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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:
ARGUMENTS FOR AND AGAINST THE LEGAL SALE OF NARCOTICS
By Dr. G. H. STEVENSON,
Canadian Narcotic Expert
It might be mentioned at this point that some people believe there is a large body of nondeliquent addicts in the community, who are presumed to work steadily and to be otherwise well-adjusted persons
The writer has not been able to find heroin or morphine users in this category. There doubtless are a few such persons, chiefly in the medical and related professions, but anyone who has had professional relationships with such persons realizes their erratic undependability land the hazard they are to their patients when under narcotic influence. There are also nondelinquent persons addicted to the barbiturates and pethidine (demerol), who secure their supplies on medical prescription. These substances are highly addictive and physicians need to be aware of these dangerous features in prescribing them. As addictions, they can be more damaging to the unfortunate user of them, than the more common drugs of addiction, alcohol, morphine, heroin.
The only proper relationship of the physician to the addict is that of helping the addict to overcome his addiction. Physicians are entitled to treat addicts, but treatment can rarely be expected to be successful by the ambulatory method or by office practice. Hospital facilities with security provisions, skilled nursing, constant medical supervision, and treatment are all essential, followed by an adequate rehabilitation program.
To return to the English "system," it should be stated at once that England does not encourage, or even permit, the administration of narcotics to addicts for the purpose of addiction only. There must be sound medical reasons for a physician to administer narcotics to a patient, or to issue a prescription for them. If prescriptions are issued, they are treated the same as any other prescription and are filled by the druggist without direct charge to the patient under the Provisions of the National Health Scheme.
Withdrawal treatment can be performed in a few days in practically every case and without undue suffering on the part of the patient. Moreover, every addict can work better after he has discontinued the use of narcotics and has had a reasonable convalescence than he was able to do while he was addicted. When one sees the way addicts improve in weight and in their general health following discontinuance of narcotics, and how much better they are able to work, one realizes the lack of need for such over-cautious handling of addicts as is the custom in England
Even if Parliament were willing to amend the Opium and Narcotic Drug Act to permit legal sale, it would have to forego its obligations in the United Nations pacts to which Canada is a signatory, and in which Canada and other signatories are pledged to fight drug addiction.
There is no reason to think that by allowing addicts to be chronically under the influence of narcotics, they will improve their capacity for work or change their lifetime habits of delinquency
There is no reason to think that simply curing the addict of his addiction, or on the other hand, supplying him with all the drugs he wants at minimum prices, will solve his problem. In both cases there is the underlying personality distortion and antisocial tendencies which have to be recognized and dealt with. Supplying the addict with free or low-cost narcotics cannot be expected to change him into a mature, socially well-adjusted citizen. Whatever chance there is of helping him will have a better likelihood of success if he is first freed from narcotic domination
The next argument for legal sale is that it would eliminate smuggling and the illegal traffic generally. This surmise sounds as if it might be theoretically correct except for the fact that legal sale, under whatever form, never has defeated the illegal traffic. Legal sale in China and other Asiatic countries went parallel with illegal sale.
Theoretically, the addict would get his rationed supply from the "narcotic," but it is one of the certain facts about heroin use that larger and larger doses are required, because of the peculiar mechanism of "tolerance." To get the desired effect the dose has to be steadily increased. Unless the "clinic" is to sell the addict as much narcotic as he requests, he must go to illegal sources for the amounts he wants. The legal outlet becomes a sure source for only his minimum purchases. The illegal traackers will still supply the excess he wants at prices which would still involve the addict in crime to secure money for its purchase.
Moreover, the addict would still have difficulty maintaining good employment because employers know that the average addict is, to say the least, an unstable personality. If an employer has to choose between a person taking drugs (legally or otherwise) and a nonuser of equal ability, he would choose the nonuser. True, the employer might never know that the addict was such but it is difficult to keep ttsr of this sort a secret. The legally addicted addict would be an addict, and would still consider himself discriminated against if he lost his position or was unable to secure remunerative employment, and, as at present, might readily revert to crime and heavier drug purchases from the illegal market
The argument that if drugs were legal they would lose their glamour and would not appeal to adolescents is very questionable. Legal sale of alcoholic beverages has not made them unattractive to our adolescents. There is no reason to think that the predisposed persons who become today's addicts, and who become so in adolescence or early adulthood, would not have become drug users if narcotics had been legally procurable. Supportive evidence for this assertion is that 15 percent of this series of narcotic addicts had already become heavy users of alcohol (which is also, of course, a narcotic), even though alcohol was legally available. If morphine was available through legal sale there would undoubtedly be an increase in the number of people who would want to use it.
It is obvious that there is no ready or easy answer to the addiction problem. As most addicts have had unfortunate home and parental influences during childhood, constant efforts should be made to improve the home life of our children.
The immediate needs are for still more vigorous efforts by the police to combat the illegal traflic in narcotics. This problem is extremely ditlticult for a variety of reasons but should not be insoluble if enough planning and effort goes into it.
Although these arguments have been presented as objectively as possible, for the information of the medical practitioners of the province, it will nevertheless be obvious that the writer has been brought to the conclusion that the proposal for legal sale of narcotics, if adopted, would not only fail to solve the addiction problems but would actually make them more serious than they are at present.