Herbertn/aBergern/an/an/an/a

To Dispel the Nightmare of Narcotics¹

For more than forty years our lawmakers and administrators have been trying to cure an illness by treating it as a crime. That illness—steadily on the increase in this country—is addiction to narcotic drugs.

Our legalistic approach, beginning with passage of the Harrison Narcotic Act in 1914 (which controlled the sale of narcotics through taxation) and continuing through the years with rulings from the Bureau of Narcotics, has wrought its own rewards. We have created a new criminal class. We have a flourishing narcotics racket. We have ever more drug addicts. Yet, in spite of the peculiar lack of success that the punitive principle has had in the narcotics field during four decades, Congress is now seeking to extend this principle.… [Recently] both the House and Senate took action to make the death penalty applicable to persons convicted of selling heroin to minors and to increase jail terms in other cases to a maximum forty years.

There is another approach to the narcotic problem. It urges that these sick people be exposed to the very medical knowledge from which they have been isolated all these years. It recognizes that their problem is ours and not theirs alone.

The public and some of our legislators have been insulated from the narcotic problem for so many years that many misconceptions about it exist. Some of them have originated in the writing of novelists, scenario writers and journalists; others have emanated from Federal sources, whose social, professional and economic survival is dependent on the maintenance of our present system of strict enforcement.

The fact that these sources provided the only possible origin for information for many years is not an accident. The medical profession, in whose hands rests responsibility for all other sick people, has been, since 1925, excluded from caring for these individuals. Therefore, the problem has not received the full impact of the tremendous surge of research which has bested so many other pathological conditions.

One of our greatest errors lies in the almost universally held belief that narcotic drugs stimulate the addict to anti-social behavior and even rapacious behavior. The opposite is true. Narcotic drugs are sedatives. They reduce fear, allay nervousness, alleviate pain, induce sleep. Under their influence, the addict becomes sedated, quiet, relaxed. The drugs do not incite the user to violence.

What manner of person is the addict? So large a group defies generalization, but by and large we know that he is shy, uncompetitive and congenitally incapable of facing adversity. He is a procrastinator, avoiding decisions and forever seeking to escape from his environment. While this is unnatural behavior, it is rather difficult to criticize; one finds it so frequently among us all. He closely resembles the food addict and is a blood brother to the alcoholic. His abnormality is lessened and he approaches conformity while on drugs. This all-important observation, first made by a distinguished student of the subject, Dr. Hubert Howe of New York City, is generally not accorded the significance it deserves.

This observation is borne out by the fact that many addicts using drugs are employable and carry on difficult and precise work as long as they receive narcotics regularly. They are found in all businesses and professions. My own, unfortunately, has many of them. A railroad switch tower operator worked, without missing a day, for forty-five years and got into difficulty only when narcotics became so expensive that he had to give up food in order to purchase drugs. He developed tuberculosis and eventually died of it. This death is wholly attributable to our present methods of drug control. Similarly, Samuel Taylor Coleridge dominated the literary scene in England for forty years, during all of which time he was an opium addict. He did not die of his habit.

These statements are not made to condone addiction, but rather to clarify it. I have no desire to indulge in maudlin sentimentality, but it bears repeating that the addict uses drugs to make himself feel better. Like most self-treatment, it’s bad. It solves no problems and cures nothing. It encourages the patient to relieve every difficulty in life chemically rather than through the use of his own native ingenuity and skill.

It is true that excellent work is being done by the two Federal hospitals (in Lexington, Ky., and Fort Worth, Tex.) and by our own municipal narcotic institution in New York. Unfortunately, these fine facilities have thus far failed to solve the problem. There is an enormous degree of recidivism. Practically all discharged addicts revert to their habit with the advent of their first adversity. It would seem that narcotic addicts can be separated from drugs only by forcibly incarcerating them in the drug-free atmosphere of a jail. This is not a cure. Unfortunately none is known. We keep hearing about a cure, and this error in thinking is probably our most serious because it leads us to the faulty conclusion that the addict is responsible for his relapse. One might as well be indicted for having a recurrence of cancer, another disease which we frequently cannot alleviate.

Our inability to realize the fond hope of permanent cure lies in our inability to cope, thus far, with the great complexity of the varying mental attitudes of these patients. Our narcotic hospitals are jail-like in nature. Consequently, the devoted men and women working there are divorced from the social cultures where drug addiction is bred and nurtured. In addition, a disease state affecting probably a quarter of a million of our citizens directly (and all of us indirectly) needs the thinking of all of the medical profession, not just that of the personnel of two or three hospitals.

At this point the relation of crime and narcotic addiction becomes apparent. The addict is denied by rulings of the Federal Bureau of Narcotics contact with physicians, pharmacists or any other licit source of the materials which he mistakenly believes he must have in order to survive. Since society shuns and abhors him, he must turn to the underworld to satisfy his demands. Its members are more than happy to comply. The profits are fabulous. Five dollars in Red China purchases an ounce of heroin. It has been sold for as much as $8,000 in New York City. Small wonder that punitive legislation has failed to remove the importer. We have created a criminal market that is both lucrative and safe. When, occasionally, one of these purveyors is caught, there are always others willing to step into his place.

The addict is thus forced to spend phenomenal sums to gratify his needs. Payments of $30 to $100 a day are not unusual. Since he has often acquired his habit at an early age, he has seldom mastered a skill that can possibly meet such expenses. Consequently, only crime offers him the means to fulfill his desires. We have forced him to consort with criminals. He learns their methods. His entire day is spent in trying to acquire sufficient money for four to six doses. His difficulties are compounded by the necessity to avoid the police and to conceal his habit from relatives, his employer and his neighbors.

The crimes he commits are for the most part bookmaking, policy slip running and pilfering. The females are usually prostitutes. The misdeeds are, for the most part, non-violent. The addicts’ most dangerous depredation to society in general is the initiation of neophytes, often school children, into the habit. The commissions on such sales guarantee their own supply.

Addicts are now hounded by police, revenue and narcotic agents who are trying to enforce the law. They are brought into courts over and over again. They are in and out of jail, never rehabilitated, never cured.…

Our narcotic problem is now the worst in the world. Our addicts are younger than ever. They face a lifetime of crime and addiction—mostly to heroin, the most powerful of the narcotics. The cost, counting Federal, state and municipal salaries, hospital care and the amount spent by the addicts, must be reckoned in billions of dollars. The last total, estimated by Congressman John M. Coffee in 1938, was $3,000,000,000 a year.

But this large sum doesn’t begin to measure the misery of the addict and the greater agonies he wreaks on his relatives, as well as on society in general. Since the addict is usually not employed, we must and do pay this bill for him.

The United States, with the world’s foremost scientific and medical advantages, is married to a system of control that is both unscientific and medically untenable.

What can be done? There seem to be only three possible courses:

(1) Destroy all addicts. This was actually tried by the Chinese only twenty years ago. (Hundreds were killed before the addicts went underground.) It is hardly likely to be recommended in a highly civilized country like the United States.

(2) Confine all addicts for life. Assuming it were possible to find them, this would cost, even with the minimal estimate of 60,000 proved addicts made by the Federal Narcotics Bureau, about $1,000,000,000 per year. We would lose, as well, the value of any productive work the prisoners might do. Such a procedure is, of course, an admission of defeat.

(3) Recognize the addict for what he is—a mentally sick person—and attempt to rehabilitate him, without drugs if it is humanly possible to do so and with them if nothing else can be done.

The third plan is a direct rather than a circumambient attack. It could best be implemented by multi-disciplined clinics staffed by nurses, pharmacists, psychiatrists, vocational guidance experts, religious counselors, sociologists, psychologists and physicians. In areas of small addict density, single physicians could be instructed to carry out these duties.

The first step would be to advise hospitalization of the addict to repair physical defects, effect withdrawal of drugs and attempt rehabilitation. Then the clinic would care for these people, acting as their crutch rather than letting the narcotics serve this purpose. Application to use such facilities would have to be voluntary or the system could not hope to succeed. If the addict wished to try treatment in the clinics, it should be attempted. None should be turned away. We must learn to look upon relapse as our own failure and not that of the addict. By such techniques we may bring the addict out of the limbo and back among us. Let us try to understand him and his problems. Now we are trying to force him to understand ours.

What could we hope to accomplish by such a step? First, we could really discover the magnitude of the problem. Then, we could prevent the criminal activities of these sick people, stop the initiation of new addicts into the habit, empty our jails and prevent unnecessary deaths from contaminated material.

With proper safeguards, such as registration and fingerprinting to prevent a patient’s admission to more than one clinic, administration of drugs only at the clinic (if they are necessary) and the substitution of our new highly successful tranquilizing drugs when possible, it seems highly probable that abuses could be prevented.

Should this program fail to cure a single addict, we should be no worse off than we are now. On the other hand, natural attrition would bring our addict population down as its members reached the end of their days, since no new individuals would be coerced into the habit.

But this is contrary to our past experience. Medicine, when the full might of its enormous research facilities is brought to bear, has solved many enigmas. God willing, this problem, too, may yield.

Are these suggestions visionary? One need only investigate countries that have adopted a medical and humane approach. The United Kingdom has 279 known drug addicts and probably very few unknown ones. There is no crime and no proselytizing there. Physicians treat addicts and write prescriptions which are filled by pharmacists. The term "criminal addict" is unknown in Britain.

Recently our Commissioner of Narcotics tried to make the British ban the importation and manufacture of heroin, since they are signatories of one of the United Nations pacts outlawing the drug. When I appeared in London to testify against this step, Parliament was quick to see that just such a step by our Government produced the enormous problem the United States has now. The ban on heroin was consequently rejected.…

In 1951, when the Boggs Act was passed, we were promised that the stiffer sentences it provided for would control the narcotic problem. But now, only five years later, we are urged by Congress that application of the death penalty will help to remedy the situation—this at a time when other civilized nations, as well as some of our own states, have abolished capital punishment on grounds that it has always been ineffective as a deterrent.

An important fact that the new bill fails to note is that peddler and addict are usually one and the same. Have we come to the point where we are going to snuff out the lives of sick people because they are sick or because we are incapable of curing them?

We at one time treated the leprous, the tubercular, the cancerous and the mentally diseased in this same fashion. One of the prides of our civilization is our recognition that these people deserve our compassion rather than our condemnation. Can we do less for our drug addicts?

¹ From Herbert Berger, "To Dispel the Nightmare of Narcotics," , July 8, 1956, pp. 12, 13, 20. By permission.