usually receive less notice from the official community and the national media.

Dr. Hubert Howe opened the session, asserting that opiate addiction is seldom curable, that no program would succeed if it simply filled larger penal institutions with more addicts, and that imprisoning addicts for any period less than life only brings them into contact with other addicts and criminals, thus defeating its own purpose. When Dr. Howe observed that persons who believe addicts under the influence of opiates to be dangerous are totally misled—probably because of common familiarity with the effects of alcohol—he was interrupted:

Senator Daniel. Doctor, what about those addicts who commit heinous crimes such as murder for pay, and robbery and burglary, and take the drug in order to get them into a mental state in order to preclude worry about what they are doing?

Dr. Howe. Well, that has been stated, but there is no definitive evidence that anything like that occurs as far as opiates go. Opiates are sedatives. If they take enough of them they put them to sleep.

When he said addiction is a disease which should be cared for by doctors, "but doctors have been scared away by the Federal Bureau," he was interrupted again:

Senator Butler. Doctor, is it your testimony that an addict who has a supply of drugs sufficient to keep him from experiencing pain and suffering that he would experience without that drug could be a useful citizen and pursue a normal occupation?

Dr. Howe. In a great many instances that is the fact. We see it right now. . . . There is evidence in all countries of that, that given a small amount of drugs, enough to prevent withdrawal symptoms, many of these individuals—and there is even further than that, there is medical evidence that suggests that some psychopathic individuals are better off with the drugs than they are when you take them away from them. . . .

Senator Butler. Would you say the alcoholic is much more of a potential threat to society than the addict?

Dr. Howe. No question about it. That goes without question.

Senator Daniel. Well no, Doctor, you might have said something a moment ago that you did not mean exactly as it was said, that the drug addict, when he had his heroin or his morphine, that he then is restored to a normal situation as far as he is concerned, and, therefore, he can go about his business just as anyone else.

Dr. Howe. That is right.

Senator Daniel. Now, is that an accurate statement? Dr. Howe. That is right . . .

Senator Daniel. Which is right, I do not know? I hope we will have enough statistics here to help us clear up the matter. But now, if you have two people with the same mental faculties, one under enough heroin or morphine to take care of his addiction, and the other person not addicted at all, not under the influence of any type of opiate, what would be his mental faculties as compared with a person, a normal person, without any opiates?

Dr. Howe. Well, he is quiet, he is comfortable, and he wants to be let alone. He will do his job; he has no enemies or anything . . .

Senator Daniel. Doctor, would you let the individual under the influence of an opiate, for instance, drive automobiles? Today a person under the influence of alcohol would not be permitted to do that.

Dr. Howe. No.

Senator Daniel. What about the person under the influence of heroin or morphine?

Dr. Howe. Well, of course, if he had enough to put him to sleep, he wouldn't. But the ordinary dose, they could drive an automobile just as well as anybody else could.

Senator Daniel. If they had the ordinary minimum dose? Dr. Howe. That is right.

Senator Daniel. To make them comfortable? You think it would be safe to put them out on a street to drive an automobile?

Dr. Howe. I certainly do.

As we noted earlier, Dr. Howe had been associated with the New York Academy proposal to provide drugs to addicts by direct administration in something like clinic facilities; this was anathema to the Bureau, and the senators got on him about it before the doctor brought it up:

Senator Butler. There has been some evidence here that some people become addicts simply to keep the addict comfortable or keep him company, or just to get in the swim, so to speak. Now, if it becomes generally known that addiction would be aided, and anybody who becomes an addict can always be kept in the happy and comfortable position of being satisfied, wouldn't you have a great tendency on the part of the addict to induce others to come in by simply saying, raft here it is a wonderful thing and a wonderful sensation, and there is no harm, you don't take any chances now. You can come in and keep this going, and live in this beautiful state all your life at public expense." boesn't that multiply your addicts?

Dr. Howe. No. Let me tell you the answer to that, which is this: We believe very decidedly that if you afforded all the present addicts their drugs through a doctor, they cannot get it any place else, that that would, to a large extent, destroy the black market. If you undersell them, if there is no profit at all in narcotic drugs, the black market cannot live and thrive. You say, "Oh, well, they will make new ones." Well, they can't live much on trying to induce—

Senator Butler. I know you may drive the black market, but the addict who talks to his brother or his sister or some member of the family and says, "This is a wonderful sensation," let us put the profit motive out of it—here is a man who wants to live in this limbo, or whatever you want to call it—

Dr. Howe. Where is he going to get his drugs?

Senator Butler. . . . and induces him to become an addict, with the assurance that he will never suffer the pains of the lack of the opiates.

Dr. Howe. May I ask you this: Where will they get their drugs?

Senator Butler. He would get it from your clinics, would he not?

Dr. Howe. No, he wouldn't. Nobody could get that unless they had had a hospital examination and been referred to a clinic and told how much he could have. That is what was brought up—

Senator Butler. Doctor, is it not a fact that you would give to the addict—you would not give him enough to make him come back every 4 or 5 hours, you would give him enough for every 20 hours. If he wanted to share that with his little brother, he could probably do that.

Dr. Howe. Well, that is a matter of administrative detail. On the whole, the idea would be, to start with anyway, probably to give everyone of them by hypo. He would have no drug. He could not spread it around to anybody else, and we believe that there are certain ways that these drugs can be made to last longer, that you can give him one hypo a day, just as we have insulin, that lasts over several periods, and he could—you see, that could quite easily be done. He would go to a clinic once a day, and he would get enough drugs to keep him comfortable for 24 hours.

Senator Butler. If he shares that with his neighbor—

Dr. Howe. How can he share it with his neighbor when it is in his arm? . . .

Senator Daniel. We are going to let you go right on. The only reason we have asked you these questions is to try to develop the entire picture, and I want you to know that we are certainly going to question the witnesses who oppose this view the same way we are questioning you.

Dr. Howe. I welcome them. It is not that I am trying to insist that this is the thing to do. If anybody else can suggest anything better, I am glad, but nobody that I know of has come up with anything except "Put them in jail; cut their heads off; do anything." Now, of course, as I have frequently said, that would be one good way to get rid of tuberculosis. If you took everybody with tuberculosis and put them in a gas chamber, there would be no tuberculosis.

Senator Daniel. The one thing the Chairman is prepared to agree with you on is that we are not solving the problem of drug addiction in this country today as we should.

After more peppering, Dr. Howe came to the basic rationale behind the New York Academy proposal:

Many people recoil with horror at the suggestion of furnishing low-cost drugs to addicts, even under the best system of supervision which our Government can devise. For those of us who want to pass laws prohibiting everything undesirable, and many Americans seem to, it is a thoroughly startling idea. The public has yet to grasp the fact that addicts are dangerous when they are without their drugs, not when they are with them. They do not realize that in Britain this problem has been solved. The question, therefore, clearly is: Why should we have narcotic laws, the practical effect of which is to force people to rob, steal, proselyte, and prostitute, in order to support their habit, especially when the need for criminal activity can be prevented for a few cents worth of drugs per addict, per day? . . .

One may also consider that, after 40 years of the Harrison Act, the addict still obtains his drug, unless he is in the strictest form of incarceration.

We are not saying to give the addicts more drugs. We are simply advising a different method of distribution. The Government says he cannot get it legally; therefore, he has got to steal and rob, and so on, in order to get it.

Well, he gets it, but we believe there is a better method of distribution than that. We are not in any way advocating that they get more than they need. But every addict gets his drug right now. As I say, unless he is in jail, every addict gets his drug, and many of them get it in jail, at least they do in New York.

Why not let him have his minimum requirement under licensed medical supervision, rather than force him to get it by criminal activities, through criminal channels? We now have, in the narcotic black market, a matchless machine for the manufacture of criminals. Isn't it about time we looked over the horizon to see how the problem has been solved elsewhere?

But the senators kept snapping away at him. How could anyone respond to psychiatric guidance or other treatment while he was under the influence of opiates? How could an addict on drugs hold a job? Who would hire him, knowing he is an addict? If an addict gets a job, isn't he likely to go on pushing dope—"or would your plan just supply everybody?" What about cocaine and marijuana?

Dr. Howe. I do not think that amounts to much. In the first place, the black market in cocaine here in New York anyway amounts to very little now because it is too expensive. Sure, you will have marijuana, and you will have alcohol, and you will have some of these other things, but I do not think—I think these can be controlled. Marijuana is not an addicting drug. They like it. Many people have told me they prefer it to alcohol because they get about the same effect, and it is cheaper. They can get a good drunk for fifty cents, and it costs them more than that to get the same effect through alcohol.

Senator Daniel. But it is habit-forming.

Dr. Howe. No, it is not.

Senator Daniel. Marijuana?

Dr. Howe. No, it is not a habit-forming drug. Neither is cocaine. . . .

Senator Butler. But the main prop of your plan is the ability of these addicts to be employed profitably?

Dr. Howe. That is right.

Senator Butler. And I seriously doubt—

Dr. Howe. That is right.

Senator Butler (continuing) . . . that that is a reality.

Dr. Howe. That could—that is a reality, and I am sure that it would work.

Senator Daniel. While they were still on the drug?

Dr. Howe. That is right, while they were still on the drug, an ordinary amount. We often have difficulty in telling—somebody would send an addict up to me—is he on drugs or isn't he? He comes in, he is perfectly normal in every way that I can see. You examine him and you find that he has some scars on his arm. You do not know whether he is taking drugs freely or whether is is not. . . .

Senator Daniel. Doctor, what would be wrong with isolating these addicts, like you do those who have leprosy or those with mental illnesses? Your program would call for a new set of laws in the country, both state and Federal. What would be wrong with a new set of laws that would follow your suggestion on not branding them as criminals, if that is all that they have ever done, but getting them in some kind of an institution or farm or something where they cannot spread their addiction to other people, and where you can try to do all these things about treating them and rehabilitating them?

Dr. Howe. Well, they have talked of all kinds of Devil's Islands and everything else for these people. But you must realize, as I say, that addicts are not a homogenous group. They are everything from doctors and lawyers and ministers and everything else all the way down, and I do not think you could very well establish a Devil's Island and put them all there. What they need is to be gotten back into society, gotten back where they can hold down jobs.

Senator Daniel. The incurable ones?

Dr. Howe. Sure, sure. They can work. What did all these clinics say? They furnished them with their drugs; they all worked. They supported their families The minute that the clinics were closed up, the whole thing disappeared. They went back underground; they got their drugs, they lost their jobs, they were put in jail, and they died in jail, and all that kind of thing. But they worked perfectly well in each one of these.

Following Dr. Howe an outspoken judge told the Subcommittee:

Common sense and experience dictate that habits cannot be controlled or cured by the criminal law. As Mr. Bumble in Charles Dickens' Oliver Twist said, "If the law supposes that, the law is an ass." . . . One thing I believe is that the medical profession is ahead of the law. They proceed on the basis of individual diagnosis and treatment and not mass-prescription. . . . I say it is a medical problem. Turn it over to the doctors, and if you give them the authority to do so, then their laboratories will go to work, they will try to find cures and use the money that you now use—that you waste, not use—that you waste in law enforcement, use it for education.

Then the Subcommittee heard Dr. Eggston, for the Medical Society of the State of New York, who supported the Academy plan and urged the establishment of narcotic service clinics to distribute drugs free of charge, with proper safeguards and in connection with rehabilitation efforts. A spokesman for the American Bar Association followed, endorsing the dissenters:

For 40 years we have been looking for ways to make the existence of the narcotic drug addict just as tough as possible. For 40 years we have asked only what new penalties, what new police techniques, might make it easier to catch him and lock him up, whether as an ordinary criminal or, more recently, in connection with some more or less sincere efforts at rehabilitation in confinement. I believe that this entire approach is open to grave question as a practical matter, and that it happens to be illegal, and very likely unconstitutional besides.

After more of this, Commissioner Anslinger took the stand leading his rebuttal team, which was headed by Surgeon General Leonard Scheele. With few exceptions, career officials in the Public Health Service have stayed in line behind the Narcotics Bureau in matters pertaining to drug addiction, since disagreement with Anslinger's pronouncements was always sure to be rebuked. Depending on the seriousness of the heresy, the retaliation could be by informal protests from top-echelon Treasury officials to their opposite numbers in the offending agency, by formal communications about the impropriety of criticizing a sister arm of government—with copies lodged in the offender's all-important personnel file—or by threats, abuse, or even budgetary pressures from the Commissioner's stable of compliant congressmen and senators. So it was not surprising that on this important occasion the Surgeon General had come to New York with a half dozen of his PHS staff to defend the Bureau.

Disclaiming much knowledge of the subject, Scheele related the background of the federal hospitals and gave bland generalities about addiction. More therapy was needed but could not be provided because of personnel shortages; there was a dearth of research about drugs and addiction; and rehabilitation programs should always be followed up by effective aftercare. He told the Subcommittee that "addicts make addicts," that although addicted persons are sick their addiction is usually a manifestation of some "personality or character disorder," and that treating addicts should be primarily the responsibility of local officials who should mobilize local resources to control the problem courageously, scientifically, and humanely.

Even so, when the senators began pushing him too hard, they got resistant answers:

Senator Butler. What I am getting at basically is this: There are certain sanctions in the law now. Would it be wise to relax those sanctions and treat these people as sick people or would it be wise to increase those sanctions? Would it be wise, for instance, if you had a man who had been in the institution, and after repeated trips went back to addiction, to permanently incarcerate a man or what would be the situation?

Dr. Scheele. I suspect there is a practical side of the whole problem that would lead one to say that such a person might just as well be incarcerated. On the other hand, as physicians, we always take a hopeful outlook. In the treatment of many forms of mental illness, and narcotic addiction falls in this category, we are not necessarily successful even though we would like to be successful in our first contact with the patient.

Next, the Public Health Service doctors testified together. When it became apparent that, though guarded in their expression, these eminent and expert careerists were unwilling merely to chorus disapproval of Dr. Howe and the New York Academy, Senator Daniel turned on them: "I will say to you frankly, Doctor, that I am disappointed that this group, after all the years of work and study with drug addicts, does not have a more definite position" Then he and Senator Butler and the Committee's counsel subjected them to an afternoon of what amounted at times to bullying cross-examination, which Senator Daniel concluded with a little speech:

Gentlemen, I tell you that, after sitting through two more days of hearings here, I am convinced that we are never going to lick this problem of the drug traffic until we get the addicts off the streets of this country. They have got to be taken off the streets, and I know it is hard. Some of the enforcement officers think it is best to get them in the jails temporarily, and the different States have passed those kinds of laws. I would like to see us at the same time that we set up our laws to take them off the streets, set up some place to have them go and get a chance for treatment, and then if they won't take it, and you cannot do anything with them, then, it seems to me, it is just as humane to put them in some kind of a colony or some kind of farm or institution like you do mental patients. . . .

Any other comments, gentlemen? I think you see that what this Committee is driving at and what kind of information we would like to have now has been brought out in the discussion, and I am sure you have some papers, studies, and other things that would be of help to us; and if we have not asked for them specifically, we will appreciate your volunteering them or any other information that would be helpful to the Committee.

Reference has already been made to the scrambling that had gone on in Canada to line up support from that country for the U.S.,Bureau's chief themes. After the PHS group stepped down, a doctor from British Columbia was called to relate how a proposal for legal sale of drugs to addicts in Vancouver had been rejected, after study, for fear that with any form of legal distribution the illicit traffic would not only continue but might increase. However, when this witness was pressed on his position with respect to so-called clinics, Anslinger's hand suddenly showed through in a way that might have been amusing in some less serious context:

Senator Daniel. What were your findings as to the actual practice in the clinics that have been attempted in the various countries, Doctor? I would like your conclusions as to the operation of
these clinics . . .

Dr. Stevenson. Yes, sir. My information . . . is one of your own documents, so that while it is here it is simply copied or taken from your own official documents; perhaps one of your own witnesses from the United States might be a more suitable person to give that evidence. But at least it is listed here, and it is available if you wish it read into the record, sir.

Senator Daniel. I am thinking now about page 6 of your report. Is this a conclusion of your Committee based on your study of these clinics there on page 6 of your report where you say: "The chief defects of these earlier narcotic 'clinics' might be listed as follows—" Is that your conclusion after having studied all of the information you could obtain concerning the clinics?

Dr. Stevenson. No. Those statements are made in that booklet published by the United States Government entitled "Narcotic Clinics in the United States."

Senator Daniel. Did you agree with those findings after your study?

Dr. Stevenson. Well, I had no reason for disagreeing with them. They were stated as facts . . .

Senator Daniel. Well, let me take up these points here just ta' see if you found similar experiences from other countries or similar reports from other countries . . .

Dr. Stevenson. I don't know any other country that has had clinics. This refers entirely to the United States. As a matter of fact, I do not know any country at all that has had clinics except the so-called clinics that were in the United States in 1919-23. I think that is a misuse of the word "clinic," too, but that is a side line.

Commissioner Anslinger thereupon addressed the Subcommittee himself, lumping his adversaries together in a characteristic performance:

Mr. Chairman and honorable Senators, the proposal of the proponents is, in fact, a proposal for the United States Government to sell poison at reduced prices to its citizens. Now, that is —narcotics are labeled as poisons all over the world, by treaty. Our traditional policy since 1912 has been to oppose legalized sale of narcotics. . . .

Those clinics were closed by the action of the medical authorities, the recommendation of the medical authorities and by the State legislature. In one year of operation—now, mind you, the proponents say, "Well, we didn't have time enough." Well, that is nonsense. They were in existence for five years. In one year of operation we seized in the illicit markets 75,000 ounces of narcotic drugs. Today we will only seize about 6,000 ounces, without clinics. . . .

The Chief of Police of Shreveport said, "Well, this is very simple for me. When I have a burglary in the town, I just go down to the clinic at 4 o'clock when they get their customary supply." Most of those addicts were selling to other addicts who would not appear at the clinic

Senator Daniel. Just a moment, Commissioner Anslinger, you say this was the Chief of Police of Shreveport?

Mr. Anslinger. Yes, sir.

Senator Daniel. Did he say these were addicts on free drugs who were committing crimes?

Mr. Anslinger. Were committing crimes. There were thieves from all over the area, and the record will show that many criminals came in from Texas to get their supply at the Shreveport clinic.

Senator Daniel. To get their supply of dope?

Mr. Anslinger. Yes, sir; and it was—the people of Shreveport demanding that those clinics be closed. . . . Now, as to the question of crime, in Formosa, the only place where they actually made a study, Dr. Tu of the University of Taipeh made this study, and he showed that criminality—of the crimes committed in Formosa at the time these monopolies or the legalized sale of drugs were in effect, 70 per cent of the crimes were committed by opium smokers who got their narcotics at Government shops at very cheap prices a few cents a day; whereas only 30 per cent of the crimes that were committed were committed by nonsmokers. Now, these proponents just skirt this question of opium smoking. Well, the active principal in opium smoking is morphine, an opium alkaloid, and are we now to establish opium dens throughout the country? We just about got rid of opium dens in the United States. . . Now, they also brush marijuana and cocaine aside. You know, cocaine was the big drug of addiction before the Harrison Act. Why, it was sold across the countrY.

You do not see cocaine addiction, but if you are going to make narcotics available to these addicts, why, you have got to consider the cocaine addict, although we have been able to get rid of cocaine addiction principally through international effort and the acts of the government in Peru in closing down illicit factories. I do not know what they say, they just say nothing about marijuana or how it is to be handled; they just avoid that.

Once again, Anslinger had ready for the Subcommittee's records a resolution which had been adopted by the compliant United Nations Commission on Narcotic Drugs, wherein the Commission, after a string of preambles, noted "that in the treatment of drug addiction, methods of ambulatory treatment and open clinics are not advisable." Anslinger then noted, "That was just two months ago; and that question was examined by the Commission on Narcotic Drugs and by the Opium Advisory Committee of the League of Nations for some 25 years now, and this is the result of the opinion of world experts, and this is world authority talking."

Then he followed with another typical play. Some time before, two prestigious quasi-governmental bodies in Washington, the National Research Council and the National Academy of Sciences, had established a joint committee on drug addiction and narcotics. Of course, no such official committee could be set up without including in its membership the Commissioner of the federal Bureau, and, naturally, in such a group Anslinger could be expected to have great influence in proselytizing his views. This was indeed the case. In October 1954 the joint committee had adopted a resolution which suggested even in syntax that it had probably come directly from the Commissioner's desk:

The Committee disapproves a policy of legalization of administration of narcotics to addicts by established clinics or suitably designated physicians because:

1. It is impossible to maintain addicts on a uniform level of dosage;

2. Ambulatory treatment of addiction is impossible and has been so judged by the American Medical Association and other informed groups;

3. The clinics would facilitate the production of new addicts by increasing drug availability; and

4. The policy is contrary to international conventions and national legislation.

Now Anslinger put this resolution into the record not once but twice, repeating it in full, first as an action of the National Research Council and then again as an action of the National Academy of Sciences.

When he had finished, Senator Daniel ( who sometimes addressed him as "Doctor" on the basis of an obscure honorary degree) whirled him into the following elephantine two-step:

Senator Daniel. Doctor, on this last point here, before you leave the international picture, this last point says the policy is "contrary to international conventions and national legislation." Is it your opinion that in order for this country to change its present policy and set up a clinic system of legalized narcotics for addicts to maintain their comfort, that we would have to revoke some of our treaty obligations?

Mr. Anslinger. You would have to have a completely new international system, completely new treaties, because the treaties from 1931, the treaties of 1936, 1946, 1948 and 1953 do not contemplate the non-medical or quasi-medical needs or legitimate needs. The word "legitimate" does not appear in those treaties. . . . In 1925, when the word "legitimate" crept into the 1925 convention, the American delegation walked out at the League of Nations because they refused to participate in any discussion which contemplated the legalized sale of poison to citizens. . . .

Senator Daniel. Can you give us some ideas as to how many state laws would have to be changed in order for these clinics to operate?

Mr. Anslinger. All of them. Forty-eight.

Senator Daniel. Forty-eight?

Mr. Anslinger. Yes, sir; they do not contemplate that.

Turning to the situation in England ( which we shall come to soon), Anslinger lashed out:

Mr. Anslinger. Now, I think there were some statements made here yesterday about the disappearance of the black market in the United Kingdom. Well, Senator, here are press clippings of just two weeks of the illicit opium traffic, heroin, hashish in the United Kingdom. I do not want these to go into the record, hut according to the seizures made in the United Kingdom they have a larger opium traffic than we have in the United States. That is for smoking opium.

Senator Daniel. Yes; that is outside the Isles themselves?

Mr. Anslinger. No, no; that is in the Isles, in the United Kingdom; right in the British Isles. . . . And very likely this condition is due to very low sentences, although I notice they are going up.

Then a plug for Senator Butler's constituents:

Senator Daniel. They did have quite a problem in Maryland several years back did they not?

Mr. Anslinger. Oh, Maryland was one of the worst states here about 1950, 1951. You found teenagers dead from an overdose of heroin, in the gutter. You do not see that any more, not the way Maryland went right to work and whipped the problem.

And a final duet:

Senator Daniel. Well, now, Commissioner, do you have any recommendation to make as to what is the best way for us to treat the addicts? We have 60,000 addicts estimated in the country. What do you think we ought to do about it? I would suppose that you would feel that they ought to be gotten off the streets.

Mr. Anslinger. Yes, sir. The legalized—you have to get an addict under legal restraint. . . . We have got to have a system of compulsory hospitalization. That is my recommendation on how to treat the addicts. I do not think any other system—any other system is doomed to failure . . .

Senator Daniel. You think compulsory commitment and treatment is the only solution?

Mr. Anslinger. That is what I have felt, and I think you will find that the experts on the United Nations Narcotic Commission are in accord, that you must have hospitalization, compulsory hospitalization. That is the opinion of the Germans, the French; and nearly all the European countries feel that way.

Spokesmen for the American Medical Association told -the Subcommittee that when the AMA position had been fixed by the famous resolution of 1924, the intent had been to condemn giving addicts large supplies of drugs for unsupervised self-administration rather than to oppose all administration of drugs to addicts not in confinement—referring thus to the confusion which had so long surrounded the word "ambulatory"—but they also advised that this AMA statement still stood, ambiguity and all, and that it had not been reviewed or clarified in the intervening thirty years.

Regarding the New York Academy of Medicine proposal, which had been referred to the AMA for action, they said that their House of Delegates had found that "additional information was necessary," and had accordingly referred the proposal to the AMA Council on Pharmacy and Chemistry, which had reported back in December 1954 that "clinics" had already been tried in the United States and were an absolute failure, and that such approaches tended to increase rather than diminish the problem. On the basis of this report "and additional pertinent material received from the National Research Council and the Federal Bureau of Narcotics," the AMA Board of Trustees had recommended that the resolution presented by Dr. Eggston ( that is, giving AMA support for the Academy proposal) be not adopted.

So here crops up again the Anslinger-inspired resolution of the National Research Council already referred to, as well as, by open reference, the ubiquitous hand of the Bureau of Narcotics. And the role played by the report of the AMA's Council on Pharmacy and Chemistry makes necessary another slight diversion: the AMA Council had made no study and had done no appraising for itself when the matter was referred to it in 1954. Instead, it relied on a statement which had been prepared for it in 1952 by "the Committee on Drug Addiction and Narcotics of the National Research Council."

But preparation of the earlier NRC statement was acknowledged actually to have been the work of Dr. Harris Isbell, then Research Director at the Federal Narcotics Hospital at Lexington, a brilliant Public Health Service careerist who was nonetheless notably uncourageous—as were most government-employed scientists of that era—in challenging Narcotics Bureau dogma. The 1952 document ( the one on which the 1954 AMA Council report relied) first appeared as a set of guidelines for physicians titled "What to Do with a Drug Addict," published as an article in the Journal of the American Medical Association and thereafter reprinted and widely distributed as an official release of the Department of Health, Education, and Welfare. And as a formal pronouncement of policy, thus expressly endorsed by both the private and official medical communities it is another timid retreat, scolding and threatening the profession. It opens with the Treasury directive which reproduces language from the Webb case—the very language the Supreme Court itself had vigorously repudiated in 1925:

An,order purporting to be a prescription issued to an addict or habitual user of narcotics not in the course of professional treatment, but for the purpose of providing the user with narcotics sufficient to keep him comfortable by maintaining his customary use, is not a prescription within the meaning and intent of the act; and the person filling such an order, as well as the person issuing it, may be charged with violation of the law.

Physicians and pharmacists are warned that they risk prosecution if they have anything to do with issuing or filling prescriptions "for the purpose of gratifying addiction," and are told that their good faith in the matter "will be established by the facts and circumstances of the case and the consensus of medical opinion with regard thereto, based upon the experience of the medical profession in cases of similar nature"—in a word, that they are likely to wind up as criminal defendants if they get near the line. Then follows this ( and bear in mind that what I am about to quote began in a directive from a tax-enforcing police agency, was thereafter picked up and repeated as an authoritative statement by a government physician to the American Medical Association, was thereupon endorsed and published as gospel by the AMA, was redistributed broadside at public expense as an official publication of the Department of Health, Education, and Welfare, and is now turning up as an exposition of the reasons why the AMA played a part in scuttling the interesting and conservative proposal of one of its own affiliates, the New York Academy of Medicine):

Mere addiction alone is not regarded or recognized as an incurable disease. It is well established that the ordinary case of addiction yields to proper treatment and that addicts can remain permanently cured when drug taking is stopped and they are otherwise physically restored to health and strengthened in will power. . . .

In general, the physician will be acting in accordance with the consensus of medical opinion with regard to addiction and will be complying with the letter and spirit of the regulations if he follows two principles: (1) Ambulatory treatment of addiction should not be attempted as institutional treatment is always required; (2) Narcotic drugs should never be given to an addict for self-administration.

At the end Dr. Isbell set forth once more ( still in the document prepared by him for the AMA Council on Pharmacy and Chemistry in 1952 ) the full wording of the 1924 AMA resolution as "the reason for establishing these principles."

Nonetheless, one of the AMA witnesses ( and now we are back with the 1955 Daniel Subcommittee hearings in New York), Dr. Leo H. Bartemeier, a psychiatrist appearing as chairman of the AMA Council on Mental Health, told the Subcommittee that he personally took a much broader view; he thought that some kind of out-patient treatment should be tried at least on an experimental basis and that ambulatory treatment might be quite possible if the approach were different:

Many patients who come to a psychiatrist's office for treatment who have been suffering for years from emotional disorders have been self-medicating themselves with large doses of barbiturates, bromides, or other sedative drugs for long periods of time.

When a psychiatrist undertakes the psychotherapeutic treatment of such patients he would most certainly feel it inadvisable to immediately prohibit the emotional calming effects that these drugs produce. Such a move might not only interfere with his immediate treatment of the patient but would in all likelihood bring about a situation wherein the patient would reject the therapist and refuse further treatment. In patients of this sort it is only after a long term of treatment during which time a feeling of confidence had been allowed to develop between the patient and his doctor and when much of the patient's anxiety and apprehension had been relieved that the patient would feel secure enough in the doctor's care to slowly cut down his need for such sedative drugs. Although this may not be an exact parallel to psychotherapeutic treatment of the drug addict, certainly there are strong elements in both types of patients that are the same and I would think, therefore, that it would be necessary for a psychiatrist or other doctor in the treatment of drug addicts on an ambulatory basis to continue to supply narcotics over at least part of the time that the patient is under his care.

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