For as long as the U.S. has been a nation, it’s had a substance-abuse problem. In its early years, Americans consumed staggering amounts of alcohol: from 5.8 gallons of pure alcohol per person in 1790 up to 7.1 gallons per year by 1830. The misery and waste caused by drunkenness prompted many Americans to beg for laws that would outlaw liquor.
But alcohol was just one addictive substance. Opium was widely used before the 20th century, and its drawbacks were not recognized early. Throughout the 19th century, opium was a common ingredient in patent medicines that relieved any pain or discomfort, from teething to kidney stones. Ben Franklin and Thomas Jefferson were both known to imbibe laudanum — a preparation of alcohol and opium — to ease pain in their later years. Morphine, an injectable form of opium, was developed in time to ease the suffering of wounded Civil War soldiers, in many cases leading to lifelong addiction.
As the century wore on, people began to notice the addictive and detrimental effects of this drug and, well before the Prohibition Era, started limiting its use. In 1875, San Francisco passed the first anti-drug law, banning opium parlors — though this was as much an anti-Chinese law as it was anti-drug.
By the 1900s, the abuse of opiates had become so widespread that the federal government intervened. Under the Food and Drug Act of 1906, patent medicine manufacturers were required to state if their wares contained opiates, cocaine, alcohol, or other intoxicants. In 1914, six years before prohibition of alcohol, the Harrison Narcotic Act regulated the production, import, and distribution of opium, even among doctors.
But as Judge William McAdoo reports, it was still a serious problem that occupied much of his efforts in the New York City courts in the early 1920s. With a wealth of experience dealing with addicts, he describes the realities of their lives, their habit, their character, and their chances for recovery.
We tend to think that booze was what made the ’20s roar, but drug abuse added to the frenzy of those times.
Narcotic Drug Addiction as It Really Is
Excerpted from an article originally published on March 31, 1923
There is an almost unbroken line of statements from drug addicts among men that they began taking drugs at public dance halls and all-night or late-at-night resorts. Here is a young fellow who has worked at an honest employment all day. He has swallowed a hasty meal, dressed himself up, gone to meet his steady-company girl, and the couple have brought up at a ball or a dance that will continue during the night. As the hours go on he becomes intensely fatigued, but he notices how wide awake appear the rivals for the favors of the other sex. They are apparently quite fresh, and are dancing and drinking without any signs of physical exhaustion. One of these young fellows whom he knows takes him out into the hall and drawing out of his pocket a small vial of heroin tells him: “Take a snuff of this. It will brighten you up.” So far as he is concerned, that is the beginning of the road to ruin, physical, mental, and moral. The addicts positively assert that a week’s use of a drug is sufficient to form the habit. This young fellow now has brightened up from the effects of the stimulant. The sleepy feeling has rolled away like a fog before the breeze, all his faculties are alert. He takes another dose in the morning before going to work — and this lamp that lights the dismal way to the caverns of despair has to be kept constantly fed during the years to come.
Sometimes you shudder as you look up at a stalwart young fellow riding on a steel beam on the 20th or 30th story of a building under construction, or tossing and catching red-hot rivets thrown as far away as 30 or 40 feet from the fire. It would seem unbelievable that this man, suspended in midair, with so cool a head and steady a nerve, was a drug addict, but in my experiences here I have found a few such cases. And the same is true of jockeys who have ridden horses for big stakes at the great race courses of the country. They will tell you that so long as they can get a full supply of the drug they have a steady nerve for these dangerous occupations, but they will readily admit that should they not get doped up, as they call it, before they undertake some especially hazardous task, they would undoubtedly fail. The lamp must be fed, the wick trimmed, and the fire alive, or it is darkness and ashes.
There is one thing that makes drug addiction much more serious than drunkenness from alcoholic liquors. The drunkard cannot conceal his vice. He may drink in secret, but he is sure to be found suffering from the effects of his drinking. If he is married, his wife and children will discover his condition; if he is unmarried, his parents and the other members of the family will know about it; and all their combined efforts, as may be found in painful cases, will not prevent detection by friends and neighbors. But the addict may be taking the drug for years without its being known by his family or immediate friends. This fact is so well known that it often gives rise to very unjust suspicions against persons who are entirely free from the habit. Mental deterioration, eccentricities in behavior, loss of memory, a vacant stare in the eyes— all these will frequently be regarded by unfriendly persons as indications that a man is taking drugs, whereas all these appearances may be from quite other causes.
This inability to detect the addict makes the vice eminently a secret one. The drunkard has difficulty in hiding his bottle, but the addict carries a vial not larger than the small finger of the hand. If he takes hypodermic injections, the needle is easily concealed. If he cannot get the needle, which is prohibited by law, he will puncture a hole in his flesh and insert the fluid from an innocent-looking eye dropper, savagely punching the hole big enough to insert the end of the blunt dropper.
Addiction, therefore, can be carried on so secretly that the addict becomes covert and illusive in his manner, suspicious, untruthful, deceptive. When needing the drug and without money to purchase it or lacking opportunity to get it, he is likely to resort to courses involving crime, and to cruel deception of those interested in him. This is one of the very unfortunate circumstances connected with drug addiction which makes the addict in many cases the potential criminal, and when a real one, much more desperate and dangerous than those persons who are normal and under no artificial stimulus to the commission of crime.
Are Drug Addictions Curable?
Away back in the old days when drug addiction was unknown and alcohol and drunkenness were prominently featured in press and on platform, what pathetic things used to be said about the callous and unsympathetic nature of the drunkard; how indifferent he was to appeals to any remnants he had left of self-respect, to his obligations to those dependent on him as father and husband. However correct this view of the drunkard may have been, its truth has certainly been demonstrated with regard to the addict, so secretive and cunning in obtaining the drug and administering it to himself. His moral deterioration is much more rapid than his physical decay. He will lie and steal to get the drug, and he has ceased in an alarming degree to regard all social obligations. I shall refer hereafter to how hard, callous, cruel, and indifferent the addict shows himself in the presence of the appeal of mother and father, wife and children.
In outward appearance and demeanor, he appears to be as stoical as [James Fenimore] Cooper pictured his red warriors facing death. Self-respect and hope are dead, and a cruel and dominant selfishness has taken their place. He must have the drug or he suffers tortures beyond description. Life means the drug. Existence without it is impossible. Under the influence of the drug, he is blind to all surroundings except those channels by which he can obtain it. He is deaf to all pleadings. No sympathies can hold him back when the narcotic demands are pulling him forward. …
Is there any standard treatment by which the addict can be cured? Is there any hope in medication or even in surgery? Speaking as a layman and only in the light of experience, I am compelled to say that, depending on medical treatment alone, I think there is none. I mean by that that I have never heard nor do I know of any prescription or any treatment by medication that can cure a drug addict. It is quite true that the acute symptoms and seemingly the desire for the drug will, under custodial care, disappear for the time, but in a great majority of cases, once freedom is gained, the drug addict goes back to its use. In weaning the drug addict from his addiction there are two different treatments known to those in charge of hospitals in which these patients are segregated, and very often a drug addict will come here and ask to be sent to a particular hospital because he prefers the sort of treatment at that institution to the other. The end of both treatments, is, of course, the same — to purge the system of the poison, alleviate the disease, take away the craving, and bring the patient back to normal conditions. …
Practically all addicts admit that the usual course is to return to the drug after treatment and that they know that it is lack of self-control and the condition of mind that drive them to it. I make it a rule to impress on the addict when he leaves the hospital that he must never on any occasion go with another addict. “Do not keep company with any other person who is an addict or whom you suspect of being one, even if he is your own brother or a member of your family.” When two addicts get together, their relapse is inevitable. Mental depression, physical suffering, financial distress, comparison of symptoms—and they both go back to the old remedy, which they look upon as opening the door to an artificial and easeful world. Their cares and sorrows are temporarily dropped, only to be added to like compound interest on an unpaid debt.
Federal and Local Laws
The first wave of popular excitement about drug addiction in New York occurred in 1913, and as is usual in such matters the public was aroused from indifference to apprehension and alarm. Legislation was hastily drawn and readily enacted.
First there was the Harrison Law — federal — and then in New York State, there were various enactments and the creation of a narcotic drug commission; special committees of the legislature were appointed to investigate the subject, a great deal of testimony was taken and modifications of the amendments to the existing laws were made. Finally all were expunged from the statute book in 1920, leaving at this writing only the ordinance of the city of New York covering the subject, and now there is an organized effort to restore state legislation.
All the state enactments were restrictive as to use, and punitive. They allowed the doctor to prescribe for the ambulatory case — a person who goes to a doctor and gets a prescription for a drug and uses it without personal supervision by a physician or anyone else is called an ambulatory case — but they compelled the doctor and the druggist to keep strict records of prescriptions and sales. They made possession without a doctor’s prescription a crime. They compelled the reporting of cases to the Board of Health. They made provision for the institutions where addicts could be committed for treatment. They provided for the punishment of dealers and peddlers. I think they did not go to the root of the evil, but I am not condemning them. As for the present New York City ordinance, we could not very well get on without it.
Last year Congress appropriated $6 million to enforce prohibition against alcohol. The Treasury Department is now earnestly requesting that it be given sufficient money to enforce the Miller Act — that is, the drug-control law. It seems to me, considering this evil, that the enforcement of the Miller Act is certainly, without making comparisons, of vast importance to this country. As I understand it, up to this time no appropriation has been made to enforce the Miller Act.
Having taken part in many public discussions by doctors and laymen, representatives of organizations and individuals on this question of drug addiction and the treatment of addicts, I became convinced that if we are to go to the root of the evil, so far as the law is concerned, it must be by way of federal legislation.
The federal law, known as the Harrison Act, passed in 1914, aimed chiefly at controlling the sale and distribution of narcotic drugs within the United States and required of druggists and physicians that they should make returns of their actions with reference to these drugs on blanks furnished to them. Practically it was intended that the doctor should act in good faith as to the diagnosis and prescribe professionally in decreasing doses, and not merely cater to the craving of the addict; and that the sales by the druggist should be strictly inspected and accounted for.
Following this, New York enacted a law somewhat on the same lines and providing for a narcotic-drug commission. After this law was repealed, the health commissioner of New York City, having large legislative powers under the charter, called together a committee, of which I was a member, to formulate enactments covering the situation, to be added to the Sanitary Code, and these were the pertinent questions in connection therewith:
Can a drug addict be cured by getting prescriptions from a physician to be filled by a druggist while the addict is at large and without any custodial supervision?
Is it absolutely necessary, in order to undertake the cure and reformation of the drug addict, that he should be put in some institution under supervisory direction and custodial authority?
Considering that at present most of the addicts — of the poor and working type, at least — buy their drugs from peddlers selling smuggled stuff, is this condition more dangerous than if the addicts resorted to certain types of conscienceless physicians with unrestricted liberty in prescribing? If the physicians were unrestricted in prescribing, would the addicts not get at the drug stores an article more potent than the smuggled stuff and for less money, and would this not really increase the number of addicts?
Before that committee, a sharp line of professional opinion was exhibited by those physicians who were backed by official action of the American Medical Association, that a physician should only administer narcotic drugs and not prescribe them, against those who favored prescription and hospital treatment, private and otherwise.
The federal district attorney for New York presented the case of one physician who issued thousands of prescriptions during one year to drug addicts, evading the law with deliberate cunning, and who had reaped a fortune from this cruel and conscienceless practice. Of course men like him are not representative of the medical profession, but they were sufficient in number in New York to make it easy for any addict to get as much of the drug as he wanted. In one case prescriptions were kept in bundles ready for use, just as it is alleged they are now kept for the sale of alcoholic drinks.
The average addict who came to this office was obliged to get about four prescriptions a week, the doctor limiting the supply to about the amount the addict would use in two days. The prices for the prescriptions ranged from 50 cents to $2 or more. An addict came in here one cold winter day, without an overcoat and devoid of underclothing, who was getting prescriptions from one of these rascally doctors and spending all his wages as a mechanic, amounting to about $28 a week, and even more, for the drug. When I asked him why he did not buy himself some clothing, he told me that he had begged the prescribing doctor to give him prescriptions for at least two weeks in advance and reduce the rates so that he might get clothing suited to the season, and that the doctor had brutally refused to do so, taking the last cent this man had.
The ambulatory case can go to the doctor and get a prescription for the drug and use it, and then under another name he can go to another doctor, and so on; and I see no reason why under such a system he cannot accumulate even more of the drug than he needs for his own personal use. From the very nature of the case the patient requires constant professional supervision, and, above all, moral aid and encouragement.
Questions of Policy
With all this contention and debate and clashing of professional interests and the opposition of the big manufacturing, commercial, and distributing agencies who produce and sell the drugs, the subject became involved, and a Babel-like confusion of tongues ensued. The lay public, alarmed at the dangerously menacing situation, was naturally anxious to arrive at some conclusion as to what was the proper course to take.
Then, too, the question of prohibition with reference to alcoholic liquors became a stumbling block. Zealous prohibitionists believed that calling attention to drug addiction and asking for federal restrictive measures were attempts to divert public attention from that which they believe to be the only evil or at least the most important one. Some of them seemed to believe that the Wets were drawing a red herring over the trail in the talk about drug addiction’s being an evil equal to alcoholism. As a matter of fact, there is more hope for the reformation and regeneration of a drunkard than of a drug addict. Addicts who were barkeepers told me that they never took, nor had any inclination to take, a drink of alcoholic liquor, even when constantly handling it.
The health commissioner of New York finally adopted as part of the Sanitary Code the law that now obtains in this city with reference to drug addiction. It is in many features in line with the former state law, was very carefully drawn, and seems to answer the purpose for which it was intended. Violations of this code are punishable by fine and imprisonment. It prohibits the possession, sale, and distribution of cocaine or opium or any of their derivatives of Cannabis indica or Cannabis sativa or any of their derivatives, except under conditions set forth in the ordinance; and provides also that any addict may, on his or her own complaint, be committed to a hospital or other institution maintained by the city of New York; or to any correction or charitable institution maintaining a hospital in which drug addiction is treated; or to any private hospital, sanatorium, or institution authorized for the treatment of disease or inebriety; and that the addicts shall not make any false statements in obtaining prescriptions.
Out of all this welter of discussion, disagreement and clashing of counter interests I long ago became convinced, as I have said, that the remedy lies through federal legislation and a more sane and practical treatment of the addict.
The weakness of the original Harrison Act lay in the fact that it did not control importations and exportations. The law, in order to be effective, should check the incoming and the outgoing of opium and its derivatives. To that end the law known as the Miller Act went into effect in 1922. This, in my judgment, is the most important and effective legislation as yet on the statute books of either nation or state, but will no doubt require amendment as weaknesses may develop. Anyone who is interested in this subject will find a report on this law when pending, Sixty-seventh Congress, Second Session, H. R. Report 852.