Alexander DeLuca, M.D.
The Drug Hang Up, America's Fifty-Year
Chapter 3: The Sensible Century and Mr. Harrison's Tax Act
IN MANY WAYS America must have been a relaxed and comfortable place in her first dozen decades-if one disregards the plight of black compatriots and the sufferings of the war that released them from slavery. The frontier heritage nurtured self reliance, and if Americans were not always right in their convictions, they seemed generally righteously serene about them. The family was the family, and father was head of it. Country and flag were objects of simple adoration. The dollar remained truly worth one hundred cents, with only moderate attraction for tax collectors. The good were good and were rewarded with opportunity, if nothing else; the bad were very bad and deservedly wound up shaven, garbed in stripes, and wearing balls and chains. Simple virtue in this world assured everlasting bliss in the next.
Nineteenth-century Americans were for the most part relaxed about personal indulgences, too. Most towns had their amiably tolerated drunks and a complement of ne'er-do-wells who squandered their lives harmlessly in pool halls and saloons. Snuff and tobacco were accepted-for men only, and not including the diabolical cigarette-but those curious strictures were also embraced without controversy. Moralists decried the evils of gambling, card playing, and Sabbath breaking more than the personal ingestion of toxic substances. Opium remained one of the most important medications available to practitioners of the healing arts; opium eating was beginning to make small inroads as an indulgent habit, but in most of America cigarettes continued to be viewed with more opprobrium than any form of the opium habit.
When morphine, a derivative of opium, was isolated by German pharmacists at the turn of the nineteenth century, it was found to have superior analgesic qualities and was soon universally relied upon for the relief of pain. In an error they have repeated with new substances since, doctors hailed morphine as a nonaddicting substitute for opium, and some recommended it unreservedly as a cure for both alcoholism and the opium habit. Codeine, another valuable opium alkaloid, was isolated a few years later, and in 1845 Alexander Wood invented the first practical hypodermic syringe.
As the nineteenth century progressed, eating-opium could be bought in grocery and candy stores, and the promoters of patent medicines, including even "soothing" preparations for children, took to loading their products with the drug. Nostrums were widely promoted to cure victims of alcoholism or the drug habit-and this was indeed what they would do, by substituting addiction to the medicine itself. A few marginal physicians, predecessors of the odious "scrip doctors" who sold drugs and prescriptions to anyone for what the traffic would bear after the advent of prescription controls, bolstered their practices by inducing addiction among patients of sufficient means so that once they were hooked they might happily continue "treatment" indefinitely.
It was the Civil War, however, that gave the American addiction rate its big boost. In those bitter years, morphine and the new syringe proved a blessed substitute for inadequate battlefield ministrations, and opium was always in short supply because it was an effective antidote for the ubiquitous dysentery which afflicted soldiers under both standards. In the years following Appomattox, addiction became tolerantly known as "the army disease."
So it would not be proper to suggest that drug abuse in this permissive era was insubstantial. In the 1880's one observer estimated that 4 per cent of the population of the United States used some kind of opiate for nonmedicinal purposes. There were simply no controls. Patients introduced to the needle by their doctors could carry on with self-administrations, if they chose, merely by addressing themselves to the neighborhood chemist for supplies. (There was another limitation on popular use of the needle, however, and that was lack of knowledge about antiseptic procedures until the turn of the twentieth century. The portrayal of user-victims as covered with abcesses might not have been an atypical distortion in Lord Lister's day and before the advent of antibiotics.)
If drug use was not really approved by society, addiction was nonetheless regarded merely as a personal weakness similar to overindulgence in alcohol, and no efforts were made-or dreamed of-to impose penal restrictions. By the 1880's, enlightened medical men were beginning to speak out, warning that opium was claiming people "who crave the effect of a stimulant, but Will not risk their reputation for temperance by taking alcoholic beverages," and that drug victims "have not come from the ranks of reckless men and fallen women, but the majority of . . . [whom] are to be found among the educated and most honored and useful members of society."
Opium received attention in the famed works of Coleridge and De Quincey, and its use by American figures like Edgar Allan Poe was well known. But the best measure of how drugs were accepted in England and America is provided by the most admired hero of Victorian literature himself the creation of a medical man-who relaxed at the Baker Street flat after his bouts with Professor Moriarity by summoning Dr. Watson to prepare him a needle.
Heroin was, isolated in 1898, again by a German, and once more this new poppy derivative was hailed by much of the medical profession not only for its very real therapeutic advantages over other drugs in dealing with bronchial and pulmonary problems, but also as the long-sought nonaddicting substitute for morphine. And during all this era, of course, doctors quite apart from the reprehensible few already mentioned who intentionally addicted patients to build up their practices, made many addicts simply because the opiates were good medicine, soothing, calming anxieties, and arresting pain in situations where medical practitioners had no other effective way to deal with their patients' problems.
Estimating the addict population at any given time, and even the composition of the addict community, easily degenerates if one does not specify careful reservation. Authoritative pronouncements can be found to buttress almost any thesis about any period. It has been noted that one accepted estimate of the pre-1900 drug-using population was 4 per cent of the nation, or 2.5 million persons based on the 1890 census. This seems high, perhaps because (like some of the figures being offered today) it may have included those who had merely tried some addicting substance as well as true addicts. The two most respected authorities on the subject, who made a retroactive examination in 1924, concluded, figuring from the amounts of opium and opiates known to have been imported and distributed, that before World War I America was sustaining an addict community (to the opiates only) of not more than 100,000.
Whatever the figure, it was agreed by most observers that in those days addicted persons were mostly middle-aged and that a substantial preponderance were women. If there was a regional weighting it was toward the South, and if any class groupings were significant they would not have been lower, underprivileged, or minority. As one eminent physician of the period observed, "Thousands of women were addicts of opiates, with no thought of wrong-doing, who would have gone on their knees to pray for a lost soul had they seen cigarette stains on the fingers of a daughter."
Lord Lister is credited with the classic comparison: "Opium soothes; alcohol maddens." In turn-of-the-century America, while their fellows were being incapacitated in ever larger numbers by drink, drug users, able to maintain their supplies without difficulty and at modest expense, generally pursued normal callings and posed no problems for society. People in responsible positions-the most-told tale being that of a New York Central engineer who never missed a run in more than two decades while he was a heavy user of morphine-carried on normally in useful lives.
There are several reasons why drug addiction (though I should repeat now and then that alcohol, nicotine, coffee, and tea are honest-to-goodness drugs by every definition, too), escaped the early missionary fury against drink which eventually swept the United States into the Prohibition experiment. Demon Rum not only disabled, but it unforgivably disabled people of the working classes, whose fidelity to the twelve-hour day was essential to America's emergence as a great industrial power. Drugs had no such threatening potential. Opium smoking, associated with laziness and nonproductivity in the Far East was inhibited by high duties laid on in the 1880's, by a law prohibiting manufacture in the United States after 1887, and by a total ban on imports for the smoking use after 1909. Smoking also received a setback in the public view in the early 1900's when it became associated to some extent with the so-called criminal classes. But this probably had the effect, among others, of inhibiting adventurous youngsters who might otherwise have tried it, driving them instead to the differently frowned-upon cigarette. The "opium den" was a dime-novel fantasy for most good citizens, while the saloon, and in cities the corrupt and corrupting saloonkeeper, were conspicuous targets.
Opium had singularly important medical uses, as we have noted, and a substantial number of addicts had acquired the habit in the course of medical treatment. Drugs were cheaper than spirits, so maintaining a habit imposed little hardship on the user or those dependent upon him. And finally, as has also been noted, when heroin was isolated in 1898 there followed a period in which the medical profession itself proclaimed this new discovery as promising all the benefits of morphine without attending disadvantages-as, in fact, a reliable cure for addiction.
We have not yet said anything about cocaine, and it deserves only passing mention in relation to the opium problem because, in the first place, cocaine is not addicting, in terms of compulsion to use, the tolerance phenomenon, and withdrawal symptoms although official propagandists now distort this classic definition. Nor is cocaine even habituating to the same degree as tobacco. It is a product of the coca plant, long known to Indians of South America who chewed its leaves to reduce fatigue and to induce mild euphoria. The pure drug was first isolated in 1883 and was widely used in medicine until more effective substitutes became available-. Coca-leaf flavoring, with the secret formulas long since changed to delete all traces of the drug, has made the plant better known to soft-drink fans throughout the world than to drug abusers.
Unlike the opiates and alcohol, cocaine is a stimulant. Ingested by sniffing or injection, it produces manic excitement, and used persistently it is capable of causing delusions. Cocaine sniffing, like opium smoking, came to be associated in the public mind with prostitutes and criminals, and -never made much short penetration into the American population at large, although it will reappear in our story in a surprising renaissance in the decade just past.
There is another touch of poetic justice in the China-Philippines story that was unfolded in the last chapter, for it was primarily the Far East involvement that led the federal government to get mixed up in drug-use repression on the home front. Decreeing prohibition for the Philippines and trying to mobilize the international community to impose abstinence on China may not have been responsible for all the excesses of the Eighteenth Amendment, although I would not rule out a possible connection. But the controlling force of these episodes in saddling the United States with its own federal drug police is scarcely open to doubt. And much of America's unique difficulty with drug problems in the ensuing decades seems directly attributable to this misguided commitment of national power in dealing with matters which chiefly affect only individual citizens' body chemistry.
U.S. preoccupation with opium in China after the turn of the century coincided handily with the push of American commercial interests to break up spheres of influence and open Far East markets to all comers. Humanitarian sentiments ran high in the American electorate, and so did lusty self-assurance about America's new role as a world power. U.S. involvement was deepened in the Philippine struggle, and when the Philippine Commission began implementing the opium prohibition Congress had specified, American authorities became more concerned about conditions on mainland Asia because of the inbound smuggling traffic that soon flourished.
When the Shanghai Conference, summoned by President Roosevelt, was convened in 1909, American delegates came with resolutions calling for cooperation to end the traffic, but the colonial powers restricted themselves to expressions of high resolve and discussions of gradual reductions. Nonetheless, the stage was set for the Hague Conference, also proposed by Roosevelt, and convened by the Netherlands government three years later.
Again at the Hague, the American delegation played a leading role, vigorously supported by the Chinese, in pressing for immediate sanctions to restrict production and end trafficking. In the Hague Opium Convention of 1912, the result of the Hague Conference, each signatory committed itself to impose controls on domestic production of opium and opium derivatives (none of the parties except China and Persia being opium producers) and to take steps to restrict domestic consumption of the drug strictly to controlled channels and legitimate medical uses (no one, again excepting China, having a large domestic-consumption problem).
As might have been expected, the Hague Convention had, at the outset, little international effect, although the U.S. delegation credited itself with a humanitarian coup and further meetings were called in 1913 and 1914 to try to induce wider acceptance of the Hague principles. Ratifications came so slowly that it was not until the aftermath of World War I that the Convention became a vital force, and then only because the document was incorporated, largely at U.S. insistence, into the Paris treaties.
But because America had been so strongly committed to the purposes of the 1912 effort, and because, as will be described in the next chapter, the United States was beginning to lose its perspective on the home front, Congress in 1914 enacted the Harrison Narcotic Act, which stood as the basic federal drug law for the next fifty-six years. The Harrison Act was not in any sense a prohibition statute, but rather a mild regulatory measure consisting of registration and record-keeping requirements to which a moderate federal tax was added in 1919. Its avowed purpose was to bring the domestic drug traffic (including cocaine) into observable channels. As one of its chief supporters, Dr. Hamilton Wright, who had been a member of the Hague delegation, explained:
The heart of the Act as it emerged in 1919 was an excise tax, at the modest rate of one cent per ounce, on opium, coca leaves, and their derivatives, the tax to be evidenced by stamps affixed to the package or container in which the drug first entered domestic commerce-that is, by the importer, manufacturer, producer, or compounder. Other provisions were logically drawn to facilitate collection of this tax. It was made unlawful for anyone to purchase, sell dispense, or distribute drugs except from the original stamped package, and unlawful for anyone to deliver or give away drugs except pursuant to a written order from the recipient prepared on special forms supplied by the Treasury Department.
Similarly, to bring the traffic into observable channels and facilitate collection, the Act required everyone whose vocation involved the handling of narcotic drugs and cocaine (hereafter we shall ignore the wholly illogical inclusion of cocaine, as has nearly everyone else for the past fifty years)-importers, manufacturers, wholesalers, druggists, doctors, dentists, researchers to register with the Treasury Department and to pay an occupational tax graduated from $1 to $24 per year. Each registrant was required to keep appropriate records, and these records were made available by law to Treasury representatives and other law-enforcement officers for inspection.
Note that the Harrison Act imposed no standards as to quality, labeling, or packaging comparable to those prescribed in the federal Food and Drug Act of a few years earlier. And note further that it imposed no restrictions of any kind on who might register and deal in the drugs, so long as the records were kept and the taxes paid. It required a far stretch indeed to make of this bland federal revenue law the fearsome instrument of repression it was soon to become. But stretch there was. And that is the sad-sometimes incredible-part of the narrative to which we come next.