The Addict And The Law

...v. Behrman) involving obvious abuse of the Act (here the doctor had given to an addict, at one time, a hugh quantity of narcotics for use as he saw fit...

...We in medicine do not accept with equanimity any treatment that fails to achieve cure in even 5 percent of the cases of any specific disease...

...Dr...

...Unfortunately this mass of research findings will not help us much in our effort to control addiction...

...Such a policy is in operation in Great Britain where, within broad limits, doctors are permitted to provide addicts with necessary drugs— at practically no cost through the National Health Service...

...It is likely, too, that few members of the "public" fully realize the utter failure of our current laws, and the harshness of measures taken to curb the activities of addicts...

...Its transformation into an antiaddict measure, however, helped breed our current addiction problem...

...The result has been described as a "reign of terror" under which medical practitioners withdrew almost completely from the treatment of addiction...

...If such efforts resulted in the conviction of higher-ups in the black market, they might be worthwhile...

...Nonetheless a similar yet even more drastic anti-addict measure was enacted in 1956...

...In the first place American addicts receive their "sustaining" doses anyway—from the peddler, at a tremendous cost to the community...

...In a unanimous opinion, the Supreme Court reversed Dr...

...Contrary to all non-governmental evidence, Anslinger contends that three-quarters of the addicts are criminals before they become addicted...

...It would not, in the first instance, reduce the amount of addiction, though it might well curb its spread...

...James Lowry, medical director of the Lexington, Kentucky, USPHS hospital for addicts, who asserted that "my function as a physician is to treat people, not to maintain them in a state of disease...

...Even the Lexington doctors have recognized that the withdrawal process is "the least important step in the treatment of narcotic addiction...

...As long as Anslinger and his associates can convince people that this is "no field in which to experiment with unproven ideas, fanciful suggestions, or curbstone opinions," the "proven" ideas of hate, violence and corruption will hold sway...

...Under this program, the rate of addiction has remained extremely low, and virtually no illicit trafficking or addict-crime has arisen...

...The committee accepted the view that "both in his interest and in the interest of community protection the chronic drug addict must be 'quarantined' or otherwise confined for long periods of time or permanently if relapses continue after releases from isolation or confinement...

...The psychiatrist attributes addiction to underlying mental disturbance, while other researchers stress situational factors and subcultural influences...

...Legislators will continue to swallow the Anslinger philosophy unless strong pressure is brought in the opposite direction...

...Police authorities and narcotics agents are unable to make any appreciable dent in this underworld apparatus...

...Few addicts can afford black market prices...

...often these diatribes emanate from the very officials who are supposed to be seeking solutions to the addiction problem...

...For one thing, he has built up a powerful organization of hard-hitting operatives who think just the way he does...

...But by 1925 the medical profession already had been intimidated into rejecting addicts as patients...

...What well-meaning observers often overlook is that the battle to completely eliminate addiction may well be a hopeless one...

...says nothing of "addicts" and does notundertake to prescribe methods for their medical treatment...

...The best possibilities for promoting reform would seem to lie with the medical profession...

...WHAT HAVE THESE POLICIES accomplished...

...But the British approach makes sense...

...It was found that with medical advice most patients were able to undergo withdrawal in their own homes assisted by their families...

...Even when the pusher tells all he knows, we only reach the dealer— merely one step up the ladder...

...In an early case under the Act (Webb v. U.S., 1919) the facts showed flagrant abuse of the law (Dr...

...The public may hear a good deal about the efforts to cure addicts at Lexington...

...At the core of Anslinger's outlook is a belief that basically the addict is a wrongdoer...

...The Bureau of Narcotics also knows about it of course, but as I have suggested elsewhere (Commentary, September 1960) most of the official American statements about British drug policies are highly misleading...

...Some sociologists feel that rather than seeking to isolate the recurring "causes" in individual cases of addiction, we should concentrate on the general process by which all these individuals "learn" to become addicts...

...The Act was not intended to control or punish addicts...

...In the 1956 Daniel committee hearings, New York Attorney General Javits said (of the New York Academy of Medicine's plan for federal clinics to dispense free drugs to addicts): "I think it is fair to say that it sort of represents throwing in the sponge...

...Webb had sold thousands of narcotics prescriptions indiscriminately, for fifty cents apiece...

...We subscribe wholly to the belief that we should do everything possible to treat and rehabilitate narcotic addicts and that we should not adopt any program to give the drug addict "sustaining" doses of narcotics which would maintain him in a state of disease...

...Anslinger insists that any non-punitive approach to addiction would "elevate a most despicable trade to the avowed status of an honorable business, nay, to the status of a time-honored profession...

...Not only is the perpetual hounding of the addict inhumane, but the lengths to which agents often must go to make narcotics arrests represent an unwarranted drain on the taxpayers' money...

...QUITE APART from the question of institutional vs...

...The futility of their task inclines them to an unusual bitterness toward the addict and to the use of highly unsavory police methods...

...And finally, we know that there is no simple medical "cure" for addiction...

...slow a person down rather than pep him up...

...But leaving aside the question of prevalence, one result of these policies is quite evident—they have driven the addict straight from the doctor into the hands of the drug peddler and into a life of crime...

...They can only hope that occasional "crash programs" and exposes will create the impression that they are doing their job...

...The Daniel committee even went so far as to recommend "an indeterminate quarantine-type of confinement at a suitable narcotics farm" for addicts who relapse more than three times...

...Yet the Government presented the issue to the U.S...

...They are diseasedand proper subjects for such treatment, and we cannot possibly conclude thatis physician acted improperly or unwisely or for other than medical purposesolely because he has dispensed to one of them, in the ordinary course, andin good faith, four small tablets of morphine or cocaine for relief of conditionsincident to addiction...

...Commissioner of Narcotics Harry J. Anslinger...

...It is true that the failures of the confinement approach might be overcome by a policy of permanent confinement of all refractory addicts...

...We know that the truly addictive opiate-type drugs (heroin, morphine, etc...

...Given the distrustfulness of most addicts, this testifies to the strong desires of many to rid themselves of addiction...

...They are the only ones who sell to teen-agers...

...Yet the United States Government is committed to a plan of action which fails more than 90 percent of the time...

...Although our current policies may be attributable to a number of factors, an important part of the story lies in the philosophy espoused by the nation's top anti-addict law-enforcer, U.S...

...Indeed the relapse rate among treated addicts is so high as to call into question the whole Federal treatment program (the one positive feature of the Government's policy...

...You just throw up your hands and give up on the problem...

...tion of innocence and other provisions of the Constitution are meaningless...

...At least two American surveys of attitudes toward various crimes (surveys in other countries might obtain quite different results) have revealed extremely strong feelings about offenses involving narcotics...

...As legal expert Rufus King has noted, "Narcotics-users were 'sufferers' or 'patients' in those days...

...Admittedly a new policy modeled on that of Britain would not be a panacea...

...In its reports, the Daniel committee quoted with approval Dr...

...And virtually all disinterested experts agree that our present policies are doomed to failure...

...Lindner the stool-pigeon had said she was in great pain from a stomach ailment and that her regular physician was out of town...

...By requiring registration of all legitimate handlers of drugs, and by requiring the payment of a special tax in connection with drug transactions, the Act enabled the Treasury Department to establish a licensing system for the control of all legitimate drug traffic...

...A recent report of the Narcotic Addiction Research Project in New York (under the direction of Dr...

...He has referred to the addict as a parasite, a hoodlum, an immoral vicious social leper...

...It is quite true that we have no assurance that such a policy would work in this country (where different conditions, and especially a tremendously larger addiction problem, exist...

...In a case last year, five detectives spent a month in Greenwich Village disguised as beatniks— one is reported even to have achieved a slight reputation as a poet...

...The Court also specifically stated that the Webb and Behrman rulings should not be extended beyond the facts in those particular cases...

...Quite probably no single personality or personal-background "factor" can supply the key to addiction—assuming even that certain people are more susceptible to drugs than others...

...One United States Attorney stated, in Congressional testimony: To convict the big operator is a difficult task and we fully appreciate that we are nowhere near the big operator when we arrest the pusher who sells to the addict...

...Apart from the tremendous cost and difficulty of administering such a scheme, it seems unlikely that public opinion would support such extreme measures...

...Now this is an astronomical figure...

...They call for conferences, more research, more hospital beds for addicts, new types of therapy, increased after-care...

...Nobody can quarrel with the short-run desirability of such measures, but neither "task forces" nor "research centers" (nor even hospital beds and therapy) can come to grips with the "core" of our present problem...

...Many feel as Judge Murtagh does, that "There is only one way to start reform—retire Commissioner Anslinger and replace him with a distinguished public health administrator of vision and perception and, above all, heart...

...The only trouble is it just doesn't make sense...

...To this very day the Narcotics Bureau quotes with approval the Webb and Behrman decisions, yet no mention is made of an interesting 1925 ruling (in the case of Lindner v. U.S...

...Faced with criticism from judges, lawyers, doctors and social scientists, he and his cronies have designated all such critics "simpletons," "pseudo-experts," "dewy-eyed, impractical, self-styled social reformers...

...Anslinger is fond of pointing out that the root of the problem really lies with the Communist Chinese, who by careful policy are promoting the flow of illicit drugs to the United States (presumably to undermine our "moral fiber" and "physical welfare...

...ambulatory treatment, is the question of whether we can really hope for addiction "cures" at all...

...One must also recognize that the interests of our special narcotics law-enforcers in some ways complement (rather than oppose) these business interests...

...and drug addicts would multiply unrestrained, to the irrevocable impairment of the moral fiber and physical welfare of the American people...

...But even prosecuters admit that current enforcement efforts ensnare minor violators much more often than major drug traffickers...

...Hipsters, according to Norman Mailer, may even view the use of opiates as part of a "new radicalism"—inspired by their belief in the current futility of strictly political dissent...

...If these interests are extensive and strong enough, it can withstand "crusades" almost indefinitely...

...And it may be worth noting that these addicts and pushers are mainly Negro while the big-shots of the narcotics racket, whose positions seem relatively secure, are largely white...

...Lindner's conviction, stating: The enactment under consideration...

...Basic to it would be the formulation of a policy to eliminate or reduce the anti-social behavior now associated with addiction...

...The addict concentration camp may not be far off...

...Similarly, Senator J. M. Butler stated, "It would seem to me that was a defeatist attitude...

...Recent reports issued by several AMA committees suggest that the profession is seriously re-thinking its stand on the treatment of addiction...

...In addition to the federal statutes, many states now have their own anti-narcotics laws—some of which make addiction itself a crime...

...it learns relatively little about the uses of decoys and agents wired-for-sound, or about the use of stomach pumps to extract evidence and the threat of cold-turkey to induce stooling...

...This really is "the end of ideology" with a vengeance...

...At the same time, it means little to speak of "giving up" on the problem of curing addiction when there is no evidence that our current efforts at cure are (or indeed that any efforts at cure might be) a significant success...

...This is so because most of the anti-social behavior associated with the narcotics problem is only secondarily related to the phenomenon of addiction as such...

...As sociologist Alfred Lindesmith points out, "To the addict, the presump...

...Decoys, for example, are acceptable...

...Furthermore it is the addict who feels the full impact of the recently-increased penalties...

...it becomes entrapment...

...More and more the drug addict is becoming both an avant-garde hero and modern scapegoat...

...but if there is evidence that the final act was planned by an enforcement agent...

...How can the Government condone such senseless policies...

...The simple fact is that invariably addicts fall back on drugs at some point following completion of withdrawal treatment...

...But surely this is where the reasoning behind the Anslinger philosophy leads...

...Real pressure by the AMA for the repudiation of the punitive approach to addiction could well turn the tide...

...she claimed she had said she was an addict...

...We know only too well, from the disaster of prohibition, from the booming abortion racket, and from other examples which might be given, that when a strong public demand is blocked by repressive law, an organized illicit apparatus will step forward to satisfy that demand...

...Here the Government prosecuted (under a Behrman-type indictment) a well-established Spokane physician who had prescribed a small amount of narcotics for a Narcotics Division stool-pigeon...

...The writing of Jack Gelber, William Burroughs, Alexander Trocchi and others has stimulated interest in the lives of "junkies...

...it would be absolutely immoral to give in to drug addiction and help perpetuate such pitiful conditions for the individual human being...

...In one of these studies narcotic peddling was more strongly condemned than armed robbery, rape, felonious assault, and burglary...

...Considering that this project attempts to employ procedures to which the Narcotics Bureau is unalterably opposed, and that it received little cooperation from New York hospitals (when such help was requested), its degree of success seems very impressive...

...In similar vein, critics who point to the success of the British approach to addiction (see below) are sternly reminded that of course their "unfortunate narcotic situation" is a reflection of "socialized medicine...

...While no one has contested Anslinger's expertise as a policeman, many feel that his ability to influence national addiction policy has proved disastrous...

...At the same time, addiction can hardly be attributed to any one kind of socio-economic system (a recent report revealed the presence of a narcotics ring in the Soviet Union, of all places...

...It has been estimated, and I emphasize these are estimates, as being anywhere between 70 to 95 percent...

...From a policy standpoint it seems somewhat useless to debate the question whether the addict is "immoral," "sick," or merely a rebel against a "sick society...

...Many people still accept what Alfred Lindesmith has termed the " 'dope fiend' mythology"—the familiar complex of mistaken views about addiction and addicts...

...But Anslinger himself is not the only stumbling block in the way of reform...

...Not even a radical reconstruction of American society is likely to eliminate all the situations in which Americans might be drawn to drug-taking...

...Most anti-narcotics activity involves continual and repeated arrests of lower-level pushers—who often themselves are addicts...

...they could and did get relief from any reputable medical practitioner, and there is not the slightest suggestion that Congress intended to change this— beyond cutting off the disreputable 'pushers' who were thriving outside the medical profession...: As a regulatory tax measure, the Harrison . Act has been extremely successful...

...When the addict is institutionalized he not only loses his value to the peddler but he is also thereby prevented from contaminating others...

...They can't help themselves...

...Unfortunately these officials seem mesmerized by what might be called the addiction-problem rhetoric (an adjunct of the Anslinger philosophy...

...In 1924 the American Medical Association passed a resolution (never explicitly repealed, and still cited by the Federal Bureau of Narcotics) opposing ambulatory treatment of addiction and supporting Government efforts to shut down the municipal clinics—which, between 1912 and 1925, dispensed low-cost drugs to addicts in many American cities...

...This law (described by Judge John M. Murtagh as "unimaginably cruel legislation") raises previous minimum sentences, and permits the death penalty (even for a first offender) for sale of narcotics to a person under eighteen...

...Given the compelling demand of the addict for his drug, the shutting off of legitimate channels of supply opened the way for a tremendous illicit traffic in drugs...

...For example, in Great Britain addicts are not confined in special institutions, but are treated in a variety of institutional and ambulatory ways...

...No one knows the exact rate of relapse...

...Three years later, there came before the Court another case (U.S...

...Accepting this restrictive definition of professional treatment, the court stated that "to call such an order for the use of morphine a physician's prescription would be so plain a perversion of meaning that no discussion of the subject is required...

...While we have developed relatively painless ways of gradually withdrawing the addict from drugs, this is no real solution...

...Marie Nyswander, who has wide experience in the treatment of addiction), also casts doubt on the assertion that ambulatory treatment of addicts cannot work...

...Both of these views are unfortunate, because they obscure the basic facts about our failure to formulate a sane addiction policy...

...he places no credence in the widely accepted findings that most addict-crime is of the money-producing variety and is impelled by a necessity to finance drug habits in the illegal market...

...Herbert Berger testified before the Daniel committee: It is quite probable that the individual who stays for a full course of treatment might well cost the United States Government $2000 to $4000...

...In the war against the addict, virtually anything goes...

...The report notes that many of the popular beliefs about the impossibility of dealing with addicts as voluntary patients were not substantiated...

...The committee itself had little difficulty in deciding that...

...Furthermore, at the present time the Anslinger philosophy probably has wide support among the general public (largely through the failure of critics to make known their opposition...

...With an assured inflow of high profits, this apparatus further entrenches its position and provides for its own protection...

...According to a news account the entire New York police narcotics squad, 140 men and women, participated in the resulting arrests...

...Thus Commissioner Anslinger, in an advisory pamphlet for doctors, asserts: "Medical authorities agree that the treatment of addiction, with a view to effecting a cure, which makes no provision for confinement while the drug is being withdrawn, is a failure, except in a relatively small number of cases...

...While this statement has a certain basis in medical fact, it may well constitute an oversimplification...

...which would seem to challenge and severely limit these earlier holdings...

...But it could materially reduce addict-crime and eliminate most of the illicit drug trade...

...This approach is now attracting increased interest among medical and legal experts in the United States...

...We know that the person who takes opiates over a substantial period of time develops a tolerance to his drug (he needs more and more, at first to achieve the desired effect and later just to stay normal) and finally an actual physical dependence (that is, when deprived of the drug he experiences an excruciating physical illness referred to as the "abstinence syndrome" or "withdrawal illness...

...Since the addict must have his drugs, narcotics which cost the "importer" virtually nothing bring enormous profits in the black market...

...The key point is that we have forced him into a life of crime and degradation—the blame for this cannot be shifted to the effects of narcotics or the nature of the addict himself...

...There is no sure way of erasing from the treated addict's mind the knowledge that at one time narcotics solved certain problems for him or offered him distinct satisfactions...

...Of this highly questionable procedure (so much like the well known vice squad technique) one report states: "There is some element of entrapment in many drug arrests, and the officer is forced to distinguish the fine line which the courts have drawn to separate legal deception...

...our present anti-addict laws provide their raison d'être...

...Addiction is a political hot potato, and one can hardly expect any politician to include a drugs-for-addicts plank in his platform...

...At first glance, it may seem quite gratifying that such busy men as Senators Daniel, O'Mahoney, Eastland, Welker and Butler should have taken time to draft or approve this highly moral and humanitarian credo...

...A major source of evidence in narcotics cases is the addict-stool pigeon—euphemistically labelled a "confidential informant...

...Though the addict-informer faces grave dangers of underworld reprisal, eagerness to stay out of jail (and avoid the "cold turkey" of sudden withdrawal from drugs) impels many addicts to "stool...

...Although enforcement officers claim that addiction is being kept under control (sometimes they even assert that the current rate represents an "irreducible minimum"), most disinterested observers think otherwise...

...For him the police state is already in being...

...The ladder may have several steps before it reaches the big importer...

...Lindner's victory remained personal...

...Official estimates that there are only between 45,000 and 60,000 addicts are held strongly suspect in almost all non-governmental circles...

...while there are available no statistics regarding British success in curing addicts, there is no reason to believe that their attempts are any less successful than our own...

...Typical was Governor Rockefeller's announcement (in November 1959) of the establishment of a "special task force" on addiction and an "experimental research center" in a state mental hospital...

...While racial and religious scapegoating are now out of date, to condemn the addict remains respectable (and this, in turn, may well explain the glorification of the junkie in bohemian circles...

...During its first year of operation, the project was voluntarily contacted by seventy addicts, forty-seven of whom indicated a willingness to undergo psychotherapy, and thirty-five of whom actually made an initial contact with the staff therapists...

...since this form of deviance need not constitute any real threat to the social order, such toleration should be possible...

...The Governor cited research as the "central need in this hitherto unsolvable problem," stating that "so long as there is no established cure for the type of addiction which represents 87 per cent of the problem, everything else that we do is at best a temporary palliative and does not go to the core of the problem...

...If the peddler were deprived of a market for his illegal wares, he would cease to exist...

...We know that the depressant effects of opiates may imperil job efficiency (as well as sexual activity)—though there have been notable cases of creative production and competence on the part of long-time addicts...

...Through research in various fields we now know a good deal about the nature of addiction, and what we know suggests that the addict, as such, tends to be neither hero nor menace...

...The only sane approach to this problem would therefore seem to require a pronounced change in our attitude toward the addict, and a radical revision of addiction policies...

...How IS ONE TO ELIMINATE this three-pronged terror of condemnation, confinement and "cure...

...Taking addicts out of the "care" of policemen would be a major step toward decency...

...Confronted with the argument that providing addicts with low-cost drugs would remove the profit incentive and thus paralyze the illicit traffic, Anslinger has replied that he could very easily see where this might lead: "to the state setting aside a building where on the first floor there would be a bar for alcoholics, on the second floor licensed prostitutes, with the third floor set aside for sexual deviates, and crowning them all, on the top floor a drug-dispensing station for addicts...

...In the wake of the Kefauver investigations of interstate crime, the Boggs Act of 1951 provided severe mandatory sentences for all narcotics violations...

...This stress on the efficacy of confinement was blandly accepted by the Daniel committee (Senate Subcommittee on Improvements in the Federal Criminal Code, chaired by then Senator Price Daniel) which recommended the deplorable 1956 Federal anti-narcotics law...

...It becomes big_ business, and many individuals have vested interests in its survival...

...hence it just isn't true that addicts are violent criminals and sex fiends...

...Thirteen of these patients underwent a full year of treatment, by the end of which time ten had ceased to use drugs, two had decreased their habit and one took drugs only occasionally...

...Many observers (including prominent jurists) condemned this law, particularly its failure to distinguish sufficiently between the non-addict peddler and the addict...

...As Judge Murtagh has pointed out, "the sick, driven addicts, are the only ones who are ever arrested as repeated offenders...

...Over the years periodic outbursts of public concern about the "dope menace" have served only to elicit increasingly repressive legislation...

...While this might seem to suggest that our current drug laws have the support of "public opinion," it must be kept in mind that that very opinion has itself been strongly shaped by those policies, through the continual denunciation of the addict by enforcement officers and others...

...It would return to the addict his human dignity, and this might even encourage addicts to undergo treatment and to remain abstinent once treated...

...But the Government (in what Rufus King terms a "trick indictment") glossed over the quite evident bad faith of the doctor, acted as though the drugs were provided in good faith for the purpose of treating the addict, and obtained a ruling to the effect that all "ambulatory treatment" of addicts by doctors (in good faith or not) violated the law...

...At the same time the profit motive serves as an incentive to the peddlers to recruit new customers, and the black market network spreads wider and wider...

...At the same time, we continue to be bombarded with inflammatory press accounts vilifying the addict as public-enemy-number one...

...A point continually stressed by Anslinger, and repeated by the Congressional committees which seem so strongly under his influence, is that non-punitive approaches to addiction amount to surrender in the battle to cure addicts...

...The addict, according to him, is a "tremendous burden on the community" (characteristically, there is no comprehension of the fact that addiction is a responsibility of the community...

...As well as relying on stool pigeons for leads, the narcotics agent himself often must attempt to obtain drugs from a suspected supplier...

...Why do we treat the addict as a criminal, when clearly he is a person in need of help...

...Supporters of harsh anti-addict measures often claim that confinement of the addict is necessary for proper treatment...

...Further studies into the causes of addiction reveal, not surprisingly, divergent theories which reflect the professional orientations of the persons doing the research...

...Indeed it is not too far-fetched to suggest that we have ourselves, by our policies toward the addict, created a large part of the problem...

...If the rate approaches 90 percent, and most addicts seem to think it exceeds that figure, then that $4000 that we spend for the treatment of one patient becomes $40,000 for cure...

...Perhaps we must be prepared to accept the existence of a certain amount of addiction in any society...

...But, one may ask, what about the serious expressions of concern so often voiced by local and state officials...

...as a result most American addicts take to stealing, prostitution or drugpushing to foot the bill...

...Supreme Court as follows: If a practicing and registered physician issues an order for morphine to an habitual user thereof, the order not being issued by him in the course of professional treatment in the attempted cure of the habit, but being issued for the purpose of providing the user with morphine sufficient to keep him comfortable by maintaining his customary use, is such order a physician's prescription [under a specific exemption provided by the Act...

...A SECOND MAJOR TENET of the Anslinger approach is that the key step in dealing with addiction is the compulsory confinement of all addicts (presumably for treatment—but one can hardly help questioning his motives here, given his stated views about addicts...

...IN 1914 CONGRESS passed the Harrison Act, designed to control the domestic sale, use and transfer of narcotics...

...This decision was eagerly grasped by the Narcotics Division of the Treasury Department (the predecessor of the current Federal Bureau of Narcotics) as a mandate to proclaim all-out war against addicts and against any doctors who attempted to treat or relieve addicts through ambulatory (i.e., outpatient) methods...

...According to Dr...

...In The Traffic in Narcotics (with W. F. Tompkins), the Commissioner states: From the practical standpoint it is fundamental that a business, legal or illegal, would be bound to fail if deprived of customers, and the peddler of narcotic drugs is no exception...

...hot baths, tranquilizers and barbiturates (and in a few cases methadone) were used to ease withdrawal difficulties...

...I am sure these are minimal figures...

...As long as the addict is at liberty to come and go, the peddler has a steady customer...