An Editorial ACAR Everyone's Responsibility CARLOAD of young people crashes; a teenage girl commits suicide; derelicts die unmourned; families are torn apart; a bearded youth loses his mind-these are some of the tragedies of drug abuse. The drug problem is becoming more and more serious in America as young people seek kicks and escape, not realizing the heartache their actions inflict on families, community and society in general. And the nation's financial burden of prevention, crime control, rehabilitation and welfare payments is growing rapidly. Perhaps selfishness-having such regard for one's own interests that the happiness and welfare of others is ignored— is one of the root causes. Drug abusers often are unwilling and unable to assume the responsibilities of citizenship but perfectly willing to grab all the advantages our society gives them. But as it does in any major crisis, America is marshalling its vibrant energy to meet the challenge. Government is expanding treatment and rehabilitation facilities and pressing educational programs. Industry is working at the in-plant and community levels to ease the impact. Schools and churches are alerting youngsters to the dangers, and parents everywhere are conferring about the problem. But young people-those who seem to be most involved with drug abuse-also must turn their talents to solving the problem. Elimination of drug abuse is everyone's responsibility. -RFH Prevention Is Good Business The Drug Problem By John E. Ingersoll Director, Bureau of Narcotics and Dangerous Drugs The growing problem of the abuse of drugs has given rise to deep concern in all informed segments of society. There is no longer any question about whether the problem exists. Daily news reports of arrests, seizures of illicit narcotics and dangerous drugs, and especially the nowfrequent details of teen-agers found dead from overdoses of drugs leave little doubt. A recent headline in a New York paper read "4 More Narcotics Deaths Here Bring Total to 170 in 10 weeks." Another, from Philadelphia says "Narcotics Arrests of Whites Mount, Spread to Affluent." But it is not only heroin that is killing people. The Los Angeles Times reported an average of 21 deaths a month or a total of 252 deaths in 1969, of persons under 25. Of the 252 total, 167 died of overdoses of barbiturates. Someone is doing a big business, and that business is manufacturing and selling illicit drugs. The market for those drugs is greatest among two relatively ignorant groups, ghetto dwellers and teenagers. Drugs are indeed big business, but it is an illegal and dirty business. Trafficking in heroin, and more recently in hashish, amphetamines, barbiturates, hallucinogens like LSD, and marihuana has become one of the largest enterprises in our society. It is estimated that addicts spend a half-billion dollars a year on heroin alone. When the cost of stolen merchandise is estimated at its replacement value, the cost to the community, including the business community, might run as high as a billion and a half dollars a year. The manufacture, distribution, and sale of drugs is as well-organized as many legitimate businesses, and much more profitable to the higher-ups who control the trafficking. The principal market for the world's illicit drugs is the North American continent. Heroin, manufactured from the opium poppy, finds its way here from Turkey through the Middle East and the clandestine laboratories of France, though lesser amounts come from Mexico and the Far East. The majority of amphetamines and barbitu May 18, 1970 Mr. Ingersoll Beginning with this issue, NAM Reports will publish a series of articles by recognized authorities dealing with drug abuse in America. This is, of course, a serious national problem that is beginning to infect industrial employes. With the growing use of harmful drugs and narcotics among school-age population, members of America's future work force also are being threatened. With a deeper understanding of the nature and gravity of the problem, business leaders will be better equipped to assist in the development of programs of education, rehabilitation and prevention. Mr. Ingersoll's article deals with the impact of the drug problem on industry. I urge you to read it. rates, on the other hand, are manufactured legitimately in the United States and are diverted from legal channels through theft, smuggling and through black market dealing by employes of a few manufacturers, wholesalers, or retailers. Hallucinogens come from abroad, or are manufactured in clandestine laboratories in this country. The distribution of these illicit drugs is carried out by organized groups large and small, which operate in different areas of the country. Though their product varies, its effects are always the same: immense profits for themselves, a loss in useful citizens and money for our society, tragedy and sometimes death for drug users, and unhappiness for their families. The illicit drug business involves manufacturing, market research, shipping, consignment of orders, processing, and sales. Part of this picture should be familiar to the businessman. However, the reasons for the existence of and increase in the illicit drug business are most complex. They do not respond to analysis through simple supply and demand economics. The insidious dealings of the various levels of trafficker include trade in fear, greed, ignorance, and corruption. The abuse of drugs is not, however, confined to the illicit ones. Many drugs legitimately prescribed by physicians and dispensed by pharmacists are abusedsometimes unwittingly-by law-abiding adults who are ignorant of the conse NAM Reports W. P. GULLANDER quences. The middle-class housewife, who takes an amphetamine to "pep her up" in the morning and a barbiturate to get to sleep at night, is a drug abuser. The truck driver who takes a stimulant to keep awake on the road when regulations say he should be resting is a drug abuser. The young secretary who takes diet pills for extended periods of time is a drug abuser. There are other factors involved in drug abuse in our society. The Attorney General has recently pointed to media advertising as a source of general conditioning for the acceptance of drugs by our youth. The television or radio message is too frequently "take somethingour pills-and you will feel better, be happier, and live happily ever after." This dependence on chemicals is being urged indiscriminately by high-pressure advertising tactics. These general aspects of the drug problem which faces our nation reveal the extent and complexity of the problem. The Bureau of Narcotics and Dangerous Drugs faces this problem with four weapons: enforcement and training of state and local law enforcement officers, which are the essential immediate and shortrange functions; and research and prevention education programs, which are the long-range objectives of the Bureau. Among the latter is joint sponsorship of a 3-year advertising program, with the National Institute of Mental Health and 1 President Nixon has designated the week beginning May 24 as Drug Abuse Prevention Week. In issuing his proclamation, Mr. Nixon said: "The past decade has seen the abuse of drugs grow from essentially a local police problem into a serious threat to the health and safety of millions of Americans. The number of narcotics addicts in the United States is estimated to be in the hundreds of thousands and the effects of their addiction spread far beyond their own lives. "Statistics tell but part of the tragedy of drug abuse. The crippled lives of young Americans, the shattered hopes of their parents, the rending of the social fabric-as addicts inevitably turn to crime in order to supply a costly habitthese are the personal tragedies, the human disasters that tell the real story of what drug abuse does to individuals and can do to our nation." Drugs Continued From Page 5 the Department of Defense, designed to inform the public about the drug problem. Business and industry have no immunity from the drug abuse problem that is affecting the rest of society. While there are no reliable statistics available, mounting reports indicate that employers can expect their working-force problems to increase. One medium-sized East Coast plant discovered nine drug users through a nurse's observation of unnaturally pinpointed pupils in a patient being treated for nosebleed Urine analysis and confidential information led to the discovery of eight other drug users. The report does not reveal the type of drugs used; however, narcotics, amphetamines and barbiturates can be detected in urine, but marihuana use cannot. A union official is quoted as saying. "Our shop stewards are finding the evidence in rest-rooms-the sweet smell of marihuana, needles, and other paraphernalia for drug injections, guys with needle marks on their arms who became ill on the job." Certainly drug-abusing employes are more likely to resemble the typical drugabuser in his lack of motivation, need for money to finance his habit, preoccupation with drugs, association with criminal elements, and generally poorer health. There are no valid statistics comparing the drug abuser in industry with the non-user of drugs. However, studies of long-term users of marihuana have shown him to have less marital stability, less likelihood of success, and greater likelihood of poorer achievement in his occupation. Though drug abuse detection and prevention programs are not common in business and industry, some are being established. For example, the Atomic Energy Commission provided an orientation this month for the plant security personnel of 165 of its supplier industries in 2 Oakland, Calif. Part of the four-day program was an orientation on the drug abuse problem, conducted by the Bureau of Narcotics and Dangerous Drugs regional office. Though heroin abuse is still most common among ghetto dwellers, the abuse of other drugs is increasing among the better-educated in our society. The drug abuse problem is not confined. The drug abuser is found on the college campus as well as the inner city, in the suburban high school as well as the ghetto. A personnel folder which contains a high level of education cannot guarantee an employe's potential if he abuses drugs. It makes good sense and is good business to begin a program of drug abuse prevention before the problem requires drastic action. Basic functions of the industrial program for abuse prevention should include the following: • Provision for educational and orientation service for industrial physicians and nurses to assist in handling general psychiatric problems, as well as abuse problems. • Provision for an educational and orientation service for those with supervisory functions to assist them in the early recognition of drug abuse. • Provision for a consulting service to physicians and management for the evaluation and rehabilitation or referral of drug abusers (when possible). • Provisions for research into possible adverse influences on employes not abusing drugs, ie., morale and productivity. • Development of relationships with community agencies concerned with the welfare of employes. • Development of an educational and informational program for employes which provides accurate, factual information about the dangers of drug abuse. Drug abuse prevention programs must also be concerned with identifying drug abuse in a factory or business. Because of the large number of employes at many plants, drug abusers may go unnoticed by supervisors for quite a while. Supervisors unaware of some of the symptoms of drug abuse may never suspect abuse, attributing unusual behavior to idiosyncrasy or eccentricity. While it must be realized that only the physician especially trained can definitely diagnose drug abuse, industrial physicians can provide training to acquaint supervisors with some common symptoms of possible drug abusers. Training required to identify the following symptoms is minimal, and can be accomplished by a combination of films and lectures. Supervisors can be trained to notice sudden unusual, unexplained changes in behavior and/or productivity, sudden increases in the number of absences from work, continual self-neglect, degeneration of performance level, and erratic changes in emotion or activity. More specific clues to drug abuse may include wearing sunglasses at inappropriate times to cover dilated or constricted pupils and long sleeves worn at all times, even on hot summer days, to hide marks caused by intravenous injection of drugs. Supervisors should also be able to recognize physical behavior resulting from the abuse of specific drugs. For example: The abuser of depressants such as the barbiturates-"sleeping pills" - usually shows most of the signs of alcohol intoxication slurred speech. staggering. etc. with one exception: there is no odor of alcohol on the breath. This type of abuser may fall asleep on the job or appear confused. Abuse of the amphetamines (stimulants) such as diet pills or "pep pills" brings about excessive activity, excitability or irritability, and heavy perspiration. The pupils may be dilated, even in bright light. These drugs may also cause unusual bad breath unlike that resulting from garlic or alcohol, and chapped or cracked lips caused by drying of the mucous membranes. The amphetamines also cause complexion problems. Finally, excessive nervousness may lead to itching, Drug dependence is a state of psychological or physical dependence, or both, which results from chronic, periodic or continuous use. Habituation is the psychological desire to repeat the use of a drug intermittently or continuously because of emotional reasons. Addiction is physical dependence upon a drug. chain smoking, or talkativeness. The abuse of heroin is perhaps the most feared of all because of the tremendous addicting properties of this drug. The most obvious symptoms of abuse of heroin are injection marks and constricted pupils. Sometimes the addict may make frequent or prolonged jaunts to his locker or to the rest room for privacy to inject the drug. He may become excessively secretive about his belongings. After injection, the user may become drowsy, "on the nod," and lethargic. Marihuana "reefers," cigarets rolled in brownish paper and crimped at the ends, are usually smoked while the users are gathered in groups. The smoke of marihuana is recognizable by its odor like that of burning rope. Smoking marihuana may produce talkativeness, bursts of hilarity, and distortion of time and space. There is some loss of coordination and the eyes may become bloodshot. As the drug wears off, drowsiness and lassitude comes on. Although it is unlikely that an employe will use hallucinogens at work, it is indeed possible. Under the influence of hallucinogens like LSD the individual appears to be in a trance or dream-like state. The most common symptom is dilation of the pupils. Mental effects are unpredictable; the user may experience exhilaration, an urge to self-destruction, or sheer panic. "Flashback" drug episodes may recur weeks later, perhaps while on the job, without further ingestion of the drug. It is necessary to be certain that there is no other explanation for the symptoms before concluding that the employe is a drug abuser. Some persons may exhibit one or more of these symptoms without drug use, and all of the symptoms may be identical to symptoms produced by conditions totally unrelated to drug abuse. For example, simple fatigue can cause a number of symptoms similar to those caused by the depressant and narcotic drugs. Sometimes employes have been prescribed drugs by a physician and there is no abuse or illegal activity involved. The plant physician must be called in to rule out the possibility of illness when the employe appears in need of care or assistance. Some companies are attempting to establish programs to assist employes with drug problems, including the problem of alcoholism. In one company, a job jeopardy rehabilitation program has been developed for present employes. Should the employe fail to rehabilitate, he or she is dismissed. Other companies refer employes to treatment centers. If the employe stays off drugs, he is kept on the payroll. On the other hand, some companies are alerting long term employes to the fact that any employe found to be under the influence of drugs (including amphetamines and barbiturates) on company premises is subject to release. This, of course, implies illegal use of these drugs. Companies have found that they must tread very carefully for fear of bringing on lawsuits or labor troubles. Some plants are reluctant to discuss or have yet to experience the increasing problems. The problem of drug abuse is not likely to be avoided by employers of large numbers of people, especially young people. If statistics are to be believed, about one teenager in four has at least tried marihuana. Young users may import drugs to the industrial setting and involve others, if they remain undetected. Corrective measures must be taken if the drug abuse problem is to be contained. Ignoring the problem, or assuming that other agencies in the community will handle it is unrealistic. The Bureau of Narcotics and Dangerous Drugs stands ready to cooperate with industry in combatting this growing threat to our nation's productivity. Informa The National Association of Manufacturers has available for members a limited number of copies of "A Federal Source Book: Answers to the Most Frequently Asked Questions About Drugs." For a free copy, write to NAM Reports, 918 16th Street, NW, Washington 20006. tional materials are readily obtained from the Bureau's regional office or from headquarters. In the near future, the Bureau will initiate seminars for industrial security personnel. In addition, the Bureau has sponsored, through its regional offices. Concerned Business Committees in a number of cities, including Washington, Philadelphia, and Phoenix. Others are being developed around the country. The drug abuse problem will only be controlled if every citizen and every organization, public and private, assume their responsibilities. Employers should recognize that they have a social responsibility and provide effective programs of drug abuse prevention. It is not only a social responsibility, however, it is both good citizenship and good business. Drugs other than narcotics can become addicting. Some people have acquired an addiction to sedatives and certain tranquilizers. Stimulants in very large doses are addictive. Certain cough syrups, the stayawake and go-to-sleep preparations, and a patent medicine used to treat asthma are sold without prescription and may cause dependence. Paregoric also is being abused. The family medicine chest may be the source of initial drug trials by children. Mr. Ingersoll Drug Abuse and Industry - II American business has always given high priority to national health campaigns in its advertising and public service activities. Over the years, such worthy drives as the Red Cross, Heart Fund, Cancer Fund, March of Dimes and other volunteer agencies have received the support of both large corporate entities and small enterprises. Generous contributions have been made, executives have chaired organized drives, and business has applied its advertising know-how to the job of inducing others to offer financial support and to take notice of the information on a particular health hazard turned out by these volunteer organizations. In recent years, a new type of health hazard has clouded our horizon. Drug abuse has reached into just about every segment of our society, abiding no economic, geographic, ethnic or age boundaries. It has threatened the foundations of family life and has fed the fires of crime. It is creditable that with very little prodding, the American business community has become involved in a large scale information program to assist in preventing the further spread of this problem. It is a pleasure to recognize in this article some of the outstanding efforts. Perhaps the first segment of the business community to expend an effort in the now well-established fight against drug abuse was the pharmaceutical industry itself. This is a quite natural reaction to be expected from the manufacturers, distributors, and retailers of drugs, for the abuse of these substances, many of which have been tried and proven true in the fight against disease, could seriously damage the reputation of the entire industry and profession. One of the first manufacturers of pharmaceuticals to apply its advertising techniques to the fight against drug abuse and narcotics usage was Smith, Kline and French Laboratories in Philadelphia. They published "Drug Abuse, a Manual for Law Enforcement Officers" which is still in use in training classes for police officers at the Bureau of Narcotics and Dangerous Drugs. Smith, Kline and 4 Businessmen Show By John E. Ingersoll Director, Bureau of Narcotics and Dangerous Drugs French's guide for teachers, "Drug Abuse Everybody's Hang-up" has taken its place in the growing library of educational films available on a loan basis throughout the country. Smith, Kline, and French has participated in and sponsored many conferences on drug abuse, notable of which was the recent symposium for industry in Philadelphia. They were joined by such other industrial giants as Boeing Company (Vertol Division), Campbell Soup, Scott Paper, Sun Oil, and the Industrial Medicine and Surgery Journal in the sponsorship of this three-day function. In addition, Smith, Kline, and French has been one of the leading supporters of the Greater Philadelphia Council on Narcotics and Dangerous Drug Abuse. Other pharmaceutical houses have participated in programs designed to teach respect for drugs and to prevent the abuse of these drugs. Many of their employes have been specially trained to give public presentations on the subject. The Pharmaceutical Manufacturers Association developed materials and slides to supplement the speaker's role. In all cases, many firms are deeply involved in antidrug programs within their home cities. The Pharmaceutical Manufacturers Association also has reached out to cooperate with and embrace educational programs of other associations. For example, it was one of the charter members of the National Coordinating Council for Drug Abuse Education and Information which is made up of nearly 100 business and professional associations, all pledged to The National Association of Manufacturers has available for members a limited number of copies of "A Federal Source Book: Answers to the Most Frequently Asked Questions About Drugs." For a free copy, write to NAM Reports, 918 16th Street, NW, Washington 20006. NAM Reports leading a concerted drive against the drug abuse problem. PMA cooperated with the American School Health Association in developing respect for drug curricula, beginning with kindergarten and progressing through the final year of high school. These curricula will be published shortly and should be available for the start of the school year in September. Almost concurrent with the U.S. Congress' drive against the abuse of legitimate drugs in the form of the Drug Abuse Control Amendments of 1965, the pharmacy profession, through two of its largest associations, the American Pharmaceutical Association and the National Association of Retail Druggists, launched other educational campaigns. Both associations prepared materials designed to arm state pharmaceutical societies and the individual pharmacist with factual information to be disseminated within his community. This was a natural choice for the front line attack on the problem, for who else in the average community, aside from the doctor, would have more insight into what the drug abuse problem is all about. The National Association of Retail Druggists developed a comprehensive speaker's kit which was distributed to over 45,000 pharmacist members. It came complete with publicity hints and visual graphics for display in stores, banks, and schools. A year later, in 1969, NARD announced an anti-drug poster contest for students. The Association's monthly publication, "The NARD Journal," has carried countless articles relative to the drug problem, and in many cases, actively supported and explained the functions of Federal efforts to counter the exploding drug abuse problem. The American Pharmaceutical Association has also devoted much of its resources and energies these past five years to educating its members to take their places in the anti-drug abuse crusade. Its monthly publication has contributed to the wealth of information available to pharmacists for dissemination at the com June 22, 1970 |