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Significantly fewer respondents seem to disapprove of daily use of alcohol, weekly use of marihuana and experimentation with legitimate pills not obtained through a physician. (See Table I-3.)

Table 1-3.-WHETHER EACH OF 10 SITUATIONS IS DRUG ABUSE

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Took pills that were prescribed for someone else...
Took any of these pills once or twice to see effect..

Context: Alcohol-What if someone had

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As the National Survey data demonstrate, drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is an eclectic concept having only one uniform connotation: societal disapproval.

The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong. Continued use of this term, with its emotional overtones, will serve only to perpetuate confused public attitudes about drug-using behavior.

Drug abuse, or any similar term, creates an impression that all drug-using behavior falls in one of two clear-cut spheres: drug use which is good, safe, beneficial and without social consequence; and

drug "abuse" which is bad, harmful, without benefit and carrying high social cost. From either a descriptive or an evaluative standpoint, the matter is much too complex to be handled in such a polarized fashion. The Commission urges that the public and its policy makers avoid such labels and focus instead on the relative risks and social consequences of various patterns of drug-taking behavior.

The Roots of a "Problem"

We have focused our initial attention on vocabulary for an important reason. The linguistic symbols which our society attaches to certain drugs and drug-related conduct illustrate the extent to which present attitudes and social responses are rooted in the past. "Drug abuse" is only the most recent in a long line of such symbols which this society has applied to disapproved drug-taking behavior or to disapproved substances. In fact, the history of drug vocabulary is also a history of the changing perception of the drug "problem" in the United States.

Current social policy is largely an accumulation of ad hoc policy responses to the use of particular substances. "Street" use of a previously unknown substance at a time of social tension tends to generate a set of untested assumptions about the drug, often including a presumed consequence of undesirable behavior, and to result in a restrictive legal policy, all of which become imbedded in public attitude.

Drug policy as we know it today is a creature of the 20th Century. Until the last third of the 19th Century, America's total legal policy regarding drugs was limited to regulation of alcohol distribution (and the periodic regional attempts to prohibit its use altogether), localized restrictions on tobacco smoking, and the laws of the various states regulating pharmacies and restricting the distribution of "poisons." Nineteenth century statutory vocabulary was simple and direct: arsenic, tobacco, alcohol, morphine and other opium alkaloids were all "poisons." Until the Civil War, distribution of opium and morphine, which were widely used as therapeutic agents, was substantially unregulated. Gradually, however, official reliance was placed on the health professions to police distribution of these drugs; Pennsylvania enacted what may have been the first prescription law in 1860, and most other states followed suit over the next three decades. Medical lexicons classified opium and morphine as "narcotics," along with most other psychoactive substances then in use, including alcohol; however, that term was not employed in most of these laws or in common parlance.

As early as the 18th Century, the medical profession was aware that the oral use of opium could result in the development of an “appetite”

or "habit," a phenomenon which was generally classed in the same category as the "alcohol habit." This awareness was not of sufficient consequence to suggest the need for caution when morphine was discovered in 1803 and when the hypodermic syringe was introduced in the middle of the century. As the hypodermic use of morphine became common in the United States, the syringes were left with patients for their own use to remedy practically every painful condition.

The drug was used indiscriminately during the Civil War for the wholesale relief of pain and, most significantly, to treat common gastrointestinal ailments. After the War, morphine was widely used in medical practice and was easily available outside the medical system in proprietary medicines. Within a few years, "morphinomania" (or the "army" disease) became a recognizable medical entity. Nonetheless, use of the drug was only minimally restricted either from outside the medical profession or within it, as Terry and Pellens noted in their classic work:

Meanwhile the ease with which pain could be relieved through the hypodermic administration of the drug, the time it saved the physician in his busy rounds, the contentment it brought the patient, and above all, the all too common inclination to relieve symptoms rather than cause, contributed to increase the practice. Consequently throughout the period of the earlier warnings of its dangers, the employment of this mode of administration was increasing by leaps and bounds wherever medicine was practiced. (Terry and Pellens, 1928)

This phenomenon of medically-based opiate use was largely invisible and was not a matter of major concern outside the medical profession for several decades.

Meanwhile, a public response was triggered by use of these same drugs and cocaine in another social context. Beginning with increased Chinese immigration after the Civil War, the practice of smoking opium took root on the West Coast and spread rapidly across the country to most urban areas. Although the practice was confined mainly to the Chinese, it also appeared to attract "sporty characters" and the underworld figures in the cities.

In 1875, San Francisco enacted an ordinance prohibiting the smoking or possession of opium, the possession of opium pipes and the maintenance of "opium dens." As the practice spread, it generated a succession of similar state laws and local ordinances. Despite a growing problem of opiate dependence arising from unrestrained distribution of these drugs within the medical system in the United States, it was the "street" use of the opiates and cocaine which accelerated professional and public interest in their habit-forming properties.

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opiate-dependent population in its midst. Although contemporary estimates of its size varied as widely as current figures do, most researchers have concluded that the total never exceeded a quarter of a million, divided evenly between "medical" and "street" dependence. As a result of increased awareness, the medical profession and state legislatures intensified their efforts to control availability of these substances, primarily by tightening the restrictions on medical distribution and prohibiting non-medical distribution. In 1906, the Congress passed the Pure Food and Drug Act, the first major federal drug legislation, which required labelling of all preparations containing "habit-forming" drugs, and proprietaries containing significant quantities of opiates soon disappeared.

By 1900, then, policy makers and the medical profession were attuned to the dangers of chronic drug use, and some commentators have suggested that the availability of more accurate information within the profession and improved methods of medical education would have retarded the medically-based opiate-dependence problem had it not been for the introduction of heroin in 1898 (Terry and Pellens, 1928). This new cough suppressant was promoted on the theory that it possessed many of the virtues and few of the dangers of morphine; some even suggested that it would be useful in the treatment of morphinism itself. From the time of its introduction, however, there were conflicting claims regarding its capacity for producing dependence. Regardless of these claims, the drug was available for the next decade in proprietary medicines and throughout medical practice.

By 1910, the medical profession had become seriously concerned about the habit-forming characteristics of heroin. The publicity attending its pleas for legislative controls on the availability of this drug. together with a crusade being waged by law enforcement officials against the street use of opiates and cocaine, aroused public anxiety about a "narcotics problem" of major proportions. Although almost every state had regulatory laws of some kind, most observers contended that the states could not control the problem. Federal legislation was also said to be necessary to implement international treaties. In addition, the movement for national alcohol prohibition began gathering steam in 1913, sensitizing the public to the possibility of national drug prohibitions. All these factors culminated in passage of the Harrison Narcotic Act in 1914 (Musto, 1973).

The Harrison Act crystallized a national policy of curtailing the availability of "habit-forming" substances. The previous failure to appreciate the habit-forming properties of new substances had now resulted in professional and legislative preoccupation with this issue. Whereas the term narcotics formerly referred to those substances which produced stupefication and sleep ("narcosis"), including alcohol, the

term now assumed a new meaning, one defined by the public policy bearing its name. The term was now associated with any unfamiliar drug which appeared on the streets among those populations which were associated with the opiates and cocaine. The acute effects of the various specific drugs became blurred. Because physicians and policy makers had now become exceedingly cautious about the dependence issue, any new drug was carefully scrutinized for habit-forming properties; if the drug was used on the streets it was often presumed "habitforming" and therefore classified as a "narcotic."

Within the next three decades, peyote and marihuana were inserted in the "narcotics" laws of many states; chloral hydrate, which had been covered by earlier drug laws, was also included in the definition of "narcotics" in the new legislation. It should be noted that legal classification of a drug as a "narcotic" tended to malign its therapeutic utility. For example, heroin, and later marihuana, were purged from the pharmacopoeia altogether. In sum, the word "narcotics" had been purged of its scientific meaning and became, instead, a symbol of socially disapproved drugs.

Other substances were introduced into the practice of medicine, notably the barbiturates and amphetamines, but they were regulated under general pharmacy laws rather than under the "narcotics" laws. Although amphetamines were introduced in 1929 and the short-acting barbiturates appeared a few years later, they did not enter the illicit marketplace on a massive scale in the United States until the 1960's and consequently were not associated with the narcotics until then.

During the last decade, succeeding waves of hallucinogens, amphetamines and barbiturates escaped from the laboratories, pharmacies and medicine chests and found they way into the streets. Together with marihuana, which moved from one socio-economic "street" to another, use of these drugs defined a new phenomenon and became associated with a new kind of drug user. To a substantial degree, the narcotics policy had from the beginning been identified with underprivileged minorities, criminals and social outsiders in general, although a common feature of each periodic drug scare, including cocaine at the turn of the century, heroin in the 1920's, marihuana in the 1930's and heroin again in the 1950's, was the fear that drug use would spread to youth. However, the drug problem of the 1960's was clearly identified with the children of the middle and upper classes. Drug use was now associ ated with unfamiliar life styles, youthful defiance of the established order, the emergence of a visible street culture, campus unrest, communal living, protest politics and even political radicalism.

The drug taking of this youth population coincided with pervasive social anxieties regarding social disorder in general and youthful behavior specifically. To many, youthful drug use offered a convenient explanation for these problems, and, as the Commission noted in its

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