THE HISTORY OF LEGISLATIVE CONTROL OVER OPIUM, COCAINE, AND THEIR DERIVATIVES
David F. Musto, MD
Legislative control over dangerous drugs may be dated from attempts in the nineteenth
century to prevent acute poisoning by certain substances that might be purchased in
ignorance of their lethal potential or might be too easily available to would-be suicides.
Opium was being sold in a crude form containing about 10 percent morphine, as well as in
concoctions derived from crude opium: paregoric, laudanum, and a solution in acetic acid
known as "black drop." Morphine had been isolated from opium in 1805 by the
German pharmacist, F. W. Serturner, but production of the powerful active ingredient of
opium on a large scale was delayed until the 1830s.1 From that time onward, in factories
in Germany, Great Britain, and the United States, morphine was produced in great
quantities. Thus when in 1868, Great Britain came to enact pharmacy laws to control
dangerous substances, "opium and all preparations of opium or of poppies" was
listed alongside such substances as oxalic acid as commodities that could not be sold
without being labeled "poison."'
The Pharmacy Act of 1868 is an important symbol of legislative control in a Western
country. The act was not the most strict among nations; perhaps the Prussian regulations
were stricter and more comprehensive, but establishment by the British of some limitation
on the availability of dangerous drugs-drugs that would eventually become more serious a
problem for society as addictive agents than as tools for suicide-was a policy also
followed by other European nations. It had an apparently discouraging effect on the per
capita consumption of opium, opiates, and cocaine in the late nineteenth century and
contributed to the low level of British consumption (at least compared to the American)
right up to the 1960s.3
The experience of the United States stands in contrast to Britain's. The Pharmacy Act
of 1868 was regulated in large part by the organized association of pharmacists, the
Pharmaceutical Society (established 1841). In order to retail, dispense, or compound
"poisons," or to assume the title of chemist, druggist, pharmacist, or
dispensing druggist or chemist, the individual had to be registered by the Pharmaceutical
Society. As well as being the testing and registering body, the Society was also given the
initial responsibility for adding new drugs to the poison list. Thus the law, which
ultimately would be enforced in British courts, was monitored by local members of the
Pharmaceutical Society as a tool in competition with unregistered druggists, grocers, and
anyone else who might attempt to purvey these drugs to the public.
While the act presumably aided the public health by having dangerous drugs sold or
dispensed by individuals knowledgeable about their qualities, it was also a convenient aid
to the trade of registered pharmacists. Although the drugs could be obtained with no
specific restraint on the amount or frequency of sale, the bottles had to be labeled
"poison." A stricter category of substances also required that the purchaser be
an acquaintance of the pharmacist or someone the pharmacist knew. This list included
arsenic and "strychnine and all poisonous alkaloids and their salts." The impact
of this modest obstacle to the acquirement of dangerous drugs should not be
underestimated. Further, the self-interest that would motivate registered pharmacists to
monitor breaches of the law provided an unpaid, but interested, drug enforcement cadre
scattered throughout Great Britain. "Patent medicines" were excepted from these
controls, and this led to a campaign against them later in the century, but the pure forms
of the drugs, e.g., morphine suitable for injection, were restricted in availability from
the time of the Pharmacy Act onward.' In the United States, throughout the nineteenth
century, both medicine and pharmacy remained essentially unorganized, although there were
some physicians and pharmacists attempting to organize their professions. The American
Medical Association, which was founded in 1847 and which we now might think of as the
dominant medical organization, was a small and nationally unrepresentative group until
about World War 1.5 The American Pharmaceutical Association, founded four years later,
grew slowly and, like the AMA, lacked the authority to license practitioners. The pharmacy
establishment was divided sharply among drug manufacturers, wholesalers, and retailers,
whose divergent interests the APhA tried to coordinate, but each segment of the profession
came to work through its own organization: the National Wholesale Druggists' Association
(1882), the National Association of Retail Druggists (1898), and many other groups.6 There
was no national group for the health professions to which government could turn for
regulation, even if the American constitutional system had permitted such an arrangement.
Licensing of pharmacists and physicians, which was the central government's
responsibility in European nations, was, in the United States, a power reserved to each
individual state. In the era of Andrew Jackson, any form of licensing that appeared to
give a monopoly to the educated was attacked as a contradiction of American democratic
ideals. State after state repealed the medical licensing laws adopted in earlier days.
Practical concerns also supported repeal: Legislators preferred to leave it to the
patients to decide which of the many competing theories of medicine was the best. Instead
of moving toward a national system of licensing for health professionals, therefore,
individual states were deregulating the professions. American medical schools were
similarly unregulated, and many flourished-some no better than diploma mills. The states
did not begin reestablishment of medical licensing until the 1880s, and even then the
movement was spotty, with a wide range of standards.' Pharmacists, also seeking to raise
standards and limit competition, likewise fought at the state level for licensing, since
the U.S. Constitution placed in the hands of states the regulation of the health
professions. Although some requirements for labeling of over-the counter medicines would
come with the Pure Food and Drug Act of 1906 as an exercise of the federal right to
regulate interstate commerce, in general, the nineteenth and early twentieth century
interpretation of the Constitution favored a strict division between state and federal
The status of legislative control of dangerous drugs during the nineteenth century may
be summed up as follows: The United States had no practical control over the health
professions, no representative national health organizations to aid the government in
drafting regulations, and no controls on the labeling, composition, or advertising of
compounds that might contain opiates or cocaine. The United States not only proclaimed a
free marketplace, it practiced this philosophy with regard to narcotics in a manner
unrestrained at every level of preparation and consumption.
Through a slower pace of professional development, the United States also lagged behind
Britain and other European countries in establishing broadly based organizations
representing the nation's physicians or pharmacists to which the central government could
turn for regulation. Second, the form of government adopted in the United States, a
federation of partly independent states, was a conscious attempt to prevent establishment
of an all-powerful central government characteristic of Europe. In the nineteenth century,
this remarkably successful form of government entailed each state making its own
regulation if it wished to; the result was an array of controls that varied from one state
to another. In fact, states made little attempt to control addictive drugs until quite
late in the last century, and those efforts did not prove very effective.
During the first part of the nineteenth century, the amount of opiates used in the
United States may have been comparable to that used in Britain, where some areas, notably
the fen counties, had a fairly large per capita consumption. Inhabitants there often took
a dose of laudanum or some form of opium daily to keep away the fevers associated with the
marshlands.8 More generally, parents reputedly purchased one or another form of opium to
rub on the gums of teething infants or to spoon-feed a child to induce sleep so that the
mother without provision for child care could work in the local factory. These accounts
are anecdotal, but recent historical studies do suggest that the taking of some form of
opium for pain, sleep, or to ward off illness was not uncommon. The occasional death of an
infant from an overdose of opium or the suicide of an adult by means of opium prompted
parliamentary interest in the distribution and labeling of the drug. In large measure, the
1868 Pharmacy Act was the result. One should note however, that through the provisions of
the act and the designation of the Pharmaceutical Society as the most responsible body,
the pharmacists also achieved some control over the profession and a lead on the other
health professions. A somewhat similar victory for U.S. pharmacy would be found in the
details of the Harrison Narcotic Act in 1914.9
In nineteenth-century America, the unimpeded importation of opium and the free economy
in opiates do give an advantage to the historian, for estimates of per capita consumption
are more reliable when there are few restrictions on the importation, sale, and
consumption of a product. Because the growth of poppies within the country and preparation
of opium from them seem to have been a minor contributor to American use, the import
statistics, begun in 1840 and continued to the present day, are reliable as a guide to
domestic consumption until the Harrison Act of 1914. Certainly the minimum level and the
trend can be observed. After the Harrison Act, these statistics grew less reliable, for
smuggling becomes a more uncertain variable, but we can say that at least during the
nineteenth century the annual per capita consumption rose steadily from about 12 grains in
1840 (an average single dose being one grain) until the mid-1890s, when it reached 52
grains annually per capita. Then statistics show that average individual consumption
gradually subsided up to 1914, by which time the per capita rate had fallen back to the
level of about 1880." In Great Britain, the per capita consumption declined during
the latter half of the nineteenth century." During that same period, opium use in the
United States rose dramatically. The peak of opiate addiction in the United States
occurred about the turn of the century, when the number probably was close to 250,000 in a
population of 76 million, a rate so far never equaled or exceeded. 12 Heroin had been
introduced into the pharmacy in 1898 and had contrasting impacts in Britain and the United
States. In New York City, the addiction capital of the United States, heroin became the
drug of choice for recreational addicts, and the number of addicts was measured in the
tens of thousands by 1920. In Britain, the addiction rate for heroin addicts by 1920 was
minuscule. 13 Of course, the use of drugs is determined by many factors, but I would like
to suggest that the contrast in easy availability of narcotics in America and
Britain-created by political and social factors removed from considerations of
addiction-underlay the strikingly different rates of addiction each country experienced
well into this century. The rise in addiction with which we are more familiar, that of the
1950s and more recently, appears to be associated with additional factors that will be
Americans have something to learn from their earlier and extensive consumption of
opiates, including heroin, and also massive consumption of cocaine, which occurred before
World War I. This era is forgotten. We commonly act as if the heroin "epidemic"
of the 1960s or the current cocaine "epidemic" is a new phenomenon in the United
States, that the widespread use of a drug implies that legalization or
"decriminalization" is the only reasonable response. The history of attempts at
legislative control in the United States suggests that other courses may be effective and
that these alternatives to legalization appear to have reduced enormous opiate and cocaine
consumption in the United States earlier in this century. Therefore, it is worthwhile to
consider these early efforts at narcotic limitation if we are to approach contemporary
policy issues with an appreciation of the range of policy options that reduce or encourage
ingestion of these substances. For in spite of the great difference in addiction rates
between the United States and Great Britain in 1920, the United States did reduce its
addiction rate to a relatively small number. On the other hand, the low heroin addiction
rate in Great Britain prior to the 1950s did not prove a protection against drug problems
in that nation, although the level of use in Britain has not reached the proportions to
which we are accustomed in the United States. Clearly the social and legal factors
affecting drug use are complex, and there is no single influence that determines a
particular level of drug use and abuse.
AMERICAN LEGISLATIVE CONTROL OVER OPIUM AND OPIATES TO 1914
The role of opium and its derivatives in the United States can be traced independently
from cocaine until 1914, when these substances were linked together as
"narcotics" through the Harrison Act. Technically, only the opiates are
narcotics, that is, sleep-inducing, and they all have different effects. Nevertheless,
most dangerous drugs, including cannabis, were grouped under the rubric
"narcotics" from at least the 1920s until the 1960s.
As mentioned above, opium was available in many forms derived from crude opium long
before the nineteenth century. In America, the two developments that spurred both
consumption and concern about opium were (1) the isolation of morphine and its injection
into the body with hypodermic syringes and (2) the introduction of smoking opium, which
had been brought to the United States mainly by a feared minority, Chinese laborers
imported to help build western railroads. The much greater ease of addiction through use
of morphine compared to the more dilute forms employed previously focused attention on the
drug, medical practitioners, and modern technology in the form of the hypodermic syringe.
Consumption of opium in the United States rose steadily before and after the Civil War.
There had been complaints before the war about "opium drunkards" by such
prominent and progressive physicians as Oliver Wendell Holmes, but in the second half of
the century, physicians, as well as the general public, widely deplored opium and morphine
addiction. To be addicted to morphine was to harbor a shameful secret to be hidden from
others at whatever cost, a point illustrated in Eugene O'Neill's moving play about his own
family, Long Day's Journey into Night. Written in his later years, it was based on his
mother's addiction by a thoughtless physician, and the pain of this memory had remained so
great that O'Neill would not permit the play's production during his lifetime. The leading
American surgeon and the first professor of surgery at The Johns Hopkins Hospital, William
Stewart Halsted, was a morphine addict for the last several decades of his life. His
secret was kept hidden carefully until the publication of Sir William Osler's private
diary in 1969." Osler had been Halsted's physician while Osler was on the Hopkins
faculty. Halsted's addiction did not appear to interfere with his work.
Americans received opium and morphine not only from their physicians for pain; they
could receive what they wanted, for whatever reason they chose, over the counter or from
mail order catalogues. The American free enterprise system, coupled with the federal
system of government, meant that a bottle heavily laced with morphine could be sold across
state lines as an "addiction cure" and affirmed on the label to contain no
morphine whatsoever, quite within the law. States could pass laws restricting such
advertising, but they were not inclined to do so. Patent medicine companies were the
leading advertisers in American newspapers. They developed an ingenious protection from
prying investigations or public pressure to reveal secret formulas, or from any state
requirement to make only valid claims for effectiveness: The proprietary manufacturers
included in their lucrative contracts with newspapers a proviso that the advertising
agreement would be void if the state in which the newspaper was published enacted any laws
affecting the sale or manufacture of the nostrums. 11
In the nation's capital, the manufacturers also fought off requirements that their
nostrums be labeled as to contents. Bills to enact such a law under the interstate
commerce clause of the Constitution were defeated repeatedly, but in the 1890s a new
reforming spirit was evident in the nation. These reforms were extensive, ranging from
control over the use of forest land, to government inspection of meat and other
comestibles and laws relating to adulterants in foods, and to drugs considered unsafe.
Attention to the danger of narcotics using the term broadly-accompanied the peak of per
capita consumption in the United States. It is clear that what were regarded as the most
negative aspects of drug use led to the passage of the new legislation. The simplest
reform, correct labeling, was part of the Pure Food and Drug Act of 1906. Any
over-the-counter medicine - commonly these would be "patent medicines"-had to be
labeled correctly as to inclusion of any of the following drugs: morphine, cocaine,
cannabis, or chloral hydrate. A long-desired reform, it simply informed the purchaser
whether any of these drugs were present; it did not prevent purchase or restrict the
amount of the drug. 16 Nevertheless, reports at the time indicate that the amount of these
substances dropped from a third to a half as a response to public concern.17 Although the
newspapers remained quiet, widely read magazines such as Collier's and Ladies Home Journal
railed against patent medicines, especially against morphine and cocaine. Even after
passage of the truth-in-labeling laws, the magazines continued their exposes unabated
until the next major step, which was restriction on the availability of the drugs
Tracing the movement to restriction, as opposed to labeling accuracy, requires a step
back to the mid-nineteenth century. Patent medicines are thought to have created some
addiction, but the number of addicts is difficult to estimate. That physicians addicted or
assisted in the addiction of patients is more certain. The problem of iatroaddiction
initially was approached by limiting renewal of prescriptions for opiates. These legal
controls were mostly in the form of additions to the health statutes and depended for
their efficacy on the judgments of physicians and pharmacists. These controls would not,
of course, affect interstate commerce in narcotics or the familiar patent medicines, which
still could be bought over the counter. No consistent police efforts to enforce these laws
appear to have been undertaken.18
As the public and leaders of the health professions became more aware of the growing
number of those addicted to opiates, chiefly morphine, state laws were amended to be more
stringent, and the police occasionally staged crackdowns. As will be recalled, however,
the professions were pretty much unorganized and struggling to achieve mandatory
licensing; a threat to take away a license could not hold much fear until a license was
required to begin with. Legislators also felt, or at least claimed, a helplessness when
neighboring states did not enact strict laws-a circumstance more familiar to us with
variations in- the legal drinking age between states-with the result that enforcement was
weak. This circumstance, combined with a poorly trained medical profession, a lack of
professional organization, and an absence of laws controlling either patent medicine or
interstate commerce in drugs, left local controls more symbolic than effective.
The nineteenth century's last decade brought the rise of what would come to be called
the Progressive Movement, a set of reforms usually taking the form of federal laws
affecting the entire nation with the ostensible purpose of improving the nation's morals
or resisting the selfish actions of the rich and powerful. Alongside it grew a temperance,
soon a prohibition, movement that would eventuate in the Eighteenth Amendment mandating
prohibition of alcohol distribution for nonmedical purposes in the United States. In many
ways, of course, the antialcohol movement was part of the Progressive Era; its startling
success and later dramatic repeal have given the alcohol issue a somewhat separate
development in our minds, but the interrelation between the battles against alcohol and
against narcotics is an important one. The antialcohol crusade helped establish the
attitude that there could be no compromise with the forces of evil, that
"moderation" was a false concept when applied to alcohol: Prohibition was the
only logical or moral policy when dealing with this great national problem. By the
nineteenth century a new wave of state prohibition laws was enacted. These were tempered
by the contemporary constitutional understanding that a state prohibition law did not
prevent purchase of liquor from a "wet" state, for that would be a form of
interstate commerce and not subject to the states' powers. This assumption helped placate
some doubters about prohibition, but the staunch fighters against alcohol also sought to
remove that loophole. This they did through the Webb-Kenyon Act of 1913. Without going
into the details of the broad and involved movement that led to national prohibition, we
should note that the significance for the control of narcotics is that another dangerous
substance, over which there was even more dispute as to the means of control, progressed
inexorably toward a policy of "no maintenance" and no compromise. The moral
question of how to deal with a dangerous substance was being fought out over alcohol, but
the case would be stronger even with narcotics when that issue was brought to national
The means by which the narcotics issue arose at the federal level was accidental.
Certainly it would have come to the attention of Congress and the president eventually as
a corollary to the alcohol prohibition movement or as a way of controlling addiction,
which was becoming a target of journalist reformers and physicians. It was acquisition of
the Philippines through the Spanish-American War that occasioned action by the federal
Again, in order to understand how the Philippines forced the central government to take
action on opium, it is necessary to appreciate the divisions between federal and state
powers that were so marked until the last half-century. The Philippines, unlike a state,
came directly and wholly under the control of the federal government. At last, Congress
could not avoid making decisions on such matters as the local availability of opium. Opium
had been provided to Chinese on the Philippine Islands through a Spanish government
monopoly. Civil Governor William Howard Taft considered whether the monopoly should be
reinstituted. It was his judgment that this would be reasonable and that the profits from
the opium monopoly could be used to help educate Filipinos, a task the United States
eagerly accepted as it sought to provide a model government for its first colony. 20
It was at the point in 1903, when this reinstitution was passing through the Philippine
government under the eye of Civil Governor Taft, that the moral question of compromising
with "evil" affected the future of opium's legal availability in that land.
Missionaries in Manila and in the United States had learned that "tainted money"
from opium sales was to be employed for education, and they besought President Theodore
Roosevelt to prevent this moral wrong. He ordered Taft to stop the bill, and that was the
end of it. The mood of moral leaders in the United States was sufficient during the first
few years of this century to prevent any such "maintenance" program, even if it
was restricted, as promised, to the Chinese in the Philippines. This immediate reaction to
allowing opium to be used for purely "recreational" purposes, coming even before
the Food and Drug Act, gave a signal as to how the federal government would respond to
later questions regarding the legal supply of opium to individuals, not for medical
reasons but for enjoyment or to satisfy their addiction.
In response to the veto from Washington, Governor Taft appointed an Opium Investigation
Committee to consider how other Asian territories handled the opium problem. This
committee introduces us to Bishop Charles Henry Brent, the Protestant Episcopal bishop of
the Philippines, who had come out with Taft to help in Americanization of this new
possession. Bishop Brent later would become world famous for his pioneer efforts to launch
the ecumenical movement among Christian churches, but his second claim to fame was as a
world leader against nonmedicinal uses of narcotics. He was appointed to the committee,
which traveled to Japan, Formosa, Shanghai, Saigon, and Singapore examining how other
nations dealt with the opium user. He and the other members of the committee found the
Japanese policy in Formosa, a Japanese possession since its seizure from China in 1895, to
be the most effective and enlightened. Japan opposed smoking opium but did not try to stop
confirmed addicts abruptly from indulging in their habit. Japan, hoped to "mature
out" the opium smokers and leave an opium-free colony. In Japan, itself, opium use
was controlled stringently by the government, rare even among Chinese aliens, and strongly
deprecated by Japanese society.
The Philippine Opium Investigation Committee recommended that (1) male opium smokers
over 21 should be registered in order to receive opium from a reinstituted government
monopoly and (2) after a three-year period, the amount provided the smokers be reduced
gradually until the smokers had been completely weaned from the drug. 1 But Congress
reacted more sternly. Congress decreed immediate opium prohibition, except for medicinal
purposes, for all native Filipinos; non-Filipinos-mostly Chinese-were allowed a three-year
period of use. Over 12,000 non-Filipino opium users were registered, and their usual
dosage was maintained for two-and-onehalf years. During the final six months of the
three-year leniency period ending March 1908, the opium provided was gradually reduced to
zero. For official purposes, opium smoking had stopped in the Philippine Islands. One
additional point: The opium dispensing stations established under these laws were the
first American narcotic clinics, although their goal was not long-term maintenance but
rather registration and detoxification.
The Philippine situation forced the federal government to take a stand on opium use for
nonmedicinal purposes, and the decision was to prohibit. To Congress, once the question
was posed, compromise with narcotics was not a politically practical alternative. The
Philippines also gave the United States leadership of the international control of
narcotics, a role it still holds. It was apparent to the Opium Investigating Committee
that the solution to the Philippine opium problem lay in the control of international
trafficking in opium, as well as in the curtailment of opium production in the original
producing states, such as India, China, Burma, Persia, and Turkey, to name some of the
most prominent sites for the cultivation of the opium poppy.
At the time that the Philippines were perceived to be a victim of external sources of
opium, the United States was having increasing problems with the Chinese Empire. Owing to
maltreatment of Chinese in the United States, merchants in China planned a voluntary
embargo on American goods. This worried American industrialists, wholesalers, exporters,
and the federal government. China had also embarked on a vigorous effort to rid itself of
opium use and, employing draconian methods, was having some success. As a means to
indicate good will to China, to aid the Philippine opium problem, and to take an
international leadership position on a moral issue of the times, the United States
proposed, following Bishop Brent's suggestion to President Roosevelt, to convene an
international meeting at Shanghai to consider the opium traffic among nations and to
suggest ways in which China's antiopium campaign might be aided.
Thus, the Shanghai Opium Commission came into being. It would meet during February
1909, with Bishop Brent as its elected president. The group was designated a
"commission" because the United States was unable to gain approval for a more
powerful convocation, a "conference," which under international law could draft
a treaty that would, if ratified, bind the signatory states. A "commission," on
the other hand, could make findings of only fact or opinion. In addition to the United
States and China, those who accepted invitations to Shanghai were Great Britain, France,
the Netherlands, Persia, Japan, Italy, Austria-Hungary, Germany, Portugal, Siam, and
Russia. Turkey accepted but did not send a representative. Persia was represented by a
The resolutions adopted by the commission were merely recommendations and, even as
such, had a comfortable vagueness that allowed a latitude of interpretations. For example,
Resolution Three, taking cognizance of the near unanimous agreement that opium for
nonmedicinal uses should be prohibited or "carefully regulated," called upon
nations to "reexamine" their laws. This could hardly be considered a clarion
call for prohibition of nonmedical uses, but it was Brent's goal to achieve a series of
resolutions that at least pointed in the direction of action to control traffic in
narcotics, with the hope that a future conference would enact a treaty initiating such
The road from the Shanghai Opium Commission to the Hague Opium Conference, which
convened in December 1911 and resulted in the Opium Convention of 1912, was a tortuous
one, but after the Shanghai meeting, the United States continued to press for a second and
more significant gathering. Eventually, the nations gathered in The Hague, and once again
Bishop Brent was elected the presiding officer.
The Hague Opium Convention (which concerned cocaine as well as opium) placed the burden
of narcotic control on the domestic legislation of each nation. Chapter Three of the
convention called for control of each phase of the preparation and distribution of
medicinal opium, morphine, heroin, cocaine, and any new derivative that could be shown to
have similar properties .24
The convention was not put into force by the dozen nations who attended the First Opium
Conference, for it was agreed that the requirements would be held in abeyance until all
forty-six world powers had signed and ratified the convention. Eventually three
conferences were held, the second in 1913 and the third in 1914, only weeks before the
outbreak of World War 1. A compromise was reached regarding the implementation of the
treaty: Any ratifying nation was permitted to put the treaty into effect in 1915, even if
ratification had not been unanimous. But only seven nations did this by the end of the
World War and the beginning of the Versailles treaty negotiations in 1919. The United
States supported incorporating the Hague Convention into the Versailles treaty, so that
ratification of the treaty ending World War I would at the same time bring the nation
under the requirements of the Hague Convention, which required national and domestic
legislation to control the preparation and distribution of opiates and cocaine. Of course,
the United States never did ratify the Versailles treaty, but it had already ratified the
Hague Convention in 1913 and had put it into effect in 1915. One significant result of the
inclusion of the Hague Convention in the Versailles treaty was the passage in Britain of
the Dangerous Drugs Act of 1920, an action taken not because of any serious problem with
addiction but because, by ratifying the Versailles treaty, Britain had committed itself to
comprehensive domestic legislation. 25
DOMESTIC NARCOTIC LEGISLATION IN THE UNITED STATES
During the year or so prior to the Shanghai Opium Commission, the United States
suggested topics to be discussed in 1909, and one of the topics was a report on domestic
antinarcotic legislation. Americans understood that strong and enforced domestic
legislation in other nations would result in diminishing the flow of drugs into the United
States, but would other nations understand why the United States had no national
antinarcotic legislation whatsoever? Americans knew that federal-state separation of
powers made a national antinarcotic law rather difficult, but the State Department decided
that something should be on the books when the U.S. delegation arrived in Shanghai.
The simplest law that could be framed and stand a chance of passage by the U.S.
Congress before the commission opened was one that excluded from the United States opium
not intended for legitimate medical uses or, in other words, opium prepared for smoking.
Here there was an ironic combination of political factors. The United States hoped one of
the major effects of the Shanghai Commission would be to placate China with regard to the
poor treatment given Chinese nationals in the United States. Such treatment was in
violation of our treaty obligations with China. The impetus for banning smoking opium from
the United States, however, had developed from the fear and loathing of the Chinese, who
were associated intimately with this particular manner of ingesting opium. Thus, the
negative American attitude toward Chinese aliens gave the push that passed a "face
saving" law designed to show China the good will of the United States.
After the law was enacted on February 9, 1909, it was announced dramatically in
Shanghai to the other nations as proof of American sincerity.26 And yet no one in the
American delegation or within the State Department had any illusions that this law would
control domestic narcotic use. Additional legislation was seen as imperative both to
curtail the American narcotics problem and to display an American example to other nations
where the implementation of narcotics control programs was essential to the solution of
the American domestic problem.
Dr. Hamilton Wright, a physician with political interests who had been appointed opium
commissioner by the State Department in 1908, oversaw the State Department's preparation
for the Shanghai meeting, which included culling information from police departments,
physicians, pharmaceutical houses, etc., regarding the narcotic problem and consumption in
the United States. Bishop Brent was the chairman of the delegation, but after his
elevation to the commission's presidency, Wright became the acting head. Back in
Washington after the commission meeting, Wright took up the battle for an international
meeting that could frame a treaty and played a leading role in the preparation of domestic
antinarcotic legislation. He had opposition within the State Department on both questions,
but he finally won the assent of Philander C. Knox, the secretary of state, and moved
Wright, who combined an aggressive personal style with self-righteousness and a thirst
for political preferment, was less effective than he otherwise might have been. He never
got the prize plum for which he yearned, the ministry to China, and his chief claim for
notability, the Anti-Narcotic Act of 1914, known even then as the "Harrison"
Act, left him at the moment of achievement with almost no further role in the antinarcotic
movement. Eventually, he volunteered to help the wounded on the western front during World
War 1, was injured 27 there in an automobile accident, and died in 1917 in Washington. His
indomitable wife, Elizabeth Washburn Wright, carried on his 28 battle for world control of
narcotics until her death in 1952.
In late 1909 Dr. Wright proposed a domestic law that would be based on the federal
government's power of taxation. The alternative federal power was that over interstate
commerce, but Wright believed that taxation would result in a detailed accounting of
narcotics from their introduction into the United States to their distribution to
manufacturers, wholesalers, and retailers, including pharmacists and physicians. Heavy
fines would be levied on anyone not keeping records accurately or selling and transferring
these products without proper reporting and payment of taxes.
Wright tried to solve the federal/state dichotomy in this manner: The information
obtained by this proposed law would be made available to state boards of pharmacy and
medicine, which would then take appropriate action to ensure that "the proper
relations . . . should exist between the physician, the dispensing druggist, [and] those
who have some real need of the drugs.' "29 So it is evident that at this early stage,
two years before the Hague Convention, Wright and the State Department did not envision a
federal role in policing the relationships between, say, an addict and his or her
supplying pharmacist or physician. The sanctity of the state's police powers would be
maintained; the federal government would supply only information. Reformers believed that
the information, however, could lead a responsible state agency to take only one action,
that is, to curb the supply of narcotics to those who did not have a medical need for
it-and "mere" addicts did not fall into that category.
The Foster Anti-Narcotic Bill (1910-1911)
Republican Congressman David Foster of Vermont introduced Wright's bill in April 1910.
In addition to opium and cocaine, as in the eventual Harrison Act, the bill was aimed at
cannabis (marijuana) and chloral hydrate, the same substances the Food and Drug Act of
1906 required to be revealed on labels. It did not allow small amounts of the drugs in
mild remedies such as cough syrup to be exempt from the stringent reporting requirements
and their severe penalties. Druggists feared the multitude of stamps and labels at each
stage; the fines, which would range from $500 to $5,000; and the one-to-five-year jail
sentences. The word "knowingly" did not qualify the prohibited actions, making
it likely that simple errors without any intention to deceive would result in horrendous
punishments. Although support for the bill could be found, the individuals in the drug
trade would not endorse the detailed and hazardous provisions of the Foster Bill. It never
came to a vote in the Sixty-first Congress, which ended in March 1911.30
The next Congress was marked by a significant change: For the first time in almost two
decades, the Democrats gained control of the House of Representatives. The South now had
achieved new importance, in that committee chairmanships changed hands. In the
Sixty-second Congress the Foster Bill became the Harrison Bill, named after Francis Burton
Harrison, a New York City Democrat who served on the Foreign Relations Committee. Dr.
Wright continued his difficult task of trying to obtain the most stringent bill consistent
with winning essential political support from the medical and pharmaceutical interests and
now from the Democratic Party. In order to mitigate the severity of the original Foster
Bill, the drug trades established the National Drug Trade Conference, which would
represent the major trade associations and try to reach a compromise position on the
complex antinarcotic bill. The NDTC, which first met in Washington, D.C., in January 1913,
provided the most powerful influence on the writing of what would become known as the
The attitude of the newly influential southern Democrats toward any potential invasion
of states' rights now had to be taken more seriously. These politicians feared an
interference with the South's local laws, which enforced racial segregation and Negro
disenfranchisement. They remembered the era of "reconstruction," when the North
ruled the South following 1865, and wanted to maintain the authority the white citizenry
had subsequently won with the withdrawal of troops and "carpetbaggers." The
narcotic control proposals threatened to intrude federal authority into the states,
affecting local pharmacists and physicians and threatening to reach right into a
neighborhood and send an individual to federal prison. Furthermore, this example of using
the federal tax power primarily to achieve a moral end-for the taxes were not intended to
bring in a significant revenue but rather to force disclosure and compliance with rules of
narcotics distribution-could be a precedent for other concerns brewing in the United
States, such as protecting Negro voting rights in the South.
Dr. Wright, therefore, faced a new set of attitudes in the Democratic-controlled House.
He reacted by stressing the impact of narcotics, especially cocaine, on Negroes. He
attributed attacks on whites to the crazed Negro cocaine fiend. He also argued that many
poor Negroes would not have the energy or knowledge to send away for the cocaine, so the
conclusion must be that northern businessmen who did not care about the South's concerns
were shipping-via interstate commerce-cocaine to Negroes. Further, unscrupulous or
ignorant employers were said to be supplying cocaine to their Negro workers .32
One further concern about the precedent the antinarcotic law would provide related to
the flourishing prohibition movement. As prohibition was achieved in state after state,
the loophole for at least the upper and middle classes was that alcohol could be ordered
across state lines and shipped into a dry state, for interstate commerce was regulated by
the federal government, which so far was not teetotal. The Webb-Kenyon Act of 1913,
however, was passed to close this loophole, survived President Taft's veto, and, much to
the surprise of many, was declared constitutional by the Supreme Court. This occurrence
removed one of the stumbling blocks to the Harrison Bill, for now a national antinarcotic
law could not serve as a precedent for curtailing interstate commerce in a dangerous
In the course of all this maneuvering, no one rallied to the defense of any of the
drugs named for control except that occasionally cannabis was described by someone as not
habit-forming or not as serious as opium or cocaine. Perhaps because the cannabis problem
was not seen to be serious or because the drug did not seem so dangerous, it was dropped
from the proposed law. Chloral hydrate, a sleeping medicine, was also dropped. The
attitude toward opium and cocaine, however, was almost totally condemnatory. The only
question was how to control their distribution most efficiently, since they had medicinal
value but were also considered dangerously addicting. This was in sharp contrast with
alcohol; its use divided the nation, and huge legitimate industries depended upon its
The government and the trades eventually reached agreement on the proposed law by
moderating the record-keeping provisions, reducing penalties, and allowing the sale of
patent medicines with small amounts of narcotics in them. Representative Harrison
introduced it in June 1913, and it was passed quickly by the House. In the Senate some
amendments were offered, a few with an apparent goal of destroying the bill's chances of
passage. In August of 1914, though, the Senate passed the bill, albeit with a few
modifications that were compromised in Conference Committee. Finally, on December 17,
1914, President Wilson signed it into law, to become effective March 1, 1915. At last the
United States had redeemed its pledge to other nations that it would enact a stringent
law, as it had urged every other nation to do.
The significance of the Harrison Act to strategists like Dr. Wright, though, was more
than just the satisfaction of redeeming pledges made to questioning representatives of
other nations. For him, the Harrison Act was the implementation of the Hague Convention of
1912, which called upon signatories to enact domestic legislation controlling narcotics
supplies and distribution. Understood as the fulfillment of treaty obligations, the
Harrison Act would have the authority to usurp the states' police powers, for the
Constitution in Article Six gives treaties concluded by the United States supremacy over
the laws of states. This would resolve the problem of states' rights interfering with the
ability of a national law to require a uniform compliance with strict narcotics control
Unfortunately, the Supreme Court at first did not give a very strict interpretation to
the Harrison Act. In the first Jin Fuey Moy case (1916), the Court declared by a
six-to-two majority that the Harrison Act could not be understood as having been required
by the Hague Convention and that physicians could prescribe as they saw fit, even to
simple addicts. 34 This decision was a stunning blow to federal enforcement, which, from
the first day of the act's implementation, was directed at pharmacists and physicians who
sold prescriptions or treated addicts without any intent to cure them.
World War 1, arriving at almost the same time as the Harrison Act, profoundly affected
American attitudes, creating an intense desire to purify the nation as it girded itself to
fight for democracy against the barbarism of the Kaiser. The fall of Russia and the spread
of Bolshevism intensified fears of contagion and the desire to be sure that the United
States remained pure and strong. Prohibition took giant strides during World War 1. The
Prohibition Amendment in an early form nearly passed the House in December 1914, a week
after the passage of the Harrison Act. In 1916 it did pass, and by January 1919
Prohibition had become part of the Constitution as the Eighteenth Amendment. Earlier,
Congress had passed wartime prohibition, which was intended to save grain for the war
effort as well as to promote efficiency in war production plants. Similarly, a battle was
being fought to overturn the Jin Fuey Moy decision, which had weakened the government's
intention for the Harrison Act. A Treasury Department committee reported that the number
of addicts in the nation was over a million." These exaggerated figures, as well as a
fear about returning veterans having become addicted on the battlefield and the specter of
alcohol prohibition, which might drive alcoholics to morphine and cocaine, led to a new
attempt to put teeth into the Harrison Act. This time the government was successful.
In March 1919, two months after the ratification of the Eighteenth Amendment (which
would go into effect a year later), the Supreme Court ingeniously decided, five to four,
that to call a prescription for narcotics intended to supply a "mere" addict
with maintenance doses was an error, for such a script could not be considered a true
prescription given in the proper conduct of medical practice. Since it was not a
prescription, the issuing physician had conveyed narcotics without the required tax; he
had therefore violated the Harrison Act and could be arrested. The four dissenting
justices were the conservatives, who argued that this was an invasion of states' police
powers, while the majority, including Holmes and Brandeis, felt that more power had to be
given the government if it was to carry out its duty to protect the public from such an
insidious evil .36 At last, the intent of the reformers had been achieved: Simple
maintenance was outlawed, and the federal government could take action nationwide to
arrest and convict health professionals who practiced it. Narcotics now had a
no-maintenance policy, which a few months later would also be the policy for alcohol.
Enforcement of both prohibitions would be the responsibility of a unit in the Bureau of
Internal Revenue, reflecting the similarity of the two conceptions.
Enforcement During the 1920s
Several additional laws completed the early legislative structure of American control
of opium and cocaine. Some were minor, such as a stipulation that no finished products
such as heroin or morphine could be imported into the United States.37 The law stated that
only coca leaves and crude opium could be imported and that the finished products,
cocaine, morphine, heroin, codeine, etc., were to be manufactured in American
pharmaceutical factories, which were given a monopoly to produce these substances. This
may have made up for revenues lost, as the amounts sold legally in the United States fell
after the Harrison Act. Other laws dealt with transshipment of drugs 38 across the United
States for foreign markets.
Perhaps the most important addition to the Harrison Act's control of opiates and
cocaine came in 1924, when the United States banned the importation of opium to be used
for the manufacture of heroin.39 The observance of federal-state boundaries is evident in
this law, for it does not ban the manufacture of heroin altogether but only the
importation of crude opium for that purpose. Just that much seemed to be within the power
of the federal government. Also, this did not require the seizure of heroin legally
available in the United States for cough medicines (the original claim for heroin's value)
or for certain other purposes, chiefly pain control or "twilight sleep" during
Heroin had been made available commercially by the Bayer Company of Germany in 1898 as
a superior cough suppressant.40 The Bayer Company believed that the addition of acetyl
groups to the basic molecule would make morphine more palatable, and this product,
diacetylmorphine, the company named Heroin, a trademark that was protected until Germany
lost such protections as a result of losing the First World War. Similarly, by adding an
acetyl group to salicylic acid to make it less irritating to the stomach when taken for
joint pains, the Bayer Company launched another successful venture. In 1899 the company
named sodium acetyl salicylic acid Aspirin, which similarly was protected by trademark
until World War 1. Few pharmaceutical firms can take credit for naming and distributing
two drugs that remain among the most popular in Western society even after nearly a
Heroin essentially had been unrestricted in the United States prior to the Harrison
Act, and by 1912 in New York City it had replaced morphine as the drug of recreational
choice among youthful males, according to the records of Bellevue Hospital. The addictive
nature of heroin had been recognized rather quickly, for the AMA issued a warning in 1902.
Heroin was popular because it could be inhaled by sniffing, like cocaine, as well as
injected by needle. When injected into the bloodstream, heroin crossed the blood-brain
barrier more quickly than morphine and therefore gave a more intense, but briefer,
"high." During the years of intense concern over social control, which began
with the First World War, heroin became linked with male gang violence and the commission
of crimes. Some believed that heroin stimulated the user to commit crimes or at least
provided the courage to pull off a bank robbery or mugging. In the early 1920s most of the
crime in New York City was blamed on drug use, chiefly the opiates, including heroin.41
The preference for heroin over morphine by recreational users, and the belief that
other opiates could fulfill heroin's role as a painkiller and cough suppressant, led to a
move to ban heroin for medical purposes. The heroin problem also contributed to American
fear of foreign nations after World War 1, for the drug was being manufactured in other
countries and then smuggled into the United States. The Swiss drug industries, for
example, produced large amounts of heroin, which found its way into this country. Heroin's
image as a foreign product popular with feared domestic groups helped support an
isolationist stance, illustrated by the American refusal to join or even recognize the
League of Nations. Influential congressmen, such as Stephen G. Porter, Republican chairman
of the House Committee on Foreign Relations, urged that all heroin production in the
United States be stopped. As an example he would try to get other nations 42 to follow at
the Geneva Opium Conferences of 1924 and 1925.
The United States did enact the legislation sought by Congressman Porter, but it failed
to achieve its goals at the meetings in Geneva. In fact, in disgust at the refusal of
other nations to agree to curb production of poppies and coca bushes, the ultimate source
of heroin 43 and cocaine, the United States walked out of the conference. The United
States, which had founded the world antinarcotic movement in Shanghai and The Hague, now
saw it taken over by the League of Nations (as the Versailles treaty had mandated) and
controlled by the very nations the United States sought to shame or force into a narcotics
policy that the United States viewed as responsible. American participation in the
worldwide effort then fell to a low point until the 1930s, when participation was resumed
in international meetings. By the outbreak of World War II, the United States was again
achieving significant participation in international antidrug activities.
AMERICAN DOMESTIC CONTROL TO THE MARIJUANA TAX ACT OF 1937
The use of cocaine, which had been in "soft" drinks like Coca-Cola until 1903
and was available easily to sniff as a treatment for sinusitis or hay fever, fell
precipitously after reaching a peak somewhere around 1905. By the 1930s cocaine use had
receded, and during the 1950s physicians and narcotics agents alike described cocaine use
as a problem that once was serious in the United States but now was practically absent.
Several reasons for its reduced use can be suggested. The drug had been introduced as a
wonder substance-Freud had called it the first medicine that worked as an antidepressant.
The Parke-Davis Company manufactured it after 1885 in many forms for drinking, smoking,
inhaling, or rubbing on the skin. Within about a decade, warnings surfaced. Consumption
peaked about twenty years after its initial distribution, and around the same time the
accounts of its effect on the lives of its users and its popularly believed-although
questionable-special link with southern blacks created in the public's mind an image so
fearful that cocaine's effects became the extreme against which other drugs would be
compared. Cocaine's association with violence, paranoia, and collapsed careers made laws
against it by 1910 a popular matter. The first strict antinarcotic law in New York State
was passed in 1913 and was directed at cocaine. Al Smith, later to be an anti-Prohibition
candidate for president and critic of Prohibition in his state while he was governor, drew
the strict anticocaine measure in his early years as a state assemblyman.44 The
combination of strict laws and intense public support of control measures brought on a
reduction in consumption, which, at the peak of its popularity, must have seemed most
unlikely if not impossible.
The effect of the Harrison Act, its court interpretations, and supplementary
legislation also appear to have reduced greatly the number of opiate addicts. The medical
and pharmacy professions were denied an easy way of providing drugs. Although it is clear
that only a fraction of either profession was liberal in their provision, this
nevertheless had been enough to maintain a large number of users. It had been argued
recently that the recreational users began to stand out more prominently, as the medically
addicted and more sedate group declined in numbers, and that the relatively small number
of addicts in the United States, about 50,000 in 1940, would have had an
"underworld" or unsavory character even without the Harrison 45 Act's
criminalization of drug use. This point of view contrasts sharply with the argument that
the Harrison Act changed citizens who were normal except for their addiction into
criminals who had 46 to violate the law to obtain their daily supply of opiates. Whatever
the reason, the number of those addicted fell from about a quarter million around 1900 to
much less than half that number by World War II. The war effectively reduced supplies of
narcotics to the United States, and in 1945 the United States probably had its lowest
number of opiate addicts since the mid-nineteenth century. The rise of addiction after
World War 11 may have built on the core of addicts left in the nation, but the dynamics of
the addiction epidemic that began in the 1960s appear in certain respects to have had a
NARCOTIC CLINICS, 1913-1925
In order to close the story of the decline in addiction after 1900, it is necessary to
consider the legendary narcotic clinics that, like the Philippine opium dispensaries, were
intended to deal with addicts who no longer could receive opiate or cocaine supplies from
local physicians .47 The first in the United States was opened in 1912 by Charles Terry,
the public health officer of Jacksonville, Florida, where he provided both opiates and
cocaine to men and women, blacks and whites. Dr. Terry went on to become a student of the
opium problem in the United States and compiled a classic book of reports, excerpts from
articles, and statistical information in The
Opium Problem, published in 1928 and co-authored by Mildred Pellens.
Other clinics followed, particularly after the Treasury Department, in enforcement of
the Harrison Act, prosecuted or threatened with prosecution health professionals who
supplied addicts indefinitely. A series of clinics in New England were established at the
suggestion of officials of the Internal Revenue Bureau. In New York State, the crackdown
on druggists and physicians emanated from state law, and clinics were established in upper
New York State through state planning and authorization. Registration of addicts was
permitted so that physicians would restrict maintenance to those already addicted.
In New York City, the Health Department did not wish to provide opiates, morphine, and
heroin on an indefinite basis but did open a clinic at the city Health Department
headquarters. This clinic provided heroin, but only as an inducement to registration and
eventual detoxification and rehabilitation. About 7,500 addicts registered, received their
drug of choice in dosages gradually decreased until uncomfortably small, usually three to
eight grains of morphine daily, and were offered curative treatment. Most declined to be
cured. Those who did receive treatment, at North Brother Island, seemed both
unappreciative and very liable-the estimate was 95 percent - to return to narcotics
available on the street or from a physician or druggist.
The Treasury Department, armed with fresh Supreme Court decisions of March 1919,
started to close down the clinics, along with prosecuting the dispensing physicians and
druggists. One argument was that the availability of easy maintenance inhibited cures and
also that giving legal permission for maintenance clinics undercut the Treasury
Department's position when it brought action against a professional for reckless provision
of drugs. From a legal point of view, the "reckless" provider was obeying the
tax laws, as was the clinic, unless the federal government wanted to get into the question
of medical competence, which was a state, not a federal, concern.
Gradually the clinics were closed, the last one in 1925 in Knoxville, Tennessee. Some
had been operated poorly, others quite responsibly with community support. Yet, because of
the intricacies of the tax powers under which the federal law operated, all were closed,
even if unfair harassment was necessary to discourage the operation. The number of
registrants was not large, about 3,000 if we exclude the New York City clinic, which was
not intended for maintenance but for bait to get addicts into detoxification. The number
of addicts registered under the New York State law, which provided for maintenance not
only in clinics but also from private physicians and pharmacists, eventually totaled about
13,000 in 1920. It can be assumed, therefore, that the clinics were not a major element in
the maintenance of addiction in the United States. One side note: The 13,000 addicted
registrants in New York State in 1920 add up to the largest number of legally supplied
addicts recorded in any Western country this century, a number not approached yet by
Britain under the socalled "British System." Although the "American
System" preceded and surpassed in size any scheme attempted then or subsequently in
Britain, it was in fact the large number of addicts in America that made maintenance so
unwieldy and unpopular.
The demise of the clinics left drug peddlers and individual members of the health
professions as the major targets of the federal government. Generally, the physicians did
not wish to treat addicts, nor did they have any sympathy with addicts. Those physicians
who, for whatever reason, did continue to treat addicts with maintenance doses were
threatened and arrested, unless the maintenance had been approved by the local narcotic
agent. Some maintenance was permitted, but only on a case-by-case evaluation. From reports
prepared by agents upon investigating narcotic clinics, it appears that an acceptable
life-style was a requirement for permission to be maintained.48
A theory had been advocated, mostly among maintaining physicians in New York City, that
longstanding addiction changed the body's physiology in such a way that opiates were
necessary for the patient to remain normal.49 Too little opiate and the patient would
experience withdrawal, too much and the patient would be "high," but just the
right amount would allow normal feelings and behavior.
This, of course, is close to the argument made in the 1950s by Drs. Dole and Nyswander
to justify methadone maintenance. After a series of scientific studies shortly after World
War 1, the government concluded otherwise .50 Those physicians who insisted on maintaining
patients without approval from a narcotics agent ran a serious risk of arrest and, if
convicted, loss of a medical license and time in a federal penitentiary. In spite of the
danger, of course, some physicians supplied narcotics without restraint or with very poor
judgment, but evidence shows that other, responsible physicians were entrapped without
good reason in order to boost the number of an agent's arrests and thereby bolster his
chances for promotion.51 An aura of fear, therefore, accompanied a physician's decision to
give an opiate to a patient, especially a new patient. On the other hand, the casualness
with which physicians once handed out morphine or some other opiate was reduced
Along with the rejection of maintenance, physicians unfortunately had no effective
medical cure available for addiction. Several had been promoted in many forms in the
nineteenth and early twentieth century, but each had been found to have no scientific
merit .52 The problem devolved into a decision of whether to stop opiates abruptly and
thereby cause the patient to go directly into full Withdrawalthe so-called "cold
turkey" approach-or gradually to reduce the opiate over a few days or a few weeks.
Because the addicted person frequently has a threshold of average daily consumption below
which the user becomes acutely uncomfortable, and because a yearning for heroin or
morphine often persists for months or years after the beginning of withdrawal, the
decision to detoxify abruptly or gradually usually was a difficult path for the patient.
Nevertheless, detoxification was the preferred route for legal reasons. Two ancient
warnings about detoxification, that the patient would die in withdrawal, or that a supply
cutoff would precipitate a rash of suicides, did not materialize.
During the 1920s and 1930s the number of addicts diminished in the United States.
Grossly exaggerated estimates came from antidrug entrepreneurs like Captain Richmond
Pearson Hobson, who had been a Prohibition advocate before unleashing his energies against
heroin and later marijuana as the head of several national and international voluntary
groups." Captain Hobson attacked heroin in a most melodramatic manner, claiming there
were 4 million addicts in the United States and comparing them all to lepers. In spite of
Hobson, the concern over opiate addicts and cocaine users declined during the two decades
after World War I.
MARIJUANA TAX ACT OF 1937
With the battle against opiate addiction apparently at a more stable, less alarming
level in the 1930s and the use of cocaine having declined dramatically, a new dangerous
drug appeared on the American horizon: marijuana. Marijuana smoking arrived in the United
States with Mexican farm workers who had crossed the border, mostly to labor in
agricultural fields in the Southwest and in sugar beet fields as far north as Montana and
Michigan. During the prosperous 1920s, about half-a-million farm workers came to the
United States, but as the Depression's widespread unemployment laid an increasingly heavy
burden on the country's citizens, the Mexicans became an unwelcome group, encouraged in
all ways to return to Mexico. Entwined with the troubles they were said to cause local
citizens was the Mexicans' custom of growing marijuana for their own use. Hence, marijuana
was linked to violence, dissolute living, and Mexican aliens.53
The greatest fear of marijuana in the United States lay in the West and Southwest. The
government was importuned to take action, but the recent experience with alcohol
prohibition (which had ended in 1933) made the Federal Bureau of Narcotics (FBN) and its
head, Harry J. Anslinger, formerly of the Prohibition Bureau, hesitant to get involved in
a drug that grew domestically and prolifically. Cocaine and heroin were both foreign
imports and therefore, at least theoretically, could be regulated more easily, but
marijuana appeared to be almost impossible to curb, let alone eradicate. The FBN tried to
address this drug by including it in a recommended uniform state narcotic law that would
leave to localities the question of prosecution and allocation of enforcement resources.
Then a curious law intended to reduce the number of machine guns provided the federal
government with a mechanism to attack marijuana nationally and at the federal level.
The Firearms Act of 1934 decreed that a machine gun could not be transferred in any way
without the payment of a transfer tax (from which law enforcement personnel were
exempted). As odd as this mechanism may sound, the law was upheld by the Supreme Court in
1937 as a legitimate use of the power of taxation for a moral objective. Within weeks of
this decision, the Treasury Department, which housed the FBN, appeared before Congress
asking for a transfer tax for marijuana. Without a stamp permit and the proper tax stamps,
marijuana could not be sold, bartered, or given away. Congress quickly approved the bill,
and President Franklin Roosevelt signed it into law later in 1937. Unfortunately for the
enforcement of this law, the FBN did not receive any more money or agents. Therefore, the
FBN relied on obnoxious descriptions of marijuana to do the job. The substance was
described to the public as a danger at least equal to cocaine or morphine, and the
penalties for its illegal use or possession were severe. Because use of marijuana does not
seem to have been great in the 1930s, the law's extraordinary severity did not concern the
general public until the 1960s, when thousands of users were arrested as marijuana's
popularity burgeoned. Furthermore, the contrast between the effects of marijuana observed
in the 1960s and the longstanding claims of the FBN regarding marijuana led to a problem
concerning the credibility of official statements, which still affects popular
WORLD WAR II TO THE PRESENT
The Second World War ended with relatively few opiate addicts and very little use of
cocaine or marijuana in the United States. The only closely controlled drug rising in use
was alcohol, consumption of which had increased in per capita rates since the repeal of
Prohibition. During all this period, sleeping pills and other barbiturates were prescribed
widely but did not appear to be a similar problem. The same holds true for the
amphetamines, which had been made available in the 1930s and continued to be manufactured
and prescribed without restriction.
Treatment of hard-core addicts did take place at the two federal narcotics hospitals in
Lexington, Kentucky, and Fort Worth, Texas. Each was, in fact, a prison in which addicts
were treated and forced to detoxify, but the patients/prisoners frequently resumed their
drug habits when they returned to their previous environments. Around 1950 a younger age
group began to be admitted for heroin addiction, an abuse that reached a very high level
in 1970 and remains high today. This threat elicited two responses. First, the federal
government enacted more severe laws that levied mandatory sentences for conviction of
dealing in narcotics. The laws, enacted in 1951 and 1956, are the peak of legal penalties
against narcotics, including marijuana, in the United States.55
The second response reflected the domestic and international tensions of the time. The
heroin menace-and it should be reemphasized that cocaine and marijuana were not seen as
anything but potentially major problems in the 1950s-was ascribed to the infiltration of
the drug trade by Chinese Communists who had taken over the China mainland in 1949. The
Red Chinese purportedly sent heroin to the United States to undermine our democracy and at
the 56 same time obtain specie, for which they had a desperate need. By the 1970s,
however, the United States was defending the People's Republic of China against the same
charge, now levied by Soviet newspapers.57 Such are the vagaries of international
relations and the domestic drug problem.
Heroin addicts in the 1950s mainly were young males concentrated in black and Hispanic
urban ghettos. These addicts concerned the federal government, as well as reform-minded
lawyers, academics, and physicians. The latter groups found the harsh penalties and the
loathing attitude toward the addicts to be inhumane. Leaders of this countermovement
included sociologist Professor Alfred Lindesmith and the attorney Rufus King. They
believed a more relaxed approach would be much more successful, as well as more kind.
Rather than depriving addicts of heroin, heroin should be provided them. Rather than
jailing addicts, they should be hospitalized, if necessary, or just left alone.58
This alternative view competed with the more hard-line style of law enforcement
exemplified by Commissioner Anslinger. After forty or more years, treating addicts
medically, which had been popular before World War I and had then been found inadequate to
the task of reducing addiction, became part of public policy in the 1960s. Methadone, a
synthetic opiate developed in Germany in World War 11, was used by Dole and Nyswander to
provide maintenance under theories similar to those which had justified maintenance prior
to the restrictive Supreme Court decisions in 1919. This marked a major break in American
narcotic control policies; maintenance again was legal, although not with heroin or
Along with the possibility of maintenance, other milder forms of control were invoked
by the federal government. Civil commitment to a narcotic treatment center,, thought more
humane than prison sentences, became possible legally in 1966, although in subsequent
years this did not prove a practical method either to reduce addiction or to cure addicts
in any marked number.59
Also in the 1960s, an enthusiasm for drug consumption of all kinds, polydrug abuse,
replaced the habitual use of one or two drugs, which had been more common in the past.
Marijuana became very popular with young people, and then gradually its popularity
expanded in both directions to even younger and to older ages. Psychedelic drugs, such as
LSD, appeared on the scene, along with injectable methedrine or "speed." Drugs
came to symbolize opposition to the government and older mores. The turmoil and dissension
caused by the Vietnam War added to the sense of alienation many young people already felt
from the older generation, which frowned on drug use other than alcohol and tobacco. In
addition to cultural alienation and the rapid increase in multidrug use, the drug problem
in the 1960s was intensified by the extraordinarily large number of young people in the
ages most likely to experiment with drugs; the post-World War 11 "baby boom"
generation had reached the teenage years.
By 1970, marijuana was used commonly, and research was showing that it did not have the
awful effects ascribed to it from the 1930s onward. Various groups and individuals
initiated movements to legalize the substance, perhaps along the lines of tobacco. The
drug situation was perceived by the public and the federal government to be so bad and yet
so difficult to control that this seemed a good time to reevaluate the nation's entire
policy. A National Commission on Marijuana and Drug Abuse was established in 1971.
In general, the members of the commission reflected traditional views on the subject of
drug control, and therefore it was with even greater impact that the commission
recommended in its first report, "Marijuana: A Signal of Misunderstanding," that
the substance be "decriminalized." By decriminalization was not meant
legalization but a step short of that position: Marijuana possession for individual use no
longer would be a crime, but its sale and distribution would be against the law. The
purpose of control at this stage would be to relieve law enforcement agencies of the
nuisance of arresting individual users and thereby allow more resources to be concentrated
on investigating large-scale crime and more dangerous drugs.6o The notion of
"decriminalization" proved difficult for all to understand. Some foreign nations
considered it to mean legalization. President Nixon refused to receive the report in
public or to comment on it except to affirm that marijuana was not going to be legalized
if he had anything to say about it.
The second and final report, published in 1973, dealt with drugs more broadly.60 It
attempted to draw attention to the actual, measurable damage done by drugs, reflected in
hospital admissions and drug-related deaths, as opposed to the myths that had evolved
around many of them. Heroin, for example, was misperceived as causing more deaths annually
than barbiturates. This approach intended to make more rational the discussion over drug
policy, but it also laid the groundwork for the inclusion of cigarettes and alcohol in the
antidrug crusade. It de-emphasized, however, the effects a drug such as cocaine has on
judgment and efficiency, the less quantifiable but still real aspects of drug use.
The enforcement of laws against individual possession or use of marijuana has fallen in
the United States to a very low level. Moreover, dealers in relatively small amounts are
reportedly not prosecuted either, because the largest dealers and smugglers, who are
involved with tons, not ounces or pounds of marijuana, require all the time of officials.
There has been a de facto decriminalization throughout large parts of the country, even if
laws against individual use remain on the books. Possession of marijuana in some states is
a small-scale misdemeanor, and the penalty is a ticket, like a parking violation. Yet, the
frequency of marijuana use by high school seniors has been dropping since 1978, and this
reduction, coupled with a more conservative national mood, has slowed further moves toward
formal federal decriminalization or more liberality in the drug laws.
The rise in cocaine's availability and popularity, for the second time this century,
has further complicated the control of drugs in the United States. The fact that first
millions should use marijuana, then millions more take cocaine raises questions about the
ability of local and national governments to control narcotics. The corruption that
follows the drug traffic and the restraints on resources that may be allocated to drug
control combine to leave a sense of frustration with enforcement policy. What will be the
result of these trends? It all remains uncertain. We appear to be in an era of widespread
drug use that would seem to make reasonable the revocation of antidrug statutes. We should
recall, however, that a similar condition prevailed around 1900, shortly before an
onslaught against drug use led to a substantial reduction in the use of opiates, heroin,
cocaine, and alcohol. That such a national response could occur must make us pause before
offering predictions for the future.
1. Rudolf Schmitz, "Friedrich Wilhelm Serturner and the Discovery of
Morphine," Pharmacy in History 27 (1985): 61-74.
2. 31 and 32 Vict. ch. 121, 1868: Act to Regulate the Sale of Poisons and Alter and
Amend the Pharmacy Act 1852 (1868 Pharmacy Act).
3. Virginia Berridge and Griffith Edwards, Opium and the People: Opiate Use in
Nineteenth-Century England (New York: St. Martin's, 1981), pp. 147-49, 227, 254.
4. Ibid., pp. 113-31.
5. James G. Burrow, AMA: Voice of American Medicine (Baltimore: Johns Hopkins Press,
1963), pp. 51-52, 62ff.
6. Glenn Sonnedecker, Krerners and Urdang's History of Pharmacy, 4th ed. (Philadelphia:
Lippincott, 1976), pp. 198-212.
7. R. H. Shryock, Medical Licensing in America, 1650-1965 (Baltimore: Johns Hopkins
Press, 1967), p. 32ff.
8. Virginia Berridge, "Fenland Opium Eating in the Nineteenth Century,"
British Journal of Addiction 72 (1977): 275-84.
- David F. Musto, The American Disease: Origins of Narcotic Control (New Haven: Yale
University Press, 1973), p. 54ff.
10. Ibid., p. 3
11. Berridge and Edwards, Opium and the People, p. 14517f.
12. Musto, American Disease, p. 5; David T. Courtwright, Dark Paradise: Opiate
Addiction in America before 1940 (Cambridge: Harvard University Press, 1982), chap. 1,
"The Extent of Opiate Addiction," pp. 9-34. Opiate addiction is the regular use
of opiates to prevent painful and uncomfortable bodily and psychic symptoms that would
occur if the drug's use were abruptly stopped. Estimates of the number of addicts in the
United States have often been susceptible to ideological and political influences. After
carefully considering contemporary surveys, importation statistics, and other estimates,
and subjecting his findings to modern statistical analysis, Professor Courtwright
concluded that the highest rate of addiction in the United States occurred in the 1890s at
the maximum rate of 4.59 per 1,000. Today that rate would result in 1. I million addicts,
about twice the current official estimate.
13. Musto, American Disease, p. 236.
14. Wilder Penfield, "Halsted of Johns Hopkins: The Man and His Problem as
Described in the Secret Records of William 0sler," Journal of the American Medical
Association 210 (1969): 2214-18.
15. James Harvey Young, The Toadstool Millionaires: A Social History of Patent
Medicines before Federal Regulation, (Princeton, N.J.: PrincetonUniversity Press,1961), p.
21 1 ff.
16. Public Law No. 384, 59th Congress, Session 1, 30 June 1906. Section 8 names the
drugs that need to be listed on the label.
17. J. P. Street, "The Patent Medicine Situation," American Journal of Public
Health 7 (1917):1037-42.
- Young, Toadstool Millionaires, p. 213ff.
19. Martin 1. Wilbert and Murray Gait Metter, Digest of Laws and Regulations in Force
in the United States Relating to the Possession, Use, Sale and Manufacture of Poisons and
Hahit-Forming Drugs, Public Health Bulletin no. 56, Nov. 1912 (Washington, D.C.:
Government Printing Office, 1912).
20. Musto, American Disease, p. 25ff.
21. Report of the Committee Appointed by the Philippine Commission to Investigate the
Use of Opium and the Traffic Therein .... Bureau of Insular Affairs, War Department, 1905.
22. Musto, American Disease, pp. 261-62.
23. Arnold H. Taylor, American Diplomacy and the Narcotics Traffic, 1900-1939 (Durham,
N.C.: Duke University Press, 1969), pp. 47-81.
24. Ibid., p. 82ff.
25. Berridge and Edwards, Opium and the People, p. 268.
26. United States 60th Congress, Public Law No. 221. An Act to prohibit the importation
and use of opium for other than medicinal purposes. Approved 9 February 1909.
27. Musto, American Disease, pp. 31-37, 40-45, 61-62.
28. Ibid., pp. 31, 198, 202.
29. Ibid., p. 41.
30. Ibid., pp. 40-48.
31. Ibid., pp. 54-68.
32. Hamilton Wright, "Report on the International Opium Question as Seen within
the United States and Its Possessions," in Opium Problem: Message from the President
of the United States, Senate Document no. 377, 61st Congress, 3rd Session, 21 February
1910, p. 49.
33. Hamilton Wright to Charles Evans Hughes, 28 June 1916, in Papers of Dr. Hamilton
Wright, U.S. National Archives, Record Group 43, entry 36.
34. U.S. v. Jin Fuey Moy, 241 U.S. 394 (1916).
35. Special Committee of Investigation, Appointed March 25, 1918, by the Secretary of
the Treasury: Traffic in Narcotic Drugs (Washington, D.C.: Government Printing Office,
36. Webb et al. v. U.S., 249 U.S. 96 (1919); U.S. v. Doremus, 249 U.S. 86 (1919).
37. 67th Congress, Public Law No. 227. To amend the act of February 9, 1909, as
amended, to prohibit the importation and use of opium for other than medicinal purposes.
Approved 26 May 1922.
38. 68th Congress, Public Law No. 274. Prohibiting the importation of crude opium for
the purposes of manufacturing heroin. Approved 7 June 1924, Section 2.
39. Ibid., Section 1.
40. David F. Musto, "Early History of Heroin in the United States," in P. G.
Bourne, ed., Addiction (New York: Academic Press, 1974), pp. 175-85.
41. Gerhard Kuhne, "Statement of Gerhard Kuhne, Head of the Identification Bureau,
New York City Department of Correction," in Conference on Narcotic Education:
Hearings before the Committee on Education of the House of Representatives, December 16,
1925 (Washington, D.C.: Government Printing Office, 1926), p. 175.
42. Prohibiting the Importation of Opium for the Manufacture of Heroin: Hearings on HR
7079, House of Representatives, Committee on Ways and Means, 68th Congress, Ist Session, 3
April 1924 (Washington, D.C.: Government Printing Office, 1924), p. 41ff.
43. Taylor, American Diplomacy and Narcotics Traffic, p. 2OOff.
44. Musto, American Disease, pp. 6-8; Laws of New York, 1913, ch. 470, pp. 9984-91,
approved 9 May 1913.
45. Courtwright, Dark Paradise, pp. 146-47.
46. Alfred R. Lindesmith, The Addict and the Law (New York: Vintage Books, 1965), pp.
47. Musto, American Disease, pp. 151-81.
48, Ibid., p. 167ff.
49. Ernest Bishop, The Narcotic Drug Problem (New York: Macmillan, 1920); see also,
David F. Musto, "Social and Political Influences on Addiction Research," in
Seymour Fisher and Alfred M. Freedman, eds., Opiate Addiction: Origins and Treatment
(Washington, D.C.: Winston, 1973), pp. 93-98.
50. David F. Musto, "The American Antinarcotic Movement: Clinical Research and
Public Policy," Clinical Research 19 (1970): 601-5.
51. H. T. Nugent, Field Supervisor of the Fl3N, Fourth Annual Conference of
Pharmaceutical Law Enforcement Officials, Toronto, Canada, 25 August 1932, Stenographic
typescript of Proceedings, Archives of the American Pharmaceutical Association,
Washington, D.C., box 31, pp. 86-87.
52. Musto, American Disease, pp. 69-90.
53. Ibid., pp. 190-94.
54. David F. Musto, "Marijuana Tax Act of 1937," Archives of General
Psychiatry 26 (1972):101-8.
58. Lindesmith, Addict and the Law; Rufus King, The Drug Hang-up: America's Fifty Year
Folly (New York: Norton, 1972).
59. Narcotic Addict Rehabilitation Act of 1966, Public Law 89-273, 89th Congress,
approved 8 November 1966.
55. 82nd Congress, Public Law No. 255, approved 2 November 195 1; 84th Congress, Public
Law No. 728, approved 18 July 1956.
56. H. J. Anslinger and W. F. Tomkins, Traffic in Narcotics (New York: Funk and
Wagnalls, 1953), pp. 69-116.
57. For example, "Poisoners: How the Maoists Smuggle Opium," Literaturnaya
gazeta, 19 March 1969, translated and reprinted in Current Digest of Soviet Press (Ann
Arbor, Mich.: Joint Committee on Slavic Studies, 1969), vol. 21, p. 7.
60. Marijuana: A Signal of Misunderstanding:
First Report of the National Commission on Marijuana and Drug Abuse (Washington, D.C.:
Government Printing Office, 1972), p. 150ff.
61. Drug Use in America: Problem in
Perspective, Second Report of the National Commission on Marijuana and Drug Abuse
(Washington, D.C.: Government Printing Office, 1973).