Some Basic Problems in Drug Addiction and Suggestions for Research*

III. THE EXTENT OF DRUG ADDICTION

It is impossible to give any exact estimates of the number of drug addicts in this country. Nor can one with full confidence determine the basic question as to whether drug addiction is increasing or decreasing. The strong social disapproval of the use of opiate drugs and the police pressures against drug users and traffickers necessarily cause drug addicts and drug takers to conceal themselves from strange or unfriendly eyes. They do not come into the open to be counted. Any statistics with respect to the extent of drug addiction must, therefore, usually be based on apprehended addicts or apprehended users of drugs. If we knew what proportion of drug addicts or users are arrested every year, we would have a reasonable basis for estimating the extent of drug addiction in this country. Unfortunately, we do not know the proportion that arrested drug addicts or drug users bear to the total addict and user population. Moreover, increases or decreases in the number of arrests are just as likely to reflect increases or decreases in police activity rather than an increase or decrease in drug use or drug addiction. A further complication is the fact that a person arrested as a drug user may not necessarily be an addict, even though he may be so classified by the police. Thus, any statements with respect to the extent of drug addiction and its changes from year to year must be viewed with a considerable degree of reserve and caution.

In 1924, Dr. Lawrence Kolb and A. G. DuMetz12 conducted a survey of the extent of narcotic addiction for the Public Health Service. They came to the conclusion, on the basis of an analysis of surveys of narcotics use, reports on narcotics clinics, statistics on narcotics imported into this country, interviews with physicians and other data that the maximum number of addicts in the U. S. was 150,000. However, Kolb and DuMez believed that the figure of 110,000 addicts for the country in 1924 was more "nearly correct." They also believed that the number of addicts had decreased steadily since l900. Before this decrease set in there may have been 264,000 addicts in this country. The careful analysis of Kolb and DuMez was criticized by Terry and Pellens, who believed that this estimate of 110,000 addicts for the country was too low: "We cannot agree that the ultimate estimate of 110,000 is warranted. While we on the one hand deplore sensational exaggerations, on the other hand we recognize the danger of basing maximal estimates on selected data."13 Until the second World War, the reports of the Bureau of Narcotics were full of statements concerning the reduction in drug addiction. For example, the 1935 Report states: "This recent survey shows that the total number of non medical addicts in the U. S. has decreased to the extent that there is now less than one addict known to the authorities in every thousand of the population"14 A similar comment is found in the 1937 Report: "From the present study it is evident that addiction has decreased to the extent that there are now less than two addicts known to the authorities in every 10,000 of the population."l5 Shortly after the second World War, the use of narcotic drugs appeared to have spread with epidemic force in the slum areas of our large cities, particularly among minority groups of the population. Negroes and Puerto Ricans were especially involved in this increasing use of narcotic drugs, particularly heroin. We do not have any specific statistics on the Puerto Ricans, but the fact that large numbers of Negroes were arrested in recent years for violations of the narcotics laws is apparent from the following figures. In Chicago in 1954, there was a total of 7,639 narcotics arrests; 6,601 of these were Negro arrests, 752 were White arrests and 286 were classified as "other races." In Detroit in the year 1955, Of a total of 1,812 arrests, for violations of the narcotics laws, ,593 were classified as Negroes; 184 were classified as White; 12 were classified as "Yellow"; and 23 were classified as Mexican. The Bureau of Narcotics made a survey of addicts in the United States in the year 1953-1954. Its report noted a total of 6,957 addicts in the Illinois, Indiana and Wisconsin areas; of this number 6,057 were Negro; 916 were listed as Caucasian and 2 were listed as Oriental. In the New York, New Jersey area, of a total of 7,931 addicts, 4,740 were listed as Negro; 3,037 were listed as White, and 160 were listed as Orientals. It should be noted that the ratio of male to female among the persons arrested for violation of the drug laws is approximately 5 to 1.* *For example, in Chicago in the year of 1954, of the 7,699 arrests for violation of the narcotic laws 6,182 were male and 1,457 were female. In New York in 1956, of a total of 6,098 arrests, 5,082 were male and 1,061 were female. In Detroit in the year 1955~ there were 1,812 arrests of which 1, 454 were male and 318 were female.

The most disturbing feature of the increasing resort to the use of narcotic drugs in the post-war period was the apparently increasing use of heroin by adolescents and "teenagers." As the Boggs Committee put it: "In 1948 an upsurge in addiction and an outbreak of teen-age use of narcotic drugs occurred. By 1950, narcotic addiction approached grave proportions in certain metropolitan areas of the country."16 A similar conclusion was reached by the New York Attorney General's Survey, 1952: "The investigation revealed with disturbing clarity that (a) Narcotic use and addiction ...has increased in tremendous fashion since World War II and particularly in the last two years.

(b) The disease has spread with alarming rapidity through the ranks of our adolescent society."17 A Chicago study of drug addiction made in 1952 determined that there were 5,310 individual drug addicts in the City of Chicago, "slightly more than 1/l0th of 1% of Chicago's 1950 population." Upwards of 90% of these persons acquired records as drug addicts during the five years 1947-1952. Males made up 83% of this drug user and addict population. Moreover, more than 4/5ths (84%) were non-white.

Public concern with the apparent increase in the use of drugs after World War II led to a spectacular rise in arrests for violations of the narcotic drug laws. Arrests for violations of narcotic laws appear in the table on pages 32-33.

It is apparent from the table below that arrests for narcotics violations of all types in New York were 712 in 1946 as against 5,965 in 1956; in Chicago the comparable figures were 424 and 9,011; in Los Angeles, 1,166 and 5,091; in Detroit, 339 and 2,646.

There appears to be little doubt that drugs like heroin were readily available in many of the slum areas of our larger cities in the post-war years, despite considerable pressure from law enforcement. This availability of heroin, together with a social and cultural climate in the areas which favored drug use, undoubtedly encouraged many teen-agers and many young adults to try heroin. This experimentation with drugs like heroin must have inevitably increased the drug addict population in this country. Just how much of an increase has resulted from the increased availability and the increased experimentation with heroin, it is difficult to say.

Despite the difficulties in determining the exact number of addicts in the country, the need for data on the extent of the problem has brought about a considerable acceptance of the Bureau of Narcotics' statement that there are almost 60,000 addicts in the country.l8 This estimate was accepted as reasonably accurate in the report to the President of the Inter-Departmental Committee on Narcotics.l9 "Many and varied estimates have been made as to the number of persons in the U. S. addicted to narcotic drugs. The Committee regards the current estimate of the Bureau of Narcotics as the most accurate available. This estimate of 60,000 is based on the records of its own agents and cooperating state and municipal authorities." "While there are far less drug addicts in the Nation today than there were before the Harrison Narcotics Act was passed and before the Federal Bureau of Narcotics was created, the figure of 60,000 addicts today is far more than the number reported by other western nations." There are indications that this estimate of 60,000 narcotics addicts for this country is too low. For example, a recent California report to the Attorney General on Narcotic Addiction stated: "What is the extent of addiction in California? No one knows with any degree of accuracy. It’ s known that we have in our State medical files some 32,000 persons who are legally using narcotics medicinally, although a certain percentage of them may be using it illegally because they are going to several different doctors concurrently The state criminal files reflect that there are approximately 10,000 additional illegal traffickers or users of narcotics in California. It is believed that 10,000 represents approximately one-half of the total illegal addicts in this State. Our estimated total, therefore, would be 32,000 medical or legal users and probably 20,000 illegal, a total of 52,000 persons.-If it is true that there are at least 20,000 illegal users of opiate drugs in California alone, then it is questionable that there are only 40,000 more addicts in the rest of the United States. It appears to be obvious that the exact number of drug addicts in this country is unknown. However, it is apparent that whatever the extent of drug addiction in this country may be, as Terry and Pellens pointed out almost 30 years ago: "The surveys and estimates indicate sufficiently the existence of a major medical-social problem.... As a matter of fact it is not necessary to know the exact number of users or even the minimal extent to realize that there are a large number in the country and that the problem is serious."21