Drug Abuse

CHAPTER 2 The effects and uses of narcotics and moral judgment

Portions of Chapter 2 in this book are reprinted from my article "Drugs and Drug Control," in J. Douglas, ed., Crime in American Society, Indianapolis: Bobbs-Merrill, by permission of the publisher, all rights reserved,

Introduction

AKNOWLEDGE OF THE PHYSIOLOGICAL EFFECTS of drugs is important to an understanding of the principal social and moral issues in the drug problem. For example, if you believe that heroin is a dangerous
drug because it turns the individual into an aggressive, hostile, and uninhibited person, your moral stand will be different than if you believe heroin (I) is destructive to health, or (2) is soothing to the nerves, or (3) simply keeps you awake at night. Indeed, a good many of the intensely moralistic arguments about narcotics are based upon conceptions of the physiological consequences of the drugs. Many of these notions are erroneous, especially the widespread current myths about the opiates. Knowledge of the fact that sustained use of alcohol has far more deleterious consequences to cell life in the body than sustained use of heroin alters the strength of the moralistic pronouncements.

If people informed themselves a bit more about the physical aspects of barbiturates and marijuana, they would probably reverse their social and moral concerns on the two drugs. That is not to say that knowledge of the physiological effects is the only determinant for social attitudes. If Junior is sneaking around in the garage taking secobarbital or dexedrine or marijuana, one can anticipate concern irrespective of pharmacological knowledge. Acts have social meanings quite apart from their physical ones. Thus, even when it is pointed out that alcohol is more physically debilitating than marijuana, centrifugal social forces are often strong enough to override this merely physical fact, and the parent is capable of saying "Ah, but the meaning of his smoking marijuana is defiance, rebellion...."

Because the physiological effects of drugs are different, the moral issues that relate to their use are different. As an extreme illustration of the point, arguments against the marketing of thalidomide (which produced deformed babies) stem from a different moral base than arguments opposed to the marketing of terpin hydrate (which produces less coughing, but contains codein). Although the differences between the physiological effects of marijuana, LSD, and heroin are less dramatic, the point is equally valid when applied to these drugs.

There are many legitimate moral questions, issues, and arguments on the sanctionable uses of drugs. However, only those positions reasonably informed about the physical basis of the narcotics can rest compelling cases on firm ground.

Narcotics

The term "narcotics" is a multicolored blanket that has been used to cover extremely diverse drugs. In contemporary use, it confuses and obscures as much as it clarifies. Although the technical term means to dull, deaden the senses, or put to sleep, many laymen use the term interchangeably with "drug." A drug can be natural (opium poppy) or synthetic (demerol). Its effect on the central nervous system can be that of a stimulant (cocaine) or a depressant (morphine). Further, it may be highly addictive (heroin), or not in the least productive of physical dependence (marijuana)

In the United States, reference to the drug problem usually is reference to opium and its derivatives, especially morphine and heroin. Opiates have two things in common: they are depressants and they are also addicting. Opiates depress the nerve centers which register pain, and are among the most effective analgesics (painkillers) known. Morphine is commonly used for medical purposes in this country and heroin is sometimes used medicinally in other countries.

Barbiturates are also depressants, but are synthetics used as sedatives. There are many forms, including phenobarbital, secobarbital, and pentobarbital. Physicians often use barbiturates in prescriptions of medicines to bring about relaxation and sleep. Effective amounts often make the user drowsy, and the after-effects of sluggishness and heaviness are quite noticeable and annoying to many. Taken in large enough quantities, the barbiturates are highly addicting.

The stimulants to the central nervous system also come in both natural and synthetic form. The most popular are the synthetic amphetamines, popularly called "pep pills" or sometimes "bennies." Drivers sometimes use them to stay awake at night, and students on occasion use these stimulants in order to study for many hours on end. Quite the opposite of the depressants, these drugs can cause heightened alertness, great nervousness, and sometimes distorted perception and hallucinations when taken in large enough quantities. What constitutes "large enough" is as much a matter of the individual physiology of the user as the actual quantity used.

This introductory list should be sufficient to make the point that the term "narcotic" alone means very little, especially when used interchangeably (and imprecisely) with "drug." Passion is a frequent companion of ignorance, and the two are like a settled married couple in the discourse about drugs. Men hold strong views and express fervent opinions about a vast array of drugs. Where opinions run so strong, many expect that there will be at least moderate knowledge of the legal and therapeutic issues involved, but that is an erroneous assumption. Because the narcotics do alter the actual physical condition of the subject in a significant way, a basic knowledge of their effects should be in the background of subsequent discussions of social and cultural issues. For this reason, the present chapter will briefly explore some of the more important narcotic drugs that are discussed and used in this country. Where possible, some statement will be included which touches upon the social and nonmedical uses of the drug.

Morphine

In the United States, morphine is one of the most popular and effective of analgesics used on the operating table. When a moderate dose is given to a patient in pain, instead of producing sleep directly, the drug evokes a kind of euphoria that is an integral part of the absence of pain. The same person taking morphine under normal conditions may feel more fear and anxiety from what is happening to his body than euphoria. This fact should be kept in mind when we turn to the social uses of this and related drugs.

In addition to the pain-killing, morphine in moderate dosage often produces drowsiness and the inability to concentrate, apathy, detachment, and lessened physical activity. However, despite the fact that it is primarily a depressant, it has some ability to act simultaneously as a stimulant. The degree to which this is true depends upon the person, though women tend to react more to the stimulating effects than do men.

Normally the drug takes effect in about fifteen minutes, reaches its peak after approximately twenty-five to thirty minutes, and may continue effective for three to six hours. For some, the effects may last for as long as twelve hours. For most people, the body returns to the old equilibrium at about fourteen to sixteen hours, or if addicted, withdrawal sets in at this point.

In moderate dosage, it may produce itching in the nose and a general feeling of heaviness in the arms and legs. The mouth feels dry, the pupils constrict, respiration is depressed to slower breathing, and hunger is muted. After a time, sleep comes, often accompanied by pleasant dreams.

A full dose, however, has quicker and more dramatic effects. Euphoria may be experienced for a very short period, followed by sluggishness and deep dreamless sleep. An overdose of morphine produces a coma, and death results from respiratory failure. Although morphine's pain-killing effectiveness lasts somewhat longer than heroin's, it produces less euphoria, and actually has more undesirable side effects. The most common of these are nausea, vomiting, and constipation. After morphine is injected, the face and neck become flushed and warm, and the subject may start to perspire. However, morphine actually causes the body temperature to fall, especially with larger doses. Three reasons are generally offered for the analgesic action of morphine. First, it induces a groggy state which allows for a greater endurance of pain. Second, and more debatable, morphine is said to alter the cognitive associations men have with pain. It is argued that while pain is perceived, it is experienced in a different manner so that the subject does not feel the usual fear, panic, or discomfort that ordinarily accompanies its perception.' Finally, morphine itself is able to raise the pain threshold.

Tolerance for the drug develops typically after fifteen to twenty days of continued use of the same dosage. That is, the body does not respond nearly as much to a similar quantity injection of the drug as it did during the first experiences. The user must take a more powerful dosage in order to achieve the same pain-killing effects after his physiology has become tolerant of morphine.

It is often reported that as tolerance for the drug develops, the subject needs greater and greater quantities to achieve the same effect because the body becomes accustomed to the previous level. This is true to a certain extent, pertains to certain kinds of sustained use, and varies with the individual. However, it is important to note that this conception of morphine usage implies an infinite progression to greater and greater tolerance. This is not true. While some addicts do achieve a remarkable tolerance level and are able to take perhaps as much as thirty times the normal therapeutic amount, there is a leveling off even for addicts with the highest quantitative consumption.

The argument that addiction is primarily psychogenically based has been thoroughly discredited. More than a decade ago, Wikler and his associates clearly demonstrated the physiological basis of addiction by isolating the withdrawal syndrome for study after frontal lobotomy.2

The effects of addiction (see Chapter 3) are generally the same for morphine and heroin. An addicted individual may remain in good health and be productive in his work if he is allowed to remain on the drug.3 However, this is not to indicate that there are no physiological consequences to morphine usage that provide other kinds of problems. For example, the dulling of pain may effectively deny the addicted individual the important danger signals which indicate and inform that something is wrong in the body. Also, there are sufficient reports of decreased sexual appetite in morphine and heroin users to indicate that there is an important relationship in this area. An addict married to a nonaddict may face this kind of problem, which has a clear physiological basis. Once off the drug, sexual desires reportedly return to normal level.

NONMEDICAL USES

The illegal traffic in morphine is restricted largely to the legal channels of its distribution, and it rarely moves into the black market. Physicians and nurses who have legitimate access to the drug may administer it to patients, close relatives, or themselves to diminish difficult pain. A tolerance may develop, and for a number of reasons, the decision may be reached to continue administration. Morphine addicts who are apprehended by the law are very likely to report that their primary reason for continuing was to maintain themselves at a normal level and to prevent withdrawal." (This is in contrast to the heroin addict, who often reports the desire for euphoria as a primary motivation.)5

The morphine addict is therefore likely to be an individual who was addicted in the course of some medical problem. Among morphine addicts, physicians and nurses are probably the most frequently represented occupational groups. Morphine addiction is primarily a middle-class addiction because medical practitioners and the patients that they treat in this fashion who subsequently continue usage are likely to be from this level in society.

Heroin

A semisynthetic derivative of morphine, heroin is far more potent and causes considerably more euphoria. The basic effects of the two drugs are the same, and the preceding discussion of morphine applies generally to heroin. However, there are some important differences. Heroin has more of a depressant effect upon the respiratory system and its action is considerably faster. After only twenty minutes, the drug reaches its peak as an analgesic. Relief from withdrawal is almost momentary. As has been noted, there are few undesirable side effects, something which heroin addicts who have tried both are quick to point out.

NONMEDICAL USES

Heroin has medical uses as an analgesic in several countries, including Great Britain, but it has been banned in the United States since 1924. As Eldridge notes, the association of the drug with the underworld produced a "heroin scare" in this country that resulted in a medical backlash.' After the Harrison Act, heroin leaped into great prominence in the underworld traffic. It seemed particularly adapted for use in this kind of market because it is easily transported and distributed in bulk in a form that requires only minimal preparation. The user simply has to make some minor alterations with highly accessible additives, and it is ready for injection. Morphine is more difficult to deal with, for it requires a more extensive and deliberate preparation to transform it from a transportable state to readiness for use.

Winick finds no evidence that sustained usage of heroin or morphine produces any toxic effects, nor that either results in damage of any kind to the central nervous system. As many others have pointed out, the physiological problems which heroin users face result from withdrawing from the drug once physically dependent upon it.8 As long as the individual remains on the drug, he can, and often did up until the first few years of this century (as was pointed out in Chapter 1), live a "normal" and productive life.

At this point, it is important to distinguish between two kinds of heroin users, or, at least two stages of heroin usage. First, there is the user who injects heroin in order to achieve euphoria. Either this can happen from the first few times that one takes it, or one can take considerable amounts all at one time later, after tolerance develops. Some addicts will take the cure voluntarily for a time in order to lower their tolerance and thereby achieve a greater kick (euphoric state) with a smaller dosage. This first group of addicts may "take a trip" to another psychic world that is as much psychological as physiological. Nonetheless, their physical abilities are altered a bit, and they are less dexterous than when not under the drug. Their reaction time is slower, and they generally are withdrawn from the world. It is this addict who has the attitude that he would be very happy if the world would leave him alone, and he would be only more than happy to leave the world alone.

This type of heroin user is much more affected by the drug than the second type, who is fully addicted and who takes the drug primarily to stave off withdrawal. The addict in this setting takes heroin primarily in order to achieve the physiological equilibrium that allows him to continue normally from day to day. He has all the appearances of normality, and it takes chemical tests to detect if he is using heroin. He drives a car, plays baseball, and performs many tasks requiring some manual dexterity (some surgeons have been addicted to morphine). This is not to say that he could not have performed more skillfully if he were not addicted and not under the influence. That is an empirical matter, and the evidence is that sheer physical matters like reaction time are slowed. It is to indicate, however, that men can and do live normal physical lives while addicted to the opiates.

Amphetamine

The amphetamine drugs stimulate the central nervous system, but the responses evoked depend largely upon the mental state and personality of the individual. The two most popular forms are generally known to college students as benzedrine and dexedrine. Their popularity stems from their ability to keep one awake for long study periods just before exams. When taken initially or infrequently, amphetamine generally produces the following effects after moderate dosage: alertness, increased initiative for otherwise boring or dreaded tasks, and greater ability to concentrate. The individual also frequently becomes more talkative and physically active, often giving the appearance of nervousness or agitation.

Larger doses or sustained usage result typically in some unpleasant symptoms, ranging from headaches, palpitation, and dizziness all the way to delirium and mental depression. Clinically, amphetamine drugs do have an analgesic action, and when used in combination with morphine, prolong the latter's pain-killing powers.

Addiction can occur, but it is very uncommon Some heroin addicts use this drug to accelerate the action of heroin and to achieve a stimulated euphoria that is a different kind of kick. One of the more frequently cited precautions to its sustained use is the masking of fatigue, which can delude the user into assuming that his body can take the physical and mental exertion that is being abnormally pursued.

There is considerable literature and considerable controversy on the therapeutic ability of amphetamine in psychogenic disorders. It has been satisfactorily employed to elevate persons out of mental depressions and certain psychoneuroses. Some reports indicate that there are forms of epilepsy that are aided by its administration. It has even been used effectively for some chronically overweight persons in weight-reducing programs because of its ability to decrease the appetite. However, there are many reports of failures to accomplish the desired ends in each of these areas, and the varying effects of the drug with different personalities have been sufficient to elicit strong warnings from medical researchers that the drug should not be self-administered for these kinds of problems.

Methedrine (Methamphetamine Hydrochloride)

Methamphetamine is closely related in its chemical construction and some of its physiological effects to amphetamine. It has one important difference which makes it of special interest: While its effect on the cardiovascular system is weaker than that of amphetamine, it is more powerful as a stimulant to the central nervous system. In this fact lie some significant consequences for its nonmedical and illegal use. The drug is marketed under almost a dozen quite different trade names, the best known of which is methedrine. It is used clinically for the same kinds of things as is amphetamine, such as sustaining blood pressure during spinal anesthesia.

Methedrine is used by some people because of its ability to stimulate the mind without greatly affecting other parts of the body. Those who use methedrine illegally tend to have artistic or intellectual leanings, and as a class are much more self-consciously concerned about creativity and individual expression than are, say, heroin users. As has been noted, the opiates depress the nervous system, and the user floats away from this world and its considerations. Quite to the contrary, methedrine heightens the individual's perceptivity and responsiveness to selected aspects of his environment, and apparently stimulates him to relate to the world rather than to withdraw from it.

Methedrine users seem to be a very small group among a large population of narcotics users, and they have some of the trappings of a separate cult. They are disdainful of heroin addicts, and hold many of the same attitudes toward them as does the general society.9

The Barbiturates

Barbital, the first of the barbiturates, was first used at the turn of the century. Following it was phenobarbital, introduced in 1912. Since that time, over 2,500 barbiturates have been developed, and more than fifty have been cleared and marketed for clinical use. They are widely prescribed by physicians, and are commonly used to induce sleep for countless different reasons. They are addicting and can be quite dangerous in dosages that exceed a minimum. In combination with alcohol they have proved unpredictably fatal.

The barbiturates are depressants to the central nervous system and are used clinically as sedatives and hypnotics. The inducement of sleep is the most frequent reason for their use. They differ from the opiates in analgesia because they are unable to produce sleep in the presence of even moderate pain. Barbiturates do not raise the threshold of pain significantly to be called true analgesics.

Despite the sensational play given to heroin and morphine addiction, barbiturate addiction is a far more serious physiological matter. A 195o research report relates how some volunteers at the federal hospital for drug addicts were given the barbiturates for an extended period :

when the drugs were withdrawn after three to five months, four of five subjects developed convulsions and four of five became psychotic. This experimental demonstration of addiction, later amplified with additional cases, did much to inform the American medical profession that primary barbiturate addiction does occur and that the abstinence syndrome is characteristic and dangerous. [Compared to morphine] ... barbiturate addiction is a more serious public health and medical problem because it produces greater mental, emotional, and neurological impairment and because withdrawal entails real hazards.1 o

The barbiturate addict is more sluggish in physical mobility and thought. His speech is slow, his memory is poor, and his comprehension is narrowed. Typical patterns also reveal exaggeration of selected personality traits, moroseness, and irritability.

Withdrawal from barbiturates for an addict can be quite serious for his psychic equilibrium. This varies by individual, but hallucinations are frequent. In the early stages of withdrawal, these hallucinations are recognized by the subject for what they are, but as they continue over time, he loses his facility to distinguish between his own unique perceptions and those which are consonant with the consensus of reality—a primary characteristic of schizophrenia. The withdrawal psychosis may clear after a few days, but there have been occasions where hallucinations have persisted for more than a month. Barbiturate addiction withdrawal is a difficult problem to treat symptomatically because the various physical symptoms are hard to distinguish from more traditionally known illness symptoms, such as delirium tremens of the alcoholic, epilepsy, and encephalitis, to name but a few. Extensive investigation and cross-checking is required to rule out these other sources of the physical problems manifested.

A standard reference work on therapeutics states that while the incidence of barbiturate addiction cannot be known, it is not only "common, but appears to be on the increase."11 In combination with the greater physical seriousness of barbiturate addiction, it seems very odd that morphine and heroin addiction should receive so much more attention. The newspapers and magazines and movies make very little of barbiturate addiction because it is not perceived in the same moralistic tones as addiction to the opiates.

NONMEDICAL USES

In recent years, barbiturates have been used increasingly outside of medical and clinical recommendation, particularly so with illegal marketing. When heroin or morphine is not readily available to a person addicted to one of these drugs, he may turn to a short-acting barbiturate. This would be either secobarbital or pentobarbital, known among addicts as "goofballs" in honor of the effects achieved. It is possible to develop a simultaneous addiction, and in order to stave off withdrawal, an addict who practices this too frequently will have to take both heroin and secobarb.

Because of the unpleasant sluggishness that accompanies barbiturate use, most heroin addicts dislike the drug, and will use it only as a last resort. They can achieve either euphoria or normality with heroin, and in either state do not feel burdened by the drug. With secobarb, on the other hand, they feel definitely restrained in their ability to manage the world. In driving a car, the slowing of reaction time from the accelerator to the brake is even subjectively perceived.

To continue a point of the first chapter, it is interesting to note that increasing public alarm over barbiturate use and addiction has paralleled its development into illegal traffic. The present situation is very much like that in 1912 with morphine consumption: Main usage is clearly with persons who take the drug for medical purposes, and there are few taints and charges of sensual gratification or kicks explaining the addiction. To further the analogy a bit, the lower classes, young male adults, and ethnic minorities seldom take barbiturates now. (The reason is only slightly different: Prescriptions are required, but more important, the subjective desire for sedation seems to be more of a middle-class phenomenon.) If a new federal law outlawed barbiturate use in this country, except under very personalized medical care, and if physicians were imprisoned for "simply prescribing without close attention," barbiturate addicts would suddenly be prime candidates for a black-market traffic. The cost of the drug would go up considerably. The middle-class addicts would fade out of the statistics partly because they could get their own personal care from private family physicians, partly because of systematically differential treatment by the agencies of law enforcement.12 Those in social categories further and further from the center would appear with great frequency in criminal citations, and barbiturate use would be transformed in the minds of the public into a vicious, evil habit in which only the willfully immoral could engage. An important reason why this has not happened has been the lack of an association between barbiturate use and the pursuit of sensual gratification. As was noted in the first chapter, morphine and heroin use did not come in for strong moral censure until the Harrison Act's interpretation and enforcement and sensational yellow journalism combined to give the public the association with sensual pursuits. Until very recently, barbiturate users were almost entirely in those social categories which do not lend themselves to moralistic denigration.13

Cocaine

Cocaine is the drug most responsible for the erroneous public image of the narcotic addict as a "dope fiend," one who takes a drug and becomes an aggressive "maniac" dangerous to himself and others. The drug is obtained from the leaves of the erythroxlyon coca trees of Peru and Bolivia. Its most important medical use is to block nerve conduction when applied locally. The drug acts first as a powerful stimulant, producing pleasurable hallucinations, great excitement and often an exaggeration of one's own powers. There is generally a feeling of tremendous mental and physical strength, and indeed, there is some evidence that mental powers are increased by the drug. Because cocaine acts to lessen the perception of fatigue, greater physical exertion is possible.

The tendency to feel stronger and more insightful than is actually the case has been known to produce paranoia in the cocaine user, partly because he then attributes his actual ineffectiveness to a conspiracy. Suffering from feelings of persecution, cocaine users may become physically aggressive towards "hostile" individuals in the immediate environment. Visual, auditory, and tactile hallucinations are reported, especially the feeling of something crawling on the skin, a perception that gives further impetus to the paranoia.

Cocaine usage is rare in the United States, and cocaine addiction is rarer. Physical dependence on the drug is not nearly as clear as with the opium narcotics, and withdrawal from cocaine is not nearly so difficult. One can develop a tolerance for the drug, so that increased dosages are required for the same effect over time, but little is known about the physiological mechanisms of cocaine tolerance.

Even though the drug is a powerful stimulant to the central nervous system in the first stages of its effect, it becomes a depressant in later stages. An overdose will depress the medullary centers causing respiratory failure and death.

Although its usage is not a problem of any size or urgency, the sensational play given to cocaine in various newspaper accounts of its use in the 192os and 193os has given to it a significance that is strongly felt whenever narcotics are discussed by laymen. As has been noted, the present-day serious issue of production, distribution, and consumption of narcotics is with the opiates. They depress the nerve centers that register pain, and they take the individual away from ordinary anxieties and restlessness. The opium addict is passive. Yet, men commonly think of the aggressive fiend who "goes crazy" under the influence of narcotics. It is the deprivation of the drug which makes the otherwise passive heroin addict aggressive. It is very specific goal-oriented behavior, and has nothing to do with the effect on the body while under the influence of heroin. Under the influence of cocaine, however, the individual may be highly stimulated to aggressive and hostile action that is a direct consequence of being "on" the drug, not "off" it.

Unfortunately, many people associate the effects of cocaine with the opiates, and this common misconception is a considerable stumbling block to a calm discussion of the narcotics problem. If men are convinced that narcotics usage ravages the body and mind, they are not likely even to entertain an argument about the possibilities of clinical treatment with that drug.14

Marijuana (Cannabis)

Marijuana is the term used in the United States for any part of the hemp plant, or any of its extracts, which produces psychic changes when chewed, smoked, or ingested. The technical name for the drug is Cannabis, and it was known to the Chinese five centuries before Christ. Because of the relative paucity of research with the drug, we do not know whether it is primarily a stimulant, a depressant, or both. It was used as an anesthetic in surgery two thousand years ago, but has long since been replaced by more powerful and dependable analgesics, such as the opiates. Marijuana has almost no medical use in Western societies, and is not used at all clinically in the United States.

Marijuana has both stimulant and depressant effects upon the central nervous system, and it is impossible to say which is the more important, or predominant, action. It varies with the individual, with his psychic condition at the time of exposure, and the kind of social environment in which he first uses. Becker has a lucid analysis of the importance of these kinds of factors in marijuana usage.15 In this light, it is fascinating to note that in experimentation with animals, there is no strong evidence that marijuana significantly affects or alters the nervous system as either a sedative or hypnotic agent.16

Research on the physiological effects of marijuana usage has concluded that many of the side effects of the drug are very likely accounted for by the central excitation associated with the drug's use.17 Nausea and diarrhea may result, as may urinary frequency, but they are hardly predictable. The primary reason for smoking marijuana seems to be the achievement of the "high," an exhilaration or euphoria that gives one a disconnected feeling from mundane life. Vivid and pleasing hallucinations are often a part of this, as is a loss of time and speed perceptions. A marijuana user once described his experience of driving an automobile while under the influence of the drug:

I kept saying to myself, slow down, slow down, you're going too fast, way too fast. I was sure that I must have been doing about 6o-70 in a 25 m.p.h. zone, and while I had this feeling, some guy comes zooming past me on a bicycle.

Some of the noticeable effects that are reported include heightened sensitivity to touch and a feeling of floating in air, suspended by one's own will. The arms and legs feel a bit heavy, and occasionally the opposite of "high" may result : The individual may become withdrawn and depressed, or he may experience fear and feelings of persecution. The imagination is sometimes stimulated to novel directions; broken ideas and broken thoughts seem profound when they are experienced, and one feels the urge to express them.

Very commonly, there is no perceived effect the first time the drug is used. This corroborates Becker's thesis that learning in a social situation is critical to the nature of the effect produced.18 Even though some reports indicated that there is a sexual quality to some of the more pleasant experiences, marijuana is evidently not an aphrodisiac. The unfounded public scare reports of the Federal Bureau of Narcotics in the late 193os associated marijuana with rape and murder, and resulted in the passage of the 1937 federal legislation on the sale and purchase of marijuana.19 The Bureau assailed the results of an empirical study published in 1945 which disputed these dangers of marijuana use. Just ten years later, the Bureau had changed its position remarkably when, in 1955, the main argument against marijuana was that it led to heroin.20 This has remained the predominant argument against the drug ever since, a subject to be addressed momentarily.

With continued use, there may be some small degree of tolerance developed for the drug, but it is minimal, and disappears when the subject stops for even a short period. There is no physical dependence upon marijuana, and therefore the drug is not addicting. As for the psychological issue of habituation, a primary reference on the pharmacological effects states:

psychic dependence is not as prominent or compelling as in the case of morphine, alcohol, or perhaps even tobacco habituation. Marijuana habitues often voluntarily stop smoking for a time and do not necessarily experience undue disturbance or craving from deprivation. Organic (physiological) dependence, as evidenced by characteristic withdrawal symptoms, apparently does not develop.21

Despite the furor and clamor about it, marijuana is far less physically harmful than is alcohol. For an excellent analysis of the marijuana problem, to which this discussion is indebted, the reader should see Alfred Lindesmith's most recent work on addiction.22 First of all, it is conclusive that sustained use of alcohol is destructive to cell life in the body. Further, alcohol has been known to produce psychosis, and clearly alters the mind with only moderate intake. Some men lose time perceptions, others are slowed in reaction time, and dexterity is drastically reduced.

Just as is alcohol, marijuana is capable of altering time perception, evoking a euphoria, and releasing inhibitions. As with alcohol, there are rare cases of psychotic episodes resulting from its use. It is not addicting, however, and alcohol demonstrably is.

The strongest thing that those who are against marijuana say about it is that it leads to heroin. In order to prove the point, they argue that heroin addicts used marijuana previous to heroin. Any freshman in an introductory course in methodology or logic can see the foolishness of this proof. We know almost nothing about the population of marijuana users who do not go on to heroin. They aren't talking, and the law enforcement agents and the social scientists have few access routes to them. The argument about marijuana leading to heroin has inadequacies ranging from glaring illogic to a complete inability to deal with critical empirical matters that would allow a reasonable statement about the relationship.

A good analogy would be the relationship between cancer and alcohol. Suppose a team of physicians discovered that a large percentage of persons with cancer drink alcohol regularly. They could not make any statement about a relationship until they found out whether others who drink alcohol regularly tend to develop this cancer. That is, they would at least have to look at a larger population of alcohol consumers than simply those in hospitals with cancer, in order to assert some relationship.23 Yet that is precisely what people are doing when they say that marijuana leads to heroin. They are dealing only with a population of heroin users, not with the critical population of marijuana consumers. A physician would be ridiculed both within his profession and outside of it if he proposed to make some connection between alcohol and cancer on the basis of looking only at cancerous patients. Yet men are constantly making outrageous claims about the relationship of marijuana to heroin by looking only at heroin users.

A more empirical example is available. It has been for some time common to hear assertions that juvenile gangs in urban areas are breeding grounds for narcotics use. However, findings reported by Isador Chein and his associates from an intensive study of this problem in New York suggest that adolescent gangs actually are strong forces against narcotics usage.24 Among several hundred gangs, a few will have narcotics use as a part of their activities. These gangs come to the attention of the law enforcement authorities, and then of the press. In fact, gangs typically act as a bulwark against drug use. They have their own systems of internal sanctions, even in high-heroin slum areas of New York.

The essential point is that, if all we know about are the narcotics gangs, then our ignorance expands into an unfounded generalization about narcotics and gangs. If all we know about are heroin addicts and their past association with marijuana, then our ignorance expands into an unfounded generalization about marijuana and heroin connections. Obviously, even a tentative exploratory statement of the relationship is dependent upon a great deal of knowledge about the population of marijuana smokers, not simply those whom the police and newspapers know as heroin addicts.

Were the consequences not so grave, it would almost be amusing to observe the illogic and inconsistency of the contemporary position that marijuana leads to heroin. For example, the very same Federal Narcotics Bureau that asserts this position also acknowledges that marijuana is widely used on college campuses without leading to heroin use:

Collegians on practically every major college campus in the country have used marijuana or other drugs—often with the approval of educators—the nation's narcotics chief has warned Congressmen. Commissioner of Narcotics Henry L. Giordano noted with alarm: "We have had a problem in just about every one of the major universities in the country with marijuana. Fortunately, you will not run into heroin. It is amphetamines, hallucinogenic drugs, tranquilizers and drugs of that sort."25

A young man or woman attending college in an urban area of the United States can locate and experiment with marijuana simply by repeatedly asserting in various campus circles that he is interested. The precise traffic is unknown, but there is good reason to believe that marijuana consumption in these areas is considerable. There are common estimates that between i 5 and 25 per cent of American college students have experienced marijuana. If marijuana leads to heroin with even the most moderate frequency, there should be droves of heroin addicts in the colleges. The fact that there are almost none is facilely and somewhat erroneously explained on the grounds of heroin's unavailability. True enough, there is no heroin market at the colleges. However, the universities where marijuana is most likely a considerable issue are in or around New York City, Chicago, San Francisco, and Los Angeles. It just happens that there is heroin traffic in all these areas, and an enterprising college student (college students who smoke marijuana are likely to be enterprising) could surely make his way into the appropriate area, make "contact," and return with his heroin packet, physically expending himself no more than he would by going, say, to the right jazz night spot.

No firm statement can be made with authority. However, if a choice has to be made, one is on far safer empirical grounds in asserting that most marijuana users do not go on to heroin, based on extrapolation from the best evidence we have on the consumption patterns of both drugs. What sense is to be made, therefore, of continual assertions that marijuana's primary danger is that it is a path to heroin?

Meperidine (Demerol) and Methadone

Meperidine is a synthetic pain-killer used extensively for medical purposes. It is similar to morphine in that the analgesia may result in euphoria, though this is less likely. It is just the opposite to the barbiturates in that it will kill pain but not put the subject to sleep. Although meperidine is addicting, the withdrawal syndrome is less severe than with morphine. The onset of withdrawal is faster, with muscle twitching and restlessness the more common symptoms. On the other hand, the drug is more debilitating than morphine, and the demerol addict can not manage as well as the opiate addict.

Since it can be used to stave off withdrawal for the opiate addict, he will resort to its use in the interim if available, although there is a strong preference for heroin or morphine.

Methadone is also a synthetic analgesic, and its pharmacological actions are almost identical to that of morphine. It is a very recently developed drug, marketed only since the Second World War. Because it effectively cancels out the withdrawal symptoms of heroin and morphine addiction, and because tolerance for (and physical dependence upon) methadone develop slower than with either of the natural opiates, it was originally greeted with enthusiastic claims as a nonaddicting cure for the opiate addict. To this extent, its early history paralleled the claims originally made for heroin. The heroin addict begins to experience the beginning discomforts of withdrawal twelve to sixteen hours after the last injection, but the methadone addict may have as long as seventy-two hours of symptom-free time before withdrawal sets in. Further, the actual symptoms are milder and more prolonged than intense. After the third day of abstinence, the subject may complain of sleeplessness and anxiety, weakness, and possibly headaches. However, this is quite preferable to the extreme discomfort experienced from abstinence from the natural opiates. Wikler has suggested that the milder symptoms from the termination of methadone use are a result of the slower rate of excretion of the drug.26 In any event, it is most effective and probably finds its most frequent use in the gradual withdrawal of the morphine or heroin addict back to drug-free equilibrium. Methadone may be administered in gradually diminishing doses to the opiate addict over a period of a week or more.

Lysergic Acid Diethylarnide (LSD)

Quite unlike every other drug that has been mentioned, LSD is rarely if ever mislabelled a narcotic. Depending upon the bias of the persons expressing themselves on the subject, it is either an hallucinogen or a psychedelic drug. If one is skeptical, hostile, or reserved about LSD, the chances are that he will call it an hallucinogen. The drug often provokes remarkable imagery, and audial and touch perceptions that to "nonbelievers" are like hallucinations outside of the working social consensus of what is really out there. If, on the other hand, one is favorable about the effects of the drug, or is sympathetic to the goals of its users, is a cultist or "believer," then the chances are that he will call LSD a psychedelic drug. The reason is that the effects provoked are seen as mind-enriching experiences that expand the horizons of man's sensory perception and offer new dimensions to thought and imagination.

The effects of LSD vary greatly with the temperament of the subject, his attitude toward the impending experience, the social milieu, and the amount of the drug used. Nonetheless, there are some patterns in the effect of the drug which have emerged. At slight to moderate dosages, between so and too milligrams, LSD tends to produce minor changes in sensory perception. Some users report no effect, others have experiences that parallel the experiences of those with larger doses.

From 100 to 200 milligrams, the following changes are frequent. First, there is a general feeling of heaviness in the extremities. Not only is the ability to concentrate on select items enhanced, but there appears to be a tendency to fixate one's attention for long periods of time on a single object. (On mescaline, Huxley reports that he could look at his trouser leg for half an hour, fascinated by the intricate weave and the interplay of colors that normally escaped his perception.27) Others report how they can look at a vase, a painting, or a leaf for extended periods, marveling at certain internal relationships in the object for the first time. (One might speculate that the ability of the catatonic to "stare" for long periods could be a function of just such heightened sensory fixation. There is already disputed evidence concerning the alleged similarity of the blood chemistry of those who habitually hallucinate to changes in the blood of those who have used LSD.)

It is also common for the subject to see new patterns and movement in ceilings and walls. It is not clear whether colors appear brighter and more sensational because of the increased concentration facility, or whether the receptors are actually transformed. The pupils dilate considerably, and the LSD user finds bright lights very annoying. Auditory receptors are not themselves notably affected, but some report that a familiar piece of music takes on completely new meanings. A Brahms symphony may be experienced and understood for the first time in terms of a wholistic dimension, and contrapuntal structure is seen in a new relationship to the newly perceived whole.

One of the more interesting effects concerns the muting or destruction of the "normalizing" ability of the mind.2S For example, we learn over time that the hands and feet and arms and legs of adult friends remain a constant size, and do not grow or shrink. So, when we look at a friend whose feet are propped on a table, facing us, we know that although it appears that his feet are much larger than his head, it is not really so. As Brunswik and others have demonstrated in experiments in transactional psychology, the precise image that strikes the retina would lead one to conclude that the object is constantly changing.29 The viewer or observer achieves a conception of the perceived object as a constant object by normalizing. He surmises from a long history with the object, or similar objects, that it remains normal despite incongruities that continually would challenge him if he relied solely upon what strikes his retina.

To put it another way, if one is to believe one's eyes, he will conclude that his fist is larger than the Empire State Building because when he holds his fist up close to his face and measures it against the structure in the distance, that is what really registers on the retina. Obviously, under normal conditions, men do not conclude this. They normalize the incongruity received on the retina by reasoning and recall. Apparently, LSD affects this normalizing process. It has led some to conclude that LSD allows one to see the world as it really is, without the constraining elements of normalizing, which, it is argued, is a consequence partly of man's recall of sensory experience, but is partly a consequence of his learning relationships a priori from his culture. Those who argue against this position assert that the drug simply produces unreality perceptions or hallucinations. This, it seems, is the core of the discussion as to whether LSD is an hallucinogen or a psychedelic.

These two orientations to LSD also reflect a difference between an underlying fear and an underlying optimism about explorations into the psychic unknown, since what LSD does to the mind precisely is an unknown.30 Tolerance for the drug is minimal, and recedes after a few days abstinence, and there is no physical dependence to worry about. Further, psychotic breaks occur with large doses of alcohol or barbiturates and whether they are more common than with LSD is an empirical matter about which we presently have no empirical answers.

Nonetheless, in 1966, LSD took its place alongside marijuana as an officially labeled "dangerous drug." As with marijuana, there is a stormy controversy over its distribution and use. Lindesmith correctly points to the civil and political issues in marijuana consumption, issues which concern the appropriate relationship between autonomy in the private and in the public areas of life, and which should be argued in the open air.3 u

These same issues are relevant to a discussion of LSD. The argument that we don't know enough about the actual physical effects of the drug or about its psychotherapeutic value is an interesting one: There are hundreds of drugs distributed every year that we don't know enough about, and that have serious and unfortunate effects on body tissues, spleens, livers, kidneys, and so on. There are so many thousand variables to deal with in prescribing the appropriate drug that no drug company could hope to control them all. It may be that certain foods combine with certain drugs in an unknown way. Unanticipated side effects that are quite harmful to the body frequently accompany marketed drugs. Some measure of this is unavoidable. A few of these drugs become sensational cases, such as chloromycetin and thalidomide.

Chloromycetin was an antibiotic advertised and marketed for household use for minor cuts and burns, but it turned out to be a cause of aplastic anemia, a fatal disease.32 Thalidomide resulted in the side effect of deformed babies. These were simply two of the more sensational cases of drugs we don't know enough about. There are many more, but we can not know about all possible variations and combinations. The best that the Food and Drug Administration can do is to require certain tests that insure exhaustive trials before a drug is marketed.

However, with LSD, we are dealing with the mind and its thought process, not simply with bodily matters. Men in society become especially wary when drugs start altering the working consensus of perceptions of reality and truth. We know some things about the effect of LSD upon the mind. To some observers, these things are alarming, while to others, LSD is a remarkable opportunity for exploration.

Summary

At the beginning of the chapter, it was pointed out that the moral arguments concerning the use of drugs are based largely upon beliefs about the physiological effects of the drugs.

In the 193os, the Federal Narcotics Bureau saw "danger" in the probability that marijuana would produce aggressive sex maniacs and murderers. When empirical research undercut the foundations of that argument, the big danger became the probability that the drug led to heroin consumption. The conditions and circumstances of marijuana use determine whether it will lead to heroin. The Bureau is now caught in an embarrassing contradiction because it publicly admits that marijuana does not lead to heroin on college campuses.

The strongest argument that is now used against marijuana is that it leads to heroin. That argument is full of logical contradictions and is not based upon any research on the population in question, namely, marijuana users. Indeed, the physiological effects of marijuana are such that Lindesmith is correct in asserting that its use can be treated as a morally private matter and regulated by the state in the same manner as other private consumption matters.33

The physiological effects of heroin, however, are such that the private consequences may be of significance in the public sphere. If that is the case, one may wish to implement legislation which addresses itself to the specific public concern for its use.
The legalization of heroin or morphine could not mean very much until the advocate of legalization spells out a detailed program of distribution and consumption. This could range all the way from a free and open market in the drug, the way aspirin is now handled, to a very tightly controlled prescription legalization. In the latter form, only men with specific problems or reasons could obtain the drug. In the former, mass consumption would be possible. Both, however, entail legalization, and for these reasons one need say more than a simple statement about being in favor of new laws.

With heroin, keeping the above qualifications in mind, it seems that the primary issues in its legalization and availability to a mass market might well revolve around the question of how the members of the society feel about the artificial, external lessening of suffering, both physical and psychic. (With heroin, the added dimension is the development of a dependence upon the drug, but then many men are dependent upon other drugs without other men raising a cry of moral outrage.) When the question is raised about whether we ought to alleviate suffering through pill and injection, one is driven back to a moral position.

One speaks from the point of view of a laymen in society and not as a social observer when he says that there are some kinds of psychological problems that people should work out on their own without a pill because that is good, productive of creativity, perhaps even a measure of greatness, and may add more insight into the meaning of life. That is my view, but I hasten to add that this is a moral issue in which my expertise can be no greater than that of any other member of the society in that I argue for what ought to be. The same is true for any "expert" in this field, whether he is a law enforcement agent, a pharmacological researcher, or a student of psychology.

We would do well to distinguish between the fear of the known (alcohol) and the fear of the unknown (LSD). We know that alcohol is a mind-transforming substance with systematic and observable consequences to the physical well-being of the individual. LSD may prove to be a drug that is dangerous to the mind and the body, but at this point in our knowledge, it is hardly consistent to label it a "dangerous mind-transforming drug" while the author of such statements composes that phrase over a dangerous mind-transforming cocktail.

LSD may be dangerous to society at another level, however. A social order is capable of being maintained through an operating consensus of reality. The real danger of LSD may prove to be that it destroys that operating consensus by provoking some to conclude that what they "really" perceive is different and unique from the perceptions of all others; or of even greater significance, perhaps ordinary, mundane life is seen as meaningless and total withdrawal and detachment from one's fellow man is the consequence.34 LSD's advocates minimize this problem and emphasize the enriching experiences of new dimensions of thought and perception. In any event, it should be clear that whatever moral position one takes, its basis is what is believed to be the actual physical effects of the drug.

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