The narcotic drug problem

by Ernest S. Bishop

The honest physician has no desire to dodge responsibility for his handling of narcotic addicts to the best of his ability, nor should he have any objection to a reasonable responsibility and accounting for narcotic drugs used in that handling; especially since the taking of narcotic drugs has in certain of its phases, developed as a serious situation entirely outside of the medical profession, in which situation these drugs are non-professionally supplied and used to such an extent as to constitute a public menace. The non-medical supplying and administering of such drugs should not, however, be controlled in such a way as to unduly hamper their honest and legitimate use by medical men, and to deprive the honest, worthy and innocent sufferer from addiction-disease of their legitimate therapeutic administration.

One of the chief and most serious phases of the narcotic drug problem, which for obvious reasons has especially called for legislation, is the illicit and illegitimate commerce in narcotic drugs. The class of addicts which constitutes a public menace is largely so supplied. This fact is recognized in the recent report of the Special Committee of Investigation Appointed by the Secretary of the Treasury, in which is stated, “This illegitimate traffic has developed to enormous proportions in recent years, and is a serious menace at the present time. It is through these channels that the addict of the underworld now secures the bulk of his supplies.”

This Report further states that “there is the so-called ‘underground’ traffic which is estimated to be equal in magnitude to that carried on through legitimate channels. This trade is in the hands of the so-called ‘Dope peddlers,’ who appear to have a national organization for procuring and disposing of their supplies. For the most part it is thought that they obtain their supplies by smuggling them from Mexico or Canada, although smaller quantities of these drugs are obtained from unscrupulous dealers in this country or by theft,” etc. There should be some way to dissociate entirely, conclusively and finally in the minds of the public the illegitimate and underworld traffic in narcotic drugs from the efforts of the honest physician to practice rational and scientific medicine in the help of the worthy and deserving addict. The regulation of the narcotic drug traffic of the underworld or “underground” is not the business of the medical profession, and the burden of responsibility for it should not be placed upon the shoulders of the medical profession or the consequences of it made to react upon the head of the honest physician and innocent addiction sufferer. There is a tremendous number of excellent and worthy and even illustrious people in whom addiction is in no way associated with vice, or other morbidity of mental or environmental origin, who are merely, solely and simply sick people suffering from addiction-disease, whose problem is the control of that disease until it can be arrested by competent therapeutic procedure, for which they constantly seek. Misconception of them and neglect of sufficient consideration of them is the tragic aspect of the narcotic drug situation, and causes tremendous individual and economic wastage. They do not in any way associate with underground traffic unless or until driven to it by failure of legitimate sources of opiate medication, or by the surrounding of legitimate sources with such restrictions as make the man of standing and reputation, afflicted with addiction-disease, fear possible publicity and economic detriment.

It is the duty of the medical organizations to see to it that these deserving purely medical problems and worthy sick people and their honest medical advisers shall no longer than avoidable be permitted to remain confused in the minds of the laity and of the medical profession itself with the problems of regulation of “underground” traffic and the control of the “underworld” addict. It is the duty of the medical organizations also to see to it that in the public press and elsewhere, and especially in their own scientific journals, the acts of the occasional individual with medical degree who prostitutes his medical standing and the aims and ideals of his profession in the commercial exploitation of the drug addict are not presented in such a way as to cause by inference or otherwise, their confusion with the honest efforts of honest medical men who are engaged to the best of their ability in the humane and ethical help of the deserving sufferer from addiction-disease.

It is, furthermore, the duty of the medical organizations to see to it that whatever laws and regulations are promulgated in the control of criminal and unworthy shall not be framed or administered in such a way as to unnecessarily jeopardize the reputation and liberties of the honest practitioner and to interfere with his conscientious efforts to care for his honest and innocent addiction-disease patients to such an extent as makes that care impossible.

Legislation or administrative regulation which limits to responsible and authorized persons possession and distribution of narcotic drugs and which compels from such persons reasonable accounting for such possession and distribution, is under conditions which have long existed but only recently been sufficiently recognized necessary and desirable. The Harrison Law was a definite response to an obvious need, in its obvious intent and draughting a wise and unobjectionable legislation. It provided for responsible possession and distribution and it enforced an accounting for the same, but did not unwisely restrict, in its text, nor hamper the legitimate possession and honest therapeutic employment of narcotic drugs. From the medical organizations and educational and scientific institutions should be available scientific study and understanding of narcotic drug addiction-disease available for the information of conscientious executives and administrators, who must exercise their best judgment in the light of available and prevailing teaching. It is the duty of the medical organizations to see to it that available and prevailing addiction-disease information and teaching is honest, unbiased and competent.

Those who are responsible for our laws should remember that the possible interpretation and administration of the laws they draught are very important considerations, and determine the real effect of the laws often more than does the intent of the makers. Legislation which is unduly stringent or is capable of unduly stringent administration may have unfortunate reaction and influence upon honest effort in the care of the deserving sick. Restricting beyond reasonable limits the care of the honest narcotic drug addict simply tends to make it impracticable and dangerous for the average medical man to have anything to do with narcotic addicts, and to drive the honest and deserving patient into the underworld, into the insane asylum or to suicide. Until we have provided scientific and clinical study, and have thoroughly investigated present and possible medical treatment and handling of narcotic-drug addiction-disease, and have established humane and effective therapeutic measures and procedures in the control and remedy of this disease, we should not deprive the majority of honest addicts of the only medication and means by which they can at present remain self-supporting citizens. The handling of the problem of the underworld and of underground supply is not going to be solved by too restrictive regulation of the honest physician. Legislation or regulation which makes it practically impossible for the honest physician to care for the honest case of addiction-disease is a boon to charlatans, and medical shysters, and the illicit underworld traffic.

It is the opinion of some that the handling and treatment of narcotic addiction should be taken out of the hands of the practitioner of medicine. The statement is made that the practitioner of medicine is not competent to handle a case of this disease. It has been advised that the treatment of narcotic addicts should be restricted to a small number of specially designated and licensed men and institutions. How and by whom are those special men and institutions to be selected? In the present state of chaotic and widely diversified medical and lay opinion as to narcotic addiction and the narcotic addict it would be a very difficult matter to select the men or the institutions for such absolute control. The comprehension, study and investigation of narcotic drug addiction has entered a stage of evolution and development in which new facts and new truths—both as to the addict and as to the condition from which he suffers—are being recognized and must be threshed out, correlated and coordinated with hitherto existing opinion before too restrictive measures will be anything but narrow-visioned, premature and harmful.

There are undoubtedly institutions, many of them not widely known, in which is available skillful, humane, intelligent and successful handling of this disease. From personal observation and experience in institutional work, and from analysis and investigation of many histories, it is my opinion that the results of institutional treatment depend more upon the quality of its medical and nursing staff than upon any other consideration. That the mere fact that addiction-disease is handled in an institution is a very minor consideration in comparison with the intelligence of that handling, is amply attested to in the testimony of the Whitney Hearings and by the experience of many addicts. Unquestionably, unknown and large numbers of narcotic addicts have been relieved of their addiction in reputable sanitaria conducted by skillful and competent medical men. Also unquestionably, large numbers of addicts have been relieved of their addiction through the honest efforts of practitioners of medicine, in private practice. Unfortunately these efforts and their results have received entirely too little recognition.

The average physician may be inexpert and not as completely educated in the appreciation, understanding and clinical handling of narcotic drug addiction-disease as he is in other diseases. The common-sense remedy for this situation, however, is not to drive the addict out of his hands, but to make him as competent in that addict’s handling as he is in any other clinical condition. It is only a matter of time and education before the competent practitioner of internal medicine can be brought to a comprehension of and ability to intelligently handle addiction-disease. It is largely a matter of securing general appreciation of and ability to clinically recognize, and interpret physical symptomatology, and to meet the indications of individual disease manifestations.