The Addict and the Law

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The writer first became concerned with the narcotics problem about 1935 and a few years later, in published articles, began to make references to the fact that it appeared to be the practice of various European nations to view and deal with addiction, not as a punishable offense, but as a medical problem to be handled by the medical profession rather than by the apparatus of the criminal law. In this connection, special reference was naturally made to the British program both because information concerning it is readily available in the English language and because the program is highly regarded and has sometimes been deliberately emulated by other European nations.

OFFICIAL ATTITUDES
A decade or so ago the idea that it might be wise policy not to apply prohibition tactics to drug addiction was generally regarded as heresy in this country. The narcotics officials of the federal government connected with the Bureau of Narcotics and the Public Health Service generally ignored the existence of anything like the British program, or, if they did take note of it, it was to disparage it and brush it aside as irrelevant to the American problem. This is still the attitude of officials. In the meantime, however, so many descriptions of the British program have appeared in print and been broadcast over radio and television that informed public opinion in this country is now fully aware of the fact that Britain, and most other European and Western nations, permit their addicts access to legal drugs and that none of these nations has a drug problem that represents more than a tiny fraction of the problem in the United States.

When the writer proposed in 1947 that the United States should seriously consider the British system of drug control, Dr. Victor H. Vogel, Medical Officer in charge of the Public Health Service Hospital at Lexington, Kentucky, commented as follows on the proposal:

In spite of known weaknesses of "police" control of narcotic addiction in the United States, which the author proposes to abolish, the fact remains that since the Narcotic Act was passed in 19 15 there has been a substantial decline in the number of addicts in this country, although the author leaves one in doubt as to whether he believes a decrease in drug addiction is really desirable....

Professor Lindesmith mentions as an advantage of this free prescription that contraband drug traffic would be wiped out, and the addicts would be able to get their required drugs at a reasonable price, as if that were desirable. Public clinics and free prescription of drugs for addicts have been tried several times with disastrous results....

The proposal for unrestricted prescription of narcotics for addicts is naive in the extreme and dangerous to the public health of the nation. Fortunately, sounder judgment than the author's will prevail and there is no likelihood of the "reforms" which he proposes being carried out.'

Another Public Health Service official from Lexington, Dr. Abraham Wikler, remarked:

As for Professor Lindesmith's therapeutic program, one could wonder how many addicts would "voluntarily" enter a hospital and remain sufficiently long for adequate treatment if they could obtain all the drugs necessary to maintain addiction through legal channels at low cost' England is cited as a desirable example of such a practice, but no facts or figures are given to support this contention. The situation in India, Iran, and China is passed over in discreet silence.2

In 1948, when these remarks were published, -the essential facts concerning European practices were as available to Public Health Service officials, as they are today It is strange that none of them ever sought to nip the heresy in the bud by describing these practices!

At the White House Conference on addiction in September 1962 very little attention was given to any foreign programs. Professor Edwin M. Schur, who had just published what may fairly be described as a definitive study of British practices on the basis of two years of on-the-spot observation and inquiry, was allotted two minutes at the very end of one session.3 Earlier in the session another speaker had, in a much longer speech, told the audience that the British program was essentially the same as the American. No attention at all was devoted to any of the many other successful foreign programs. The President's Ad Hoc Committee which met before the I 1962 White House Conference. as well as the President's Advisory Commission appointed after the conference, which issued its report in November 1963 gave little attention to foreign experience or dismissed it as irrelevant.

THE BRITISH SYSTEM

The description of British practices which follows will be abbreviated because it is believed that the essential aspects of the program are generally understood in this country and are no longer under serious dispute. It will be noted that British practices are here reerred to as a "system." despite the fact that it is alleged by various writers that British officials deny that their program constitutes a system. It is said by these writers that the '&so-called British system" was invented by Americans for propaganda purposes. In defense against these critics, it is worth noting that British practices have been called a "system" by a prominent British official. formerly with the Ministry of Health and a joint Secretary of the famous Rolleston Committee-Dr. E. W. Adams.-The Rolleston Committee, by its report of 1926, virtually established the British system through its interpretation of the Dangerous Drugs Laws of 1920- interpretation which was accepted as official and continues to be so regarded.

Dr. Adams had this to say about his country's program:

The regulations made under the Dangerous Drugs Acts are so strictly and impartially enforced that the person who has had the misfortune to contract a drug habit soon finds it difficult or impossible to get supplies of his drug sufficient to satisfy his craving and he begins to suffer the pangs of partial or more or less complete abstinence. This state is so distressing that he is driven to consult his doctor and to reveal to him the nature of his ailment in the hope that he may at least be furnished, for the time being, with enough of the drug to keep him going. Nor is this hope ill founded, for he will most likely be submitted to the so called "ambulatory treatment" under which the patient is at large -while being treated, and is allowed to receive such supplies of his drug as the doctor thinks to be necessary for therapeutic purposes. For it is never possible at once to cut off the patient from his drug by this method. He takes advantage, in fact, of what, to speak frankly is neither more or less than a system of legalized purveying. [italics added.] Even -where the addict has, from the nature of his profession, special opportunities of access to narcotic drugs, as is the case with members of the medical and ancillary professions, yet, sooner or later, the same difficulty of supply confronts him, for unusual purchases of "dangerous drugs," beyond the reasonable necessities of his professional requirements, sooner or later attract attention and are revealed to the authorities 'either by inspection of his own records or those of the supplying druggists. He can, therefore, in the long run hardly escape detection and is then constrained to place himself under the care of a brother practitioner to whom the nature of the case will of necessity have to be revealed.4

The Home Office annually reports the number of persons known to be using drugs regularly, It maintains a file in which the cases are classified into two sections medical and non medical. The
former contains data concerning persons regularly receiving drugs because of disease, such as cancer patients; the latter, persons who are simply addicts-that is, persons who are receiving drugs primarily because the y are addicted to them and not because of disease. The number of addicts reported in 1955 was 335, a total which was evidently secured by counting the number of cards in the
non medical section. Since 1955 the number has risen to over 500. The information recorded in these files is obtained from data voluntarily supplied by pharmacists and doctors, as well as from regular
inspection of the pharmacies.

Narcotics Bureau spokesmen in the United States have suggested that British statistics are unreliable and that there are probably more addicts than they indicate. This is true to some extent, for the only figures disseminated by British officials are those pertaining to addicts known to the Home Office. They do not offer estimates concerning unknown addicts except to say that the number is relatively small. British narcotics statistics are, in fact, considerably more reliable than our own, as one would
expect from the fact that addiction is handled as a medical matter and that the motives for concealment are correspondingly less. It is also pointed out with respect to British totals that they do not include opium smokers, of whom there are said to be a small number, mainly of Oriental extraction, in a few of the larger cities.

In May 1955 Mr. John H. Walker, the British delegate to the United Nations Narcotics Commission, described the British drug problem and how it is handled to a special committee of the Canadian Senate. On the matter of hidden addiction he commented as follows:

From time to time, the Home Office has received confirmation of its opinion that the degree of hidden addiction is small. One of the leading physicians in the country, who lives and practices in a large provincial conurbation, asked over seventy local practitioners if they had a drug addict among their patients. None of them had. The physician himself was aware of one case in the district, which was of therapeutic origin. The chief constable of a provincial seaport (a city where, if drug addiction flourished at all in the United Kingdom it would certainly be found) in response to allegations about the existence of vice and drug addiction in the city, and in particular among seamen of Asiatic origin, conducted a most thorough enquiry and found no evidence whatever of drug addiction....

There are one or two minor pointers which suggest the same conclusion. For some years the metropolitan police isolated the figures for dangerous drugs in respect of theft from unattended motor vehicles. This practice was discontinued because the number of cases was so small that the information was worthless. The prewar practice of keeping statistics of all drug addicts admitted to prisons fell into partial disuse for the same reason. A recent survey of admissions to the principal prisons in Great Britain revealed less than two dozen addicts were admitted in the two years ending December 31, 1954.... The "Criminal" addict, i.e., the addict who is a confirmed criminal apart from his drug addiction, is virtually unknown in the United Kingdom.5

These statements have since been fully confirmed by an American sociologist, Edwin At. Schur.6

The basic anti narcotic statutes of Britain were passed in 1920 and are known as the Dangerous Drugs Laws. Like the Harrison Act, these statutes make no reference to drug addicts or to addiction, and like the Harrison Act they do not state what is regarded as the proper medical practice with respect to addicts, A memorandum issued to doctors and dentists by the Home Office states that doctors and dentists may have or use drugs only for ministering to the "strictly medical or dental needs" of patients.-, This rule reflects the attitude of the law enforcement agencies and the Home Office immediately after 1920 until the Rolleston Report appeared. The latter was an official committee consisting of medical men which was appointed in 1924 to resolve what appeared to be a conflict of views between physicians who were in fact caring for addicts, and law enforcement bodies, which thought that the 1920 statutes prohibited this. The Rolleston Committee resolved the issue in favor the physicians when it ruled that drugs might be administered or prescribed regularly for addicts when "the patient, while capable of leading a useful and relatively normal life, when a certain minimum dose is regularly administered, becomes incapable of this when the drug is entirely discontinued. "8 This rule had the effect of defining as "treatment,,' the regular provision of drugs for addicts and gave to physicians the final authority in handling addicts.

The above interpretation of the statutes by the Rolleston Committee is the crux of the difference between the British program and ours. It has created a situation in Britain such that the addict is under pressure to go to the physician, for if he does so he not only may obtain regular supplies of pure drugs but he can also avoid all entanglements with the law. There is a small black market in some of the larger cities but all operations on this market, whether by addicts or non addicts, are subject to punishment. The penalties generally consist of fines of less than $500.00 or of jail or prison sentences of less than one year. The maximum prison term specified in the statute is ten years, the same as in the Harrison Act.

The British program with respect to addicts is in reality absurdly simple and almost impossible to misunderstand. The addict simply goes to a doctor, confides in him, and is taken care of by the doctor. The latter is under a professional obligation to attempt to cure the addict, but there is no provision for forced cures, and the user must therefore be persuaded to submit himself to a hospital for withdrawal of the drug. Under the National Health Act, the addict's habit costs him only the few cents that all patients are charged for each prescription - two shillings, or 28c. The doctor who cares for the addict takes no risk of criminal prosecution, The addict can be prosecuted for forging prescriptions, going to two doctors simultaneously to augment his legal supplies, or patronizing the black market. The British program has no necessary connection with what is commonly called "socialized medicine," since it was in existence before the latter. The British addict is handled about the way in which a few upper-class addicts in this country are, namely, as a patient afflicted by disease.

The advantages which seem to follow from the British program are numerous and important. Since the demand for narcotics which maintains the illicit traffic stems from addicts, the profits of that traffic are seriously undermined when addicts are largely, removed from the market. Legal accessibility to drugs through physicians makes it possible for the addict to avoid the social disgrace and demoralization associated with criminality. The motivation to commit property crimes to pay high illicit prices is removed. The addict is protected from exploitation by peddlers and police alike. Most important of all, perhaps. is the fact that the addict is accorded a decent right to privacy. and does not face the constant prospect of seeing the unhappy details of his habit and personal life published on the front pages of the daily newspapers. From the standpoint of costs, the program is also attractive because it involves little expenditure of public funds and does not require a large bureaucracy or many special public institutions. Unlike the program in the United States. the British program has less tendency, to draw all addicts and peddlers together to form a self -perpetuating narcotic subculture.

American critics sometimes say that the British program does nor put enough emphasis upon curing drug users of their habits. However, there is nothing to indicate that cures are any less frequent there than here. The central difference in this respect is that we attempt to cure by compulsion while the British do not. While it may seem at first glance that a forced cure is better than none at all, it should not be forgotten that there is a price to pay for compulsion in terms of criminality, the illicit traffic. and the demoralizing, self-perpetuating effect that inevitably attends the congregate handling of addicts in large public institutions. As we have seen in an earlier chapter, it is characteristic of Britain and apparently of virtually all countries with this type of program that the number of addicts is relatively low, that there are very few youthful user& and that addiction contributes little to the crime problem in proportion to the number of addicts. If a pro gram of this sort contributes to creating these effects, it deserves more serious consideration than it has yet been given.

OFFICIAL VS. PUBLIC OPINION'

For a considerable number of years after 1954 the Federal Bureau of Narcotics circulated an anonymous, undated document attacking the present writer and seeking to discredit the British program or deny its existence. This document opened as follows:

Several years ago a professor of sociology at an American university, who is a self-appointed expert on drug addiction, after interviewing a few drug addicts, wrote an article in which he advocated that the United States adopt the British system of handling drug addicts by having doctors write prescriptions for addicts. He reported that this system had abolished the black market in narcotics and that consequently there were only 326 drug addicts in the United Kingdom. The professor followed the method used by- dictators to "make it simple, say it often"; true or false, the public will believe it. "Adopt the British system" is now urged by all self-appointed narcotic experts -who conceal their ignorance of the problem by ostentation of seeming wisdom. The statement was recently used by- a Columbia University, professor on a television program and in a national press release in advocating this system. A Citizen's Advisory Committee report to the Attorney General of California urged the British system. It has appeared in articles by, university, professors in several states. The Yale University Law Review published a supporting article. It is now accepted as a fact. [italics added.]

Nothing could be further from the truth. The British system is the same as the United States system .... 9

This states the theme which the Bureau of Narcotics and its followers have been promoting during the last decade. It is a theme which the new head of the Bureau. Henry L. Giordano, has taken over from his predecessor. it is significant to observe that the statement contains a phrase which is used over and over again by Bureau spokesmen and law enforcement personnel -" self appointed expert." This term is applied by the Bureau, often with the added clause "who conceal their ignorance of the problem by ostentation of seeming wisdom," to most of its critics. This involves tacit recognition of the interesting fact that the demand for basic narcotics law reform in the United States arises from the informed general public and is opposed by officialdom. A narcotics official, even if he disagreed with the Bureau, could not be called "self appointed."

The tactics followed by the Bureau under Mr. Anslinger were, in the main. to deny that the British program is any different from ours, to equate the program with the clinic system, to disparage the accuracy and reliability of British official reports and statistics, to include Hong Kong in Britain, and to argue that the British program is not a "system." To cite a few examples from Mr. Anslinger, in 1953 he remarked:

No government in the world conducts such clinics, no matter what is said about England. What about all the seizures there? What about the trouble doctors are having keeping their bags from being stolen'
In England, the British Government reports annually only 350 drug addicts known to the authorities - mostly doctors - and nurses. When we ask them about the statistics on seizures of opium and hashish [marihuana], they say: Negroes, Indians, and Chinese are involved. In this country, we don't distinguish; we take the situation as a whole. England, during the past year, has had a surge of hashish addiction among young people. A year ago they were looking at the United States with an "it can't happen here" attitude. Suddenly, hashish addiction hit the young people. Ordinarily hashish is only, something for the Egyptian, the Indian. Now the British press is filled with accounts of cases of addiction of young people.10

From these statements one would not suspect that prosecutions for offenses involving marihuana reached a peak of 152 in Britain In 1954, or that in most years no seizures of manufactured drugs and no cases of the theft of legitimately manufactured drugs are reported to the police.

In a review of Mr. Anslinger's 1953 book, a British police official who signed his review with the initials "R.M.H." remarked as follows:

There are one or two attacks on English complacency about the drug position in this country. On page 279 we read: 'Suddenly hashish addiction hit the young people and now the British press is filled with accounts of cases of addictions of young people." This statement is, of course, quite untrue.11

Speaking of the distribution of legal drugs to addicts. Mr. Anslinger in 1955 said:

There is only one place in the world- well, there are three places in the world where that is done. There is a transitory condition there in India and Pakistan, where the eating of opium will cease in 1958 and they have registered their last opium smoker in both of those places. So there is only one. There is only one country which still permits the so called ambulatory treatment of drug addiction through pipe smoking, and that is Thailand.12

The conception of legalized opium smoking as a form of "treatment" and the implication that the opium-smoking den is a type of clinic are interesting. In 1957, Mr. Anslinger was quoted as follows: "There is a great deal of misconception about the so-called British system; the European countries, except Denmark, have the same system as ours, and England does not permit prescribing for a non-medical addict."13

From an interview by Pete Martin with the new head of the Federal Bureau of Narcotics reported in the American Legion Magazine, it is apparent that the Bureau is continuing to stick to its guns. The following conversation is reported:

MARTIN: I'd like to begin by asking you about the difference between the American system and the English system of narcotics control. I understand that in England they have free clinics for addicts to get their daily shot; -while in this country we discarded that system back in the twenties and are more inclined to grab the addicts and institutionalize them.

GIORDANO: The so-called British system has been discussed many times in this country and tried as you mentioned-but there's really very little difference between the methods actually practiced today in
England and those employed here. Dr. Granville Larimore and Dr. Henry Brill from New York State went over there to study British methods.... When they came back they said in effect that they could find very little difference between the control method used in England and here....
Britain has never made a real census of drug addiction. For three years they've published figures, indicating they had 350 addicts, two 'years 290 400, and last year 500. This seems unrealistic when not long ago they tried and convicted a doctor for selling drugs to hundreds of addicts among, his "patients" alone' The only figures they have in the United Kingdom are when a doctor chooses to report them.

MARTIN: Five hundred seems a completely unrealistic figure to me. Just what is this British system?

GIORDANO: As far as we're concerned, there really isn't such a thing, even though everyone talks as if there is. The trouble is they seem to have ignored the problem, apparently have refused to acknowledge it. Now in Hong Kong, where they have an accurate census, they admit having 200,000 to 250.000 addicts, and it is a serious, sizable problem. The British have a growing marijuana problem at home, too.14 

There are a number of puzzling aspects in the above remarks. For example, if the British program is no different from ours. what does Mr. Giordano mean by agreeing with Martin that the program
was tried in this country in the 1920's and abandoned' Also, if the programs are the same, why try to show that the program in England is not as effective as claimed. Giordano's reference to an English doctor who sold drugs to his patients seems to be a reference to Dr. John Bodkin Adams. Dr. Adams, however, was tried for murder, not for selling drugs, and he was acquitted. The assertion that Dr. Adams sold drugs to many of his patients seems to have been based on newspaper reports in this country and not on any facts developed in an English court. The reference to Hong Kong is especially ironic because, as we will point out in a subsequent chapter, the program in use there is essentially the American one of prohibition and punishment. It is true that Britain does not have a census of addicts; but neither does the United States, or Hong Kong.

Narcotics enforcement officials at the State and municipal levels generally follow the line established by the Federal Bureau of Narcotics and if they read any of the literature it is most likely to be materials distributed by the Bureau. Those who read more widely run into the problem of trying to reconcile the Bureau's position with what they read. This is exemplified in 2 book already referred to, by Lt. Thorvald Brown (now Captain Brown) of the Oakland, California, police department. Following the lead of the federal authorities, Brown makes many disparaging remarks about "uninformed experts," the "many who know so little," and, on the first page of a chapter devoted to "The British System and the American Clinic Plan," flatly asserts: "after serious consideration and study, it is soberly suggested that Her Majesty's government knows little about the illicit traffic in the British Empire."15

Lt. Brown, however, is an honest cop, and as one continues to read his account of the British program, the existence of which he at first seems to deny, it becomes perfectly clear that he knows that English addicts are provided with drugs legally by physicians. He comments, for example:

The government makes no demands of proof that addicts who are furnished drugs are leading normal and useful lives, or that drugs are essential or given in the minimum doses necessary for this purpose.
Physicians receive a government subsidy for writing narcotic prescriptions and the high consumption of legal drugs suggest the existence of much hidden addiction.

A survey made in England indicates there are probably close to one thousand addicts rather than the 350 known to the Home Office .... 16

As we have seen, many spokesmen for the Bureau's curious position on Britain's policies preface their comments on it by deploring public misconceptions of it in this country. As a matter of fact, however, the American public probably has a much clearer picture of the British program than of the American. After all, the former is extremely simple and consistent and its essentials can be spelled out in a paragraph. Millions of Americans, moreover have listened to top British officials explaining their system on national television programs in this country. The American program, on the other hand, is extremely complex, inconsistent, and varied, as anyone quickly discovers when he tries to comprehend it.

THE LARIMORE-BRILL REPORT

This report on British practices with respect to drug addiction was submitted to Governor Rockefeller of the state of New York in 1959. 17 Its authors were two officials of the state government, from the Departments of Health and of Mental Hygiene. It will be recalled that the present head of the Bureau of Narcotics has cited this study in support of his contention that there is no distinctive British program. Since the Larimore-Brill report was made, it has been reprinted in quantity and widely circulated free of charge by the Public Health Service and the Federal Bureau of Narcotics. The writer, for example, has received four unsolicited free copies of it! No other report on this subject has been accorded this honor.

The central distinctive aspect of the Larimore-Brill report is that these authors, after accurately stating the fact that English physicians legally provide addicts with regular supplies of drugs nevertheless conclude that the program is little different from that in the United States. The logical processes involved in reaching this conclusion have never been divulged and are not understood. At a conference in Los Angeles at the University of California in April 1963, Leslie T. Wilkins, well-known statistician, student of delinquency and crime, and Home Office official, indicated with unmistakable
clarity that he regarded this conclusion of Larimore and Brill as nonsense." The New York Academy of Medicine reached a similar conclusion.19 Both Mr. Wilkins and' the Academy agreed that the description provided by Schur is a more cogent and accurate one than that of Larimore and Brill.

An argument presented by these authors and picked up by Americans who favor the status quo is that the admittedly small extent of the British narcotics problem is the cause of the program rather than the reverse. The implication is that the nature of the program has nothing much to do with the number of addicts. From this viewpoint, since the British and American programs are allegedly the same. the British adopted their system because they had so few addicts and we adopted the same system before they did because we had so many. The number of addicts in a country, according to Larimore and Brill, is determined mainly by the number of addiction-prone personalities in the population, 'not by the system of control. The illicit traffic in drugs, they imply, depends upon the demand for drugs from such addiction-prone persons, not on the demand from those who are addicted. The absence of
an illicit traffic in Britain is to them an indication that there are very few addiction-prone people in Britain. The influence exerted on the illicit traffic by taking addicts out of the market is wholly overlooked, as is the influence of the traffic on the factor of availability. An addiction-prone person does not become addicted unless drugs are made available to him. usually through the illicit traffic, and the latter cannot flourish if addicts can secure low-cost legal drugs.

Since virtually all of the countries of Europe have programs substantially the same as that in Britain, and since all of them also have relatively small numbers of addicts. the Larimore-Brill argument must be that they have medical programs for addicts because they have so few of them. If this position is taken seriously in conjunction with the contention that the extent of the drug problem is determined by cultural and personal susceptibilities to addiction, there could be no possible objection to American adoption of the British program which, in any case, is said to be the same as the American, because this would have no effect upon the number of addicts in the country, just as it allegedly has had no such effect in Europe.

The Alice-in-Wonderland nature of the reasoning in this report is well exemplified in the following remarkable statement by Larimore and Brill in the condensed version of their report:

In England what appears to be the major gap in the epidemiologic picture, probably for cultural reasons, is the susceptible individual. Certainly the drugs are available (even though limited) through medical channels and by our standards an environment conducive to spread exists in certain areas although admittedly there is no environment which appears to be as heavily seeded with narcotics as are certain areas in this country. The lack of organized crime with 2 criminal element interested in the narcotic traffic is, of course, a factor. However, the fact that traffic is carried on in marihuana in spite of efforts to control it does not lend credence to the belief that it is superior law enforcement that is the sole reason that narcotic addiction does not flourish in England. There is also little to suggest that the availability of drugs through medical channels is the only reason why there is little or no criminal activity in connection with narcotics. While theoretically narcotics are available through medical channels, they are, as one British official told us, actually quite "hard to come by" in England so that if
there was widespread susceptibility to addiction and a consequent demand for the drugs criminal activity might be able to supply the demand. Law enforcement is obviously good in England, but it has sufficient failures, such as the control of marihuana, to indicate that it would not be omnipotent in coping with criminal forces bent on supplying a real demand for narcotics if such actually existed. Thus the answer must lie, for the most part, in the British people themselves and their apparent lack of a cultural susceptibility to narcotic addiction.20

The authors seem to say that narcotics are simultaneously available and unavailable in Britain and obviously do not recognize that bootleg narcotics, like bootleg liquor, depend on prohibition. The reference to marihuana is totally beside the point because it, unlike heroin and morphine, is prohibited in Britain as in the United States. It is precisely for this reason that there is a fairly brisk illicit traffic in marihuana and almost none in heroin and morphine.

It is unfortunate that the Larimore-Brill report has received so much attention by virtue of the fact that is has been circulated so widely by agencies of the government. Nevertheless, for those who actually read the original 3 1 -page document it can serve a useful purpose, for its factual content is detailed and accurate. Its authors evidently allowed their preconceived biases to distort their interpretations of the facts. It is also possible that, as members of the Health and Mental Hygiene departments of the state of New York, the writers may have come in contact with unusual types of addicts from the upper classes or the medical profession and so may not have had too clear an idea of how the average American drug user is in actuality dealt with.

Another source which the Bureau has relied on in the past is the writing of a Canadian, G. H. Stevenson, who, like Larimore and Brill, states that British addicts receive their supplies of drugs legally from physicians and that they are handled the same as users in the United States. Stevenson has also published articles denouncing the clinic plan and he was asked by Senator Daniel whether his conclusions; were not based on a study of all available material concerning clinics. Stevenson replied: "No. Those statements are made in that booklet published by the United States Government entitled, 'Narcotic Clinics in the United States'. 21 Asked by Senator Daniel if he agreed with the findings stated in the pamphlet, the Canadian expert responded: "Well, I had no reason for disagreeing with them. They were stated as facts.".

OTHER BRITISH-TYPE FOREIGN PROGRAMS

Most of the nations that are members of the United Nations Organization make annual reports to the Commission on Narcotic Drugs of the Economic and Social Council of that body. These reports are summarized in an organized form and published annually in English under the title, Summary of Annual Reports of Governments.22 It is a common practice of the reporting nations to describe briefly their systems of handling addicts in one report and not to repeat this description annually but instead to refer back to the earlier description. From the perusal of these annual summaries it is evident that most Western nations follow a program of narcotics control which, in broad terms, is like that used in Britain in that addicts are permitted  to have regulated access to legal supplies of drugs provided to them by physicians. A frequent pattern of control is that such distribution is supervised by public health authorities, that a register of known addicts is maintained, and that addicts are required to patronize only one doctor and one pharmacy.

In view of the evident tendency in the United States to regard Britain as a unique instance of a country which has succeeded with a program not suitable for the United States, it is important to observe that in actuality the punitive treatment of addicts as practiced here is the unusual and exceptional type
of program. From an examination of the U.N. Summaries for the years from 1949 to 1956, it appears that the nations listed here, among others, handle addicts as medical cases. Each of these nations also provided an estimate of its addicted population. The approximate population of the country is supplied to facilitate comparisons:

While some of the above estimates of the numbers of addicts are no doubt too low, a compensating tendency is that of including "medical addicts," who are not included in American official estirnates.

It will be observed that the above list represents a great variety of cultural conditions and a considerable range in the extent of the problem, with Germany seeming to have the most severe one. It is pertinent to inquire whether the experiences of any of these nations is relevant or can be applied to any aspect of our problem. Or must we take the view implicit in the manner in which this foreign experience is disregarded by our lawmakers and officials, that the United States is so absolutely unique culturally that none of the many successful foreign programs now operating in dozens of Western nations have any relevance for us? Is it enough to argue that the small number of addicts in most of these countries is caused by a lack of "cultural susceptibility" to addiction, or that the relatively large number of addicts in Germany contributes very slightly to that nation's crime problem because they happen to be of the "medical" rather than "criminal" type?

The following excerpts from a few of the annual reports of the listed nations to the United Nations are presented as examples to give a more concrete picture of characteristic attitudes and programs.

The Netherlands
The number of suspected patients, including addicted medical practitioners, is approximately 300.
Addicts are generally of middle age and, in most cases, women. Medical practitioners constitute approximately twenty-five per cent of the total, which also includes a few nurses....
Where a case of addiction is established on the basis of excessive medical prescriptions, the Inspector of Pharmacies informs the Medical Inspector of the Health Department and they make a joint investigation. In some cases the medical practitioner concerned is required to make an attempt to cure his patient; in other cases an attempt is made to persuade the addict to discontinue the use of drugs. A number of patients have been requested to select a special pharmacist in the town in which they live, and other pharmacists have been forbidden to sell them drugs. Once each month the Inspectors interrogate these pharmacists concerning the quantities of drugs prescribed and dispensed.24

Spain
The number of drug addicts who have been registered is about a thousand.... Most drug addicts suffer from this vice because of the extreme pain endured from cancer or malignant tumors, or because they have previously, endured some suffering or a surgical operation.
A detailed register is kept of patients and addicts needing special supplies of narcotics; each is given an "extra-dose book" and is registered on an index card bearing his photograph and such particulars as his age, status , medical history and the name of his physician and of the dispensing pharmacy. Pharmacies are required to submit monthly returns on these persons.25

Israel
There was no compulsory treatment Of addicts. Each addict was connected with a pharmacy where he received his daily dose of a narcotic solely by a prescription issued by a medical officer through the above health office [District Health Offices of the Ministry of Health].
The majority of the drug addicts were immigrants who had come from North Africa, the Middle and Far East and had indulged in the abuse of narcotic drugs in their native countries-26

Austria
There is no general obligation to report addicts. All persons who obtain narcotic drugs on long-term prescriptions and for whom the prescribed dosage exceeds the normal maximum daily quantity allowable by law, are registered....
Disintoxication treatment is given only in closed institutions.... This type of treatment is compulsory only for the addict who is a danger to himself or to others.27

Germany (West)
There is no compulsory registration of addicts. The view prevails that addicts or persons requiring narcotic drugs should be regarded as sick persons whose dignity is to be respected unless the patient infringes on the rights of others or jeopardizes his own safety or public order and security.28

Switzerland
The number of addicts remained the same, with 109 persons. of whom 52 were women and 57 men. Their ages range from 27 to 80 years. They are practically all therapeutic addicts. A list of their names is available to every physician and pharmacist to prevent them from obtaining narcotics illicitly. When necessary, addicts who are considered sick persons receive the doses they need from the official physician or 2 physician appointed by the authorities.29

Australia (Queensland)
The registration of 211 addicts is compulsory.... There are 34 addicts to manufactured drugs.... The sources of supply of these addicts were authorized medical prescriptions, and the addictions were all of therapeutic origin.... In addition to the addicts to manufactured drugs, there are 68 elderly Chinese [ex-opium smokers] who were authorized- to receive tincture of opium in doses varying from nine to sixteen ounces.30

THE PRESIDENT'S COMMISSION DISREGARDS FOREIGN EXPERIENCE

After the White House Conference in 1962, a presidential commission of citizens was appointed to examine the narcotics problem and make recommendations. In this Commission's final report three-fourths of one page is devoted to the British program, with no mention of any other foreign system.-"' This program is referred to as the "so-called British system," as is customary among those who would rather not talk about it. The Commission did dare to admit that the British system differs basically from the American and that the crucial difference was in the authority exercised by the British doctor "to treat the addict as he deems best in his medical judgment." Two pages earlier, the Commission recommended that the definition of proper medical practice with respect to addicts be determined by the medical profession. This, of course, is exactly what is done in Britain.

Nevertheless, the Commission went out of its way to suggest that the British program really had little significance for the United States. "The British addict," they said, unlike his American counterpart, "appears to have sufficient motivation to pursue an ordinary life." The national policy, however, has nothing to do with this point or with the fact that there are so few addicts in Britain, according to the report. The reason for the small number of addicts, they say, lies outside of the system and is attributed to "British abhorrence of narcotic drugs and the lack of cultural susceptibility to drug taking." This nonsense is clearly drawn from the discredited Larimore-Brill report.

The Commission points out that most British addicts are "medical addicts," explaining that they first experienced the effects of drugs when they had been prescribed for them by a physician in connection with illness and had later become addicted. It is argued that the British have their program because their addicts are "medical." The fact that before the Harrison Act most addiction in the United States was also therapeutic in origin, or that it is characteristically so in nearly all countries with the British type program, was either ignored or not known by the Commission. It was not pointed out that persons who acquire their addiction therapeutically in the United States are given no special consideration by the law and are ordinarily forced to become "criminal addicts."

MIGRATION OF CANADIAN ADDICTS TO BRITAIN

The most decisive refutation of the position that the British program is no different from the American, or that it has no applicability to the American problem, is probably provided by recently published evidence which suggests that substantial numbers of Canadian addicts are going to England to avoid harsh punishment in Canada and to be treated. As we have seen, the Canadian System is essentially the same as ours: addicts are arrested and sent to jail for possession of illicit drugs, as they are here. In a Canadian medical journal published early in 1964, Lady Frankau, a psychiatrist who operates a clinic in London, reports on fifty Canadian drug addicts who received treatment from her.32 Most of these had left Canada to escape the Canadian system.

It was noted earlier that during the last several years the reported total of known addicts in Britain has increased from something over three hundred to more than five hundred. The article indicates that
a substantial portion of this increase is accounted for by an influx of Canadian users who had heard about the "British system." Even more illuminating is the story of what happened to the fifty Canadian users under Lady Frankau's care. Eighteen are reported to have been freed of their habits and to have been off drugs at the time the article was written. Nineteen were getting regular daily allotments of heroin and were at the same time working regularly at jobs and were not known to their associates or their employers as addicts. Seven got into trouble with the British police or were headed for such trouble by reason mainly of attempts to secure narcotics by illegal means. The remaining six were either dead or their status was ambiguous.

The fifty Canadian users were grouped in three categories. The first of these consisted of ten persons with good family and cultural backgrounds, who came to the clinic first. They had either become addicted while living in Europe or had left home immediately after beginning to use drugs. The second consisted Of 31 persons who appeared to have no criminal record which antedated their addiction. After being hooked, however, these persons had engaged in criminal activity of various sorts connected with narcotics and with raising money. to buy narcotics. The third category. consisted of nine persons who had criminal records before becoming addicted. All of the seven who had trouble with the British police or were threatened with it came from this last group.
The forty, addicts in the last two categories came to England during the two years before the article was written. They were described as follows:

Few of these patients had ever worked steadily, all had been dependent on an illicit supply of drugs and none had been normal, gainfully employed members of society. Two reasons were given to explain" their inability to work steadily: (a) they would not be able to earn enough money to maintain the necessary supply, of drugs, and (b) if they did find work their employers were c informed, sooner or later. that they were drug addicts. The few who had money belonged to the upper hierarchy of the drug peddling world, but at one time or another the majority, had been involved in selling drugs to support their addiction.33

This is a reasonably standard description of what is known in the United States and Canada as the "criminal addict." The reasons given for not working would probably be viewed here as transparent rationalizations. The apparent fact that a large proportion Of these persons became self-supporting and law-abiding in England when they were on a regular daily heroin allotment is of considerable significance. In the face of this report by Lady Frankau it is difficult to see how the position that British experience is irrelevant for the United States because we have "criminal addicts" can be any longer maintained. As we have seen, this is the position taken by the President's Advisory Commission on Narcotic and Drug Abuse.

The system used by Lady Frankau in treating addicts is also of considerable interest in connection with the belief in this country that compulsion and authoritarian handling are necessary. The first step in the program was to establish a daily dosage for each of the Canadian addicts which was just sufficient to keep -him comfortable. At the same time the patients were repeatedly assured that they need not fear for a lack or shortage of heroin and that a supply was always available and would be furnished if needed. They were also assured that they would not be forced to do anything against their wills and no attempt to achieve final withdrawal of the drug was ever made without the consent and full cooperation of the patient. The addicts were advised not to seek contacts with other users. In general all phases of the program including the medical techniques were explained to the addicts so that they knew what to expect.

The article by Lady Frankau evidently grew out of a talk which she had made in 1963 before a Canadian conference in which she described the results obtained in treating some 350 narcotics addicts.34 A Canadian policeman objected to her "permissive" approach and offered as evidence that his agency knew of eight Canadian addicts who had been treated by Lady Frankau and had returned to Canada. Of these he said that One had died of an overdose, three were known to he using drugs and were being sought by the police, and the behavior of the other four indicated that they
too might soon be in trouble. It is of interest that one of the important reasons for some of the addicts returning to Canada may well have been that they were deported from England. In any case, the policeman's testimony supports the conclusion that Canadian addicts behave very differently when they are in England. There seems to be some evidence that the Canadian Government is moving toward a more liberal and permissive approach resembling that in Britain.

Materials like those in the article by Lady Frankau and television programs such as one presented by Chet Huntley for the National Broadcasting Company during the summer of 1963 are making it extremely hard to maintain the fiction that there is no British system. 35 In Huntley's program, for example, a Scottish writer and an addict, Alexander Trocchi, contrasted his experience in the United States with his life in England, where he fled to escape the American system. Inspector Leonard Dyke, head of the Dangerous Drugs Branch of the Horne Office, explained that one who becomes addicted in Britain can go to a doctor to get the drugs he needs. Viewers must have wondered what Dr. Henry Brill was talking about when, toward the end of the program, he said that there really was no significant difference between the American and British programs and that "there is no cause and effect relationship between the favorable situation which England enjoys with respect to narcotic addiction and the so-called British system.''

We have seen in this chapter that there has been a growing interest on the part of the American public in the systems of narcotics control used in Europe and especially in Britain. This interest reflects a growing realization that the American program has not been successful and that it is out of line with the conception of addiction as a disease. just as vested bureaucratic interests in this country have distorted and misrepresented the problem here, so also have they misrepresented the situation in Britain. Despite this, there is now a large and growing demand from informed public opinion that more attention be given to foreign programs and that the basic assumptions of our present policy be reexamined and overhauled. The 1963 report of the President's Advisory Commission was a relatively weak expression of this trend.

A perusal of reports to the U.N. over a period of the last ten years overwhelmingly suggests that there is a close relationship between the type of control program used and the characteristics and origins of the addicted population. There is a distinct pattern in all of the European countries and other Western nations with medical programs for addicts, which tends to be repeated almost monotonously. In the next chapter we shall see that in the Far East, where the prohibition system of control has become the usual one since the end of World War II, new addicts are recruited mainly from segments of the population which correspond closely to those which are currently most susceptible to addiction in the United States. All of this strongly indicates that a national control policy is, in fact, a matter of decisive importance in determining both the nature and extent of the narcotics problem. The effects of policy appear to be determined by its tendency to encourage or discourage a secret illegal traffic.

introduction | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10

Notes
i. American Journal of Public Healtk 38 (June, 1948), 88S.
2. American Journal of Psycbiatry, 104 (JulY, 1948), 75.
3. In Proceedings: White House Conference on Narcotic and Drug Abuse, pp. 110-15. Dr. Schur's remarks are given much greater prominence than they had at the actual conference.
4. E. W. Adams, Drug Addiction (London: Oxford University Press, 1937), pp. 65-66.
5. Reproduced in Daniel Subcommittee Hearings, Part 5. P. x 862.
6. E. M. Schur, Narcotic Addiction in Britain and America. This book represents the most comprehensive sociological account of the British program that is available.
7. Cf. ibid., P. 75.
8. Ibid., P. 76. The Brain Committee report in x96i suggested no basic changes in British policy. See ibid., pp. x5964, for a discussion.
9. Originally published in j.A.M.A., 156, No. 8 (Oct. 2 3, 1954), 788; reproduced in the Boggs Subcommittee Hearings, 1956, PP. 470-71.
io. H. J. Anslinger and W. F. Tompkins, The Traffic in Narcotics,
PP. 2 79, 2 90.
11. The Britisb Journal of Delinquency, 5, No. 3 (Jan., 1955), P. 242.
12. Daniel Subcommittee Hearings, Part 5, 1955, P. 44.
13. SPectr`2m, 5, No. 5 (March 1, 1957), 139.
14. Pete Martin, "What Hope for Narcotics Control?" p. 9.
15. T. T. Brown, The Enigma of Drug Addiction, p. 153.
x& Ibid., pp. ~9.
17. Dr. Granville W. Larimore and Dr. Henry Brill, "Report to Governor Nelson A. Rockefeller of an On the Site Study of the British Nar
coric System" (mimeographed: March 3, j959). A condensed sumnialy appeared in New York State journal of Medicine, 60, NO- 1 O'n- 1,
1960), PP. 107-15
A. In a paper presented to a conference at the University of Califorria in April 1963, and published in Daniel Wilner and Gene Kasseb2urn, eds., Narcotics (New York: McGr2W-Hill, 1965), chap. 9.
ig. The Committee on Public Health of the New York Academy of Medicine, "Report on Drug Addiction II" (mimeographed: 1963), pp. 56-64.
2o. Dr. G. W. Larimore and Dr. H. Brill, "Repom" condensed sumMary, PP. 113-14.
z i. Daniel Subcommittee Hearings, Part 5, 1955,11- 1418
ii. These annual publications will hereafter be riferred to as U.N.
Summary.
2 3. From U.N. Summary, 1949, P. 3 8 (Netherlands); 19f4 addendum P- 17 (Argentina); 19M P- 49 (Norway), P- 49 (Spain), P- 43 (Israel), PP. 45-46 (Belgium), P. 45 (Austria), P- 47 (West Germany), p. 5o (Switzerland), p. 52 (New Zealand), p. 51 (New South Wales and Queensland); 190, P- 53 (Luxemburg), p. 53 (Norway), P- 54 (SP690, P- 51 (West Germany), p. 5o (Finland).
24. U-N- Summary, 1949, P- 38
25- U.N. Summary, 19y6, P- 54, and 1955, P- 49
26. U.N. Summary, 195T) P- 43
27. Ibid., P- 45
28. U.N. Summary, i9y6, p. 5 z.
29. U.N. Summary, t955, p. 5o.
3 0. Ibid., p. 5 1.
3 1 - Final Report: The President's Advisory Commission on Narcotic
and Drug Abuse, November, 1963 (Washington, D.C.: US. Government Printing Office, 1963), P, 59.
P. Lady Frankau, "Treatment in Engl2nd of Canadian Patients Ad-dicted to Narcotic Drugs," The Canadian Medical Association Journak go, No. 6 (Feb. 8, 1964), 421-24
33- lbid.,422
34. NAPAN Newsletter, i, No- 4 (JuIY-Aug., 1963), 4. The Newsletter is published by the National Association for the Prevention Of Addiction to Narcotics, Hotel Astor, New York City.
35. NAPAN Newsletter, i, No- 3 (June, 1963), 3.