PART II Opiate Addiction as a Social Problem
CHAPTER 10 FEDERAL ANTI-NARCOTICS LEGISLATION
Certain of the provisions of Section 1 came to be of crucial importance for the addict. They ran as follows:
It shall be unlawful for any person to purchase, sell, dispense, or distribute any of the aforesaid drugs except in the original stamped package or from the original stamped package ... provided, the provisions of this paragraph shall not apply . . . to the dispensing, or administration or giving away of any of the aforesaid drugs to a patient by a registered physician, dentist, or veterinary surgeon or other practitioner in the course of his professional practice, and where said drugs are dispensed or administered to the patient for legitimate medical purposes, and the record kept as required by this Act.(1)
The interpretation of the phrases "legitimate medical purposes" and "in the course of his professional practice" has led to controversy between enforcement agencies and those medical men who insist that prescribing drugs for an addict falls within the legitimate province of the physician.
In Section 2 of the act a similar statement and a similar exception occur:
It shall be unlawful for any person to sell, barter, exchange, or give away any of the aforesaid drugs except in pursuance of a written order of the person to whom such article is sold, bartered, exchanged, or given.... Nothing contained in this section shall apply to the dispensing or distribution of any of the aforesaid drugs to a patient by a physician, dentist, or veterinary surgeon registered under this Act in the course of his professional practice only.(2)Again in Section 8 the following statement occurs:
It shall be unlawful for any person not registered under the provisions of this Act ... to have in his possession or under his control any of the aforesaid drugs . . . provided, that this section shall not apply ... to the possession of any of the aforesaid drugs which has or have been prescribed in good faith by a physician, dentist or veterinary surgeon registered under this Act. (3)
Some physicians have felt that the phrases "legitimate medical Purposes," "professional practice," and "prescribed in good faith" mean that they are entitled to regard addiction as a disease and the addict as a patient to whom they may prescribe drugs to alleviate the distress of withdrawal. English drug laws do interpret addiction in this manner and allow physicians to prescribe drugs for addicts. If the Harrison Act bad been interpreted in this mailner, American addicts would have been able to buy low-cost legitimate drugs and the illicit traffic in these drugs would probably not have developed. There is virtually no illicit traffic in opiates in England. The Treasury Department has, however, interpreted the Harrison Act to mean that a doctor's prescription for an addict is unlawful although exceptions are allowed in the case of the aged and infirm addicts for whom withdrawal of the drug might result in death and in the case of addicts suffering from incurable disease.(4)
It is specified in this connection that physicians will be held accountable if through carelessness or lack of sufficient personal attention the patient secures more narcotic drugs than are necessary for medical treatment, and devotes part of his supply to satisfy addiction."(5)
Anyone who is at all acquainted with addiction knows that this requirement is impractical and cannot possibly be strictly observed.
The Harrison Act has thus made it almost impossible for the addict to obtain drugs regularly from any legitimate source. The doc t -or I s prescription, the drugstore and patent medicines were eliminated as sources. In their place, to meet the insistent demand for drugs, the illicit traffic grew up. The illicit drug was sold to consumers at prices which were often ten to fifty times higher and more during World War I than the price of the legitimate product.
In 1922 in the Jones-Miller Act, Congress provided a fine of not more than $5,000 and imprisonment for not more than ten years for anyone, who fraudulently or knowingly imports or brings any narcotic drug into the United States or any territory under its control or jurisdiction, contrary to law, or assists in so doing, or receives, conceals, buys, sells, or in any manner facilitates the transportation, concealment, or sale of any such narcotic drug after being imported or brought in, knowing the same to have been imported contrary to law.' (6)
The act also specified that mere possession of the drug was sufficient evidence for conviction unless the defendant could explain the possession to the satisfaction of the jury.(7)
Some of the effects of the legislation mentioned were, no doubt, desirable; others were definitely undesirable. On the credit side it should be pointed out that for most portions of the population the removal of the drug from open and unrestricted sale and the regulations imposed upon doctors reduced the availability of narcotics and to this degree prevented the spread of the habit. Severe penalties imposed upon addicts and vendors of the drug may also have acted as deterrents. The exorbitant prices charged by illicit dealers also to some extent act as a deterrent to persons who might use the drug if it cost less. No reliable figures are available, however, to indicate whether the number of addicts in the United States has been increasing or decreasing.Among the undesirable effects of the legislation are the creation of the illicit traffic, the pauperization and demoralization of addicts, and the stimulation of crime, particularly theft and prostitution. All of these effects follow from the high cost of the illicit drug and from the fact that no legitimate sources of supply are open to most drug users. While it is true that some addicts are criminals prior to addiction, many, perhaps most of them, turn to crime only when the high price of the drug and the danger and inconvenience of maintaining a supply force them to do so. The vast proportion of all the crimes committed by addicts are either violations of the drug laws or theft in order to obtain money to buy the drug.
During the nineteenth century there were many opiate addicts, known as "opium eaters," who were not forced to live in the underworld because of their habits. As has been pointed out, they were usually reasonably respectable members of society, and there is even reason to believe that many of them belonged to upper strata of society. Today, this class has virtually ceased to exist, its former members having been forced into the underworld. Anyone who becomes an addict now finds it extremely difficult and hazardous to maintain his status as a law-abiding person. Since no legitimate sources of the drug are open to him be must take the risk of dealing with peddlers. Once he is caught and sentenced his fate is sealed. He is branded as a criminal. He must thereafter live by his wits whether be wishes to or not.
While the severe restrictions that are placed upon the handling of drugs prevent a part of the population from being exposed to the possibility of addiction, it should be noted that, at the same time, the illicit traffic, called into being by the same regulations, imports and distributes a vast quantity of the forbidden drugs, thus doubly exposing another portion of the population to addiction. The illegal dealer does not keep records or pay taxes on the supplies he handles, and there is nothing to prevent him from giving or selling the drug to anyone he pleases. As a consequence, the spread of the habit in the underworld is not subject to any public control.
There is no doubt that the existence of the illicit traffic in opiates in the United States today is directly dependent upon the enforcement of the Harrison and Jones-Miller acts, which prevent almost all competition between the legal and illegal businesses in narcotics. Prior to 1914 there was some smuggling of opium for smoking, but it was not until some years later, when the Harrison Act began to be seriously enforced, that illicit prices rose and the smuggling of drugs became a really big business.Another interesting feature of our anti-narcotics legislation is that, whereas it purports to be aimed at the peddler of the drug rather than at the user and does not specifically define the use of drugs as a crime, it does in fact make every addict in the United States a criminal unless he happens to be so old and infirm that withdrawal of the drug would cause death or unless he has an incurable disease. It is possible for a man to be a chronic alcoholic and to drink himself to death without violating the law. It is not possible for an addict to use drugs without violating the law or causing someone else to violate the law. As a consequence of the drug user's vulnerability to arrest, much of the punishment for the violation of the drug laws is banded out to the user of the drug rather than to the peddler. The - federal institutions and prisons are filled mainly with the victims of the drug traffic, not with those who profit from the traffic.
The current evil reputation of drug addicts in the United States arises from the peculiar historical development of the problem of addiction in this country. The fact that opium smoking became a fad in the American underworld probably provided the original grounds for the idea that there is an inherent connection between crime and addiction and provided the impetus for anti-narcotics legislation. This legislation in turn reinforced the notion that addicts are necessarily criminals by actually making them that. The agencies which enforce anti-narcotics legislation have become a vested interest in the status quo, and the fact that addicts in most of the other nations of the West are not nearly as criminal as those of the United States has been ignored. In no other country in the world does the opiate addict pay as much for his supply as he does here. This not only accounts for most of the crimes committed by addicts but has also made the United States the most lucrative market in the world for the illicit trafficker. It has also stimulated the cultivation of the poppy in remote portions of the earth.
A competent English observer and medical man commented upon the American situation:
In the United States of America a drug addict is regarded as a malefactor even though the habit has been acquired through the medicinal use of the drug, as in the case, e.u., of American soldiers who were gassed and otherwise maimed in the Great War. The Harrison Narcotic Law was passed in 1914 by the Federal Government of the United States with general popular approval. It places severe restrictions upon the sale of narcotics and upon the medical profession, and necessitated the appointment of a whole army of officials. In consequence of this stringent law a vast clandestine commerce in narcotics has grown tip in that country. The small bulk of these drugs renders the evasion of the law comparatively easy, and the country is overrun by an army of peddlers who extort exorbitant prices from their helpless victims. It appears that not only has the Harrison Law failed to diminish the number of drug takers-some contend, indeed, that it has increased their numbers-but, far from bettering the lot of the opiate addict, it has actually worsened it; for without curtailing the supply of the drug it has sent the price up tenfold, and this has had the effect of impoverishing the poorer class of addicts and reducing them to a condition of such abject misery as to render them incapable of gaining an honest livelihood.(8)
1. Taken from the text of the act as given by Terry and Pellens, The Opium Problem (New York: Committee on Drug Addictions and Bureau of Social Hygiene, 1928), Appendix VIII, P. 984.2. Ibid., p. 985.
3. Ibid., p. 989. See also Chapter 11, pp. 745-8o6, for a discussion of the implications of this law for the medical profession.4. Ibid., P. 756. Treasury Decision, NO. 28og, March 2o, igig.
5. Ibid., P. 757.
6. Ibid., Appendix IV, pp. 962-63.
7. Ibid., p. 963.
8. Harry Campbell, "The Pathology and Treatment of Memphis Addiction," British Journal of Inebriety (1922-23), 20: 147.