Drug Abuse

Opium, Cocaine and Marijuana in American History
Over the past 200 years, Americans have twice accepted and then vehemently rejected drugs. Understanding these dramatic historical swings provides perspective on our current reaction to drug use

by David F. Musto
Scientific American July 1991, 20-27

DAVID F. MUSTO is professor of psychiatry at the Child Study Center and professor of the history of medicine at Yale University. He earned his medical degree at the University of Washington and received his master's In the history of science and medicine from Yale. Mus to began studying the history of drug and alcohol use in the U.S. when he worked at the National Institute of Mental Health in the 1960s. He has served as a consultant for several national organizations, including the Presidential Commission on the HIV epidemic. From 1981 until 1990, Musto was a member of the Smithsonian Institution's National Council.

Dramatic shifts in attitude have characterized America's relation to drugs. During the 19th century, certain mood-altering substances. such as opiates and cocaine, were of ten regarded as compounds helpful in everyday life. Gradually this perception of drugs changed. By the early 1900s, and until the 1940s, the country viewed these and some other psychoactive drugs as dangerous, addictive com pounds that needed to be severely con trolled. Today, after a resurgence of a tolerant attitude toward drugs during the 1960s and 1970s, we find ourselves, again, in a period of drug intolerance. America's recurrent enthusiasm for recreational drugs and subsequent campaigns for abstinence present a problem to policymakers and to the public. Since the peaks of these episodes are about a lifetime apart, citizens rarely have an accurate or even a vivid recollection of the last wave of cocaine or opiate use. Phases of intolerance have been fueled by such fear and anger that the record of times favorable toward drug taking has been either erased from public memory or so distorted that it becomes useless as a point of reference for policy formation. During each attack on drug taking, total denigration of the preceding, contrary mood has seemed necessary for public welfare. Although such vigorous rejection may have value in further reducing demand, the long-term effect is to destroy a realistic perception of the past and of the conflicting attitudes toward mood-altering substances that have characterized our national history.

The absence of knowledge concerning our earlier and formative encounters with drugs unnecessarily impedes the already difficult task of establishing a workable and sustainable drug policy. An examination of the period of drug use that peaked around 1900 and the decline that followed it may enable us to approach the current drug problem with more confidence and reduce the likelihood that we will repeat past errors.

Until the 19th century, drugs had been used for millennia In their natural form. Cocaine and morphine, for example, were available only in coca leaves or poppy plants that were chewed, dissolved in alcoholic beverages or taken in some way that diluted the impact of the active agent. The advent of organic chemistry in the 1800s changed the available forms of these drugs. Morphine was isolated in the first decade and cocaine by 1860; In 1874 diacetylmorphine was synthesized from morphine (although It became better known as heroin when the Bayer Company introduced it in 1898).

By mid-century the hypodermic syringe was perfected, and by 1870 it had become a familiar instrument to American physicians and patients (see "The Origins of Hypodermic Medication," by Norman Howard-Jones; Scientific American, January 19711. At the same time, the astounding growth of the pharmaceutical industry intensified the ramifications of these accomplishments. As the century wore on, manufacturers grew Increasingly adept at exploiting a marketable Innovation and moving it into mass production, as well as advertising and distributing it throughout the world.

HEROIN COUGH SYRUP was one of many pharmaceuticals at the turn of the century that contained mood-altering substances. The name "heroin" was coined by Bayer In 1898. a year before the company Introduced aspirin.

During this time, because of a peculiarity of the U.S. Constitution, the powerful new forms of opium and cocaine were more readily available in America than in most nations. Under the Constitution, individual states assumed responsibility for health issues, such as regulation of medical practice and the availability of pharmacological " products. In fact, America had as many laws regarding health professions as it had states. For much of the 19th century, many states chose to have no controls at all; their legislatures reacted to the claims of contradictory health care philosophies by allowing free enterprise for all practitioners. The federal government limited its concern to communicable diseases and the provision of health care to the merchant marine and to government dependents.

Nations with a less restricted central government, such as Britain and Prussia, had a single, preeminent pharmacy law that controlled availability of dangerous drugs. In those countries, physicians had their right to practice similarly granted by a central authority. There fore, when we consider consumption of opium, opiates, coca and cocaine in 19th-century America, we are looking at an era of wide availability and unrestrained advertising. The initial enthusiasm for the purified substances was only slightly affected by any substantial doubts or fear about safety, long term health injuries or psychological dependence.

History encouraged such attitudes. Crude opium, alone or dissolved in some liquid such as alcohol, was brought by European explorers and settlers to North America. Colonists regarded opium as a familiar resource for pain relief. Benjamin Franklin regularly took laudanum opium in alcohol extract-to alleviate the pain of kidney stones during the last few years of his life. The poet Samuel Taylor Coleridge, while a student at Cambridge in 1791, began using laudanum for pain and developed a lifelong addiction to the drug. Opium use in those early decades constituted an "experiment In nature" that has been largely forgotten, even repressed, as a result of the extremely negative reaction that followed.

Americans had recognized, however, the potential danger of continually using opium long before the availability of morphine and the hypodermic's popularity. The American Dispensatory of 1818 noted that the habitual use of opium could lead to "tremors, paralysis, stupidity and general emaciation." Balancing this danger, the text proclaimed the extraordinary value of opium fn a multitude of ailments ranging from cholera to asthma. (Considering the treatments then in vogue-blistering, vomiting and bleeding-we can understand why opium was as cherished by patients as by their physicians.)

Opium's rise and fall can be tracked through U.S. Import-consumption statistics compiled while importation of the drug and its derivative, morphine, was unrestricted and carried moderate tariffs. The per capita consumption of crude opium rose gradually during the 1800s, reaching a peak in the last decade of the century. It then declined, but after 1913 the data no longer reflect trends in drug use, because that year new federal laws severely restricted legal imports. In contrast, per capita consumption of smoking opium rose until a 1909 act outlawed its importation.

Americans had quickly associated smoking opium with Chinese immigrants who arrived after the Civil War to work on railroad construction. This association was one of the earliest examples of a powerful theme in the American perception of drugs: linkage between a drug and a feared or rejected group within society. Cocaine would be similarly linked with blacks and marijuana with Mexicans in the first third of the 20th century. The association of a drug with a racial group or a political cause, however, is not unique to America. In the 19th century, for instance, the Chinese came to regard opium as a tool and symbol of Western domination. That perception helped to fuel a vigorous anti opium campaign in China early in the 20th century.

During the 1800s, increasing numbers of people fell under the influence of opiates-substances that demand ed regular consumption or the penalty of withdrawal, a painful but rarely life-threatening experience. Whatever the cause-over prescribing by physicians, over-the-counter medicines, self indulgence or "weak will"-opium addiction brought shame. As consumption increased, so did the frequency of addiction.

At first, neither physicians nor their patients thought that the introduction of the hypodermic syringe or pure morphine contributed to the danger of addiction. On the contrary, because pain could be controlled with less morphine when injected, the presumption was made that the procedure was less likely to foster addiction.

Late in the century some states and localities enacted laws limiting morphine to a physician's prescription, and some laws even forbade refilling these prescriptions. But the absence of any federal control over interstate commerce in habit-forming drugs, of uniformity among the state laws and of effective enforcement meant that the rising tide of legislation directed at opiates-and later cocaine-was more a reflection of changing public attitude toward these drugs than an effective reduction of supplies to users. Indeed, the decline noted after the mid-1890s was probably related mostly to the public's growing fear of addiction and of the casual social use of habit-forming substances rather than to any successful campaign to reduce supplies.

At the same time, health professionals were developing more specific treatments for painful diseases, finding less dangerous analgesics (such as aspirin) and beginning to appreciate the addictive power of the hypodermic syringe. By now the public had learned to fear the careless, and possibly addicted, physician. In A Long Day's journey into Night, Eugene O'Neill dramatized the painful and shameful impact of his mother's physician-induced addiction.

In a spirit not unlike that of our times, Americans in the last decade of the 19th century grew increasingly concerned about the environment, adulterated foods, destruction of the forests and the widespread use of mood-altering drugs. The concern embraced alcohol as well. The Anti Saloon League, founded in 1893, led a temperance movement toward prohibition, which later was achieved in 1919 and became law in January 1920. After overcoming years of resistance by over-the-counter, or patent, medicine manufacturers, the federal government enacted the Pure Food and Drug Act in 1906. This act did not prevent sales of addictive drugs like opiates and cocaine, but it did require accurate labeling of contents for all patent remedies sold in interstate commerce. Still, no national restriction existed on the availability of opiates or cocaine. The solution to this problem would emerge from growing concern, legal ingenuity and the unexpected involvement of the federal government with the international trade in narcotics.

Responsibility for the Philippines in 1898 added an international dimension to the growing domestic alarm about drug abuse. It also revealed that Congress, if given the opportunity, would prohibit non medicinal uses of opium among its new dependents. Civil Governor William Howard Taft proposed reinstituting an opium monopoly-through which the previous Spanish colonial government had obtained revenue from sales to opium merchants-and using those profits to help pay for a massive public education campaign. President Theodore Roosevelt vetoed this plan, and in 1905 Congress mandated an absolute prohibition of opium for any purpose other than medicinal use.

To deal efficiently with the anti-drug policy established for the Philippines, a committee from the Islands visited various territories in the area to see how others dealt with the opium problem. The benefit of controlling narcotics internationally became apparent.

In early 1906 China had instituted a campaign against opium, especially smoking opium, in an attempt to modernize and to make the Empire better able to cope with continued Western encroachments on its sovereignty. At about the same time, Chinese anger at maltreatment of their nationals in the U.S. seethed into a voluntary boycott of American goods. Partly to appease the Chinese by aiding their anti opium ef forts and partly to deal with uncontrollable smuggling within the Philippine Archipelago, the U.S. convened a meeting of regional powers. In this way, the U.S. launched a campaign for worldwide narcotics traffic control that would ex tend through the years in an unbroken diplomatic sequence from the League of Nations to the present efforts of the United Nations.

The International Opium Commission, a gathering of 13 nations, met in Shanghai in February 1909. The Protestant Episcopal bishop of the Philippines, Charles I Henry Brent, who had been instrumental in organizing the meeting, was chosen to preside. Resolutions noting problems with opium and opiates were adopted, but they did not constitute a treaty, and no decisions bound the nations attending the commission. In diplomatic parlance, what was needed now was a conference not a commission, The U.S. began to pursue this goal with determination.

The antinarcotics campaign in America had several motivations. Appeasement of China was certainly one factor for officials of the State Department. The department's opium commissioner, Hamilton Wright, thought the whole matter could be "used as oil to smooth the troubled water of our aggressive commercial policy there." Another reason was the belief, strongly held by the federal government today, that controlling crops and traffic in producing countries could most efficiently stop U.S. non medical consumption of drugs.

To restrict opium and coca production required worldwide agreement and, thus, an international conference. After intense diplomatic activity, one was convened in the Hague in December 1911. Brent again presided, and on January 23, 1912, the 12 nations represented signed a convention. Provision %,as trade for the other countries to comply be fore the treaty was brought into force. After all, no producing or manufacturing nation wanted to leave the market open to nonratifying nations.

The convention required each country to enact domestic legislation controlling narcotics trade. The goal was a world in which narcotics were restricted to medicinal use. Both the producing and consuming nations would have control over their boundaries.

After his return from Shanghai, Wright labored to craft a comprehensive federal antinarcotics his path doomed the problem of states' rights. The health professions were considered " a major cause of patient addiction. Yet how could federal law interfere with the prescribing practices of physicians or require that pharmacists keep records? Wright settled on the federal government's power to tax; the result, after prolonged bargaining with pharmaceutical, import, export and medical interests, was the Harrison Act of December 1914.

Representative Francis Burton Harrison's association with the act was an accidental one, the consequence of his introduction of the administration's bill. If the chief proponent and negotiator were to be given eponymic credit, it should have been called the Wright Act. It could even have been called a second Mann Act, after Representative James Mann, who saw the bill through to pas sage in the House of Representatives, for by that time Harrison had become governor-general of the Philippines.

The act required a strict ac counting of opium and coca and their derivatives from entry into the U.S. to dispensing to a patient. To accomplish this control, a small tax had to be paid at each transfer, and permits had to be obtained by applying to the Treasury Department. Only the patient paid no tax, needed no permit and, in fact, was not allowed to obtain one.

Initially Wright and the Department of justice argued that   t the Harrison Act forbade indefinite maintenance of addiction unless there was a specific medical reason such as cancer or tuberculosis. This interpretation was rejected in 1916 by the Supreme Court-even though the justice Department argued that the Harrison Act was the domestic implementation of the Hague Opium Convention and therefore took precedence over states' rights. Maintenance was to be allowed.

T hat decision was short-lived. In 1919 the Supreme Court, led by Oliver Wendell Holmes and Louis Brandeis, changed its mind by a 5-4 vote. The court declared that indefinite maintenance for "mere addiction" was outside legitimate medical practice and that, consequently, prohibiting it did not constitute interference with a state's tight to regulate physicians. Second, be cause the person receiving the drugs for maintenance was not a bona fide patient but just a recipient of drugs, the transfer of narcotics defrauded the government of taxes required under the Harrison Act.

During the 1920s and 1930s, the opiate problem, chiefly morphine and heroin, declined in the U.S., until much of the problem was confined to the periphery of society and the outcasts of urban areas. There were exceptions: some health professionals and a few others of middle class or higher status continued to take opiates.

America's International efforts continued. After World War I, the British and U.S. governments proposed adding the Hague Convention to the Versailles Treaty. As a result, ratifying the peace treaty meant ratifying the Hague Convention and enacting a domestic law controlling narcotics. This incorporation led to the British Dangerous Drugs Act of 1920, an act often misattributed to a raging heroin epidemic in Britain. In the 1940s some Americans argued that the British system provided heroin to addicts and, by not relying on law enforcement, had almost eradicated the opiate problem. In fact, Britain had no problem to begin with. This argument serves as an interesting example of how the desperate need to solve the drug problem In the U.S. tends to create misperceptions of a foreign drug situation.

The story of cocaine use in America is somewhat shorter than that of opium, but it follows a similar plot. In 1884 purified cocaine became commercially available in the U.S. At first the wholesale cost was very high-S5 to $10 a gram-but it soon fell to 25 cents a gram and remained there until the price inflation of World War I. Problems with cocaine were evident almost from the beginning, but popular opinion and the voices of leading medical experts depicted cocaine as a remarkable, harmless stimulant.

William A. Hammond, one of America's most prominent neurologists, extolled cocaine in print and lectures. By 1887 Hammond was assuring audiences that cocaine was no more habit-forming than coffee or tea. He also told them of the "cocaine wine" he had perfected with the help of a New York druggist: two grains of cocaine to a pint of wine. Hammond claimed that this tonic was far more effective than the popular French coca wine, probably a reference to Vin Mariani, which he complained had only half a grain of cocaine to the pint.

Coca-Cola was also introduced in 1886 as a drink offering the advantages of coca but lacking the danger of alcohol. It amounted to a temperance coca beverage. The cocaine was removed in 1900, a year before the city of Atlanta, Ga., passed an ordinance (and a state statute the following year) prohibiting provision of any cocaine to a consumer without a prescription.

Cocaine is one of the most powerful of the central nervous system euphoriants. This fact underlay cocaine's quickly growing consumption and the ineffectiveness of the early warnings. How could anything that made users so confident and happy be bad? With in a year of cocaine's introduction, the Parke-Davis Company provided coca and cocaine in 1 S forms, including coca cigarettes, cocaine for injection and cocaine for sniffing. Parke-Davis and at least one other company also offered consumers a handy cocaine kit. (The Parke-Davis kit contained a hypodermic syringe.) The firm proudly supplied a drug that, it announced, "can supply the place of food, make the coward brave, the silent eloquent and... render the sufferer insensitive to pain."

Cocaine spread rapidly throughout the nation. In September 1886 a physician in Puyallup, Washington Territory, reported an adverse reaction to cocaine during an operation. Eventually reports of overdoses and idiosyncratic reactions shifted to accounts of the social and behavioral effects of long-term cocaine use. The ease with which experimenters became regular users and the Increasing instances of cocaine being linked with violence and paranoia gradually took hold in popular and medical thought.

In 1907 an attempt was made in New York State to shift the responsibility for cocaine's availability from the open market to medical control. Assembly man Alfred E. Smith, later the governor of New York and in 1928 the Democrat ic party's presidential candidate, sponsored such a bill. The cost of cocaine on New York City streets, as revealed by newspaper and police accounts after the law's enactment, was typically 25 cents a packet, or "deck."

Although 25 cents may seem cheap, it was actually slightly higher than the average industrial wage at that time, which was about 20 cents an hour. Packets, commonly glycine envelopes, usually contained one to two grains (65 to 130 milligrams), or about a tenth of a gram. The going rate was roughly 10 times that of the wholesale price, a ratio not unlike recent cocaine street prices, although in the past few years the street price has actually been lower in real value than what it was in 1910.

Several similar reports from the years before the Harrison Act of 1914 suggest that both the profit margin and the street price of cocaine were unaffected by the legal availability of cocaine from a physician. Perhaps the formal ity of medical consultation and the growing antagonism among physicians and the public toward cocaine helped to sustain the illicit market.

In 1910 William Howard Taft, then president of the U.S., sent to Congress a report that cocaine posed the most serious drug problem America had ever faced. Four years later President Wood row Wilson signed into law the Harrison Act, which, in addition to its opiate provisions, permitted the sale of cocaine only through prescriptions. It also forbade any trace of cocaine in patent remedies, the most severe restriction on any habit-forming drug to that date. (Opiates, including heroin, could still be present in small amounts in nonprescription remedies, such as cough medicines.)

Although the press continued to reveal Hollywood scandals and underworld cocaine practices during the 1920s, cocaine use gradually declined as a societal problem. The laws probably hastened the trend, and certainly the tremendous public fear reduced demand. By 1930 the New York City Mayor's Committee on Drug Addiction was reporting that "during the last 20 years cocaine as an addiction has ceased to be a problem."

Unlike opiates and cocaine, marijuana was introduced during a period of drug intolerance. Consequently, it was not until the 1960s, 40 years after marijuana cigarettes had arrived In America, that it was widely used. The practice of smoking cannabis leaves came to the U.S. with Mexican immigrants, who had come North during the 1920s to work and it soon extended to white and black jazz musicians.

As the Great Depression of the 1930s settled over America, the immigrants became an unwelcome minority linked with violence and with growing and smoking marijuana. Western states pressured the federal government to control marijuana use. The first official response was to urge adoption of a uniform state antinarcotics law. Then a new approach became feasible in 1937, when the Supreme Court upheld the National Firearms Act. This act prohibited the transfer of machine guns between private citizens without purchase of a transfer tax stamp-and the government would not issue the necessary stamp. Prohibition was implemented through the taxing power of the federal government.

Within a month of the Supreme Court's decision, the Treasury Department testified before Congress for a bill to establish a marijuana transfer tax. The bill became law, and until the Comprehensive Drug Abuse Act of 1970, marijuana was legally controlled through a transfer tax for which no stamps or licenses were available to private citizens. Certainly some people were smoking marijuana in the 1930s, but not until the 1960s was its use widespread.

Around the time of the Marihuana Tax Act of 1937, the federal government released dramatic and exaggerated portrayals of marijuana's effects. Scientific publications during the 1930s also fearfully described marijuana's dangers. Even Walter Bromberg, who thought that marijuana made only a small contribution to major crimes, nevertheless reported the drug was "a primary stimulus to the impulsive life with direct expression in the motor field."

Marijuana's image shifted during the 1960s, when it was said that its use at the gigantic Woodstock gathering kept peace-as opposed to what might have happened if alcohol had been the drug of choice. In the shift to drug toleration in the late 1960s and early 1970s. investigators found it difficult to associate health problems with marijuana use. The 1930s and 1940s had marked the nadir of drug toleration in the U.S.. and possibly the mood of both times affected professional perception of this controversial plant.

After the Harrison Act, the severity of federal laws concerning the sale and possession of opiates and cocaine gradually rose. As drug use declined, penalties increased until 1956, when the death penalty was introduced as an op tion by the federal government for any one older than 18 providing heroin to anyone younger than 18 (apparently no one was ever executed under this statute). At the same time, mandatory minimum prison sentences were extended to 10 years.

After the youthful counterculture discovered marijuana in the 1960s, demand for the substance grew until about 1978, when the favorable attitude toward it reached a peak. In 1972 the Presidential Commission on Marihuana and Drug Abuse recommended "decriminalization" of marijuana, that is, legal possession of a small amount for personal use. In 1977 the Carter administration formally advocated legalizing marijuana in amounts up to an ounce.

The Gallup Poll on relaxation of laws against marijuana is instructive. In 1980, 53 percent of Americans favored legalization of small amounts of marijuana; by 1986 only 27 percent supported that view. At the same time, those favoring penalties for marijuana use rose from 43 to 67 percent. This reversal parallels the changes in attitude among high school students revealed by the Institute of Social Research at the University of Michigan.

The decline in favorable attitudes toward marijuana that began in the late 1970s continues. In the past few years we have seen penalties rise again against users and dealers. The recriminalization of marijuana possession by popular vote in Alaska in 1990 is one example of such a striking reversal.

In addition to stricter penalties, two other strategies silence and exaggeration, were implemented in the 1930s to keep drug use low and prevent a recurrence of the decades-long, frustrating and fearful anti drug battle of the late 19th and early 20th centuries. Primary and secondary schools instituted educational programs against drugs. Then policies shifted amid fears that tat" about cocaine or heroin to young people, who now had less exposure to drugs, would arouse their curiosity. This concern led to a decline in drug-related information given during school instruction as well as to the censorship of motion pictures.

The Motion Picture Association of America, under strong public and religious pressure, decided in 1934 to re fuse a seal of approval for any film that showed narcotics. This prohibition was enforced with one exception-To the Ends of the Earth, a 1948 film that lauded the Federal Bureau of Narcotics-until Man with a Golden Arm was successfully exhibited in 1956 without a seal.

Associated with a decline In drug information was a second, apparently paradoxical strategy: exaggerating the effects of drugs. The middle ground was abandoned. In 1924 Richmond P. Hobson, a nationally prominent campaigner against drugs, declared that one ounce of heroin could addict 2,000 persons. In 1936 an article In the American Journal of Nursing warned that a marijuana user "will suddenly turn with murderous violence upon whomever is nearest to him. He will tun amuck with knife, axe, gun, or anything else that is close at hand, and will kill or maim without any reason." A goal of this well-meaning exaggeration was to describe drugs so repulsively that anyone reading or hearing of them would not be tempted to experiment with the substances. One contributing factor to such a publicity campaign, especially regarding marijuana, was that the Depression permitted little money for any other course of action. Severe penalties, silence and, if silence was not possible, exaggeration became the basic strategies against drugs after the decline of their first wave of use. But the effect of these tactics was to create ignorance and false images that would present no real obstacle to a renewed enthusiasm for drugs in the 1960s. At the time, enforcing draconian and mandatory penalties would have filled to overflowing all jails and prisons with the users of marijuana alone.

Exaggeration fell in the face of the realities of drug use and led to a loss of credibility regarding any government pronouncement on drugs. The lack of information erased any awareness of the first epidemic, including the gradually obtained and hard-won public insight Into the hazards of cocaine and opiates. Public memory, which would have provided some context for the anti drug laws, was a casualty of the anti drug strategies.

The earlier and present waves of drug use have much in common, but there is at least one major difference. During the first wave of drug use, anti drug laws were not enacted until the public demanded them. In contrast, today's most severe anti drug laws were on the books from the outset; this gap between law and public opinion made the controls appear ridiculous and bizarre. Our current frustration over the laws' ineffectiveness has been greater and more lengthy than before because we have lived through many years in which anti drug laws lacked substantial public support. Those laws appeared powerless to curb the rise in drug use during the 1960s and 1970s.

The first wave of drug use involved primarily opiates and cocaine. The nation's full experience with marijuana is now under way (marijuana's tax regulation In 1937 was not the result of any lengthy or broad experience with the plant). The popularity and growth in demand for opiates and cocaine in mainstream society de rived from a simple factor: the effect on most people's physiology and emotions was enjoyable. Moreover, Americans have recurrently hoped that the technology of drugs would maximize their personal potential. That opiates could relax and cocaine energize seemed wonderful opportunities for fine-tuning such efforts.

Two other factors allowed a long and substantial rise in consumption during the 1800s. First, casualties accumulate gradually; not everyone taking cocaine or opiates becomes hooked on the drug. In the case of opiates, some users have become addicted for a lifetime and have still been productive.

Yet casualties have mounted as those who could not handle occasional use have succumbed to domination by drugs and by drug-seeking behavior. These addicts become not only miserable themselves but also frightening to their families and friends. Such cases are legion today in our larger cities, but the percentage of those who try a substance and acquire a dependence or get into serious legal trouble is not 100 percent. For cocaine, the estimate varies from 3 to 20 percent, or even higher, and so it is matter of time before cocaine is recognized as a likely danger.

Early in the cycle, when social tolerance prevails, the explanation for casualties is that those who succumb to addiction are seen as having a physiological idiosyncrasy or "foolish trait." Personal disaster is thus viewed as an exception to the rule. Another factor minimizing the sense of risk is our belief in our own invulnerability-that general warnings do not include us. Such faith reigns In the years of greatest exposure to drug use, ages 15 to 25. Resistance to a drug that makes a user feel confident and exuberant takes many years to permeate a society as large and complex as the U.S.

The interesting question is not why people take drugs, but rather why they stop taking them. We perceive risk differently as we begin to reject drugs. One can perceive a hypothetical 3 percent risk from taking cocaine as an assurance of 97 percent safety, or one can react as if told that 3 percent of New York/Washington shuttle flights crash. Our exposure to drug problems at work, In our neighborhood and within our families shifts our perception, gradually shaking our sense of invulnerability.

Cocaine has caused the most dramatic change in estimating risk. From a grand image as the ideal tonic, cocaine's reputation degenerated into that of the most dangerous of drugs, linked In our minds with stereotypes of mad, violent behavior. Opiates have never fallen so far in esteem, nor were they repressed to the extent cocaine had been between 1930 and 1970.

Today we are experiencing the reverse of recent decades, when the technology of drug use promised an extension of our natural potential. Increasingly we see drug consumption as reducing what we could achieve on our own with healthy food and exercise. Our change of attitude about drugs is connected to our concern over air pollution, food adulteration and fears for the stability of the environment.

Ours is an era not unlike that early in this century, when Americans made similar efforts at self-improvement ac companied by an assault on habit-form ing drugs. Americans seem to be the least likely of any people to accept the inevitability of historical cycles. Yet if we do not appreciate our history, we may again become captive to the powerful emotions that led to draconian penalties, exaggeration or silence.

FURTHER READING

AMERICAN DIPLOMACY AND THE NARCOTICS TRAFFIC, 1900-1939. Arnold H. Taylor. Duke University Press, 1969.

DRUGS IN AMERICA: A SOCIAL HISTORY, 1800-1980. H. Wayne Morgan.Syracuse University Press, 1981.

DARK PARADISE: OPIATE ADDICTION IN AMERICA BEFORE 1940. David T. Courtwrlght. Harvard University Press, 1982.

THE AMERICAN DISEASE: ORIGINS OR NARCOTIC CONTROL. Expanded Edition. David F. Musto. Oxford University Press, 1987.

AMERICA'S FIRST COCAINE EPIDEMIC. David F. Musto in Wilson Quarterly, pages 59-65; Summer 1989.

ILLICIT PRICE OR COCAINE IN TWO ERAS: 1908-14 AND 1982-89. David F. Musto in Connecticut Medicine, Vol. 54, No. 6, pages 321-326; June 1990.