Free Narcotics for Drug Addicts?

American attitudes about how we deal with drug addicts seem to be shifting. According to polls from the Pew Research Center, 67 percent of Americans believe the government should focus more on treating drug addicts than on prosecuting them. The same study says that more than half of Americans support — or at least don’t oppose — the legalization of marijuana.

But legalization arguments extend beyond marijuana. Some countries that are faced with drug addiction problems are trying an alternative approach: providing addicts with the drugs they need, for free, under professional supervision.

At first glance, such an approach seems reckless, heartless, and wasteful of social resources and addicts’ health. Yet these countries report that many addicts live with their addiction while leading productive lives. The state benefits from that productivity while saving the money it would otherwise spend arresting, trying, and imprisoning those drug abusers. Not only do addicts stay out of trouble with the law, many have used this service to reduce and even quit their dependency.

Providing free drugs to addicts is not a new idea. The argument was exemplified half a century ago in the following two opinion pieces.

In “Give Drugs to Addicts,” from our August 8, 1964, issue, Nathan Straus III emphasized that drug abuse was a medical, not a legal, problem. He wanted to focus on what would work for addicts and for society and believed that giving drug addicts regulated access to narcotics could be beneficial.

Straus was the head of the National Association for the Prevention of Addiction to Narcotics, an organization that was starting the first national study of addiction. In later years, the NAPAN sponsored conferences to introduce the methadone treatment for opioid addiction.

Two years later, Jonah J. Goldstein made some of the same points from a different angle in “Give Drugs to Addicts so We Can Be Safe.” A judge in New York’s court for 25 years, Goldstein knew addicts and what a drain on the legal system they could be. Out of this experience, he made a surprisingly practical and original argument for decriminalizing drugs: to protect everyone else.


Give Drugs to Addicts

By Nathan Strauss III

Originally published on August 8, 1964

Nathan Strauss
Nathan Straus, head of the National Association for the Prevention of Addiction to Narcotics, has testified on drug abuse before a House subcommittee and a presidential commission.

Free drugs for addicts — no plan for coping with the national tragedy of narcotics addiction prompts greater outrage. All manner of “experts,” from government officials to heads of citizens’ groups, denounce the plan as immoral and dangerous.

“We can’t let dope fiends get drugs from clinics and then stalk the streets,” the typical argument runs. “They’ll prey on women and children — no one will be safe. Addicts will have a ‘free-drug ride’ through life, and addiction simply will be perpetuated, made acceptable …”

All such objections are shortsighted. Allowing addicts to obtain drugs legally from doctors, instead of from underworld “pushers,” is the one step that may end the chaos of drug abuse.

Today, after years of hysteria, neglect, and downright cruelty to the addict, we are still woefully ignorant about his disease. We still don’t know exactly what addiction is, or what causes it or cures it. We do know that the police method of “treating” addicts — throwing them in jail — does not work. Addicts must not be punished or put away but treated in their own communities, if science is ever to make meaningful discoveries about their shattering sickness.

Even if there are risks, we must try treating addicts in clinics, for all else has failed. In our big cities there are tens of thousands of addicts, perhaps hundreds of thousands. Every year they consume at least $350 million worth of heroin and related opiates. Increasingly, young people are turning to cheaper, addictive “dangerous drugs,” amphetamines and barbiturates. (Of the 10 billion barbiturate and amphetamine pills produced annually in the United States, it is estimated that half end up on the illegal market.) The underworld thrives on illicit drug sales to addicts, and addicts themselves are forced to become criminals. Desperate for money to support their habit, they commit millions of thefts annually, and occasionally they murder.

The situation has become uncontrollable. A presidential commission reported recently that 95 percent of the heroin that smugglers bring to the U.S. every year gets past law-enforcement officials. Police freely admit that one addict may commit 500 or 1,000 or even 1,500 crimes before he is apprehended. In New York City alone, addicts commit about half the city’s crimes, resulting in losses of more than $1 million per day. And the total is constantly increasing.

Of the addicts jailed or locked in hospital wards to “detoxify,” an estimated 90 percent or more soon return to “shooting dope.” Many of them resume taking drugs the day they are freed. Their “connections” wait for them outside the jail or hospital walls.

To combat this horror, we must bring addiction out into the open, as we have epilepsy, mental retardation, and, to a certain extent, emotional illness. We must regard it as a disease that can be studied, treated, and, hopefully, cured. “Actually, the addict is a sick person, not a criminal,” says a report of the New York Academy of Medicine. “He needs medical care, not a jail sentence.”

Where should we start? The organization of which I am president, the National Association for the Prevention of Addiction to Narcotics, will initiate this year a program with two goals: to help addicts conquer their addiction, and to provide medical and social scientists with sorely needed facts about the fundamental nature of the disease. With the cooperation of law-enforcement officials, NAPAN plans to establish two outpatient clinics for addicts, one in New York, the other in California. These are the states with the most serious addiction problems. The program, the first of its kind, will be operated on a strictly scientific, experimental basis.

In these clinics small groups of addicts, carefully selected and closely supervised, will receive drugs in gradually decreasing quantities. And, because addiction is related to emotional distress, the addicts will receive psychiatric treatment, counseling about education and jobs, and other forms of assistance. Only through such a comprehensive assault will we learn how to take the addict off drugs and keep him off.

Why attempt such studies of addiction? Because experience has shown that by studying illness in the “walking patient,” science learns things it never learns from patients confined to hospitals. Researchers in heart disease, for example, learned a great deal about anticoagulant drugs by studying their effect on heart patients leading their usual lives in the outside world. We may never find the secrets of addiction unless we study the addict who is out in the world and being tempted to take drugs by forces in his usual environment. The locked hospital ward simply does not permit this kind of searching and practical inquiry.

Through research with these selected addicts, we may learn whether addiction is fundamentally psychological or environmental, or whether it has a physical basis. Why does one person succumb to addiction while his brothers and sisters often do not? Why are teenagers so susceptible to the disease? And why do some 30- and 40-year-old addicts simply “walk away” from their addiction? At present we do not have the answers.

Is it unreasonable to hope for a specific, valuable treatment for addiction? I think not. It is just possible, for example, that addiction stems from an abnormality in body chemistry. If this is true — and we’ll never know unless we study patients — perhaps we can isolate and neutralize the guilty chemical factor. Then we might be able to prevent addiction altogether, either through medication or by some “immunizing” injection.

Even if research fails to yield quick answers, the very fact that addicts can get drugs from doctors will have one tremendous effect. The addict will be lifted from the cellar of the criminal world to the level of the medical center where, as a sick person, he can be helped. This one measure will do a great deal to rid the addict of the stigma of his disease and to end his degradation. This has happened in England, where the punitive approach to addiction has been abandoned, and with excellent results. There doctors are allowed to treat addicts as exactly what they are — sick people. Most addicts in England are treated in doctors’ offices. Only a handful are involved with the underworld. (The English, however, have yet to mount the intensive research effort outlined above.)

It has taken years, but the American Medical Association has finally come round to the conclusion that addiction is basically a medical problem. Recently, the AMA conceded for the first time that it would be ethical for physicians to treat addicts on an experimental, out-patient basis. Similar endorsements have come from the New York County Medical Society and from the New York Academy of Medicine. The latter organization has declared that as long as the police approach to addiction prevails, the disease will continue to spread.

What until now has prevented organized medicine and individual doctors from supporting clinical research with addicts? For one thing, police agencies, especially the Federal Bureau of Narcotics, have threatened and intimidated doctors. Federal regulations restrain doctors from treating addicts — even though Supreme Court decisions clearly indicate that doctors are entitled to do so. As the New York Academy of Medicine report states, the Federal Bureau of Narcotics opposes the practice “because it really does not trust doctors.” The bureau, says the report, maintains that the only way to treat addicts is by abruptly depriving them of drugs. Its insistence on this harsh and futile method has crippled narcotics control in this country.

Organized medicine, too, has been shamefully timid about addiction. Doctors, like most of the rest of us, have passed the buck to the police, saying in effect, “We aren’t interested in this kind of sickness. Lock up the addicts. Keep them away from nice people.” Today the climate is changing. More and more doctors and law-enforcement officials are convinced that something new must be attempted — simply because all previous efforts have failed.

What of the bitter objections to outpatient treatment of addicts? For example, will addicts on maintenance doses endanger innocent people? Hardly. An addict becomes desperate only when he has no access to drugs or has no money to buy them. Under the influence of drugs, most addicts are quite harmless.

Will addicts use free drug doses simply as a “convenience”? Critics believe that the addict will not be content with controlled doses but will use them as a starting point for his “kicks.” After leaving the clinic, the argument goes, the addict will return to his criminal sources for additional drugs.

This objection is ill-founded. Soon precise new laboratory techniques will let doctors determine exactly how much narcotic is in the blood. If an addict-patient obtains drugs from a criminal pusher, the doctor will know immediately and the addict will have to answer to the police about his criminal sources of supply.

Many opponents of maintenance doses feel the most compelling argument of all is that if addicts are provided drugs, the door will be opened wide to lifetime addiction. As one misguided doctor said to me recently, “Let’s not permit doctors to lead the addict down the primrose path.”

I must say that this objection, too, is shallow. In the treatment of cancer, heart disease, arthritis, and all other illness, we do everything we can to cure the patient. However, if we fail to cure, we then try to control the patient’s symptoms, so that he will remain productive and relatively comfortable, physically and emotionally. Perhaps after years of research we will find that some addicts cannot be cured. We may find, however, that by giving these incurables maintenance doses, we can control the symptoms of their disease and enable them to lead productive and relatively normal lives.

In short, it is just possible that some addicts will need continued, reduced doses from the clinic in order to function in society. It is just possible, too, that their addiction itself serves to control a more serious and socially dangerous psychological sickness. Wouldn’t it be ironic if we discovered that drugs keep some addicts from becoming murderers, rapists, or arsonists?

As hopeless as the narcotics picture may appear, much can be accomplished if we view the addict with compassion, not fear. Fear has led us to punish the addict instead of helping him. But we can no longer afford to indulge ourselves in this barbarity. For, as crime statistics grimly show, when we punish the addict, we punish ourselves.


Give Drugs to Addicts So We Can Be Safe

By Jonah J. Goldstein

Excerpted from an article originally published on July 30, 1966

Jonah J. Goldstein
Jonah J. Goldstein was a New York City judge for over thirty years.

Not long ago an office building in New York’s Rockefeller Center area hired private detectives to catch the thieves who were stealing everything movable and salable from the offices in the buildings, night after night. The detectives caught 49 men; 43 of them were narcotics addicts.

Half the crimes in New York City today — the robberies, the muggings, the burglaries — are committed by drug addicts, and other cities are beginning to share New York’s dangers. A while back, one of our newspapers carried a banner headline: NEW CRIME WAVE EXPECTED. Because federal narcotics agents had seized a big heroin shipment in the port, the story explained, heroin prices would go up, and addicts would have to rob more people to buy their shots.

What kind of police protection is it — what kind of law, is it — that turns a great triumph of law enforcement into the cause of a crime wave?

Discussions of drug addiction always seem to turn on the question of what happens to the addict. Instead of worrying so much about the one-tenth of one percent of the population who are hooked on drugs, let’s worry about the 99.9 percent who aren’t, and whose homes and lives are less secure because we drive sick people to crime with our narcotics laws.

Mind you, the drug addict is almost never dangerous when he’s under the influence of drugs — narcotics are sedatives. What makes him dangerous is the desperate need for the money to buy the next dose. And the costs are stupendous. The $50-a-day addict must steal $250 to $300 in merchandise daily to support his habit; and when you catch him, it costs $15 a day of tax revenues to keep him alive in jail.

I don’t want the kind of system where people have to register to get their narcotics. Some addicts are wanted by the police: They wouldn’t register. All we need is a simple arrangement by which the addict who can pay for the shot can go to his doctor and get it — and the poor addict can go to the clinic, just as the poor diabetic goes to the clinic for a shot of insulin.

Nobody would have to sign up for “treatment” unless he wanted it; nobody would even have to give a name or sign a receipt — just walk in the front door, get the shot, and walk out the back door. Any nurse could do the job. The single dose, of course, would have to be moderately light. If a man’s condition is such that he needs another dose, he can come around to the front door again.

A simple test could guarantee that nobody gets narcotics at the clinic unless he is already addicted. Another test, perhaps an invisible-ink time stamp that comes out under an ultraviolet lamp, could give enough control on the number of doses to make sure nobody used the clinic’s narcotics to the point of killing himself.

One night at dinner at the Grand Street Boys Association, I was talking about narcotics with a monsignor of the Catholic Church. He asked me if I’d give a man five dollars if he asked me for five dollars to buy a shot of heroin. I said, “Of course I would.”

“Wouldn’t you be concerned that you might be shortening his life?” the monsignor said.

“That’s his business,” I said.

I think there’d be a good case for giving the addict his drugs even if it did help him harm himself. There are a thousand times as many people who are not addicts as there are addicts, and the important thing is to help them. And I can’t see how an addict can harm himself more by going to a clinic than he does now by roaming the streets and robbing people to get the money to buy adulterated stuff from a vicious pusher. Is the female addict any better off as a prostitute? Anyway, why do you think the addict is so sure to be harmed?

When I was on the bench and the cops brought in a workingman who was an addict, I’d call him and his wife into my chambers and I’d show them a map of Texas. I’d say, “Pick a town near the Mexican border, and go down there and get yourself a job. When you need the drugs, just walk across the border — you can buy the stuff there for the price of a pack of cigarettes. So you don’t work eight hours a day, you only work six — you’re still a lot better off than you will be up here, going in and out of jails and hospitals.”

In my 25 years as a judge, I never had a rich user brought before me. I said that while I was still on the bench, and the newspapers picked it up. The next day I got a call from the government’s chief New York narcotics agent, who said he wanted to see me. He came up to my chambers and said, “It’s not true we don’t go after the rich addicts. We’ve been following one for five years, and one of these days we’re going to get him.”

I asked for the name, and he mentioned one of the most famous and best-loved men in America, a man who’s given away fortunes to charity, especially charity to help kids. I asked the federal chief what good he thought it would do to take a man like that and throw him in jail and ruin him, just because he used drugs. And then — as a citizen, not as a judge — I called the man and warned him. He said sadly, “I know about it.”

Some say that giving shots to addicts will increase addiction. I doubt it. I don’t think the end of prohibition increased the consumption of alcohol, or the number of alcoholics.

During prohibition important people never had any trouble getting whiskey. And there are some important people who have no trouble getting drugs today. Harry Anslinger, who was federal Commissioner of Narcotics, once testified to supplying a congressman with drugs out of the government’s own stock, because it would be dangerous to let somebody outside get that kind of hold on a congressman. Everybody knows about doctors and anesthetists who have the habit. Narcotics agents don’t want to let the doctors handle the problem because the police know that many doctors are addicts themselves. Men work as orderlies in hospitals for less money than they could make washing dishes in a cafeteria, because the job brings them near the source of their drugs. But why touch them — if they can live with their habit and do their work?

For years I have been receiving letters from people who are addicts, but nobody knows it except themselves and their doctors. They were in an accident or a fire once, or badly wounded in the war (I once had a man before me who got the habit as a prisoner of war in North Korea). The doses that then kept them from agony later became the curse of their lives. Some of them became substantial businessmen and professional men, but they had to live with the knowledge that they and their doctors were breaking the law every day.

Though many of the addicts we now make criminals could live useful lives with their habit, many others are hopeless derelicts. Nobody who has served as a judge in a criminal court could ever deny that addiction is a terrible thing. If we had a cure for addiction, there might even be an argument for the sort of program Governor Rockefeller has been advocating — ordering users to hospitals for treatment as soon as their addiction is discovered. But the hospitals don’t help. We’ve had federal narcotics hospitals for more than 30 years in Lexington and Fort Worth, and the biggest claim I’ve ever seen for cures is 10 percent. Most doctors I know think 2 percent is optimistic.

In planning what to do right now, we have to start with the fact that addicts as a rule can’t shake the habit, and that nothing we know how to do is much help to most of them. The psychiatrists have quit on the problem. One of them, Dr. Joost A.M. Meerloo, recently put their belief in his own kind of language: “Drug addiction is much more related to the pusher and the existence of criminal seduction and hypocritical laws than to circumscribed pathology within the individual.” Do you eliminate the pushers and criminal seduction and hypocritical laws by ordering people into hospitals?

All the police and the courts can do with today’s laws is increase the risk to the pusher. The greater the risk to the pusher, the higher the profits from pushing, and the stronger the temptation to push. The mob opposes reform of the narcotics laws now, just as the bootleggers always backed the drys in the fight on prohibition.

Make the drugs easily available to the addicts, and you take the profits out of pushing. Then if you find anybody pushing drugs, especially to kids, you can slap him in jail and throw away the key — let him rot. The law can do its job. Without the profits, there won’t be new pushers to come up and replace the jailbirds.

Giving away the drugs doesn’t solve the problem — we’ll still need a cure for addiction as much as we ever did. Today’s stupid laws make it nearly impossible to launch a research project big enough to get near the problem. Dr. Berger estimates that in New York, the worst-afflicted city, there are now only five or six doctors interested in the addiction problem. Take the stigma off the subject and provide money, and maybe we can have doctors instead of pushers and police determining what happens to sick people in our country.

But let’s keep our eyes on what our criminal laws are supposed to do. We don’t write them to protect or to rehabilitate the addict or the criminal, to mete out exact Solomon-like justice to the pusher. We write them to protect the society, all the ordinary people who obey the law without even knowing that’s what they’re doing. Our laws on narcotics should benefit the 190-odd million who don’t take drugs, not the 200,000 who do. I think it would turn out that we’d help them, too, but that’s not what’s important. The significant victim of the present law is not the derelict half-crazed addict with the need for drugs who mugs the old lady on the street, but the old lady herself.

Let’s forget some of the fancy theories and make our cities safer by giving the addict the narcotics he needs.

Narcotics Hysteria and the Criminalization of Drug Addiction

What is a proper reaction to reports, in the 1940s and ’50s, that imply the existence of 4 million drug addicts in the U.S.? One reaction — the one ultimately chosen the federal and state governments — was to pass stricter new laws and regulations that sought out those involved with both using and selling drugs and locked them up, away from civilized society. Another way, the one championed by Dr. Laurence Kolb of the U.S. Public Health Service, was to check those numbers and find out if the problem was really so widespread.

To be sure, there was a narcotics problem. At the end of the 19th century, opium and its derivatives — like heroin, morphine, and laudanum — had found their unregulated way into hundreds of over-the-counter pain relievers for everything from teething to arthritis. People were becoming addicted, and doctors were starting to notice.

In 1914, the Harrison Act limited access to opiates and cocaine. Clinics were set up to help the addicted under the care of professional supervision. But over the next 10 years, most of those clinics closed as political positioning and journalistic sensationalism shifted public opinion away from helping addicts and toward criminalizing them. New laws and their interpretations meant that addicts seeking medical help were more likely to face conviction than convalescence.

Amid the hysteria, in 1924, Dr. Kolb published his report for what would become the National Institute for Public Health, estimating that addicts in the United States “never exceeded 246,000.” Drug addiction was a problem, yes, but not as great a problem as headlines led people to believe. What’s more, Kolb argued, our reaction to the drug problem was wrong-headed.

In 1956, Dr. Kolb wrote “Let’s Stop This Narcotics Hysteria!” for the Post. In the 32 years since his original report, our approach to drug addiction hadn’t changed much. In this article, he argues for a more enlightened view, showing how treating all drug addicts as criminals makes little sense medically, economically, or socially. He also offers an alternative.

Today, the so-called war on drugs continues, and the outlook doesn’t seem much different. According to the Federal Bureau of Prisons, nearly half of federal prison inmates are there for drug violations. A Justice Policy Institute study has shown that treating a drug addict costs, on average, $20,000 less per year than imprisonment. Given the cost of incarceration, punishment instead treatment is not simply shortsighted and vengeful, but it’s also impractical.

Let’s Stop This Narcotics Hysteria!

By Laurence Kolb, M.D.

Excerpted from an article originally published on July 28, 1956

Many years ago, when I was a stripling, I sat listening to a group of elderly men gossiping in a country store. They were denouncing the evils of cigarette smoking, a vice that was just coming in.

This store had on its shelves a jar of eating opium, and a carton of laudanum vials — 10 percent opium. A respected woman in the neighborhood often came in to buy laudanum. She was a good housekeeper and the mother of two fine sons. Everybody was sorry about her laudanum habit, but no one viewed her as a sinner or a menace to the community. We had not yet heard the word addict, with its sinister, modern connotations.

Since those days, public opinion has done a complete about-face. The “sin” of smoking cigarettes, in 50 years’ time, has become a socially acceptable habit, while drug addiction has been promoted by hysterical propaganda to the status of a great national menace.

As an example, one prominent official has said that illegal heroin traffic is more vicious than arson, burglary, kidnapping, or rape, and should entail harsher penalties. Last May 31st, the United States Senate went even further, in passing the Narcotic Control Act of 1956. In this measure, third-offense trafficking in heroin becomes the moral equivalent of murder and treason; death is the extreme penalty, “If the jury in its discretion shall so direct,” for buyer and seller alike, whether addicted or not.

In my opinion, the lawmakers completely missed the point. For drug addiction is neither menace nor mortal sin, but a health problem — indeed, a minor health problem when compared with such killers as alcoholism, heart disease, and cancer.

I make that statement with deep conviction. My work has included the psychiatric examination and general treatment of several thousand addicts. I know their habit is a viciously enslaving one, and we should not relax for a moment our efforts to stop its spread and ultimately to stamp it out completely. But our enforcement agencies seem to have forgotten that the addict is a sick person who needs medical help rather than longer jail sentences or the electric chair. He needs help which the present Narcotics Bureau regulations make it very difficult for doctors to give him. Moreover, no distinction has been made, in the punishment of violators, between the nonaddicted peddler who perpetuates the illicit traffic solely for his own profit and the addict who sells small amounts to keep himself supplied with a drug on which he has become physically and psychologically dependent.

Hunter college students under arrest
“Two Hunter College students covering their faces with books, at police headquarters after they were picked up on narcotics”
World Telegram & Sun photo by Herman Hiller.

Library of Congress

The Council of the American Psychiatric Association, in a public statement issued after the Senate passed its bill, declared that this and a companion measure introduced in the House, “represent backward steps in attacking this national problem.” The association, after listing some of the points I have just made, concludes by remarking that “additional legislation concerning drug addiction should be directed to making further medical progress possible, rather than discouraging it. The legislative proposals now under consideration would undermine the progress that has been made and impede further progress. Thus, they are not in the public interest.”

I was launched in this field of medicine in 1923, when the United States Public Health Service assigned me to study drug addiction at what is now the National Institute of Public Health. In 1935, I opened the service’s hospital for treatment of addicts at Lexington, Kentucky. Three years later I became Chief of the Division of Mental Hygiene, overseeing administration of the Lexington hospital and a similar institution at Fort Worth, Texas. And after retiring from the service in 1944, I continued to be active in psychiatry. So I know a great deal about addiction, and how perverse our attitude toward it has become.

Most addiction arises from misuse of marijuana, cocaine, alcohol, opium, or opium’s important preparations and derivatives — eating opium, smoking opium, laudanum, morphine, and heroin. Alcohol is a yardstick with which to measure the harm done by other drugs. There are 4,500,000 alcoholics in this country, and about 700,000 of them are compulsive drinkers who are on “skid road” or headed for it — gripped like opium addicts by psychological forces they cannot control.

Until recent times, millions of people in Asia and Africa were habitual users of opium. Dr. C.S. Mei, a physician and Chinese government official, told me in 1937 that there were about 15,000,000 opium smokers in China. He was interested in the anti-opium campaign because the slavish habit was lowering users’ diligence and industry. But he remarked that opium smoking had little or no effect on health and no effect whatsoever on crime.

Addiction is far less common among Western peoples, chiefly because of our preference for alcohol. At the highest point of drug addiction in the United States, 1890–99, when all kinds of opiates could be bought as freely as candy or potatoes, there was only one opium addict for every 300 of the population. Today we have about 60,000 addicts in the United States — that is, about one in 2,800 of the population. About 50,000 of them are addicted to opiates, mostly heroin, about 5,000 to opium-like synthetic drugs, and about 5,000 to marijuana. Cocaine, once widely used, has practically disappeared from the scene.

Lawmakers may feel that addicts as well as sellers deserve death, but few doctors would agree. I have in mind particularly a report issued in June 1955 by a group of prominent New York physicians, appointed by The New York Academy of Medicine to study the addiction problem. The gist of their report is that drug addiction is not a crime, but an illness, and that the emphasis should be placed on rehabilitation of addicts, instead of on punishment.

This committee deplores the fact that addicts are forced into crime by unwise suppressive methods. It recommends that, under controlled conditions, certain morphine and heroin addicts be given the drug they need while being prepared for treatment. For certain incurable cases, the committee advocates giving the needed opiate indefinitely at specially regulated clinics, although many physicians oppose using clinics in this way. My own proposal, which I shall go into later, would be to have such cases evaluated by doctors appointed for their competence in this field. The New York committee also recommends counseling services for patients after withdrawal treatment, to help them resist the temptation to return to the drug when stress situations arise.

A key fact to bear in mind is that the man addicted to an opiate becomes dependent on frequent regular doses to maintain normal body functions and comfort. If the drug is abruptly withheld he becomes intensely ill. In rare cases he may even collapse and die.

I once saw a woman who had come here from abroad, where she had been taking eight grains of morphine daily. Cut off from her supply, she got into an American hospital where suppression of the “drug menace” was more important than the relief of pain. She died in two days, due to sudden stoppage of the drug. There was nothing in the law to forbid giving this woman morphine to relieve her suffering, but propaganda about drugs had clouded the judgment of someone in authority.

The effect of opiates on the general health of addicts is not definitely known. There is a lack of positive evidence that a regularly maintained opium habit shortens life, but it probably does so, especially when large doses of morphine or heroin are used. The few reports that indicate harm are based on death statistics of groups of addicts, mostly opium smokers, many of whom started using the drug to ease already existing illness. Addicts in American jails undoubtedly have a high death rate. Some are repeatedly ill due to many periods of forced abstinence. Others, unable to buy enough food after paying for needed drugs, arrive at the prison gates half starved and a prey to infections.

In the 1920s, the average American addict was taking six grains of morphine or heroin daily. It was impossible to find harmful effects among those who got their dose regularly. I have known a healthy, alert 81-year-old woman who had taken three grains of morphine daily for 65 years. The well-fed opiate addict who regularly gets sustaining doses is not emaciated or pale, nor does he have pinpoint pupils, as is popularly supposed. He cannot be recognized as an addict on sight.

Cocaine is another story. It is fortunate that cocaine addiction is seldom seen nowadays, for excessive use of this drug causes emaciation, anxiety, convulsions, and insanity. Neither cocaine nor marijuana has the merit of making some neurotic people more efficient, as is the case with opiates. And the use of marijuana or cocaine can be discontinued abruptly without bringing on uncomfortable or dangerous withdrawal symptoms. When cocaine is suddenly denied a large user, he simply goes into a deep and very prolonged sleep. Therefore, there is no reason why any cocaine or marijuana user should be allowed to have his drug, even for a short time.

In an earlier period, opiates could be bought anywhere in America without restriction, and many people became addicted. Still, they worked about as well as other people and gave no one trouble. Only the physicians were concerned. They saw that the cocaine user and 60-grains-a-day morphine addict were injuring their health. More important, they saw thousands of unhappy opium eaters, opium smokers, and laudanum, morphine, and heroin users seeking relief from slavery, and often failing to get it.

Distressed by the evil, physicians advocated laws to prohibit the sale of opiates without prescription. By 1912, every state except one had laws regulating in some way the prescribing or sale of opiates and cocaine. As a result, the number of addicts fell from 1 in 300 of the population during the decade 1890–99, to 1 in 325 during the next decade. And after 1909, a ban on smoking opium caused a further decline in addiction.

Until 1915, however, addicts who needed opiates to continue their work in comfort could get their supplies legally without much trouble or expense. Then the Harrison Act became effective. This important federal law had both good and bad effects. Unable to get opiates, hundreds of addicts were cured by deprivation. These were mostly normal or near-normal people who were not seriously gripped by the psychological forces which hinder treatment of neurotic addicts and drunkards.

The bad effect came through unwise enforcement of the law. Physicians thought they could still prescribe opiates to addicts who really needed them for the preservation of health or to support the artificial emotional stability which enabled so many addicts to earn their livings. However, physicians prescribing for such people wound up in the penitentiary. Inability to get opiates brought illness to many hard-working citizens, and illness cost them their jobs. Some of them committed petty crimes to procure narcotics.

To remedy the situation, narcotic clinics were established throughout the country, where addicts could get needed drugs. Practically all of these clinics were forced to close by 1923. They had not been well run, but the chief reason for closing them was that addiction had become a crime, by legal definition.

The arrests of physicians, some of which were justifiable, and the sending of hundreds of addicts to prison, brought about a perversion of common sense unequaled in American history. Uncritical observers concluded that opium caused crime. The sight of so many law-abiding citizens applying to the clinics for help, instead of arousing public sympathy, was interpreted as evidence of moral deterioration, calling for increased penalties. The stereotype of the “heroin maniac” was born.

The number of addicts continued to decline. In 1924, the United States Public Health Service reported there were only 110,000 of them. By 1925, however, propaganda had led people to believe that there were 4,000,000 addicts in the country, and our fancied heroin menace was in full swing.

An ex-congressman appeared before the Senate Committee on Printing in 1924 to urge publication of 50,000,000 copies of an article entitled “The Peril of Narcotics — A Warning to The People of America.” He wanted a copy in every home.

Among other strange things, the article warned parents not to allow their children to eat away from home. If they did, it was said, some other child — a heroin maniac — might inject the drug into an innocent-looking titbit; whereupon the child eating it might instantly become an addict and join in a campaign to promote heroin addiction among other children. A Public Health Service physician persuaded the committee that this was nonsense, but propaganda about the heroin menace continued.

The Cocaine Fiends title card
There was money to be made in movies about the drug problem, particularly if the film used generous helpings of lurid imaginings.
By Willis Kent Productions (The Cocaine Fiends (1935) at the Internet Archive) [Public domain], via Wikimedia Commons
It was said that thousands of school children in New York were heroin addicts. An investigation was made, and in 1927 Dr. Carlton Simon, Deputy Police Commissioner in charge of the Narcotics Bureau, stated that a thorough survey had failed to reveal one case of heroin addiction among 1,000,000 New York City school children.

When American physicians advocated laws regulating narcotics, they had in mind the kind of laws in force in most Western European countries. What our physicians did not foresee was that they would be bound by police interpretations of the regulations; and that doctors who did not accept police views might be tricked into giving an opiate to an informer, who pretended to need it for pain or disease. Conviction meant that the physician went to prison.

Europeans regulate narcotics, as we do, but they are not alarmed by addiction, as we so obviously are. They have never lost sight of the fact that, as a great English physician wrote in the 17th century, “Opium soothes, alcohol maddens.”

In 1954, England controlled the illegal-narcotic traffic with the conviction of only 214 persons, 74 for opiate violations, 140 for violations involving marijuana. In the same year 12,346 persons were convicted in the United States for similar offenses. Allowing for differences in population, we had about 14 times more convictions than the English. Prison sentences meted out here ran into thousands of years — a fact that zealots boast about. In England, light sentences sufficed to discourage illegal traffic — 28 days to 12 months for opiate offenses, 1 day to 3 years for marijuana violations.

England’s sensible, effective policy is in sharp contrast with what goes on in the United States. I became well acquainted at the hospital in Lexington with a paralyzed, bedridden man who had been sentenced to four years for a narcotic violation. Just how he could be a menace to society was never clear to me. In Europe he would have been allowed to live out his last days in comfort. Only in the United States must addicts suffer and die or deteriorate in prison.

Unreflecting and sometimes unscrupulous people — and newspapers too — have contributed to the hysteria about drug addiction. News items reporting the seizure of “dope” frequently exaggerate the contraband’s value. One “$3,000,000 seizure” of heroin which made headlines was actually only enough to last seven six-grains-a-day addicts for a year. To justify the $3,000,000 figure, heroin would have to bring $196 a grain. Some addicts do spend from $5 to $10 a day on the habit, but few can afford it; hence the sickness and stealing.

Distorted news has prepared the public to support extreme measures to suppress imagined evils. When legislators undertook last spring to do something about the so-called drug menace, federal law provided two years in prison for a first-time narcotic-law offender. The minimum for a second offense was five years, and for a third, 10 years, with no probation or suspension of sentence for repeaters. The Narcotic Control Act of 1956 proposed increasing penalties for heroin trafficking to a minimum of 5 years for the first offense, 10 years for the second offense, life imprisonment or death for the third offense.

What happens under such laws? In one case, under the old law, a man was given 10 years for possessing three narcotic tablets. Another man was given 10 years for forging three narcotic prescriptions — no sale was involved. And another 10-year sentence was imposed on a man for selling two marijuana cigarettes, which are just about equal in intoxicating effect to two drinks of whisky. Extremists have gone on to demand the death penalty. They would do away with suspended sentences, time off for good behavior, the necessity for a warrant before search. They want wire tapping legalized in suspected narcotic cases, and they would make the securing of bond more difficult.

Existing measures and those which are advocated defy common sense and violate sound principles of justice and penology. There is nothing about the nature of drug addicts to justify such penalties. They only make it difficult to rehabilitate offenders who could be helped by a sound approach which would take into account both the offense and the psychological disorders of the offender.

Drug addiction is an important problem which demands the attention of health and enforcement officials. However, the most essential need now is to cure the United States of its hysteria, so that the problem can be dealt with rationally. A major move in the right direction would be to stop the false propaganda about the nature of drug addiction and present it for what it is — a health problem which needs some police measures for adequate control. Our approach so far has produced tragedy, disease, and crime.

The opinion of informed physicians should take precedence over that of law-enforcement officers, who, in this country, are too often carried away by enthusiasm for putting people in prison, and who deceive themselves as well as the public about the nature and seriousness of drug addiction. We need an increase in treatment facilities and recognition that some opium addicts, having reached the stage they have, should be given opiates for their own welfare and for the public welfare too.

Mandatory minimum sentences should be abolished, so that judges and probation and parole officers can do what in their judgment is best for the rehabilitation of offenders.

Medical opinion should have controlling force in a revamped policy. This is not to say that every physician should be authorized to prescribe opiates to addicts without restrictions. Some would be dishonest, others would be indifferent to consequences. Neither should the old type of clinic be re-established. A workable solution would be to have the medical societies or health departments appoint competent physicians to decide which patients should be carried on an opiate while being prepared for treatment and which ones should be given opiates indefinitely. Physicians would report individual cases to local medical groups for decision. And that decision should never be subject to revision by a nonmedical prosecuting agency.

The details of a scheme of operation should be worked out by a committee of physicians and law-enforcement officers, with the physicians predominant in authority. The various states could make a start by revising their laws to conform to actual health and penological needs. The medical profession could help by giving legislators facts on which to take action.

It should be stressed that it is easy to cure psychologically normal addicts who have no painful disease. Even the mildly neurotic addict is fairly easy to cure. Severe withdrawal symptoms pass within five days, although for several months there are minor physical changes that the patient may not feel or even know about, but which increase the likelihood of his relapse. The reason for the apparently large relapse rate among addicts is that a difficult group remains to be dealt with after the cured cases have been dismissed. The most difficult cases, perhaps, are neurotic addicts who suffer from migraine or asthma. Neurotics who have a painful disease are liable to have a psychic return of pain when their drug is withdrawn. When several treatments fail, such persons should be allowed to have the drug they need.

Thomas Jefferson, distressed over the ravages of alcohol, once said that a great many people spent most of their time talking politics, avoiding work, and drinking whisky. One wonders what he would say today if some muddled citizen warned him that opiates were rotting the moral fiber of our people. I suspect that he would advise his informant to take care, in walking down the street, lest he stumble over one of our 4,500,000 alcoholics and break a leg.

For a modern look at the problems of opium addiction, read “The Drug Epidemic That Is Killing Our Children,” from our September/October 2016 issue. 

Narcotics Anonymous: Addiction, the Post, and the Next 12 Steps

In 1941, the Post published Jack Alexander’s report “Alcoholics Anonymous,” the first bit of media attention the six-year-old program had received. In the weeks that followed, AA received an overwhelming number of inquiries, and AA tripled its membership within the next year. That Post article helped thousands of people find the help they needed to break their addiction.

In 1954, the Post hoped to repeat those results with Jerome Ellison’s “These Drug Addicts Cure One Another,” a report on Narcotics Anonymous, a 12-step program similar to AA. NA was a harder sell, both to the public and to those addicted to narcotics. Alcoholics might be reluctant to join a group and talk about their problems, but drug addicts were even more hesitant because the substances they abused were illegal. Speaking publicly about their addiction could incriminate themselves and others.

NA started slowly — when it was founded in 1953, only three participants showed up for the first meeting. But the results were undeniable, and word spread around. Reluctant or not, addicts in NA and other 12-step narcotics addiction groups were finding the help they needed and getting their lives back.

Although Ellison’s report, reprinted below, didn’t have the same immediate and astonishing effects as the earlier piece on Alcoholics Anonymous, it did help get the word out. Since then, NA has offered continued hope and improvement to addicts and has spread around the world. Now, 67,000 NA meetings in 139 countries are held every week.

For more information about Narcotics Anonymous or to find a meeting near you, visit


These Drug Addicts Cure One Another  

By Jerome Ellison

Originally published August 7, 1954


Tom, a young musician just out of a job on a big-name dance band, was pouring out the story of his heroin addiction to a small gathering in a New York City YMCA. He told how he started three years ago, “fooling around for thrills, never dreaming to get a habit.” His band went on the road. One night in Philadelphia, he ran out of his drug and became so shaky he couldn’t play. It was the first the band management knew of his habit. He was promptly sent home.

“Music business is getting tough with junkies,” Tom said.

His audience was sympathetic. It was composed of former drug addicts who had found freedom from addiction. They met twice weekly to make this freedom secure, and worked to help other addicts achieve it. The New York group, founded in 1950 and called Narcotics Anonymous, is one of several which have been piling up evidence that the methods of Alcoholics Anonymous can help release people from other drugs than alcohol — drugs such as opium, heroin, morphine, and the barbiturates.

The groups enter a field where patients are many and cures few. The population addicted to opiates has been placed by competent but incompatible authorities at 60,000 and at 180,000. The Federal Bureau of Narcotics estimates that the traffic in illegal opium derivatives grosses $275,000,000 a year. About 1,000 people a month are arrested for violations of federal, state, or local laws regulating the opiates. Addiction to the barbiturates, it is believed, involves more people. There are some 1,500 known compounds of barbituric acid, some of them having pharmaceutical names and others street names such as yellow jacket, red devil, and goof ball.

Addicts work up to doses sufficient to kill a nonaddicted person or an addict with a lesser tolerance. In New York recently, three young addicts met and took equal portions of heroin. Two felt no unusual reaction; the third went into convulsions and in a few hours was dead. Many barbiturate users daily consume quantities which would be lethal to a normal person. Others have demonstrated an ability to use barbiturates for years, under medical supervision, without raising their consumption to dangerous levels.

The drug addict, like the alcoholic, has long been an enigma to those who want to help him. Real contact is most likely to be made, on a principle demonstrated with phenomenal success by Alcoholics Anonymous, by another addict. Does the prospect, writhing with shame, confess to pilfering from his wife’s purse to buy drugs? His sponsor once took his children’s lunch money. Did he steal the black bag of a loyal family doctor? As a ruse to flimflam druggists, his new friend once impersonated a doctor for several months. The NA member first shares his shame with the newcomer. Then he shares his hope and finally, sometimes, his recovery.

To date, the AA type of group therapy has been an effective ingredient of “cures” — the word as used here means no drugs for a year or more and an intent of permanent abstinence — in at least 200 cases. Some of these, including Dan, the founder of the New York group, had been pronounced medically hopeless. The “Narco” Group in the United States Public Health Service Hospital at Lexington, Kentucky, has a transient membership of about 80 men and women patients. The group mails a monthly newsletter, The Key, free to those who want it, currently a list of 500 names. Many of these are interested but nonaddicted friends. Most are “mail-order members” of the group — addicts who have left the hospital and been without drugs for periods ranging from a few weeks to several years. The HFD (Habit-Forming Drug) Group is a loosely affiliated fellowship of California ex-addicts who keep “clean” — the addict’s term for a state of abstinence — by attending Alcoholics Anonymous meetings with volunteer AA sponsors. The federal prison at Lorton, Virginia, has a prisoner group which attracts 30 men to its weekly meetings. Narcotics Anonymous in New York is the sole “free world” — outside-of-institution — group which conducts its own weekly open-to-the-public meetings in the AA tradition.

Today’s groups of former addicts mark the convergence of two historic narratives, one having to do with alcohol, the other with opium. References to the drug of the poppies go back to 4000 B.C. According to Homer, Helen of Troy used it in a beverage guaranteed to abolish care. Opium was employed to quiet noisy children as early as 1552 B.C. De Quincey and Coleridge are among the famous men to whom it brought disaster. In its dual role it appears today, through its derivatives, as the friend of man in surgery and his enemy in addiction.

The alcoholic strand of the story may be taken up in the Zurich office of the Swiss psychologist Carl Jung, one day late in 1933. At that time, the eminent doctor was obliged to impart an unpleasant bit of news to one of his patients, an American businessman who had come for help with a desperate drinking problem. After months of effort and repeated relapses, the doctor admitted that his treatment had been a failure.

“Is there, then,” the patient asked, “no hope?” Only if a profound religious experience were undergone, he was told. How, he wanted to know, could such an experience be had? It could not be obtained on order, the doctor said, but if one associated with religious-minded people for a while —

Narcotics Anonymous AAs Young Brother  

The American interested himself in Frank Buchman’s Oxford Group, found sobriety, and told an inebriate friend of his experience. The friend sobered up and took the message to a former drinking partner, a New York stockbroker named Bill. Though he was an agnostic who had never had much use for religion, Bill sobered up. Late in 1935, while on a business trip to Akron, Ohio, he was struck by the thought that he wouldn’t be able to keep his sobriety unless he passed on the message. He sought out a heavy-drinking local surgeon named Bob and told him the story to date. They sat down and formulated a program for staying sober — a program featuring 12 Suggested Steps and called Alcoholics Anonymous. Bill devoted full time to carrying the AA message, and the news spread. The now-famous article by Jack Alexander in The Saturday Evening Post of March 1, 1941, made it nationally known, and by 1944 there were AA groups in the major cities.

In June of that year, an inebriate mining engineer whom we’ll call Houston “hit bottom” with his drinking in Montgomery, Alabama, and the local AAs dried him up. Houston gobbled the AA program and began helping other alcoholics. One of the drunks he worked with — a sales executive who can be called Harry — was involved not only with alcohol but also morphine. AA took care of the alcoholic factor, but left Harry’s drug habit unchanged. Interested and baffled, Houston watched his new friend struggle in his strange self-constructed trap. The opiate theme of the narrative now reappears. Harry’s pattern had been to get roaring drunk, take morphine to avoid a hangover, get drunk again, and take morphine again. Thus he became “hooked” — addicted. He drove through a red light one day and was stopped by a policeman. The officer found morphine and turned him over to the federal jurisdiction, with the result that Harry spent 27 months at Lexington, where both voluntary and involuntary patients are accommodated, as a prisoner. After his discharge, he met Houston and, through AA, found relief from the booze issue. The drug problem continued to plague him.

During this period, Houston, through one of those coincidences which AAs like to attribute to a Higher Power, was transferred by his employers to Frankfort, Kentucky, just a few miles from Lexington. “Harry’s troubles kept jumping through my brain,” Houston says. “I was convinced that the 12 Suggested Steps would work as well for drugs as for alcohol if conscientiously applied. One day I called on Dr. V.H. Vogel, the medical officer then in charge at Lexington. I told him of our work with Harry and offered to assist in starting a group in the hospital. Doctor Vogel accepted the offer, and on Feb. 16, 1947, the first meeting was held. Weekly meetings have been going on ever since.”

The Phenomenon of Physical Dependence  

Some months later, in a strangely woven web of coincidence, Harry reappeared at “Narco” as a voluntary patient and began attending meetings. He was discharged, relapsed, and in a short time was back again. “This time,” he says, “it clicked.” He has now been free from both alcohol and drugs for more than five years. Twice he has returned to tell his story at meetings, in the AA tradition of passing on the good word.

In the fall of 1948 there arrived at Lexington an addict named Dan who had been there before. It was, in fact, his seventh trip; the doctors assumed that he’d continue his periodic visits until he died. This same Dan later founded the small but significant Narcotics Anonymous group in New York. Dan’s personal history is the story of an apparently incurable addict apparently cured.

An emotionally unsettled childhood is the rule among addicts, and Dan’s childhood follows the pattern. His mother died when he was three years old, his father when he was four. He was adopted by a spinster physician and spent his boyhood with his foster mother, a resident doctor in a Kansas City hospital, and with her relatives in Missouri and Illinois. When he was 16, he developed an ear ailment and was given opiates to relieve the pain. During and after an operation to correct the condition, he received frequent morphine injections. Enjoying the mood of easy, floating forgetfulness they induced, he malingered.

Living in a large hospital gave Dan opportunities to pilfer drugs, and for six months he managed to keep himself regularly supplied. An addict at the hospital had taught him to inject himself, so for a time he was able to recapture the mood at will. He was embarrassing his foster mother professionally, however, and though not yet acknowledging the fact to himself, was becoming known locally as an addict. Sources of drugs began to close up, and one day there was no morphine to be had. He went into an uncontrollable panic, which grew worse each hour.

There followed muscular cramps, diarrhea, a freely running nose, tears gushing from his eyes, and two sleepless, terror-filled days and nights. It was Dan’s first experience with the mysterious withdrawal sickness which is experienced sooner or later by every addict.

In one of the strangest phenomena known to medicine, the body adjusts to the invasion of certain drugs, altering its chemistry in a few weeks to a basis — called “physical dependence” — on which it can no longer function properly without the drug. How physical dependence differs from habit may be illustrated by imagining a habitual gum chewer deprived of gum. His unease would be due to the denial of habit. If he were denied gum and also water, on which he is physically dependent, he’d feel an increasingly painful craving called thirst. The drug addict’s craving is called the “abstinence syndrome,” or withdrawal sickness. In extreme cases it includes everything Dan experienced, plus hallucinations and convulsions. Withdrawal of opiates rarely causes the death of a healthy person; sudden cessation of barbiturates has been known to. The violent phase, which is usually over in two or three days, may under expert care be largely avoided. Physical dependence gradually diminishes, and ordinary habit, of the gum-chewing type, asserts itself.

This is the interval of greatest vulnerability, NA members say, to the addict’s inevitable good resolutions. He has formed the habit of using his drug when he feels low. If he breaks off medical supervision before he’s physically and mentally back to par, the temptation to relapse may be overwhelming. It is in this period, Dan says, that the addict most needs the kind of understanding he finds in N.A. If he yields to the call of habit, physical dependence is quickly re-established and his body calls for ever greater doses as the price of peace.

Dan went through the cycle dozens of times. Besides the half dozen withdrawals at Lexington, there were several at city and state institutions, and numerous attempts at self-withdrawal. He tried sudden and complete abstinence, the “ cold turkey “ method. He tried relieving the withdrawal pangs with alcohol, and found it only canceled out his ability to think, so he automatically returned to drugs. When he attempted withdrawal with barbiturates, he “just about went goofy.”

All this, however, was to come later; in his early 20s he had no intention of giving up the use of drugs. Haying been spotted as an addict in the Kansas City area, he sought fresh fields. He found a job as a salesman and traveled several Midwest states. The demands of his habit and his scrapes with the law made it hard to hold a job long. Drifting from one employment to another, he found himself, in the early 1930s, in Brooklyn.

His attempts at withdrawal resulted in several extended periods of abstinence, the longest of which was three years. When off drugs Dan was an able sales executive and a good provider. He married a Staten Island girl. They had a son. Dan continued to have short relapses, however. Each new one put a further strain on the family tie. For a time, to save money for drugs, he used slugs in the subway turnstiles going to and from work. He was spotted by a subway detective and spent two days in jail. A few months later he was caught passing a forged morphine prescription. As a result, he was among the first prisoner patients at the new United States Public Health Service Hospital for addicts at Lexington, when it was opened on May 28, 1935.

After a year there, he made a supreme effort to be rid of drugs for good. To keep away from the temptations offered by New York drug pushers, he found a job with a large Midwest dairy. He worked hard, saved his money, and sent for his family. By this time, however, it was too late; his wife refused to come, and a divorce action was begun. “Her rebuff gave me what I thought was a good excuse to go back on drugs,” Dan reports. After that, his deterioration accelerated. On his seventh trip to Lexington, in 1948, he was in a profound depression.

After a month of sullen silence, he began attending the group meetings, which were a new feature at the hospital since his last trip. “I still wouldn’t talk,” he reports, “but I did some listening. I was impressed by what Houston had to say. Harry came back one time and told us his story. For the first time, I began to pray. I was only praying that I would die, but at least it was prayer.” He did not die, nor did he recover. Within six months of his discharge he was found in possession of drugs and sent back to Lexington for a year—his eighth and, as it turned out, final trip.

“This time things were different,” he says. “Everything Houston and Harry had been saying suddenly made sense. There was a lawyer from a Southern city there at the time, and a Midwestern surgeon. They were in the same mood I was — disgusted with themselves and really ready to change. The three of us used to have long talks with Houston every Saturday morning, besides the regular meetings.” All three recently celebrated the fifth anniversary of their emancipation from the drug habit.

Dan, conscious of what seemed to him a miraculous change of attitude, returned to New York full of enthusiasm and hope. The 12th of the Suggested Steps was to pass on the message to others who needed help. He proposed to form the first outside-of-institution group and call it Narcotics Anonymous — NA. He contacted other Lexington alumni and suggested they start weekly meetings.

There were certain difficulties. Addicts are not outstandingly gregarious, and when all the excuses were in, only three — a house painter named Charlie, a barber named Henry, and a waiter we’ll call George — were on hand for the first meeting. There was uncertainty about where this would be; nobody, it seemed, wanted the addicts around. Besides, missionary or “12th step” work of the new group would be hampered by the law. When the AA member is on an errand of mercy, he can, if occasion warrants, administer appropriate “medicine” to stave off shakes or delirium long enough to talk a little sense into his prospect. If the NA member did so, he’d risk a long term in jail. Drug peddlers were not enthusiastic about the new venture. Rumors were circulated discrediting the group.

Out of the gloom, however, came unexpected rays of friendliness and help. The Salvation Army made room for meetings at its 46th Street cafeteria. Later the McBurney YMCA, on 23rd Street, offered a meeting room. Two doctors backed their oral support by sending patients to meetings. Two other doctors agreed to serve on an advisory board.

There were slips and backslidings. Meetings were sometimes marred by obstinacy and temper. But three of the original four remained faithful and the group slowly grew. Difficult matters of policy were worked out by trial and error. Some members once thought that a satisfactory withdrawal could be made at home. Some hard nights were endured and it was concluded that the doctors were right —for a proper drug withdrawal institutional care is necessary. Addicts are not admitted to meetings while using drugs. Newcomers are advised to make their withdrawal first, then come to NA and learn to live successfully without drugs.

Group statisticians estimate that 5,000 inquiries have been answered, constituting a heavy drain on the group’s treasury. Some 600 addicts have attended one or more meetings, 90 have attained effective living without drugs. One of these is a motion picture celebrity, now doing well on his own. One relapse after the first exposure to NA principles seems to have been about par, though a number have not found this necessary. “A key fact of which few addicts are aware,” Dan says, “is that once he’s been addicted, a person can never again take even one dose of any habit-forming drug, including alcohol and the barbiturates, without running into trouble.”

The weekly “open” — to the public — meetings are attended by 10 to 30 persons — addicts, their friends and families, and concerned outsiders. The room is small and, on Friday evenings when more than 25 turn up, crowded.

There is an interval of chitchat and visiting, and then, about 9:00, the secretary, a Brooklyn housewife, mother, and department-store cashier, opens the meeting. In this ceremony, all repeat the well-known prayer: “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” The secretary then introduces a leader — a member who presents the speakers and renders interlocutor’s comments from his own experience with a drugless life. The speakers — traditionally two in an evening — describe their adventures with drugs and with NA. In two months of meetings, I heard a score of these case histories. I also charted the progress of a newcomer, the young musician named Tom, whose first NA meeting coincided with my own first reportorial visit.

Within the undeviating certainties of addiction, individual histories reveal a wide assortment of personal variations. Harold, an optometrist, is a “medical” addict; he got his habit from the prescription pad of a doctor who was treating him for osteomyelitis. An outspoken advocate of psychotherapy for all, Harold absorbs a certain amount of ribbing as the group’s “psychiatry salesman.” Florence, the housewife-cashier-secretary, recently celebrated her first anniversary of freedom from morphine, which she first received 25 years ago in a prescription for the relief of menstrual cramps. Carl, an electrician, became interested in the effects of opium smoke 30 years ago, and reached a point where he could not function without his daily pipe. He eventually switched to heroin, and his troubles multiplied.

Manny, an executive in a high-pressure advertising agency, and Marian, a registered nurse with heavy administrative responsibilities, began using morphine to relieve fatigue. Don, Marian’s husband, regards alcohol as his main addictive drug, but had a bad brush with self-prescribed barbiturates before he came to AA and then, with Marian, to NA. Pat, another young advertising man, nearly died of poisoning from the barbiturates to which he had become heavily addicted. Harold and Carl have now been four years without drugs; Manny, three; Marian, Don, and Pat, one.

Perhaps a third of the membership are graduates of the teenage heroin fad which swept our larger cities a few years ago, and which still enjoys as much of a vogue as dope peddlers can promote among the present teenage population. Rita, an attractive daughter of Spanish-American Harlem, was one of the group’s first members. Along with a number of her classmates, she began by smoking marijuana cigarettes — a typical introduction to drugs — then took heroin “for thrills.” She used the drug four years, became desperately ill, went to Lexington, and has now been free of the habit four years. Fred, a war hero, became a heroin addict because he wanted friends. In the teenage gang to which he aspired, being hooked was a badge of distinction. He sought out the pusher who frequented the vicinity of his high school and got hooked. There followed seven miserable and dangerous years, two of them in combat and one in a veteran’s hospital. In December of 1953, he came to NA and, he says, “really found friends.”

Lawrence’s story is the happiest of all. He came to NA early in his first addiction, just out of high school, just married, thoroughly alarmed at discovering he was addicted, and desperately seeking a way out. NA friends recommended that he get “blue-grassed,” an arrangement by which a patient may commit himself under a local statute to remain at Lexington 135 days for what the doctors consider a really adequate treatment. He attended meetings in the hospital and more meetings when he got home. Now happy and grateful, he thanks NA. His boss recently presented him with a promotion; his wife recently presented him with a son.

Besides the Friday open meeting, there is a Tuesday closed meeting at the Y for addicts only. As a special dispensation, I was permitted to attend a closed meeting, the purpose of which is to discuss the daily application of the 12 steps.

The step under discussion the night I was there was No. 4: “Make a searching and fearless moral inventory of ourselves.” The point was raised as to whether this step might degenerate into self-recrimination and do more harm than good. Old-timers asserted that this was not its proper application. A life of drug addiction, they said, often built up an abnormal load of guilt and fear, which could become so oppressive as to threaten a relapse unless dealt with. When the addict used Step 4 honestly to face up to his past, guilt and fear diminished and he could make constructive plans for his future.

The Narco meetings at Lexington have borne other fruit. There was Charlie, the young GI from Washington, D.C., who once looted first-aid kits in the gun tubs of a Navy transport en route to the Philippines and took his first morphine out of sheer curiosity. After his Army discharge, his curiosity led him to heroin and several bad years; then to Lexington, where the Narco Group struck a spark. He heard about Dan’s work, went to New York to see him, and on his return to Washington looked around to see what he could do. He discovered that there was a concentration of addicts in the Federal penitentiary at Lorton, Virginia. Working with Alcoholics Anonymous, which already had meetings in the prison, he obtained permission to start a group like the one at Lexington. Now a year old, these meetings, called the Notrol Group — Lorton backward — attract the regular attendance of about 30 addicts. Washington has no free-world group, but Charlie helps a lot of addicts on an individual basis, steering them to AA meetings for doctrine.

Friendliness of ex-drug addicts with former devotees of alcohol sometimes occurs, though Bill, the same who figured so prominently in AA’s founding, says a fraternal attitude cannot be depended upon. The average AA, he says, would merely look blank if asked about drug addiction, and rightly reply that this specialty is outside his understanding. There are, however, a few AAs who have been addicted both to alcohol and to drugs, and these sometimes function as “bridge members.”

“If the addict substitutes the word ‘drugs’ whenever he hears ‘alcohol’ in the AA program, he’ll be helped,” Houston says. Many ex-addicts, in the larger population centers where meetings run to attendances of hundreds, attend AA meetings. The HFD (Habit-Forming Drug) Group, which is activated by an energetic ex-addict and ex-alcoholic of the Los Angeles area named Betty, has dozens of members, but no meetings of its own. Individual ex-addicts who are “making it” the AA way include a minister in a Southeastern state, a politician in the deep South, a motion-picture mogul in California, and an eminent surgeon of an eastern city. The roll call of ex-addict groups is small. There is the parent Narco Group, Addicts Anonymous; Narcotics Anonymous; the Notrol Group; and the HFD Group.

A frequent and relevant question asked by the casually interested is, “But I thought habit-forming drugs were illegal — where do they get the stuff?” The answer involves an interesting bit of history explaining how opiates came to be illegal. In the early 1800s, doctors used them freely to treat the innumerable ills then lumped under the heading “nervousness.” Hypodermic injection of morphine was introduced in 1856. By 1880, opium and morphine preparations were common drugstore items. An 1882 survey estimated that 1 percent of the population was addicted, and the public became alarmed. A wave of legislation swept the country, beginning in 1885 with an Ohio statute and culminating in the federal Harrison Narcotic Law of 1914. Immediately after the passage of this prohibitory law, prices of opium, morphine, and heroin soared. A fantastically profitable black market developed. Today, $3,000 worth of heroin purchased abroad brings $300,000 when finally cut, packaged, and sold in America.

Among the judges, social workers, and doctors with whom I talked there is a growing feeling that the Harrison Act needs to be re-examined. Dr. Hubert S. Howe, a former Columbia professor of neurology and authority on narcotics, says the statute, like the Volstead Act, “removed the traffic in narcotic drugs from lawful hands and gave it to criminals.” In an address before the New York State Medical Society, he asserted that the financial props could be knocked from the illegal industry by minor revisions of present laws and rulings, with no risk of addiction becoming more widespread. Doctor Howe proposes a system of regulation similar to that of the United Kingdom, which reports only 364 addicts.

Meanwhile the lot of those who become involved with what our British cousins rightly call “dangerous drugs” is grim. It is just slightly less grim than it might have been five years ago. Since then a few addicts have found a way back from the nightmare alleys of addiction to a normal life which may seem humdrum enough at times, but which when lost, then regained, is found to be a glory.