Treating Drug Problems Volume 2 (1992) / Chapter Skim
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A Century of American Narcotic Policy
A Century of American Narcotic Policy
Pages 1-62
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From page 1... ...
During the 1960s the police approach was challenged and gradually superseded by a hybrid approach, combining traditional law enforcement with new treatment strategies, including methadone maintenance and therapeutic communities. Since 1965 drug abuse has been regarded as a medico-criminal problem, the likely pattern of the future, although there are signs that the pendulum is beginning to swing back in the direction of strict law enforcement.
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Often told separately, the histories of drug and alcohol use in America are in fact intertwined, perhaps never more so than in the last decade. THE SOCIAL AND LEGISLATIVE ORIGINS OF NARCOTIC CONTROL During the nineteenth century there was virtually no effective regulation of narcotics in the United States.
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Narcotic addiction was not entirely ignored by the medical profession. As the number of addicts grew in the 1870s and 1880s, some physicians began to specialize in treating addiction and to develop theories about it.
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Even as the country was having second thoughts about alcohol prohibition, there was virtual consensus on the need to suppress narcotic addiction. (Some extremists in the 1920s and 1930s even proposed firing squads as a permanent solution for the drug problem, on the theory that the only abstinent addict was a dead one.)
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A wreck, mentally, physically and morally, he is given a life sentence or the electric chair.3 What is particularly interesting about this account is its harsh, judgmental tone. It was not just that the old-fashioned medical addicts were disappearing and being replaced by a new breed, it was how people felt about it.
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It is fair to say, however, that the sinister transmogrification of narcotic addiction was a critical precondition for the legal developments that followed. It would have made no sense -- politically, culturally, morally, or in any other way -- to repress addicts if they had still consisted disproportionately of sick old women.
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As a result of their efforts an international opium commission met at Shanghai in February 1909. The American delegation, anxious to assume a leadership role but fearful that the laissez-faire narcotic market at home left them open to charges of hypocrisy, pressed for at least token congressional legislation.
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SOURCE: U.S. Senate, Report on the Intemational Opium Commission and on the Opium Problems as Seen Within the United States and Its Possession (Washington, D.C.: U.S.
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The Treasury Department officials who administered the law assumed a negative stance and initiated several prosecutions against addicts, physicians, and pharmacists for conspiracy to violate the Harrison Act. At first the Supreme Court rebuked the Treasury Department for attempting to stop physicians from prescribing for addicts; ultimately, however, it reversed itself and narrowly ruled in favor of the antimaintenance position.
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That fact, as far as addicts were concerned, was the chief legacy of the Harrison Act and the 1919 Supreme Court decisions. There was one other alternative to the black market, but it was shortlived.
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One thing, however, they did have in common: all were eventually closed by the federal government, most within a year of opening their doors. Treasury Department officials, determined to eliminate both licit and illicit sources of narcotics for addicts, viewed the clinics as dangerous precedents and potential obstacles to the rigorous enforcement of the Harrison Act, as recently interpreted by the Supreme Court.
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There was still a powerful, visceral fear of narcotic addicts and all they stood for. It was the social and moral connotations of narcotic addiction that mattered, not just the mental and physical effects of the drugs themselves.
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Anslinger understood that narcotic trafficking was international in scope and required diplomatic efforts as well as strict domestic enforcement. He tirelessly attended meetings sponsored by the League of Nations, seeking agreements that would make it more difficult to smuggle drugs.
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Although Kolb occasionally complained to Anslinger of overly zealous law enforcement, the approaches of the two men were on the whole quite compatible.20 Kolb and his coworkers at the U.S. Public Health Service oversaw two federal narcotic farms at Lexington, Kentucly, and Fort Worth, Texas.
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A second narcotic farm was opened in Fort Worth in 1938. Of the two, Lexington was the larger and more prominent.
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Why not set up bars for alcoholics or department stores for kleptomaniacs or brothels for homosexuals.n You know, there are so many experts in drug addiction," he complained in 1957, "that I think if we made a survey we would find more experts than addicts.n22 Anslinger appealed to the conservatism and anti-intellectualism of ordinary Americans, and also to their nativist and racial fears. He relied on the antinarcotic consensus to help him in his long, preemptive battle against maintenance; he was abetted by reporters, editorialists, political cartoonists, and filmmakers, who consistently portrayed narcotic traffickers as murderous villains.
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The key change was the growing use of heroin by black men. Blacks were not considered heavy drug users early in the century.
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Aces with populations greater than 2,500 who were black Percent of those admitted to Lexington and Fort Worth Hospitals who were black Percent of U.S. blacks living outside the south FIGURE 1 Indices of black narcotic use SOURCES: P
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So were their children, particularly those who had left school, were out of work, and spent their time on the street. The result could easily have been predicted: a growing incidence of black heroin addiction, particularly among the traditional high-risk group of single males in their late teens or early twenties.
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Each step took them farther away from the primary illicit narcotic markets; indeed, to distance themselves from drugs and crime was one of the reasons suburbanites moved in the first place. Low-income blacks were not as fortunate.
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In 1951 it passed the Boggs Act and in 1956 the Narcotic Control Act, providing progressively stiffer, mandatory sentences for possession and sale. The inflexible provisions of these laws sometimes resulted in blatant mis
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These were not isolated events; across the country nonfederal narcotic prosecutions were up sharply during the l950s.34 THE END OF THE CLASSIC PERIOD, 1960-1965 Historians who have studied American narcotic policy are agreed that the 1950s marked the zenith of the punitive approach. The "new spasm of concern" felt during this decade translated into "increased regulation in familiar patterns," comments H
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From page 23... ...
Several of the most important of these programs, such as Daytop Village, Odyssey House, and Phoenix House, had their inception in the middle 1960s. They did not expand rapidly, however, until the later 1960s and early 1970s, when the Lexington approach was officially discredited, the counter was in the midst of a youthful drug epidemic, and private and public funding for community drug treatment programs of all sorts was readily available.
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Lindesmith and others essentially charged the Narcotics Bureau with benighted prohibitionism, resulting in huge costs to both users and society. "The American narcotics problem," summed up Marie Nyswander in 1965, "is an artificial tragedy with real victims.n40 If the crime issue was one fault line along which the narcotic consensus fractured, then marijuana was another.
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Although this social revolution did not peak until the 1970s, it was well under way by the mid-1960s, and it did not augur well for strict narcotic control.45 Recall Anslinger's remark that maintaining addicts with drugs was like pandering to homosexuals. That analogy would be effective with a traditionalist, one who was instinctively homophobia.
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From page 26... ...
Authored by a panel of physicians, lawyers, and judges, and based on three years of research in the United States and Britain, the Interim Report was a temperate critique of the police approach with suggestions for further research and trial programs. Doubting Whether drug addicts can be deterred from using drugs by threats of jail or prison sentences," it recommended the establishment of an experimental outpatient clinic that might, under certain circumstances, supply addicts so they would not have to patronize illicit dealers.47 Anslinger, who saw this guarded proposal as the hole that would sunder the dike, immediately plugged it with his fist.
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Anslinger did not disappear from the scene altogether; he put in an appearance at a large White House Conference on Narcotic Drug Abuse in September 1962 but seemed uncharacteristically subdued.53 This same conference recommended the establishment of a presidential commission, which met and issued its report the following year. Among its recommendations were more flexible sentencing, wider latitude in medical treatment, and more emphasis on rehabilitation and research.54 Heresies were spreading about the land now, and these even bore the imprimatur of a presidential commission.
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There was, inevitably, a reaction as both the premises and results of methadone maintenance were called into question. Critics said that the hypothesized metabolic change was mere speculation; that methadone was just a quick chemical fix, substituting one drug for another; and that it failed to significantly reduce criminal or antisocial behavior because it ignored the underlying problems of addicts -- inferior or abnormal personalities, broken families, anomie, inebriety, ghetto squalor, deviant peers, structural unemployment, and so on down the list.
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From page 29... ...
DRUG POLICY AND DRUG USE SINCE 1965 American narcotic policy from the early 1920s until the middle 1960s had two key objectives: the quashing of legal maintenance and the suppression of illicit narcotic transactions through vigorous police enforcement. What has happened since then has been a qualified abandonment of the first goal, but not of the second.
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They should be able to make decisions without being controlled by their need for a substance."58 It was ironic, then, that Richard Nixon, who styled himself a hardliner and a moral conservative, should have been the president to preside over the rapid expansion of methadone maintenance. On June 17, 1971, he delivered a special message to Congress on drug abuse prevention and control.
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Between June 1971 and March 1973 the number of federally funded methadone patients doubled.6t Counting both federal and nonfederal programs, there were 80,000 persons enrolled in methadone maintenance by October 1973.62 Despite SAODAP's imprimatur and increased funding, there was still a great deal of suspicion and hostility toward methadone within the federal bureaucracy. This attitude was manifest in-a barrage of detailed regulations governing dosage, duration of treatment, and security.
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I think people really wanted to express their hostility against a problem that was so evanescent that they couldn't do it any other way.6' Finally, there were the addicts themselves, many of whom balked at entering treatment programs. There were garbled fears about methadone, complaints that it would "get into the bones" or render patients dependent for life.
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Caused by the human immunodeficiency virus (HIV, formerly known as LAV or HTLV-III) , the virus is spread among intravenous drug users through the sharing of syringes and needles.6 There is no evidence that the virus can be spread through casual contact or the use of noninfected drugs; however, it can be spread through both homosexual and heterosexual contact and to the fetus in utero.
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From page 34... ...
These considerations have apparently prompted changes in the behavior of intravenous drug users in the New York area, where addicts have increased their use of sterile needles and reduced the number of persons with whom they will share drug injection equipment.72 It is possible that "safer" needle use will become the norm for intravenous narcotic addiction in the future. Fear and natural selection are both operating in that direction.
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From page 35... ...
after 1973; this was of little strategic significance, however, because the combined Mexican, Southeast Asian, and Southwest Asian supplies have more than made up for the deficit.76 The failure to stop the heroin traffic was by no means the only or even the worst setback for law enforcement since 1965. Officials have also had to contend with the emergence of several new street drugs, such as LSD and PCP; the diversion and abuse of licit drugs, such as Methedrine and methaqualone; and the increased popularity of illicit nonopiate drugs, such as marijuana and cocaine.
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From page 36... ...
Marijuana use has declined somewhat during the 1980s, but it remains a popular illicit drug and a source of huge profits for both international traffickers and, increasingly, domestic cultivators.79 Equally remarkable was marijuana's popularity among high school and junior high school students. Peter Santangelo, a former undercover narcotic agent who worked in southern Connecticut in the early 1970s, was struck by the youth of those who bought and sold marijuana and other drugs.
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Others raised money by selling part of their methadone on the street. Proponents of methadone maintenance were caught in a political bind.
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What was different about the 1970s and 1980s was the spread of cocaine beyond these rarefied circles to the middle and professional classes, notably among baby boomers who had gone to college, flirted with the counterculture, smoked marijuana, and learned to discount official warnings about drug abuse. They also had the money and the disposition to become users, albeit on a lesser scale than the superstars.
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From page 39... ...
It made no sense, pharmacologically or otherwise, to lump these things together as "narcotic use, let alone "narcotic addiction. Some researchers sought to expand the concept of addiction itself when they saw that dependence could develop with nonopiate drugs.
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The simultaneous, sustained increases in several types of drug abuse and the consequent growth in the number of addicted persons requiring treatment raise some important questions, particularly about law enforcement strategies. Why were the police and customs agents collectively unable to contain the importation and use of illicit drugs after 1965?
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From page 41... ...
They have also been known to torture, possibly to kill, interloping American narcotic agents. Some trafficking organizations, like the Shan United Army, which operates along the Burma-Thailand border, are so large and well armed that they do not need to infiltrate governments; they are themselves autonomous political entities.
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From page 42... ...
drug testing; improved treatment and rehabilitation programs; greater public intolerance of drug abuse; and stepped-up enforcement against domestic and international traffickers. In remarks to Republican congressmen before the address, Reagan set as his overall goal a 50 percent reduction in drug use and promised that his escalating war would mean "Pearl Harbor for the drug traffickers." A little more than a month later, on September 14, 1986, the President made a nationally televised address, accompanied by First Lady Nancy Reagan.
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was blocked by the Senate, the bill that did pass nevertheless specified longer prison sentences for those who recruited juveniles to sell drugs or those who sold drugs near schools. The law also authorized $1.7 billion in additional expenditures, with most of the money to go for law enforcement and drug education.~06 Iko years later, just before the 1988 general election, Congress passed a second omnibus bill.
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From page 44... ...
When circumstances changed, when the antinarcotic consensus eroded, the underclass grew and festered, new drugs became fashionable on campus, and hundreds of thousands of American troops were sent to fight in opium-rich Southeast Asia, then the scope of the problem was bound to widen. One factor alone, the coming of age of the nearly 80 million Americans born between 1946 and 1965, ensured an upsurge in drug use; in epidemiological terms, there was an unusually large number of susceptibles in the population immediately after the classic era.
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From page 45... ...
I,here is no objective evidence to support the idea that disallowal of maintenance saved the country from a series of mid-century narcotic epidemics. If the narcotic clinics had not been closed back in 1919-1920, if medical discretion and supervision had been permitted within the context of detoxification-or-maintenance programs, and if this approach had been widely emulated, then incalculable suffering, crime, and death could have been averted.
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From page 46... ...
One is struck by the fact that, at virtually every crucial juncture in the evolution of narcotic policy between 1909 and 1919, the key legislative and judicial decision makers had to rely on distorted and exaggerated figures. Addiction was understood as not merely bad but malignant, threatening to engulf the
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From page 47... ...
In 1922 Congress passed the Narcotic Drugs Import and Export Act, placing further restrictions on the international narcotic trade and strengthening provisions against unauthorized possession; in 1924 it outlawed heroin altogether. In both practical and symbolic terms, however, it was the elimination of organized maintenance in 1923 that most clearly demarcated the classic period of narcotic control.
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From page 48... ...
His story is told in David T Courtwright, Charles Terry, The Opium Problem, and American Narcotic Policy, Journal of Drug Issues 16 (1984)
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From page 49... ...
The Hearst cartoons are of particular interest, not only as vivid illustrations of how the hard-line narcotic policy was reinforced by mass media but because they sharply differentiated between drug and alcohol prohibition, upholding the former and condemning the latter. The comic strips of the Prohibition era also generally portrayed alcohol in a neutral or slightly favorable way.
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34Musto, American Disease, 1973 edition, 230-232; Bonnie and Whitebread, Manjuana Conviction, 215; Edward M Brecher et al., Licit and Illicit Drugs (Boston: Little, Brown, 1972)
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43Brecher et al., Licit and Illicit Drugs, 422, report that marijuana arrests In California rose from 1,156 in 1954 to 7,560 in 1964; two years later, in 1966, the total stood at 18,243. The growing skepticism over the harmfulness of marijuana during the 1960s is discussed in Chap.
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From page 52... ...
Interim and Final Reports of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs (Bloomington: Indiana University Press, 1961; seventh printing in 1969)
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From page 53... ...
-- r s2Narcotic Addiction, 169. Eldridge's Narcotics and the Law, cited above and first published in 1962, carried a similar message: The treatment of addiction and research into possible preventative medicine are medical problems and should be dealt with as such." Eldridge accorded a role to law enforcement but argued that physicians should be free to individualize treatment, just as judges should be free to individualize sentences (118-125)
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From page 54... ...
Heroin and Public Policy (Chicago: 59nSpecial Message to the Congress on Drug Abuse Prevention and Control, June 17, 1971,~ Public Papers of the Presidents of the United States: Richard Nixon...1971 (Washington, D.C.: U.S. Government Printing Office, 1972)
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From page 55... ...
68H.W. Cohen et al., "Behavioral Risk Factors for HTLV-III/LAV Seropos~tivity among Intravenous Drug Abusers," paper presented at the International Conference on the Acquired Immunodeficienc~y Syndrome (AIDS)
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From page 56... ...
Neshin, "New Jersey Community Health Education Project: Impact of Using Ex-Addict Educators to Disseminate Information on AIDS to Intravenous Drug Users," paper presented at the International Conference on AIDS, Paris, June 23-25, 1986; Jeffrey Schmalz, Addicts to Get Needles in Plan to Curb AIDS," New York Times, January 31, 1988, Sec.
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From page 57... ...
Sells, "Reflections on the Epidemiology of Heroin and Narcotic Addiction from the Perspective of Treatment Data, both in Joan Dunne Rittenhouse, The Epidemiology of Heroin and Other Narcotics, NIDA Research Monograph 16 (Rockville, Md.: Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse, Division of Research, 1977) , 63-78 and 161-163, respectively; John C
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From page 58... ...
, 52-53; "The Growth of Cocaine Abuse: A Report by the Strategic Cocaine Unit of the DEA Office of Intelligence," Drug Enforcement 9 (Fall 1982) , 18-20; Charles Blau, "Role of the Narcotic and Dangerous Drug Section in the Federal Government's Fight Against Drug Trafficking, Lang Enforcement 11 (Summer 1984)
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From page 59... ...
24. See also the comments by Frank Gawin in Virginia Cowart, "National Concern About Drug Abuse Brings Athletes Under Unusual Scrutiny," Journal of the American Medical Association 256 (1986)
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From page 60... ...
Devine, "International Patterns of Drug Abuse and Control," in Millman et al., 17, and Laura M Wicinski, "Europe Awash with Heroin," Drug Enforcement 8 (Summer 1981)
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From page 61... ...
5. The political logic of this bill, which President Reagan signed into law on October 27, 19&6, is apparent when one considers poll data showing that Americans then ranked drug abuse as a national problem second only to the federal deficit (Wall Street Joumal/NBC News Poll, p.
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From page 62... ...
Very few new medical addicts were being created and many old ones, left over from the nineteenth century, were dying off. The Bureau's efforts were targeted at nonmedical addicts, and their numbers did not appreciably diminish, except during World War II.
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