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.

FINAL REPORT

of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs

FINAL REPORT RECOMMENDATION

The joint committee recommends to the House of Delegates of the American Bar Association and the House of Delegates of the American Medical Association that its activities as a special committee be terminated; and that the study of the narcotic drug traffic and related problems, initiated by it, be carried forward cooperatively through appropriate instrumentalities and research facilities within the permanent structures of the two associations.

REPORT

In this report the Joint American Bar Association-American Medical Association Committee on Narcotic Drugs is completing its original assignment as set forth in the A.B.A. House of Delegates resolution of February 22, 1955, "To explore with the American Medical Association the possibilities of a jointly conducted study of the narcotic drug traffic and related problems..,"* It's principal conclusions are two: that present methods of dealing with narcotic addiction and narcotic addicts raise questions which are urgently in need of study; and that the legal and medical professions, equally concerned, can most fruitfully pursue the subject in close cooperation through their respective associations.

* 80 A.B.A. Rep. 408 (1955).

In passing, it is noted with great satisfaction that the joint committee's two years' work has been, in view of all concerned, a rewarding and eminently successful experiment in inter-professional cooperation.

The joint committee offers its observations and tentative conclusions here, and recommends its own dissolution, because it has reached a point where it believes the full resources of its parent associations must be called into play. The research it deems necessary seems too extensive to be undertaken by a temporary committee--when both associations support permanently organized research foundations precisely designed for such projects; and the policy determinations which must ultimately be made lie within the jurisdiction of permanently constituted divisions within both parent bodies.

With the aid of a grant from the Russell Sage Foundation, the joint committee has completed a factual analysis of present policies and present knowledge concerning narcotic addiction and the control of narcotic drugs, which was submitted with its interim report to the A.M.A. and A.B.A. House of Delegates last year. This interim report, with its appendices, contains information concerning the medical, social and legal problems confronted in dealing with drugs and drug addiction in the light of existing policies and available knowledge. It does not attempt to provide solutions, but does reflect a degree of dissatisfaction within the legal and medical professions concerning current policies which tend to emphasize repression and prohibition to the exclusion of other possible methods of dealing with addicts and the drug traffic.

The interim report recommends additional research in five major areas:

1. An experimental facility for the outpatient treatment of drug addicts, to explore the possibilities of dealing with at least some types of addicted persons in the community rather than in institutions.

2. An extensive study of relapse and causative factors in drug addiction.

3. The development of sound and authoritative techniques and programs for the prevention of drug addiction.

4. A critical evaluation of present legislation on narcotic drugs and drug addiction.

5. A study and analysis of the administration of present narcotic laws.

The joint committee urges that the above projects and studies be carried on under the auspices of its parent associations, in order to provide additional experience and data needed to appraise alternative methods of controlling narcotic addiction and dealing with the drug addict.

In making these recommendations, the joint committee is aware that they may encounter opposition from those who tend to view the drug problem as essentially a problem of criminal law enforcement, and specifically that the United States Narcotics Bureau has indicated that it will oppose them. The joint committee regrets this attitude demonstrated by the Narcotics Bureau. In the committee's opinion, the Narcotics Bureau, together with all other persons and agencies interested in the problem, should welcome research in the areas which have been indicated. The narcotics problem is too important to be insulated from intensive study and investigation.

While zealous law-enforcement efforts have unquestionably played a part in reducing drug addiction--and will indisputedly continue to be required in curbing the illicit drug traffic--experience has not demonstrated that the laws and enforcement policies urged by the United States Narcotics Bureau provide the full answer to the problem.

On the contrary, experience suggests that further investigation of the problem is essential. The joint committee trusts that nothing- will be permitted to hamper inquiries which may lead to fruitful results, and which should, at the very least, provide a factual basis for appraising alternative roaches to the problem.

On the basis of its studies and deliberations, the joint committee has reached the following conclusions concerning narcotic addiction and methods of dealing with narcotic addicts, which it submits for the purpose of indicating the need for further studies along the lines recommended above, and with the hope that these conclusions, although subject to reappraisal in the light of additional data, will be serviceable guides:

1. There appears to have been a considerable increase in drug addiction in the United States immediately following World War II; the increase was most apparent in the slum areas of large metropolitan centers and especially among minority groups in the population.

2. As a result, the federal government and many states passed legislation imposing increasingly severe penalties upon violators of the drug laws, as a means of dealing with the apparent increase in addiction.

3. This penal legislation subjects both the drug peddler and his victim, the addict, to long prison sentences, often imposed by mandatory statutory requirements without benefit of the probation and parole opportunities afforded other prisoners.

4. Though drug peddling is acknowledged to be a vicious and predatory crime, a grave question remains whether severe jail and prison sentences are the most rational way of dealing with narcotic addicts. And the unusual statutory basis of present drug-law enforcement, substantial federal domination in a local police-power field established by means of an excise measure enforced by a federal fiscal agency, invites critical scrutiny.

5. The narcotic drug addict because of his physical and psychological dependence on drugs and because of his frequently abnormal personality patterns should be as much a subject of concern to medicine and public health as to those having to do with law enforcement. But the ordinary doctor is not presently well equipped to deal with the problems of the narcotic addict, and even his authority to do so is in doubt.

6. The role of medicine and public health in dealing with drug addiction and the drug addict should be clarified. There must be a new determination of the limits of good medical practice in the treatment of drug addiction, and an objective inquiry into the question whether existing enforcement policies, practices and attitudes, as well as existing laws, have unduly or improperly interfered with good medical practice in this area. As part of this evaluation, consideration should also be given to the possibility of helping both the addict and persons formerly addicted through open clinic facilities as well as in closed institutions such as Lexington and Fort Worth.

7. It can be stated emphatically that no acceptable evidence whatsoever points to the indiscriminate distribution of narcotic drugs as a method of handling the problem of addiction. On the contrary, the use of such drugs, except for legitimate medical needs, should be discouraged by the best available means. Individuals who have become addicted should be given the benefit of all known medical and paramedical procedures to encourage them to withdraw from dependence on narcotic drugs voluntarily; those who have withdrawn should be given psychiatric and social-agency help as long as necessary to assure against relapse. We need much more information than is presently available about the best means of handling addicts who, despite the best professional efforts, continue to be dependent on drugs. An experiment conducted by experts (as proposed above in this report) should be charged with getting information on this point.

8. There is a high rate of relapse on the part of addicts who have been in the care of narcotics hospitals and installations for the treatment of addiction. The real reasons for this must be determined. Factors to be considered include the physical and personality make-up of the individual, the social pressures applied to him, both adverse and constructive, and the attitude and sophistication of medicine and the law regarding addicts and addiction.

9. some responsible authorities state that the physical and psychological dependence of addicts on narcotic drugs, the compulsion to obtain them, and the high price of the drugs in the illicit market are predominantly responsible for the crimes committed by addicts. Others claim that the drug itself is responsible for criminal behavior. The weight of evidence is so heavily in favor of the former point of view that the question can hardly be called a controversial one.-But this point is so fundamental to the development of a sound philosophy of management of the problem that any residue of reasonable doubt must be resolved. )In this connection the joint committee deplores the hysteria which sometimes dominates the approach to drug addiction problems by persons in positions of public trust. In terms of numbers afflicted, and in ill effects on others in the community, drug addiction is a problem of far less magnitude than alcoholism. Crimes of violence are rarely, and sexual crimes are almost never, committed by addicts.

In most instances the addicts' sins are those of omission rather than commission; they are ineffective people, individuals whose great desire is to withdraw from the world and its troubles into a land of dreams.

10. It appears that neither compulsory hospitalization of all addicts nor permanent isolation is practicable at the present time. Hospital facilities to deal with narcotic addicts are not adequate in numbers, staff or program, and the permanent isolation of addicts, even if feasible, would not be a solution but only a temporizing maneuver--the very antithesis of the medical and scientific approach to the physical and behavioral problems of man.

The foregoing recommendation and report will be submitted to the House of Delegates of the American Medical Association with resolutions similar to those appended hereto, merely conformed to adapt the language of the resolutions to A.M.A. purposes. The object of the resolutions is to continue cooperation between the two associations in further mutual efforts along the lines suggested in this report and the joint committee's interim report.

It is firmly believed by the joint committee that the work it has already done clearly indicates a need for further joint efforts, carried on by both associations through permanent instrumentalities which have greater continuity, more facilities, and a broader mandate than the joint committee. Accordingly, favorable action on this report and its appended resolutions is respectfully urged.

For the American Medical Association:

C. JOSEPH STETLER

R. H. FELIX, M.D.

ISAAC STARR, M.D.

For the American Bar Association:

RUFUS KING, Chairman

EDWARD J. DIMOCK

ABE FORTAS