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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:
COMMENTS by Mr. LYNN A. WHITE,
Deputy Chief of Police; co Personnel and Training Bureau, Los Angeles Police Department; head, Narcotic Division, Los Angeles Police Department
1. The report contains no new solution or thinking in the field.
2. It fails to explore the historical background of the conditions which brought about the enactment of the Harrison Act, which should be of extreme importance in evaluating the contemporary problem and in evaluating the effect of the Harrison Act. The same failure attaches also to the absence of inquiry into the addiction rates in other western countries in 1914.
3. The report is based primarily on a review of commonly known "selected" materials in the field and some conclusions are drawn therefrom. Other materials, vital to such a study, are ignored.
4. It ignores, or at least fails to report upon, the outstanding success the enforcement program has achieved in reducing the addiction rate of this Nation.
5. By the very nature of the treatment of the materials and limited selections thereof, and the absence of other critical materials, it appears that the committee and the writer of the report were predisposed to minimize the effects of the narcotic enforcement program and to propose the distribution of opiates to addicts through clinics.
6. The experiences of several States with the so-called clinic systems are dismissed only with a passing glance and summed up in the report with-"there is too little objective data concerning the operation of these clinics." Yet the clinic philosophy is adopted in the committee's recommendations without thorough research into or analysis of these earlier experiences.
7. The report appears to accept the theory that narcotic addiction is a "disease," yet avoids any reference to the fact that it is a contagious "disease." It also completely ignores the manner in which the "disease" is communicated, and offers no recommendation to the means through which the disease might be contained.
8. It fails to find that the current medical and psychiatric treat ment of narcotic addicts may be considered a near total failure which conclusion requires only an analysis of the abundant data which are available. But rather than tread in that sensitive field, it sidesteps with the statement-"It is not possible to measure the worth of treatment and rehabilitory measures without more data than has yet been accumulated on the rate relapse."
9. Even though the committee was composed of several members of the medical profession, it recommends the perpetuation of "disease" i. e., through the establishment of clinics, rather than cure when such cure is well known and established, i. e., the removal of the drug from the user.
10. The report, by absence of critical analysis, tacitly places its blessing on the so-called "English system" without any consideration of the sociological and other differences in the two nations.
11. The material contained in appendix B is hardly "an appraisal of national, British, and selected European and narcotic drug laws, regulations and policies," but rather it is st subjective treatment of the British system and a cursory coverage of several other systems.
12. It is highly significant (of the report writer's biased position) that no full discussions are made of nations whose severe or harsh prohibitory programs are, or have been, successful. Most noteworthy is the absence of any comment of the success which was resulting from China's program, prior to World War II.
Many other erroneous or misleading statements and conclusions in the report can be successfully refuted, but time does not permit an elaboration on other than several of those mentioned above. Some of following comments are based on this writer's observations and investigations of the problems of narcotic addiction, made during more than 20 years' experience as a narcotic officer and as a police administrator in one of the great cities of this Nation.
Success of The "Prohibitory Approach"
Ploscowe's statement that because we have more drug addicts any other western country, despite 40 years of enforcement of prohibitory laws, "raises doubts concerning the wisdom of the prohibitory approach to problems of drug addiction" [emphasis is mine], is utterly unsound and is completely unsustained by the facts; and is thoroughly false a premise, as it would be to conclude that after 40 years of effort (because we still had, in 1957, 400,000 active and 10 inactive cases of tuberculosis), our tuberculosis control program is an utter failure!
Ploscowes conclusion causes an informed person to doubt the validity,or at least, the objectivity of the entire study, for it ignores consideration of 40 years of changes in such vital factors as: )
(1) Population increase.--The population of the United States in 1918 was 103,203,000; today it is in excess of 170 million, an increase of 64 percent.
(2) Sociological Changes.--A lowering of the standards of morality; a current divorce rate that is 100 percent greater than in 1918; a juvenile delinquency rate that is disturbing the Nation; a general weakening of family unity; and a crime rate that is increasing at four times the rate of increase in our population, all add up to the conclusion that there has been a general deterioration in this Nation standards of social behavior in the past 40 years. (Accurate crime figures for 1918 are not in existence.)
(3) Narcotic Addiction rates. Of great significance is the port's failure to mention the grave national problem which brought about the enactment of the Harrison Act and to make a comparsion of the frequency of narcotic addiction in 1914 and now.
At the outset, this writer emphatically states that there are no accurate, complete records of our national rates of addiction available to anyone, anywhere. Therefore, any rates quoted by anyone merely subjective "estimates" and must be treated with caution.
Note.--In 1924, Rolb and Du Mes' concluded: "Some of the estimates mere guesses * * * It is impossible, at this time, to make an esact count persons addicted * * *."
* Lawrence Kolb and a. G. Du Mee, Prevalence and Trends of Drug addiction in the United States and Factors Influencing It. Reprint No. 924 From tbe Public Health Reports May 23, 1924 (pp. 1179-1204)
Like every general statement there are partial exceptions to above; two are worthy of mention: (1) The rejection rates for reason of addiction obtained through the conscription procedures during our two World Wars.
(2) Records of convictions of persons having been found "illegally" addicted to narcotics.
Prior to the enactment of the Harrison Act, it was "estimated" tha 1 person in every 400 used opiates. (Source: Kolb and Du Mez, p. 2 Statistical Digest, 1957, p. 5.) Thus, the United States had an "estimated" addiction rate of 2.5 addicts per 1,000 population prior to the enactment of the Harrison Act. If the pre-Harrison Act "estimated" rate had continued to present, we would now have 425,000 ADDICTS.
Examine now the "estimated" current addiction rate, and permit Ploscowe's observation concerning the Bureau of Narcotics' estimate, "There are indications that this estimate is too low"--to be given a 33 percent-plus weight (80,000 rather than 60,000) for possible error on the low side, and it discloses that this Nation's current narcotic addiction rate is 0.47 per 1,000 population.
THIS CLEARLY SHOWS AN 81 PERCENT REDUCTION IN THE ESTIMATED RATE OF NARCOTIC ADDICTION IN THE UNITED STATES SINCE THE ENACTMENT OF THE "PROHIBITORY APPROACH." However, since the above rates are highly subjective, less subjective rates available to the investigator must also be examined. The number of convictions for narcotic addiction cannot be used comparatively since there are no records of such violations 40 years ago. Therefore, the investigator must finally turn to the only reasonably comparative, nonsubjective data--the rejection rates, for reason of narcotic addiction in World War I and World War II.
The World War I rate was 0.75 per 1,000. (Source: Kolb and Du Mez, The Prevalence and Trend of Drug Addiction, etc., 1924.) the World War II rate was 0.10 per 1,000. (Source: Dir. Med. Statistics Div., Army Services Div., in letter to Commissioner Anslinger, September 1945.) It is therefore apparent that, from 1914-18 to 1941-45, this Nation experienced an 81 percent reduction in narcotic addiction in the very group (males 18 to 38) that contributes the greatest percentage of our contemporary addiction problem.
Is it coincidental that a comparison of the pre-Harrison Act and estimated rates indicates the same outstanding reduction in a as does the comparison of the most valid nonsubjective information available?
To what can this reduction be attributed? A resurgence of national morality? No! For during that period, commenced (and is continuing) the greatest period of lawlessness, immorality, divorce, and juvenile delinquency this Nation had ever known. Public education? This may have helped but to what degree, no one can measure.
Many other factors may have contributed none of which can be weighed; therefore, in the absence of such, one must conclude, AS MORE THAN COINCIDENTAL, that since the enactment of the Harrison Act the rate of addiction in the United Xtates has been drastically reduced.
Consider this sober question: In this tense, restless, problem-ridden era with its conflicts and anxieties, what would our narcotic problem have been today if the narcotic addiction rate had increased at the same tempo as have our other evidences of antisocial behavior during the past 40 years?
How could the enforcement program have been more successful?
The lack of objectivity in the "study" is again demonstrated by the failure to explore this critical question!
Plosscowe, himself, unwittingly provides, in part, an answer to this question:
*** inadequate recruiting and training of police officials, lack of specialized expert direction of police departments, political selection of chiefs and district attorneys, part-time and amateur administration in district attorneys' offices and courts, political selection of judges, lack of coordination between law enforcement agencies, lack of State supervision of local law enforcement, conflicts between uncoordinated law enforcement, inadequacies in the law of arrest, search, and seizure, and other branches of procedural law, etc.
Ploscowe fails, however, to report that in most areas, law enforcement has made greater advances in the past 25 years in matters of selection, training, techniques, interagency coordination, and in eliminating political interference, than have most other branches of Federal, State, or local governments.
The onset of this improvement may be said to have occurred at the time the FBI instituted the high standards of selection for own its agents and established the National Police Academy as well as the zone schools for local police. Those philosophies and teachings have continued to spread until now, they may be considered to be widely accepted in this Nation.
The gaps between Federal, State and local law enforcement agencies have been bridged solidly enough in many areas to indicate that much greater efficiency is attainable through more widespread cooperative effort.
Ploscowe neglects to comment on the many failures of the Congress, State, and local legislative bodies to provide sufficient funds for the selection of adequate numbers of narcotic enforcement officers, and to supply adequate funds for their training and investigative needs, Ploscowe again ignores the facts in stating:
Moreover, even if it were possible to eliminate the drug traffic through strict and uniform enforcement of narcotic laws, this objective is practically unrealistic. [Emphasis is mine.]
He needed only to examine the splendid results obtained under several of the States' systems to be aware that such is completely realizable. All of the weaknesses in the enforcement program Ploscowe mentioned have been proved to lend themselves to correction (with the aid of an aroused public and with the wholehearted support of the legislative and judicial branches) with far greater ease than has been the "cure" of narcotic addicts by any known method, other than enforcement.
What may be considered to be several of the greatest obstacles to a totally successful enforcement program, are mentioned, but only casually, in the report:
* * * the ambiguous provisions of some of our narcotic drug laws and in court decisions through which they have been, applied.
*** inadequacies in the law of arrest, search and seizure *** [Emphasis is mine.]
Both Ploscowe and the committee neglected to evaluate the debilitating effect (on effective narcotic enforcement) of such "unusual judicial legislation" as has appeared in recent court decisions in cases such as: Rochin v. Califomia, 342 U. S. 165; Irvine v. Califomia, 347 US 128; Jencks v. U. S. A., 353 U. S. 657; Lambert v. California 353 US 979; Mallory v. U. S. A., 354 U. S. 449; People v. Cahan, 44 Cal 2d. 434.
The committee also ignored in its "study," the ineffectiveness contributed by the many courts in meting out lenient or "token" sentences, particularly in those involving convictions for the sale of drugs.
The committee, before it "approved the substance" of the conclusion regarding the effectiveness of the enforcement program, should have certainly considered that there has never been a coordinated, "get tough" sentencing policy, in all of the State and Federal courts in narcotic cases. This is most unfortunate, for if the committee had but reviewed the salutary effect that a tough sentencing program had upon the frequency of the crime of kidnapping for ransom, after the Lindbergh law was enacted, surely they would have concluded, that strict enforcement and severe penalties may be real and effective methods of coping with crime.
This Nation is becoming increasingly aroused as more and more obstacles are erected by the courts to hinder law enforcement and to assist the narcotic peddler and other law violators to escape punishment.
This awakening was magnificently stated recently by the Honorable Burr P. Harrison, Representative, United States Congress, Winchester, Virginia:
I have asked the question: "In the struggle between the forces of law and order and those of crime and treason, on which side are the men who are the justices of the Supreme Court of the United States?" These nine men have opened the secret files of the FBI to the criminal; they have struck down criminal laws of the States; they have licensed the seller of filth and obscenity to the youth; they have assaulted the rights of officers of the law to arrest for felonies committed in their presence; they have swept away the power of police to fight crime by reasonable interrogation of suspects and by introduction evidence of voluntary and truthful confessions; they have decreed that the Congress of the United States, which this year spent $35 billion of the people's money to protect against communist invasion, has no power to control hostile communist activities in the United States or even make inquiry into Communist doings or to remove communists from Government payrolls; in countless other decisions, they have gladdened the hearts and built up the power of criminals and subversives. I ask you--on whose side do you think they are?
Was the committee aroused?
No! The committee ignored, in toto, an evaluation of one of the greatest causes why the enforcement program has not been a success.
Since the courts (in some cases, parole boards), not the police the prosecutor, ultimately determine the effectiveness of a law-enforcement program, why did the committee fail to consider this?
In good conscience, the committee could not have failed but to conclude, as Federal Judge Alexander Holtzoff did recently:
The victim of a crime must not be a forgotten man. His rights are much greater than those of a criminal. WHEN THE CRIMINAL LAW CEASES TO PROTECT THE PUBLIC, IT HAS FAILED OF ITS PURPOSE. (Emphasis mine. )
Had the committee been unbiased and thoroughly objective, its conclusion would necessarily have been:
Had the Federal, State and local governments provided carefully selected, adequately trained, narcotic officers in sufficient numbers; and with sufficient funds; joined with firm support from the prosecutors; and strong, vigorous action by the courts in their sentences and decisions; the narcotic enforcement program in this Nation would have been an overwhelming success today.
The "disease" theory
The report appears to adopt the finding that opiate addiction is a "disease." It is somewhat surprising, particularly since the committee included men of the medical profession, that this "disease" theory was not explored in a manner typical of the medical profession's investigation of other diseases. It has long been presumed by the writer that inquiry into disease by the medical profession is accompanied by an objective investigation of:
1. What causes the disease?
2. How is it communicated or "carried"?
3. How is it cured?
(1) What Causes The Disease of Narcotic Addiction?
The cause of narcotic addiction is so well established that it did not deserve more thorough investigation in the report. The report, however, fails to mention that addiction is a "permissive disease"; that the sufferers, except for those few who acquire the disease through medical treatment, and the insignificant number who acquire the disease under conditions amounting to fraudulent overtures, become narcotics addicts by self-administration; i. e., with and by their own permission. Therefore, narcotic addiction (particularly after an addict has once undergone a "cure") may be considered as a self-induced or, more pointedly, a "disease" resulting from self-abusive indulgence. In this sense, it is not a true disease such as tuberculosis or diphtheria nor may those who become self-infected be considered unfortunate victims of a disease of contemporary society acquired innocently in the course of normal, moral pursuit of life.
(2) How Is The "Disease" of Narcotic Addiction Communicated?
Information concerning the manner in which the "disease" is spread may be considered bountiful and readily available to the committee and, had they not chosen to ignore this, a vitally important aspect of their inquiry. (sic - editor's note. The above sentence is exactly as it was written. It was a structurally incomplete sentence in the original.)
Inquiry would have disclosed that the "disease" is truly "communicated" and, with the exception of the relatively few who "acquire" addiction through medical treatment, or who have easy access (doctors, and others in allied occupations) to drugs, it may be said that all other addicts are first induced into the use of the drug by the blandishments, enticements or urgings of other addicts or, in a small percentage of cases, by nonaddict peddlers.
The committee could have learned that addicts, when their supply is plentiful, are gregarious, and wish to share their pleasure with others. As a result of this, addicts have infected their friends, wives, sons, daughters, brothers and sisters, without the least compunction.
Then those infected, in turn, continue to "infect" others. This has been observed even in cases where the initial addict obtained his drugs by prescription for a legitimate pathology.
Therefore, it may be concluded that: ADDICTS BEGET ADDICTS.
It is difficult to assess the reasons why the committee ignored the contagion element of addiction. A cause of greater confusion however, is Ploscome's naive observation (App. A-p. 62):
The only value of jail or prison for the treatment of drug addiction is that the addict may be temporarily withdrawn from drugs during the period of incarceration.
It ignores completely that while the addict is confined he is not stealing and more important--HE IS NOT INFECTING OTHERS.
Does the committee recommend a program under which the contagion may be contained?--No.
It recommends the establishment of an "out-patient clinic" where the "carriers" of the disease may obtain the "virus" which will be carried away to be used to "infect" another "uninfected" person, who will become "infected," who in turn will present himself at the "clinic" to obtain more "virus" to "infect" another, ad infinitum.
Would any member of the committee, lay or medical, recommend that we repeal our Federal, State, and local quarantine laws which require the confinement of active tuberculars" Of course not.
Would they recommend establishing an "out-patient clinic" for the purpose of supplying active tuberculars with mycobacterium tuberculosis in order that the "infected" might maintain a constant continued level of infection?
More detailed comments concerning "clinics" will be made in further treatment of the subject.
(3) How is Narcotic Addiction Cured-The answer is known--deprive the addict of the drugs, and, historically, any other approach has been proved to be practically useless.
To one who has been associated with the problem of narcotic addiction for 20 years, the committee's failure to inquire more thoroughly into, and report upon, the efficacy of historical and contemporary medical and psychiatric treatment of addiction, is perplexing.
Abundant data are available to the committee which would have disclosed that the high rate of recidivism ("relapse") among addicts who have been "cured" at the various institutions in this country causes any informed, unbiased observer to conclude that the current medical and psychiatric methods of treatment are near failures.
Why the committee "sidestepped" an evaluation of the rate of "relapse" is difficult to determine.
How they could possibly find that, "it is not possible to fi measure the worth of treatment and rehabilitation measures mit: more data than has yet been accumulated on the rate of lapse***", when Pescor's work alone, should have permitted committee to make positive finding of near failure?
(Michael J. Pescor, "Follow-Up Studies of Treated Narcotic Drug Addicts," Sup No. 170 to the Public Health Reports, 1443. 18 p.)
Assuredly, such a reported rate of relapse for any other disease would normally cause the medical members of the committee to find the treatment anything but successful.
Surely, there is no justification for continued research on the subject of relapse, unless, of course, the committee hesitates to reach a conclusion without (the impossible) absolute data on this point.
This caution or reluctance to make findings and recommendations without objective, absolute data is not evident elsewhere in the report; e. g., the recommendation to establish an "out-patient clinic" is made without any sustaining datum.
The out-patient clinic recommendation, however, is, in effect, finding that current medical-pychiatric treatment has failed. Such inconsistency must, of course, be considered unintentional.
The committee also failed to inquire into the effectiveness of cures which have resulted from the sentencing of addicts to jails and prisons.
While this writer knows of no ready source from which this data can be immediately obtained, surely an objective study would have attempted to obtain and evaluate such information.
It has been this writer's personal experience with the many addicts he has known who have been "cured," more were "cured" by "jail treatment" than were "cured" by the "hospital treatment."
The "jail-cured" expressed it by, "I just got tired of having to 'kick' my habit 'cold.'"
(Admittedly, the above is a subjective observation.)
Why did the committee fail to inquire into the important question-After an addict is successfully cured does he return to society as a law-abiding citizen who has been fully rehabilitated or does he return to former criminal pursuits?
Considerable data of this nature can be obtained from the various prisons of this nation which should have permitted the committee to at least, a presumptive conclusion on this significant question.
From experience, this writer has observed that criminal addicts, who abstains from the use of drugs for any reason, nearly always resume their former criminal pursuits. (This predilection to crime ahs been observed even when an addict develops a pathology for which he ultimately receives his drugs by prescription.)
The outpatient experimental clinic for the treatment of drug addicts
Had the committee recommended that arthritics be treated with cincophen (a drug once widely used for arthritis; effective, but it destroyed the liver and the patient died), a conscientious investigator on addiction could not have been more startled than he is by the recommendation the Committee made:
*** that the possibility of trying some such out patient facility on a controlled basis should be explored, since it can make an invaluable contribution to our knowledge***
Ploscowe outlined a number of reasons why such procedures will not be, and have not, been successful which he and the committee steadfastly ignored.
Such a recommendation can only mean that the committee intended, the outset of the study, to make such a recommendation regardless of any evidence to the contrary.
Nowhere in the report is the committee's lack of objectivity and bias so pronounced as it is in clinic recommendation for to make such bommendation under guise of any other reason, the committee must concede it: (sic)
(1) Failed to objectively evaluate the experiences of earlier clinics and,
(2) Presumed that many physicians operating such earlier clinics were not competent, were inexperienced in planning, inadequately trained, and made mistakes.
They have here, as they have throughout the report, totally ignored the fact that the raison d'etre of our State and Federal Narcotic is:
To protect the people of the United States from becoming a nation dependent on drugs.
NOT ONCE IN THE REPORT IS THERE MADE ANY REFERENCE OR RECOMMENDATION AS TO HOW CAN WE KEEP THE UNTOLD THOUSANDS, NOT NOW ADDICTED, FROM BECOMING ADDICTED THROUGH ASSOCIATION WITH PERSONS WHO ARE NOW ADDICTED!
Why is the committee so preoccupied with the belief that a narcotic problems are limited to the 60,000-80,000 addicts' comfort or discomfort; or whether "unrehabilitable addicts can be transformed into productive members of the community if their drug needs are met?"
THESE ARE NOT THE PROBLEMS FACING THIS NATION!
The "problems" are:
(1) What can be done to prevent further spread of narcotic addiction?
(2) What can be done to reduce, to an irreducible minimum, this nation's narcotic drug problem? Sixty to 80,000 addicts are a very small group toward which to direct our national effort and certainly inconsistent with the total national interest. Therefore, to attempt to solve our national problem of addiction by perpetuation of the disease, i- e., by subsidizing the self indulgence of relatively few immoral people in order that they might be comfortable, or perhaps be rehabilitated, and all the while permitting them to "infect" other countless thousands, cannot be considered less than sheer blindness, perhaps worse.
This Nation became great, not by coddling the evildoers, or pampering the morally weak and perpetuating their immoral appetites, through vigorous action which removed them from our society -- so only will we remain a great Nation.
In recent years we have indulged our young criminals and have given them a nice title to describe their little acts of misconduct; we have "rehabilitated" our prisons' inmates; and then worried and fretted when they again repeated their little depredations against innocent victims; such "thoughtful consideration" has been so successful in reducing crime, that our Nation is now the most lawless in the world.
The committee's report at hand, we are again confronted with "do-gooders'" philosophies; obviously written by persons so concerned with the comfort of a few hopheads they would recommend a system whereby we could become, in time, a nation of drug addicts.
The time has come, if we are to survive as a nation, that we must return to the standards of morals and ethics of our forebears and again require adherence to the laws of our Nation by all. The clinic method of perpetuating the immoral weakness of a few is certainly not the road that will lead us back to a strong, vigorous, law-abiding nation.
The writer finds little with which to agree in the proposals the committee has made for future study. While this writer fully endorses further research and inquiry into an effective method for the cure of addiction, it is his opinion that effort and money should not directed to such ineffectual action as the gathering of more statistics regarding the "rate of relapse," but perhaps into such areas as the promise the physico-chemical field holds forth.
It is not advocated that the "hospital treatment" for the "cure" of narcotic addicts be abandoned. However, it is recommended that addicts, admitted for treatment in public institutions, be screened on selective basis--admitting only those who possess those qualifications which lend themselves to the greatest possible chance of successful cure.
Too long now, and too many millions of dollars of public funds been uselessly expended in admitting addicts to institutions only for the purpose of st "reduction treatment", without the slightest possibility of effecting permanent cures.
This phase of the narcotic addiction problem presents a most worthwhile inquiry the committee could have adopted. It may be stated as:
What criteria can be developed which will predict, prior to treatment at public expense, an addict's potential success or failure of cure?
A wealth of material is available for such a study and the potential savigs in money and manpower are incalculable.
To one, who over two decades, has been close to the problems stemming from narcotic drugs, the report is a deep disappointment. For it clearly indicates that well-intentioned men are still blindly floundering around in the darkness--all the while disdaining the helpful hand of recorded historical enlightenment.
If only the committee and Judge Ploscowe followed the dictum Patrick Henry, who in March 1775 said:
I know no way of judging the future but by the past,
a report would never, in good conscience, have been written.