The Opium Problem

Extent

For the most part, only if addicts are using extreme amounts would outsiders recognize that something was wrong, let alone that it was opium addiction.

p. 2

“Quite aside from this individual point of view [that with prohibitory legislation individuals made attempts to hide their ‘condition’] is the fact that only in cases where large doses of the drug are being consumed can casual observation or even a fairly careful examination determine the existence of the condition. There is a popular belief extant that practically anyone can detect the so-called “dope fiend,” that he is a miserable, emaciated, furtive individual with pinpoint pupils, trembling hands, sallow complexion and characterized bgy a varied group of moral attributes, needing only to be observed to render identification of the condition complete. As a matter of fact not even one of these alleged characteristics need be present and it is safe to say that in many cases only one or another of them exists and by no means would suffice to give the ordinary observer an idea of the true situation. It has been reported that for many years husbands and wives, to say nothing of other members of a family, have lived in complete ignorance of the existence of this condition in one or the other and that quite possibly the average physician, unaccustomed to dealing with the condition, might have difficulty in determining its existence.”

P. 9

Surveys of Opium Use

O. Marshall, 1878: Surveyed physicians in small towns, urban, rural, and semi-rural communities; but not the larger cities of Grand Rapids, East Saginaw, and Detroit. The summary (by Marshall):

The total number of opium eaters reported in the places given is 1313; of these 803 are females, and 510 are males… The population of the citiesw and villages including the townships in which they are situated, according to the State census of 1874, was 225,633. The population of the whole State at the same time was 1,334,031. If the number of opium eaters, including morphine eaters, in proportion to the population in the places given holds good for the entire State, the total number of opium eaters, all classes, in the State would be 7,763. Taking every degree of the habit into consideration, this estimate of the number is probably not too large.

Smallest community: 315; largest: 1,235; average of the 96 towns: 2350.

P. 14

This would be a small estimate, if applied to the country because: a) it didn’t include cities, which were presumed higher in opium eaters; and b) Michigan is not on the coasts, where maritime traffic contributed to the habit.

“The fact that in one town, Monroe, the physician addressed reported but one case while a druggist stated that there were about sixty, is indicative possibly of a very great error in Marshall’s total figure.” [Druggists did not have to require a doctor’s prescription to sell drugs in those days.]

p. 15

“If applied to the country as a whole for the year in question, 1874, this figure gives a total of 251,936.”

P. 16

C.W. Earle—1880

Earle interviewed “a number of” druggists in Chicago. “Fifty druggists have 235 customers, or an average of nearly five to each store.”

J. M. Hull—1885

From the Biennial Report of the State Board of Health of Iowa, 1885. Hull sent 1500 circulars; received 123 replies, reporting 235 opium users. 129 used morphin, 73 gum opium, 12 laudanum, 6 paregoric, 3 Dover’s Powder, and 4 McMunn’s Elixer. Hull said that there were about 3,000 stores in Iowa where opium was kept for sale, and if reports came in in the same ration, there would be 6,000 users. However, his reports were mostly from the small villages, where the habit, according to Hull, was less common. “I feel safe in saying that there are in this state over 10,000 people who are constantly under the influence of an opiate.” The estimated U.S. population in 1884 (when the study was done) was 55,379,154; for Iowa, 1,742,084. Using 5,732 as the number of users in Iowa (3000/123 * 235), gives 182,215 chronic users in the U.S. in 1884.

P. 24

C. E. Terry—1913

Terry collected data for Jacksonville, Florida. 541 persons used opium or some preparation thereof; about .81% of Jacksonville. Jacksonville had a population of 67,209; the U.S., 97,163,330; this gives a total for the country of 782,118.

P. 27

“free prescriptions were available to any user asking for them and the price of the drug in the drug stores was in the neighborhood of 60 cents for a drachm of morphin when sold in original bottles or large fractions.”

Lucius P. Brown—1915

Tenessee required that addicts register themselves; on January 1, 1915, there were 2370 individuals registered; Brown believed that not more than one-half, and possibly not more than one-fourth, of the addicts were registered. Tennessee had 2.3% of the population of the U.S. He estimated (with other calculations, such as adding 25% because Tennessee was rural, and assuming 5,000 addicts in Tennessee) 269,000 addicts in the U.S, and assumed this a “very conservative calculation.”

P. 29

The federal anti-narcotic law (Harrison Narcotic Act) passed December 7, 1914.

P. 30

Special Committee of Investigation, Secretary of the Treasury—1918

A questionnaire to physicians who registered under the Harrison Act: received replies from 30 and 2/3% of the physicians; showing under treatment 73,150 addicts. Multiplying to 100% replies gets 237,655 addicts.

Another questionnaire from them to State, district, county, and municipal health officers, reported 105,887 addicts, and were received from 26% of the total, resulting in 420,000. They believed this low, however, and estimated over 1,000,000 addicts.

Development of the Problem

Patent medicines that were advertised as curing opium addiction might themselves contain opium. Heroin was advertised similarly. And, of course, the Harrison Act bolstered the black market and moved opium both underground and towards heroin.

p. 54

A.R. Neligan, in The Opium Question, with special reference to Persia, London, 1927, says “The earliest known mention of the poppy is in the language of the Sumerians, a non-Semitic people who descended from the uplands of Central Asia into Southern Mesopotamia.” Neligan presumably got this information from Dr. R. Campbell Thompson, translator of the Assyrian Medical Tablets, taken from the Royal Library of Ashurbanipal, now in the British Museum. They date to the 7th century BC and are copies of older texts.

Professor R. P. Dougherty, in charge of the Babylonian Collection at Yale, claims that the Sumerian ideogram for opium was HUL GIL; “I should say that the basic meaning of the sign HUL is ‘joy,’ ‘rejoicing.’ GIL as a single ideogram represented a number of plants.” The ideogram cannot be dated definitely, but “probably goes back to the fourth millenium B.C.”

p. 57

In 1803-5, Serturner, a chemist at Einbeck, discovered meconic acid and morphium (an alkaline base) in opium. Robiquet in 1817 isolated narcotin and in 1832 codein, the same year Pelletier discovered narcein, thebain, papaverin, cryptonin, gnoscopin, xanthalin; other alkaloids followed, as did their derivates: apocodein, heroin, dionin, peronin, etc.

P. 65

Alexander Wood, of Edinburgh, is attributed with inventing the hypodermic needle, and injecting drugs under the skin in liquid form.

P. 67

“The hypodermic use of morphin spread rapidly…. In America the instrument came into general use later than in Great Britain but its popularity was stimulated markedly during the Civil War. This was the first occasion when the instrument was available for the wholesale relief of pain.”

“Wood’s wife was probably the first individual to succumb to this method of administration [‘chronic opium intoxication’ via hypodermic], dying a victim of her husband’s ingenuity.”

P. 73

“Shortly after the end of the Civil War the smoking of opium, which had hitherto been confined in this country to the Chinese, began among the whites. According to Kane a sporting character by the name of Clendenyn was the first white man to smoke opium in San Francisco in 1868. The second, Kane says, induced to try it by the first, smoked in 1871.” Importations of smoking opium rose markedly in 1871. The practice spread from San Francisco to “practically every town and city in the country in its progress from West to the East coast.”

P. 75

One trick of the patent medicines was to advertise medicines for the cure of opium addiction, when the preparations contained opium or some derivative.

P. 76

Dreser, in Germany, 1898, produced heroin (diacetylmorphin); it was put out as a “safe preparation free from addiction-forming properties, possessing many of the virtues and none of the dangers of morphin and codein, and recommended even as an agent of value in the treatment of chronic intoxication to these drugs.”

P. 87

The report of the Committee on Traffic in Narcotic Drugs, June, 1919:

In recent years, especially since the enactment of the Harrison law, the traffic by ‘underground’ channels has increased enormously and at the present time it is believed to be equally as extensive as that carried on in a legitimate manner.

P. 90

After the Harrison act, patients who used to get their opiates from the druggist flocked to physicians; “This adjustment was not too difficult, however, and while it somewhat increased the cost to the drug user and added inconvenience it doubtless had a beneficial effect as it brought these cases into the hands of the physician and led to an increase in professional interest that stimulated study and inevitably would have led to many cures and improvements in methods of treatment.”

The regulations, unexpectedly, were used against physicians; “The interest of physicians in these cases thus was checked and they even began to refuse to prescribe. Pharmacists also refused to fill prescriptions and chronic users wandered from one to another and finally were forced in order to secure their drug to seek it wherever it could be gotten—from the peddler at his own price.”

Etiology

Where physicians had no particular desire to spread heroin use, addicts apparently did.

Most investigators placed the cause of narcotic addiction at the hands of physicians; estimating half to 75% to 90% of all addictions.

After the Harrison act, most were introduced by other addicts.

General Nature

The personality changes in addicts can be attributed to their desire to hide their addiction from their friends and family, and a belief that no one will believe that their addiction is not merely a matter of not enough willpower. The prejudices of society against addicts tends to drive addicts into a mode of life that society then claims is caused by their addiction.

p. 197-204

In 1911, Daniel Morat reports “the most extensive pathologic studies of chronic opium intoxication which our search of the literature has revealed.” Morat selected 34 cases out of 146, selecting to exclude other conditions which might confound, such as alcoholism. He followed blood changes, taking four specimens each: before reducing morphin; three days after withdrawal; fifteen to twenty days after; and forty days after.

During intoxication: no “marked changes” in the blood; “and the pallor of some of these cases should be attributed to peripheral vasomotor phenomena rather than to anemia…. Coagulation was nearly normal although in many cases a delay of 10 to 15 minutes was noted.”

Red Cells: resistance of red cells may have been diminished. Possibly more red cells.

White Cells: no effect on the number. 2 to 3% of the polynuclears and “many of the large mononuclears show alterations of shape and color, vacuoles in the nucleus and protoplasm, a reduction of the protoplasm to a reticulum and a scattering of granules in the plynuclear eosinophiles.” Lower leukocytic resistance than normal individuals (white cell resistance).

Did not mention any life-threatening situation on withdrawal.

P. 209-211

G.E. Pettey (1913) believes that the psychic changes noted in addicts is due to their having to hide their use from family and friends; they first try to withdraw, realize they cannot; and realize that no one will believe them. So they go to great lengths to keep their addiction a secret.

P. 237

Torald Solmann: 1924-1926

The life of the addict is dominated by the abstinence symptoms that start when the effect of the dosage begins to wear off; by the consquent need of obtaining the drug at any cost; and often by the fear of detection. If the supply is regular, the addicts may appear quite normal; so much so that the addiction may be kept secret for many years, and the addict may occupy responsible positions… A large part of the traditional depravity of the addicts exists in the minds of the public, rather than in life. This pariah-attitude makes it more difficult for the addicts to lead a normal life, and thus tends to drive them into the very vices of which they are accused… The moderate use of opiates may not produce any definite physical deteriorations…. With more severe addiction, the digestion becomes seriously disturbed, obstinate constipation alternating later with equally obstinate diarrhea, loss of appetite alternating with voracious hunger and thirst and polyuria. The patient loses weight rapidly, and suffers from marasmus and cachexia. P. 249 Dr. Lawrence Kolb, 1925, Pleasure and deterioration from narcotic addiction, Journal of Mental Hygiene, Vol IX, No. 4, Oct, 1925, pp 699-724 “No preparation of opium produces any appreciable intellectual deterioration.”

Pathology (continued) Tolerance—Dependence—Withdrawal

Tolerance—the ability of regular users to tolerate otherwise fatal doses— is “the only fundamental characteristic of opium intoxication that is generally conceded.”

p. 312

All agreed that tolerant individuals can take amounts of opiates that would be fatal to non-tolerant individuals. “This tolerance constitutes the only fundamental characteristic of chronic opium intoxication that is generally conceded.”

P. 313

Codein and apomorphin rarely “if ever” leads to addiction: Committee on Narcotic Drugs on the Council of Health and Public Instruction of the American Medical Association; report adopted by the House of Delegates. 1921.

P. 315-316

Others disagreed. (Sollier, Lambert, Pettey). Lambert, 1922, reports 17 cases of codein habit out of 1,593 narcotics users.

P. 387

Ernst Joel (1932) Zur Pathologie der Gewöhnung. Therap. Gegenwart. 1923, Vol. 64, p. 397-403; 441-447: Talks about mechanisms for opiate tolerance; also mentions (but it is not reproduced here) addiction to nicotin.

P. 404

T. Takayanagi—1924: “Some of the rats were injected once, others repeatedly, with morphin. At various intervals after injection they were killed, passed through a meat-chopper, and tested in accordance with my method, previously described, for the amount of morphin present.”

Types of Users

It is extraordinarily difficult to overcome the prejudices that people have regarding the kind of person a drug addict is. It would be nice to be able to say that researchers no longer do a survey and then extrapolate the basically random results into causation, but we still have major studies of the kind that reported that women with light blue eyes and flaxen hair are the most susceptible to addiction.

p. 469

A. Calkins: 1871: “in the division of sex the women have the majority.”

O. Marshall, 1878: 38.8% males, 62.2% females; Michigan. 1313 cases.

P. 470

H.H. Kane: 1880 “Kane quotes Bartholow as follows:”

A delicate female, having light blue eyes and flaxen hair, possesses, according to my observations the maximum susceptibility.”

J.M. Hull, 1885: “We may count out the prostitutes so much given to this vice, and still find females far ahead so far as numbers are concerned.” In Iowa, 36.2% males, 63.8% females. (235 cases)

p. 471

T.C. Albutt, 1905: Believed greater numbers of females; some of his colleagues disagree, so he’s not sure.

C.E. Terry, 1913, cases handled at health office, Jacksonville, Florida: 42.1% males, 58.9% females.

L.P. Brown, 1914, Tennessee; 2370 cases; 33.1% males, 66.9% females.

C.B. Farr, 1915, heroin use at Philadelphia General Hospital, 75.8% males, 24.2% females. 120 cases; 176 cases of opium-54.41% males, 46.59% females. “The types here represented were quite evidently largely drawn from the underworld where, as would be expected, the origin of the condition was mainly evil association,—hence, both the preponderance of males and the large number using cocain and heroin.”

P. 472

J. McIver and G.E. Price, 1916, Philadelphia General; 70.1% males, 29.9% females, 147 cases.

The majority of women were prostitutes, and some few of the men were or had been cadets. A number were notorious crooks and thieves…. The majority were dwellers in, or frequenters of, the ‘tenderloin.’

J. A. Hamilton, 1919, Workhouse, Blackwell’s Island, New York City, 388 persons in 1918 for drug treatment. 90.5% males, 9.5% females.

P. 473

S.D. Hubbard, 1920, New York City Narcotic Clinic, 7464 cases in 1919. 78.8% males, 21.2% females. Dr. Bucher gives a report from the Los Angeles clinic, 389 cases, 66.8% males, 33.2% females. Dr. Webster, 681 cases in a Cleveland narcotic clinic, 65.5% males, 34.5% females.

P. 474

“As a very general rule, it will be found that those giving a preponderance of women have been private practitioners of medicine, or those whose surveys presumably covered all classes, while those giving a preponderance of men have had experience wholly or chiefly with the inmates of correctional or other public institutions.”

P. 483

“With the advent of the hypodermic the use of the alkaloids was increased markedly and for a while they usurped almost completely the places held by the earlier preparations.”

P. 484-485

“Another factor responsible for the recent increasing widespread use of heroin, namely the illicit traffic. There have been times in this commerce when smuggled heroin has been more easily obtainable than morphin and above all the ease with which heroin permits of adulteration without fear of discovery, thus permitting a very greatly increased profit to the trafficker, has made for its popularity in the underworld traffic…. Also in conjunction with the deterring effect of anti-narcotic laws on the handling of cases of chronic opium intoxication by reputable physicians, a further increase in its use has occurred. Many individuals who had been using opium in some other form particularly morphin have been driven to peddlers for their supplies and, finding principally heroin available, have perforce adopted its use.”

P. 492

S. Block—1915

Normal persons will never become drug habitués…. The author has found it convenient to divide all cases into two great groups: first, those whose trouble is like a neurasthenia, if there is such a sickness; second, those who have a definite hysteria. Most of the cases belong to the hysterical class.”

P. 496

C.B. Pearson, 1919: “The straight morphin addict, he says, rarely becomes a degenerate.

So far as my experience goes I have yet to see my first case. The causes of degeneracy among morphine addicts are the immoderate use of alcohol, mixed drug taking, syphilis of the nervous system, the repeated attempts at heroic treatment that end in failure, or repeated shocks due to abstinence from the drug from any reason, viz., imprisonment, or accidental separation from the source of supply due to lack of funds or any other reason…. I do not mean by this that morphine is not one of the causal factors of degeneracy in the latter type of cases. While morphine acting upon one who lives a normal hygienic life in all other respects has not in my experience proved to be sufficient to cause degeneracy we can readily see that the casre may be different when the drug acts upon an individual whose power of resistance is being or has already been broken down the the excessive use of alcohol, cocaine, chloral hydrate or other powerful hypnotics, syphilis, the repreated shocks of mistaken methods of treatment, even if only one of these factors is working with the morphine….. However, it is really surprising how long some of them bear up under all these factors of degeneracy and still retain a fair degree of mental and moral integrity for some time.

P. 497

T.S. Blair, 1919

Morbid and unstable individuals who become drug addicts are the ‘horrible examples’ held up too much to public view and reprobation. It is not true that all drug addicts, nor even one-fourth of them, ever become such creatures as are depicted in fiction.

P. 504

Lawrence Kolb, 1925

Addressing opiates causing criminal behavior, a study of 225 cases of criminal addicts, found that “in the vast majority of cases the addict was a criminal before he became addicted, and that “…no opiate ever directly influenced addicts to commit violent crime…. No addict who receives an adequate supply of opium and has money enough to live is converted into a liar or thief by the direct effect of the drug itself.”

For cocaine, a certain amount makes the criminal more efficient; over that brings “uncertainty, fear, and anxiety.” “The drug does not arouse criminal impulses in anyone, but enhances the criminal’s mental and physical energy.”

P. 509 (Lawrence Kolb again)

All preparations of opium capable of producing addiction inhibit aggressive impulses and make psychopaths less likely to commit crimes of violence.”

P. 513

“It is not unnatural, for instance, for the head of a penal institution in which cases of chronic opium intoxication are treated to come to the conclusion that the underworld and criminal classes are especially prone to this condition; for the head of a state hospital to conclude that the mentally unstable form a considerable majority of these patients, and for the proprietor of a private institution, where the cost of treatment is within the means of only a favored few, to claim that financiers, individuals highly successful in the business world, and professional groups able to pay the highest prices to a large extent are susceptible to opium.”

Treatment

Even among all of the prejudices back then, there were still people who realized—and put into practice—that removing the external forces that drive the addict into a downward spiral can end that spiral. A lessened use of the drug follows.

p. 559-561

E.S. Bishop—1912-1920.

“Our stumbling-block in the past has been that our minds have been too much focused upon the mere use of narcotic drug and upon the stopping of drug use and too little upon the individual we were treating and the mechanism of his disease.”

“Intelligent addicts” manage to figure out that the less number of times a day they take the drug, “the less constipated and more normal they are, and the smaller amount of narcotic drug they require to maintain them physically and mentally competent.”

“In caring for the narcotic addict, therefore, one of the most important therapeutic measures is the regulation of the interval of his narcotic drug administration. I have repeatedly experimented upon addicts who were not confined or under restraint in any way. I explained to them the inhibitory effects of too frequent dosage and instructed them to use the amount of drug they found necessary for twenty-four hours in large doses at longer intervals. This procedure alone, in many cases transforms the pallid, starved, constipated and deteriorated addict within a surprisingly short time into a well-nourished, well-reactive and practically normally functionating individual. With the return of health, vitality, and normal nutrition and elimination, his body requires still less drug and he voluntarily and without mental struggle and nervous strain reduces the amount of drug used. I wish to emphasize that in these experimental cases there were no other therepeutic measures employed in the way of medication.”

Lawrence Kolb—1927

p. 620

“Opium, unlike alcohol, does not cause, so far as known, any destruction of tissue or permanent protoplasmic change.”

Control

Opium prohibition was part of a web of international treaties designed to give national governments some plausible deniability.

p. 629

International Opium Commission, Shanghai, February 1, 1909, adjourned February 27th. Called by the United States, attended by Austria-Hungary, China, France, Germany, Great Britain, Italy, Japan, the Netherlands, Persia, Portugal, Russia, and Siam.

P. 631

Phillipines: total prohibition of importation of opium into Phillipines in 1908.

P. 632

Commissioners appointed to represent U.S.: Bishop Charles H. Brent, Dr. Hamilton Wright, and Dr. Charles D. Tenney.

P. 636

American delegates to the 2nd International Opium Conference: Bishop Charles H. Brent, Hamilton Wright, and Henry J. Finger.

P. 653

Hague Convention ratified on October 18, 1913, by Senate; October 27, 1913 by President. On January 17, 1914 President approved act restricting exportation of opium and its preparations.

Control—National

The Harrison Narcotics Act destroyed all of the successes of the only “prohibition” act to ever work successfully—the labeling act of 1906. Instead, opium prohibition ended up with all of the success of alcohol prohibition.

p. 745

First mention of opium in tariff acts in July 14, 1832, section 3; it was exempt from duty. Later, duty frequently changed. First made to pay a duty on tariff act of August 30, 1842.

P. 748

National Food and Drug Act of 1906. Prohibited the introduction of adulterated or misbranded drugs.

Sec. 2. That the introduction into any State or Territory or the District of Columbia from any other State or Territory or the District of Columbia, or from any foreign country, or shipment to any foreign country of any article of food or drugs which is adulterated or misbranded, within the meaning of this act, is hereby prohibited.

P. 753

HR6282: approved December 17, 1914. The Harrison Narcotic Act. (Amended in the Revenue Acts of 1918 and 1926, and the act of March 3, 1927) Drugs included: “Opium and coca leaves, and compounds, manufactures, salts, derivatives or preparations thereof.” Exceptions: “Certain preparations containing not more than two grains of opium, one-fourth grain of morphin, one-eighth grain of heroin or one grain of codein or any preparations of them in one ounce.” Providing that they are for medicines and not evading this act, and that a record is kept, except that: “Decocainized coca leaves and other preparations which do not contain cocain are excepted.”

P. 766

An Act of Congress, approved March 3, 1927, created the Bureau of Prohibition, under the Treasury Department. The Harrison Narcotic Act enforcement was transferred from the Commissioner of Internal Revenue to the Prohibition Commissioner. Effective January 1, 1928.

Control—State

The Texas law, on the surface, appears to make some sense: why not reduce the violence of prohibition by making it illegal to carry weapons while dealing in prohibited drugs? But its an example of our inability to back down in the face of bad decisions. One law results in more violence, and rather than repeal that law we add more laws to it, much as if we were addicted to bad laws.

p. 810

North Dakota: “any habit-forming drug, whatever its nature or character, or any substance or residue left after the smoking of opium.”

P. 822

Texas passed, in 1923, a law making it a felony to carry a pistol or other weapon while possessing for unlawful sale, furnishing, or giving away, any of the proscribed drugs.

Control—Miscellaneous Suggestions

As above, it may have been their consensus, but I’ll bet it was also their consensus that they needed to receive and apply more resources to combat this crime, rather than back off and end the spiral of violence around it.

p. 890

E.H. Williams—1921

He says that it seems to be “the consensus of opinion among federal, state, and county officials that after five years of enforcement the number of drug takers and the amount of drug consumed are just as great if not considerably greater than before.”