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|Interim report of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs, 1958|
Interim report of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs
by Advisory Committee to the Federal Bureau of Narcotics
JULY 3, 1958.
Note: To fully understand this document, and the context in which it arose, you should also read these other documents which are in the Schaffer Online library:
by Dr. EDWARD R. BLOOMQUIST,
member of faculty, School of Medicine, College of Medical Evangelists, Los Angeles, Calif.; narcotic expert, author of various articles on drug addiction among physicians
A review of this report makes one starkly aware of the current trend, in most instances a good one, to be sympathetic with people who are experiencing personal problems. But sympathy, particularly if misguided and uncontrolled, can often cloak both an apathy to actually help the unfortunate and a. misdirected effort to provide him with a form of negative assistance that can only worsen his situation.
A rather interesting example of misguided emotion that somewhat parallels that expressed in this report is that shown in one of the concepts of raising children which arose a generation or so ago and is still going strong in some circles--a concept of never stifling a child's developing drives lest his tender ego become damaged in the process. We see the result of this pathetic psychology today in a significantly large collection of youthful vipers whose disrespect for authority, parental, religious, governmental or otherwise, is responsible for a wave of juvenile delinquency unparalleled in the history of our Nation.
The preparation and in time the public dissemination of the material included in this report will undoubtedly cause thinking people to come to one of two decisions, unless they wish to assume a complete apathy toward the subject of narcotics and narcotic addiction. The first decision is to agree with the sociologist who recently suggested that the American people must accept narcotic addiction as a part of our social structure, much as we have accepted the presence of women in bars. The other decision is that we will have no part in permitting a handful of emotionally disturbed individuals and their well meaning, but unwise, supporters to force upon the majority of
Americans a habit so foul that its propagation can result in nothing but destruction of our Nation.
To suggest that a segment of our population be provided with a socially approved pharmacological crutch so they can continue to avoid personal responsibility, and to permit them to mingle with a population which includes a significant number of potential addicts looking for a similar method of escape from the pressures of reality is comparable to promoting a fifth column.
There are many points mentioned in this report which make it difficult to believe it is sponsored by men of the integrity of those on the committees involved in its preparation. The very fact that such men have closed their eyes to the danger of the program proposed should fill those charged with the responsibility of controlling the narcotic problem in America with energy sufficient to counteract the dangerous attitude which general release of this report could bring to Americans.
The following are points which seem to this reviewer to be inaccurate, misleading and in need of further discussion:
1. There is apparently a desire on the part of some to argue the old "chicken or egg first" philosophy and apply it to narcotics. Some seem to wish to believe that all the evils of narcotics come only after an unfortunate victim of circumstances, biochemical, hereditary, environmental or otherwise, has come in contact with the strong arm of the law. Several investigators are quoted, but the quotations tend to cancel one another. Dr. Nathan Eddy notes that there is evidence that a change in the cells of the nervous system occurs in addicts and admits the fundamental mechanism is unknown. But it is not pointed out that a biochemical change in the body following the chronic use of any toxin is not uncommon or that the presence of such
a change is not an excuse per se for chronically using a toxic drug.
Lindesmith is quoted as asking why, if the toxic effect of the drug on the.central nervous system promotes degeneration or if addiction is a biochemical affair, there does not exist a character degeneration in our own upper class such as that manifested among addicts apprehended by authorities--a degeneration which Lindesmith seems to feel comes because of police activities and not because of the drug.
Lindesmith apparently chooses to overlook the fact that character degeneration is one of the principal causes for concern when a physician takes to narcotics-narcotics that are free and easy to obtain.
Then Wikler and Rasor are quoted. Their notation indicates that the use of an opiate drug may actually improve the social functioning of a person taking morphine. Their conclusion is drawn from opinions solicited from, the addict as the addict evaluates his own situation.
This improved function, according to the authors, accomplishes this for the addict: A reduction of appetite, pain and erotic urges of all types, normal or deviated, and the production of a transient thrill comparable to sexual orgasm which is usually felt in the abdomen.
This improved status then permits the addict to be "at ease" and "free to do what they want to do"--in other words they can now function well because society can be damned and the addict no longer has a need to try and meet his weakened sense of social responsibility.
After all this, the authors naively comment that some opiate users have noted that these agents do not impair and other addicts state that they actually improve their ability to do useful work. For these addicts who do not suffer from this delusion of self-improvement the opinion is offered by the author that opiates make some addicts less aggressive and keep them out of trouble.
It is incredible that responsible investigators would give credence to the opinions of a segment of our population whose weak vacillating approach to minimal adjustment within a community is so poor that they must, on slightest provocation, resort to self-indulgence which consists of pseudoerotic stimulation and daydreaming.
The average addict can no more adequately judge whether or not he can function well under the influence of continued narcotics than the average citizen is equipped to assemble an atomic warhead.
In talking to and working with a number of intelligent addicts over a period of years I cannot remember one who, when honestly discussing his problem at a time when, he had nothing to gain by lying, felt he ever contributed anything constructive to society while on "the needle".
An example of this: A certain physician suspected of using narcotics arrived one evening to deliver a baby. As far as he was concerned, he was functioning well for he had just received, from a private, easily accessible, totally nonprofit source, an injection to feed his habit.
He put his knife on the perineum and casually cut clear through the rectal sphincter. His only comment: "Whoopsl I guess I was too heavy on the knife." Here was an intelligent individual, functioning "normally" and "usefully" in society whose sense of reasoning was totally warped from Demerol. It is interesting to ruminate on his activities if he had been taking heroin.
Apparently the proponents of this socially approved narcotic program intend to utilize heroin. If they do not, they are wasting their time, for an addict, other than a professional person whose reasons for taking narcotics are diametrically different than the average addict, (i e., the doctor takes them to relax and meet responsibility, the average addict takes heroin for its pleasurable effect and the chance to avoid responsibility) wants only heroin and he wants it in increasing
doses to meet his tolerance. The only apparent reason for an addict wanting to decrease his tolerance lies in the fact he cannot afford the high doses which are eventually required. With free narcotics, he will lack this incentive to decrease his tolerance and as soon as there is a threat that it is about to be cut in these proposed ambulatory clinics he will resort to black market heroin to satisfy his habit. Unless the proponents of this plan to treat addicts as they mingle among the
general population with as much heroin as they desire, they might as well forget their euphoric ideas of restoring these addicts to "normal" life with perpetual, socially approved injections, and the idea that the pusher and his profit motive will ever disappear.
Further, the philosophy that addiction will not increase hand over fist under this proposed "be kind to the addict" program is a pathetic dream. One of the primary problems surrounding the treatment of addicts and the control of addiction lies in the addict's almost compulsive urge to pass the habit on to someone else. And in this insecure, authority despising generation there are many looking for just such a habit to assuage what little sense of responsibility still exists.
The idea that a man on continual injections of narcotics will try to function in a fashion contributory to society is quite ridiculous.
The addict lives for his habit. When he is not experiencing his pharmacological nirvana he is looking forward to his next dose. What possible position of responsibility or trust could be given to a person whose goal is to "do as he pleases."
2. It is felt that until drug addiction is placed in the hands of the medical profession where "it belongs" there will never be a solution.
There are several things to consider here, the first being that physicians should by all means have a hand in the treatment of and where feasible the elimination of addiction. But the average physician with his present training in the field of narcotics is about as capable of handling an addict properly as he is to walk into the nearest surgery and remove a brain tumor. This does not mean that a physician should be restrained from treating addicts if he wishes to take the time to learn the problems of what amounts to a specialized field. But this training must necessarily consist of more than casual reading of a pamphlet issued by some committee and the establishment of a section of his office where a long, lucrative line of addicts can pass dreamily through for perpetual injections.
Further, let us consider the much lauded British system of treating addiction, a system which leaves the handling of narcotics and addiction entirely within the hands of its physicians: A system in a culture completely different from ours so that comparisons of what happens there and what happens here are most invalid; a system which, admittedly lists only 333 known addicts in 1956, one third of whom were members of the British medical profession; a system which cannot point with any pride to its success in other portions of the British Empire where in Hong Kong, for example, there was a recorded 17,691 arrests for narcotic violations in 1957; a system which is in force in Canada also which permits problems which are essentially no different from than in the United States where the "cruel" system of narcotic enforcement is being attacked as inefficient, responsible for criminal associations and physical and moral degeneration in persons who some feel would be acceptable members of society if only they could pursue their pathetic escape from reality in peace.
Let's look at Sweden, praised, although not too accurately, as country with broad opinions. Here, 20 percent of its addicts are physicians. There are no profit motives, no slums, no persecutions by
Police - yet Sweden has banned heroin and regards outpatient treatment of addicts in the open departments of public health hospital unsuccessful because "the drug peddlers are right in the lounge waiting" for the addict when he finishes the doctor's approach to treatment.
Norway is another example quoted, but Norway is becoming worried about its drug problem. Certain physicians have apparently made racket of feeding addicts under this socially approved system, and the Department of Health is pressing for new regulations to create a control board similar to Denmark.
Here is an example of the effects of placing euphoria producing substances totally in the "hands of the medical profession where it belongs." Currently we have a new escape drug--the tranquilizer. It is in the hands of the medical profession. It has been prescribed in fantastic quantities by honorable physicians who have concluded their patients are better off taking the drugs under their supervision than going down the street and obtaining them from a licensed practitioner whose reticence to prescribe may be clouded by finances.
As a result, for a time before production caught up with an unbelievable demand for drugs to relieve the pressures and responsibilities of modern living, we had long queues of people lined up before drug stores bearing the distasteful banner "YES, WE HAVE MILTOWN" to boost their ever increasing profit.
Do we want this with narcotics? Is it possible that anyone could believe that the American people do not possess among them enough persons demanding a pharmacological crutch that the same pressure would be placed upon physicians, if the handling of narcotics are left only to them, as was the experience with the tranquilizers and before that the barbiturates?
Some apparently overlook the terrific drive that exists among addicts to perpetuate their habit. Recently a law enforcement officers in Los Angeles conducted a private survey among addicts. He asked them if they would agree to being locked away from society if, by accepting this isolation, they could obtain an unrestricted supply of free narcotics. Almost to a man, the addicts replied, "Where do I sign?"
There are those who will counter with the argument that the tranquilizer example is misleading for these drugs helped patients function "normally." In some cases, where they were limited to acute emotional upsets, this is undoubtedly true. But to others they had and still have but one effect. To these people it made it possible for them to say "I don't give a damn about anything". Fortunately, controls are being placed and public warning is being given to America by people who recognize the danger of a tranquilized Nation, men who know from history that it was a tranquilized Babylon who sat in a drunken stupor of self-indulgence while an alert group of Medes and Persians ciept under their walls and destroyed them
3. It has been erroneously assumed that the majority of our addicts can be "cured." I have never met an addict, reformed or otherwise, who felt that he was cured. The return to Hell is just one injection away. Instance after instance is available from police narcotic records of individuals who mere doing all right until they suddenly came face to face with available narcotics. And down the hill they went! To some it is no more reasonable to feed narcotics to an addict because he wants them than it is to feed glucose to a diabetic because he has an appetite for sugar. Neither person profits from his poison.
4. The idea that the enforcement program has failed because addicts still remain or are on the increase is as misleading as the conception that medicine has failed because people still become ill or die. The threat of jail is all that stands between some addicts and the return to the needle and its associated crime. And jail is not without its benefits, for the addict is withdrawn from his drug, he gains weight, he gets a warm room and a bath. True, it is not pleasant to be jailed: but would the addict be any better off reporting to some licensed agency for another boost of his habit as frequently as his rising tolerance demands it? The fact that the addict returns is not an evidence of failure on the part of law enforcement but the evidence of a wishy-washy public attitude and an inexact and inconsistent difference of opinion among physicians, judges, and police officers. The answ to the correction of narcotic addiction lies in a resolving of differences between persons charged with the responsibility of handling the narcotic problem.
5. The idea that one can encourage addicts to accept and stay on "treatment" by offering them narcotics during their treatment is as insane as providing a homosexual with a male prostitute while trying to rearrange his sexual direction. Or, as another example of puerile thinking, provide a specific source of alcoholic beverages for the chronic alcoholic so he can stand his weekly session with Alcoholics Anonymous. It's fantastic that thinking individuals could even consider yet propose such a plan.
6. The suggestion that addicts coming to outpatient clinics can be monitored and prevented from obtaining additional narcotics from outside sources is a naive misevaluation of the intelligence and drive of the addict. This thinking has been noted by the committees themselves when they pointed out that a society of addicts consider themselves important and the nonaddicts "squares." It is conceivable that the addicts invited to participate in this free narcotics-for-the-asking program will add another epithet to their ever growing vocabulary, an epithet quite old and cliche, but never-the-less accurate-"sucker".
7. The suggestion that addiction is essentially a symptom of underlying emotional instability is tarnished by the report because it has not been completely proved. Still, in nearly every case history one dominant feature is recorded--the desire to escape reality and responsibility
With the dearth of knowledge we have concerning the basic problems of addiction, one could spend endless, useless hours arguing this "chicken or egg first" idea that addiction is basically an abnormal biochemical process versus the thought that addiction is primarily an indication of emotional instability.
The interesting thing about the Sage report as it discusses this, is the admission that most of these addicts had a marginal adjustment to society prior to their addiction. Now if this is true, is it actually better to perpetrate this synthetic existence under the guise that the addict can function normally again, rather than "dry him out" and give him the impetus to stand on his own two feete? Is a sense-drugged existence better than marginal adjustment with the hope of promoting a socially acceptable personality?
8. Apparently it is politically expedient to limit the discussion of the profit motive to criminal elements in this country. It's fantastic to note, particularly in this period where recession is the watchcry, the millions of dollars we are giving away under the guise of "loans" to countries who show absolutely no interest in decreasing the production of lucrative narcotics which they are well aware are being funnelled into the United States for its eventual destruction. The questionable statement in appendix B, page 4, by Rufus King that there is no substantial evidence that any nation is actively engaged in fostering traffic of illicit drugs into America makes one wonder if he has ever read United Nations reports.
9. It is felt by some that the prevention of treatment of addicts by doctors is an invasion of the right to practice medicine. Nothing is further from the truth unless by treatment one means the perpetuation of the habit and the promotion of new cases of addiction. The report itself states:
the courts have been clear in holding that (if a doctor) acts in good faith and prescribes a narcotic drug in the course of his professional practice he is entitled to the benefit of the exception of the act.
They decry that a physician, if found in significant violation of the lew, must prove by trial that he has exhibited good faith and has adhered to ethical standards.
Apparently they have overlooked the fact that even in a profession where ethics are as important and professional integrity as jealously guarded as it is in medicine, there are a few individuals who are far from being pristine pure, exemplified by the fact that now and then the profit motive has created a professional Esau.
There most certainly should be a court for a decision regarding the activities of physicians, but it should be a court of medical peers who understand the situation. This has proved successful in those cases where medical ethics boards really function with authority. There is no reason why it should not be universal.
10. On the subject of inadequate judges, juries, and courts, as with the medical profession, there are jurists with grimy hands
Further, they are not immune to misguided and sometimes addlepated thinking. An example of this latter judicial tragedy is that of a Los Angeles judge who recently sentenced an addict to go to church a specific number of Sundays so religion could "cure" his habit.
11. The report also praises Dr. Lawrence Kolb who wants to list narcotic problem as a health problem needing no enforcement for its control. I'm sure he would not hesitate to ask for police enforcement of laws protecting the country if an epidemic of bubonic plague developed and endangered the general population, even though the plague victims were sick individuals. Yet, with a health menace as dangerous, although slower and less dramatic in producing its inevitable effects, he wants to coddle the addict and "understand" him even though this may mean detrimental effects to the public as a whole.
I respect Dr. Kolb for his interest in wanting to help the addict.
I think all of us want to help the addict, but not if treating him gently means endangering our civilization. It is interesting to note the mailed fist now being employed in the Orient where the danger to the nation as a whole is recognized. The Oriental addict may be recognized as being an ill person, but these nations, who incidentally do not suppress the production of narcotics for eaport, want no part of addiction in their own culture
12. I shall not comment on the New York Academy Plan other than to state that I regret that it bears the seal of approval of fellow physicians. It has little to offer but chaos.
In contrast I would like to laud the recommendations offered by the Citizens Advisory Committee on Crime Prevention to the Attorney General's Office in California. It has the courage to put teeth into the system of evaluating and treating the addict. The point of permitting an addict access to the general population is one thing with which, however, I disagree.