The Narcotics Problem
Who Live in Shadow.
By John M. Murtagh and Sarah Harris.
McGraw-Hill. 207 pp. $4.50.
Who line in shadow is a constructive and challenging appraisal of the problem of narcotics addiction. Judge Murtagh is Chief Magistrate of the City of New York, and Mrs. Harris is a sociologist. Together, they have anatomized the illicit traffic in narcotics, identified its villains and its victims, scored the deficiencies in current public policy, and offered a controversial proposal for reform.
The authors concede that existing but hitherto unsuccessful efforts at international control, national customs control. and Federal and local criminal prosecution must continue, and they urge redoubled educational activity. Their controversial proposal is that outpatient clinics attached to Federal narcotics hospitals should be established to treat addicts who have been discharged; this would involve the administration, and even the dispensing, of narcotics outside an institutional setting. The proposal is not new; in 1919, outpatient narcotics clinics were operating in fifteen states. By 1924, all had been closed by order of the Federal Bureau of Narcotics, without—the authors contend—a fair trail. Although the proposal to revive these clinics has not lacked support among distinguished physicians and judges, Congress has remained unmoved. Relying on the advice of the Commissioner of Narcotics, and appalled by the prospect of appearing to feed a vice by condoning its appeasement, it has met the rising social cost of the narcotics traffic primarily by stiffening penalties. In 1956, Congress prescribed a forty-year sentence for third offenders on narcotics charges, and the death penalty—that barbaric reflex to social frustration—for a first offense in selling narcotics to a person under eighteen.
The authors defend supervised, legalized, outpatient treatment, including the administration of narcotics where medically indicated, by the argument that addiction does not, in itself, present a great social problem. Like alcoholism, drug addiction supplies relief from a variety of psychic pressures. It is bad for the addict, but does not, at least in the case of heroin and morphine, which are depressants, stimulate to crime. What creates the social problem is that once “hooked” (i.e. once the body of the addict has been affected to the point where the withdrawal of the drug subjects him to physical agony), he seeks further supplies at any cost and increasing tolerance requires even greater doses. At this point, prohibition plays its part; bootleg drugs are expensive. Fear of the excruciating withdrawal symptoms drives the addict to begging, prostitution, and larceny for the money to obtain his dose; many can solve their personal supply problem only by themselves becoming pushers and peddlers. If relief can be achieved lawfully, at cost, the principal market for illicit, exorbitantly priced, and often heavily adulterated drugs will cease to exist.
Although there are instances of protracted drug-taking which does not lead to addiction, and cases of unrecognized addicts who, having easy access to their drug, lead outwardly normal lives, the prospect of the typical drug user is a bleak one. True, he can be committed to, or voluntarily enter, one of the very few narcotics hospitals. Here he will be scientifically weaned from the drug, his system cleansed of its effects, and he will be given psychiatric and vocational counseling. But all this ends with his discharge; there is no follow-up. The pressures which resulted in the original addiction reassert themselves, and readdiction is the rule rather than the exception.
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A difficulty of existing criminal laws is that they make no distinction between big operators, who are rarely apprehended, and the pitiful pushers and peddlers, often themselves addicts, who are frequently caught. Narcotics traffic in the United States is big business, and police controls have been ineffective. As Alden Stevens, writing in Harper’s for November 1952, put it: “Just as long as two pounds of heroin can be bought for $10 and when cut can be sold for $80,000, it will be cut and sold. Half a million enforcement agents . . . could not prevent this so long as addicts must have it no matter what crimes must be commited to get the price.”
That the addict must resort to this vicious racket the authors attribute to a distortion of Federal law. The Harrison Act of 1914, which imposes rigid controls on the sale, distribution, and possession of narcotics, is essentially a revenue law. It was not intended to interfere with the practice of medicine. Indeed, it specifically exempts the dispensing or administration of narcotics by registered physicians for legitimate medical purposes. After the flagrant abuse of this privilege by a Dr. Webb, the Supreme Court sharply condemned the issue of prescriptions to addicts for their comfort, rather than in the course of treatment or attempted cure. Later this decision was limited in Under v. United States (268 U.S. 5, 1925), where the Court said:
It [the Harrison Act] says nothing of addicts and does not undertake the prescribed methods for their medical treatment. They are diseased and proper subjects for medical treatment, and we cannot possibly conclude that a physician acted improperly or unwisely or for other than medical purpose solely because he has dispensed to one of them, in the ordinary course and in good faith, four small tablets of morphine or cocaine for relief of conditions incident to addiction.
Meanwhile, however, the Treasury Department had adopted its present policy against all forms of ambulatory treatment of addicts, and the medical profession as a whole has been extremely reluctant to deal with addicts at all. “At present,” the authors state, “dope addiction and the pathological conditions underlying it constitute the only maladies for which a patient may not receive treatment from his physician in accordance with the doctor’s own best judgment.” The clinic plan would deliver the addict from this trap.
What are the objections to such a plan? The Commissioner of Narcotics believes in incarcerating addicts “because of the manner in which addicts spread the habit to their close associates” (FBI Law Enforcement Bulletin, January). To this, the authors reply that existing and potential hospital facilities are inadequate to deal with all addicts and make no provision, except recommittal, for discharged addicts who revert. Others object that it is immoral to permit the dispensing of drugs at all, that addicts will refuse to register and cannot be controlled in an outpatient setting, that they will cheat, and that, released from the risks of imprisonment and deprivation, they will easily revert.
Many of these objections cannot be answered without a trial. The authors do not say what effect the legalizing of outpatient treatment will have on experimentation for “kicks”; nor do they explain why the availability of relief from withdrawal symptoms will strengthen rather than undermine the resistance of discharged addicts. On balance, though, the plan seems worth another trial. Existing measures are not working well, while medicine and psychiatry have advanced in the forty years since the clinics were closed. It should be possible, at first on a limited experimental basis, to provide adequate supervision of the clinics and to guard against cheating and abuse of privilege. Such clinics can also serve as research centers, contributing data that will yield an answer to the hitherto unanswered question of whether addicts can be permanently cured.
Because the issues raised by this book demand further public discussion, this reviewer has introduced in the House of Representatives a bill to authorize the establishment by the Surgeon General of the United States of a post-hospital treatment program for drug addiction. Under this bill, clinics would provide guidance, and give medical and psychiatric help to persons released from narcotics hospitals after treatment for addiction. They would assist local authorities in working toward rehabilitation. Addicts are not fiends, but sick people in need of treatment. Every effort known to science should be brought to bear on their full restoration as useful members of society.
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