Introduction

This Report originated five years ago in a growing conviction on our part, and on the part of others associated with Consumers Union, that the illicit drug scene in the United States was rapidly becoming intolerable:

• Heroin, marijuana, LSD, cocaine, the amphetamines, the barbiturates, and many other mind-affecting drugs had become readily and increasingly available on the illicit market in many parts of the country.

• The use of illicit drugs, especially by young people, appeared to be increasing year by year.

• The United States had focused its efforts to curb illicit drug use primarily on penalties—arrest, imprisonment, discharge from jobs, expulsion from schools and colleges, social contempt, and exclusion. But those penalties were damaging our society in many ways, most significantly in the criminalization and alienation of large numbers of young people. *

• Programs designed to warn children and young people away from drugs had failed to accomplish their purpose; some programs, indeed, were perhaps even contributing to the rising tide of drug use.

An earlier CU publication, The Consumers Union Report on Smoking and the Public Interest (1963), had been well received and had had a significant impact on public attitudes toward cigarette smoking. That report had also proved helpful to the Surgeon General's Advisory Committee on Smoking and Health in the drafting of its 1964 report. A similar CU report on drugs seemed urgently needed. In 196T, accordingly, CU's Director of Special Publications was authorized to launch a search for a writer capable of drafting a sound report on illicit drugs, and a start was made toward assembling source materials for such a report.

One of the drafters of CU's 1963 smoking report, Edward M. Brecher, was our choice for the new assignment, and he agreed both to conduct the necessary research and to draft the new report. He set to work early in 1969.°

The present Report was initially planned as a modest handbook on illicit drugs—a slim volume that would describe the pharmacological effects of each drug on the mind and body, and recommend measures for curbing drug misuse. As Mr. Brecher's review of the medical, pharmacological, sociological, psychiatric, and psychological literature proceeded, however, it became clear that such a limited handbook would serve no useful purpose. It might even further muddy the already confused debate on drugs then raging. That debate, it increasingly became apparent was overemphasizing the supposed pharmacological effects of drugs while paying curiously little attention to the effects of drug laws, drug policies, and drug attitudes. Accordingly, the project as first conceived was expanded in several directions.

First, the major licit drugs—caffeine, nicotine, and alcohol—are considered here along with the illicit drugs. Any book about drugs that ignores such socially approved and legally marketed substances, we are convinced, sacrifices its credibility among young readers—and seriously distorts the perspective of older readers. Considering the licit and illicit drugs together makes both groups more readily understandable.

Second, each drug is presented in its historical setting.

Third, the history of drug laws, policies, and attitudes is presented along with the history of the drugs themselves. A historical perspective helps distinguish the direct effects of a drug on mind and body—relatively stable decade after decade—from the effects of laws, policies, and attitudes, which may vary from decade to decade. The practical advantages of that distinction can hardly be overemphasized. For while little can be done to alter the direct impact of a drug on mind or body, a great deal can be done to alter the impact of laws, policies, and attitudes. Out of an integrated review of pharmacological effects, legal effects, and social effects, there emerges at the end of this Report a set of recommendations designed to minimize both adverse pharmacological effects and adverse legal and social effects of drug use.

Our recommendations, it is true, do not constitute a panacea—"six easy ways to eliminate the drug menace." But they do point the way to both short-term and long-term improvements in the present critical situation.

We hope this Report and the historical perspective it provides will prove useful in several ways. At the very least it can warn against further reliance on "solutions" that have repeatedly failed in the past. It can provide concerned citizens with the historical background needed to evaluate proposals for change. We hope it will help them to contribute wisely to the search for sound fresh solutions.

We also believe that this Report, and especially the recommendations concerning drug attitudes, will help parents and community leaders faced with drug problems in their own families and neighborhoods. Educators responsible for tailoring more effective educational programs will, we hope, find useful information in many chapters. Finally, young people will find here information they can trust about licit and illicit drugs.

Part I of this Report, the longest part, is concerned with the narcotics —primarily opium, morphine, and heroin. Detailed attention is paid to those drugs because their history in the United States has a lesson to teach. The relentless campaign to suppress heroin, since the Harrison Narcotic Act of 1914, has been more prolonged and more intensive than the campaign waged against any other drug. That campaign has failed. Until society recognizes and accepts the reasons for that failure, it can hardly formulate sound laws and policies with respect to any drug. Further, attitudes toward heroin, the most hated and most dreaded drug of all, subtly tinge popular attitudes toward other illicit drugs. Many people tend to transfer to all illicit drugs, even marijuana, the hate and dread aroused by the mere mention of heroin. Hence, a clear understanding of heroin and a rational attitude toward it are prerequisites for a rational approach to other d4ugs and for formulating effective politics toward drugs in general. *

Throughout this book; many descriptions of drug effects will be found. The reader should bear in mind that the effects described will be in the context of who is taking the drugs in what dosage, by what route of administration, and under v.«hat circumstances. Thus, à cocktail which makes one drinker sociable and garrulous makes another silent and morose. A man happily drunk on three highballs may find himself suicidally drunk on four. A woman buoyed up by a few drinks on Saturday night may find herself depressed by the same dose the next Saturday night. An alcoholic on a quart of brandy a day may display fewer signs of drunkenness than he did on a couple of beers a few years earlier.

Much the same is true of the other psychoactive drugs reviewed in this Report. Readers who traditionally thin}; in terms of t1le effect of a drug will learn here that even the simplest drugs have a wide range of effects—depending not only on their chemistry but on the ways in which they are used, the laws that govern their use, the user's attitudes and expectations, society's attitudes and expectations, and countless other factors .

The findings of this Report are firmly rooted—as the text and reference notes will demonstrate—in the published scientific literature. Other lines of inquiry, however, have enriched and buttressed the published data. Mr. Brecher visited leading drug research and drug treatment centers from Boston to San Francisco, as well as in Canada, England, Sweden, Denmark, and the Netherlands. He interviewed authorities in many disciplines, and a number of them generously made available unpublished material. He attended major conferences on drug problems. Well-known drug-use centers from Paradiso in Amsterdam and the West End in London to the Haight-Ashbury in San Francisco and Fourth Avenue in Vancouver were included in his research itinerary, and he talked with many drug users—ranging from marijuana smokers to heroin addicts and alcoholics.

This Report was further enriched by Mr. Brecher's participation in two other undertakings. The first was the work of the Ad Hoc Committee on the Treatment and Prevention of Drug Addiction and Drug Abuse, a committee assembled in November 1970 by Dr. Jerome H. Jaffe, associate professor of psychiatry at the University of Chicago-Pritzker School of Medicine, and director of drug abuse programs for the State of Illinois.e This ad hoc committee met in New York, Washington, and San Francisco; the typed transcript of its proceedings ran to more than 1,500 pages. Mr. Brecher also served in 1971 as a member of an advison panel on evaluation of drug treatment programs, assembled by the Cambridge consulting firm Arthur D. Littlew Inc., under a federal contract. Mr. Brecher's participation in these guroups significantly broadened his perspectives and thus enriched this Report. The conclusions reached here, of course, are wholly independent of conclusions reached by the Jaffe ad hoc committee and the Arthbr D. Little, Inc., advisory panel.

A major problem in publishing a book in any field in which the news media report almost daily developments and discoveries is when to call a halt. For this Report a halt was called on January 1, 1972. Thus developments after that date, and the impact of those developments on what preceded them, are not reflected here. Consumers Union, however, will continue to monitor the field and will report major developments in the pages of Consumer Reports. Meanwhile, to Edward M. Brecher goes this special word of appreciation for his extraordinary contribution to a better understanding of licit and illicit drugs and of laws and attitudes concerning them.

THE EDITORS OF CONSUMER REPORTS

Consumers Union

Mount Vernon, New York

Dr. Jaffe was subsequently, in 1971, appointed director of President Nixon's Special Action Office for Drug Abuse Prevention.

Mr. Brecher has written for Consumer Reports from time to time since 1938. He and his late wife, Ruth E. Brecher, who also participated in the drafting of CU's 1963 smoking report, were recipients of the Albert Lasker Medical Journalism Award for 1963, and of the American Psychiatric Association's Robert T. Morse Writers Award for 1971, "in recognition and appreciation of their distinguished contributions to the public understanding of psychiatry." They were associate editors of Consumer Reports in the 1940s, and joint authors of several books, including The Rays: A History of Radiology in the United States and Canada (Williams & Wilkins, 1969). Mr. Brecher is the author of The Sex Researchers (Little, Brown, 1969).

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