Drug Addiction, Crime or Disease?

Interim and Final Reports of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs.

Summary and Recommendations of Report on Narcotic Addiction

by the Council on Mental Health of the American Medical Association (1956)

SUMMARY

1. Study of the operations of clinics which dispensed drugs to addicts between 1919-1923 shows that data available on these clinics are not sufficiently objective to be of any value. The clinics were set up hastily as emergency measures, did not have well defined objectives, were inadequately staffed, and made little effort to rehabilitate addicts. There is no doubt that there was some abuse of the clinics, but the extent of the abuse is undeterminable.

2. The medical profession played a major role in formulating a policy which led to closing the clinics.

3. The best evidence indicates that the incidence of addiction in the United States has declined since passage of the Federal Narcotics laws. During World War II, the number of addicts reached an all-time low, probably because of the decline in illicit traffic, due to war-time conditions.

4. Addiction in persons under 21 years of age has also increased since World War II. The extent of adolescent addiction, however, does not justify the degree of public alarm which has arisen. Adolescent addiction is not a new phenomenon.

5. The greatest incidence of addiction occurs in minority groups residing in the slums of certain large cities. Such areas have the highest rates of delinquency, alcoholism, crime, and mental disease, as well as of addiction.

6. Deliberate proselyting by drug peddlers in order to expand their market plays only a minor role in spreading addiction; rather, addiction spreads from person to person. Initial doses are usually supplied to the neophyte by a friend, and as a friendly gesture.

7. The most common psychiatric entities associated with addiction are personality disturbances and character disorders.

8. Opiates do not directly incite persons to commit violent crimes. Crimes committed by addicts are usually crimes against property. A proportion of addicts - various sources give figures ranging from 25 to 80% - have records of delinquent activity prior to addiction.

9. Current treatment of addiction is unsatisfactory. The relapse rate, though not known exactly, is high. One possible reason for such poor results is the lack of post-institutional treatment.

10. The advisibility of establishing clinics or some equivalent system to dispense opiates to addicts cannot be settled on the basis of objective facts. Any position taken is necessarily based in part on opinion, and opinions on this question are divided.

RECOMMENDATIONS

1. Improvement of the care of addicts.

It is recommended that the American Medical Association continue to study and to support reasonable proposals designed to improve the treatment and prevention of drug addiction. Such measures might include:

(a) Development of institutional care programs in cities and states with significant problems.

(b) Study of various means to obtain institutional care in states with small addiction loads. One such proposal is for several states to set up an institution which could be operated jointly.

( c) Development of programs for intensive post-institutional treatment of addicts. Such measures would include supplying of various social services, vocational rehabilitation and, where possible, psychotherapy to addicts for adequate periods following discharge from institutions. In many instances, available facilities in other programs might be utilized. States with serious problems should develop special programs for addiction.

(d) Development of methods for commitment of addicts to institutions by civil action rather than through actions in the criminal courts. In this connection the Council further recommends that where civil commitment procedures can be used criminal sentences for addicts who are guilty only of illegally possessing and obtaining opiates, marihuana, and cocaine should be abolished. Criminal sentences for illegal sale of narcotics should be retained but persons who are addicts and who are sentenced for such offenses should have the same opportunity for probation and parole as is afforded offenders against other laws. Mandatory minimum sentences for addict violators would interfere with the possible treatment and rehabilitation of addicts and therefore should be abolished.

(e) The Council strongly recommends that the policy of voluntary admissions for the treatment of addiction should be continued, extended and encouraged.

(f) Continue support and expansion of mental health programs. Because of the importance of psychiatric factors in addiction, such programs should eventually have an effect in reducing addiction even though not specifically aimed at that problem.

2. It is recommended that the American Medical Association support proposals for increased research on the problems of addiction. One of the current difficulties in formulating adequate programs is lack of knowledge which can be gained only through research. Support should be given not only to "basic" laboratory investigations but also to continuation of sociological studies, and to an intensive program of clinical research based on adequate facilities for following addicts after institutional discharge. Such research might yield results that would be valuable in areas other than addiction.

3. Clinic Plans. In view of all of the available evidence at the present time it does not seem feasible to recommend the establishment of clinics for the supply of drugs to addicts. This is true for the Eggston resolution and the plan of the New York Academy of Medicine even though there are many aspects of these plans that could be looked upon with favor. This opinion should be subject to frequent review in accordance with new scientific knowledge that may become available.

4. It is recommended that the American Medical Association continue to study the narcotic laws with the view of further clarification of the rights and duties of physicians and allied professional persons in the handling of addicts.

The phrases in the current law "... in the course of professional practice only" and "prescription," remain vague and confusing, despite Supreme Court decisions. Regulations on dispensing drugs to addicts should be eased so that the patients can have a reasonable time to arrange their affairs prior to entering a hospital for treatment. The 1924 Resolution of the House of Delegates should be revised.

Consideration should be given to broadening the Resolution to include a plan endorsing regulations somewhat similar to those currently in force in England.