was a cure for pain. So the medical addicts frequently will do pretty well.

We find plenty of them who are given large doses of drug for some illness who get well.

Of course, a great many of them don't get well. As a matter of fact, there are probably in this country far more medical addicts than there are underworld addicts. Every doctor sees medical addicts.

Senator DANIEL. Is it your idea that the average confirmed addict should be given enough of the drug at the low cost or free to keep him comfortable?

Dr. Howe. That is correct.

Senator DANIEL. Doctor, when the person has enough to make him have a sense of well-being and stay comfortable, what does that do to his mind and his body?

Dr. Howe. Well, I wouldn't want to say for one minute that it is practically beneficial to him mentally. I think that some of these people do become schizoid; I think that it does alter him mentally, but there is very little evidence that it does anything to him physically.

Alcohol is quite different. Alcohol does cause very definite bodily disturbances. But these drugs they can take for 50 years with very little evidence that it has bothered any organ.

Senator DANIEL. Would they be under what you would call the influence of the drug when enough is given to them in the form of maintenance doses to keep them comfortable?

Dr. Howe. Yes, they would. But they will simply take enough to keep away from these withdrawal symptoms, and under those circumstances a great many of them would work fairly effectively. I mean, it has been done before, and it has been done in England, so I don't mean that we would not like to take everybody off drugs. There is no question about that. And this plan, which I will tell you about in a few minutes, naturally we would like to get them off drugs, but we realize that with a great proportion of them we can't do it as long as it is available in the world.

If they couldn't get it they might stay off, but they can get it. There is no way-if the police can stop the illicit practice, we have no trouble. Senator BUTLER. Doctor, do you say there were more medical addicts than there were underworld addicts?

Dr. Howe. I believe so.

Senator BUTLER. Will you elaborate on that statement just a little? Dr. Howe. Every person who develops an incurable cancer with pain-now, 1 person in 6 in this country dies of cancer. There are a terrible lot of painful cancers and other incurable diseases for which doctors administer opiates, not expecting the patient to live.

Nevertheless, after a period the patient becomes an addict. They are no trouble because they are taken care of by the doctors, and they function and they die; so that is entirely a different group.

But when I say there are more, that is my opinion.

Senator BUTLER. What is the percentage of that type of addict to the general overall 60,000 referred to?

Dr. Howe. Well, I think there are 350,000 doctors in this country, and every doctor has medical addicts.

Senator BUTLER. So they would not be included in the 60,000 addicts who are more or less on the public

Dr. Howe. Oh, no, they are never seen, because most of them have a fatal disease, and they die. But they function.

You take those addicts, they can function fairly well. They may have a painful cancer, a painful something. You relieve their pain, but they can function fairly well.

Of course, plenty of them are quite sick, but I think the average doctor never sees one of these underworld addicts, but he sees plenty of the medical addicts.

Senator DANIEL. As I understand it then, you would separate the medical addicts completely from the 60,000 addicts that the lawenforcement authorities talk about as being the real problem in the country?

Dr. Howe. That is right.

In that paper that I gave you I divided them into three groups: The medical addicts, the professional addicts, that is the doctors-I think again that is a different group-and this underworld group, which is the main one we are talking about, and they are the main problem. The doctors are not a problem.

Senator DANIEL. Doctor, with reference to the 60,000 group that we have talked about, and that you referred to as the underworld group, do you agree with those who say this is a communicable disease, that these addicts communicate it to other people?

Dr. Howe. They do. But they do it for a purpose. I think that is the greatest way that it is spread. Up here in Harlem-you see practically all the addicts, practically all of the pushers on the streetMr. Anslinger said 70 percent-here we have thought 85, other police, and so on have told me 100 percent-the addict says so, practically every addict at sometime sells drugs, and they want to increase their trade, so that at a party they will-here is a child who is seeking sensations, and they tell them, "Come on, I have got something that will give you a thrill," and they persuade them.

They call him "chicken" or a "square," as I have said a little bit later, something else and, of course, children want to conform to everybody else. They feel very strange if they are not conforming; therefore they take it.

They are given it free until they want it. When they want it they pay for it, and at the present time giving it to them free is a little more than giving them a glass of beer.

They tell me now in Harlem that a package of one-sixteenth, which is the ordinary amount that an addict uses, 1 or 2 a day, is $15 a day. Senator DANIEL. You are speaking of heroin?

Dr. Howe. Heroin, yes, sir; so that that is the way this thing is spread.

There is another way, too. I mean if a husband is addicted, he frequently addicts his wife, just as an alcoholic. He wants his wife to drink, too; he doesn't want her to look down on him, so that is also another way.

But so far as the underworld addict goes, it is largely spread through association with others.

Senator DANIEL. Now, some witnesses have appeared before the committee, including addicts themselves, and have testified that they have spread it to members of their families and to friends, not through a profit motive, but wanting company, being of the mental type they wanted someone to enjoy this ease and happiness.

Dr. Howe. I think that it is not as much that-probably, if they are honest about it-as I think they don't want to be the only addict to be looked down on by the rest of the family.

If all the family are addicts, then there is not criticism of this particular one. You see that in alcoholics all the time.

They try to get their wives to drink, their relatives, and so on, I mean, the people they associate with.

Senator DANIEL. So for some reason it does seem the addicts spread this disease to their associates.

Dr. Howe. Yes, there is no question about that.

Senator DANIEL. And in that sense it is a communicable disease. Dr. Howe. That is right. But I think that the profit motive among the greater proportion of them is the thing that is the real-it is really back of it.

Senator DANIEL. Doctor, proceed; excuse us, but you were on a very important point, this matter of disease.

Dr. Howe. Of course, the most obvious solution to the whole problem would be to completely and permanently cut off the supply of drugs. This was the philosophy of the Harrison Act passed in 1914. We have been trying this for over 40 years. It has proved more difficult than was originally suspected.

Our Federal Government attempts to curb the spread of addiction through suppression of illicit traffic in narcotic drugs by international and domestic action. The situation has become so acute and so difficult to handle that even the great and efficient law-enforcement agencies of the United States Government have been unable to cope with it.

The Commissioner of the Bureau of Narcotics has recently testified, according to the press report, before your subcommittee, that smuggling is impossible to control. He was quoted as saying:

If you had the Army, the Navy, the Coast Guard, the FBI, the Customs Service and our (narcotics) service, you would not stop heroin coming through the port of New York.

This is another of the basic facts of the situation which must be considered and weighed.

The remaining method of prohibition involves plans to invoke more severe penalties for possession and selling drugs. As previously stated, the discipline of the vendor is so much more definite and powerful and the compulsion of being without the drug so much more vivid and painful than the fear of being apprehended that no threat of legal punishment deters the addicts still at large. Those who know the magnitude of the problem believe it would be impractical to keep all addicts in permanent confinement; if not completely impractical it would certainly be fabulously expensive.

The ultimate alternative, in terms of severity, is, of course, the death penalty. This has been suggested in some quarters, not so much on the theory it would restrain the addicts yet alive, but on the hypothesis that it would thin their numbers. I cannot believe that the public would put up with such mass bloodshed, nor is it either necessary or desirable, as long as any other approach is possible.

Of course drug addiction is not new. It has been going on for centuries in many parts of the world. This automatically raises the question as to whether the situation in other countries has been the same

as ours. The fact is, that in many places their experience has been quite different.

In the United Kingdom, the regulation regarding the prescription of narcotics states:

The continued supply of drugs to a patient, either directly or by prescription, solely for the gratification of addiction, is not regarded as a "medical need." However,

Morphine or heroin may properly be administered to addicts in the following circumstances, namely: "(a) Where patients are under treatment by the gradual withdrawal method with a view to cure. (b) Where it has been demonstrated, after prolonged attempt to cure, that the use of drugs cannot safely be discontinued entirely, on account of the severity of the withdrawal symptoms produced (c) Where it has been similarly demonstrated that the patient, while capable of leading a useful and relatively normal life when a certain minimum dose is regularly administered, becomes incapable of this when the drug is entirely discontinued."

Senator BUTLER. Doctor, can I ask you a question at that point? Dr. Howe. Yes.

Senator BUTLER. How long can a person continue the use of narcotics without going just to pot!

Dr. HowE. We don't know. There have been-the Mayor's Committee Report where they studied those addicts at Bellevue from 1928 to 1930, they had one who had been there 50 years, and certainly 20, 30, 40, it is not uncommon at all.

Senator BUTLER. Would you say he was not an abnormal person? Dr. Howe. Well, I wouldn't want to say for 1 minute that this does not affect them mentally and make them as efficient as they would be without it. But the fact is, in my opinion, that the great proportion of them could work and carry on more effectively than they do now if they had a minimal amount of the drug, of course, under medicolegal control.

Nobody is suggesting that you hand this out. That is ridiculous. This is not peddling it on the street. But if you were under medical care, I believe the greater proportion of the addicts would be returned to industry.

Senator BUTLER. But, doctor, when he is under the type of medical care he is referred to, he is a free agent to move about as he wills? Dr. HowE. That is right.

Senator BUTLER. And you have no way of knowing what he does when he leaves the clinic?

Dr. Howe. That is perfectly true. But

Senator BUTLER. And he may want a little more to get hopped up or something of the kind.

Dr. HowE. They don't get more hopped up; they get more sedatized.

Senator BUTLER. They do really?

Dr. Howe. That is right.

Senator DANIEL. That is on the two drugs you are speaking about? Dr. HowE. That is right. I am not talking about marihuana or cocaine.

Senator BUTLER. What is the relation of the drugs you are speaking of and marihuana and cocaine? Do they induce the desire to take marihuana and cocaine?

Dr. Howe. They are stimulating drugs; they are not sedative drugs.

Senator BUTLER. I see. Does the sedative drug in any way stimulate the appetite of the addict to take the other drugs to stimulate him and build him up, get him out of his lethargy?

Dr. HowE. Taking opiates there is, first, what is called a honeymoon period. That is, he gets somewhat of a real elation; he, at least, is not elated, but he has a very pleasant feeling that he desires.

But after he has taken it for a little while, that disappears, and he only takes the drug to escape the withdrawal symptoms. He feels just as you and I do, they will tell you; they only take it to feel normal, because when they do not take it, they are distressed, they have all these physical symptoms.

Now, later on they may try to take more to try to get back some of this honeymoon experience, and they may in increasing it. So there is no question about that, they would, perhaps, like more.

Senator BUTLER. Doctor, they take it to make themselves feel normal, but they must be very abnormal people when they take it.

Dr. Howe. Perhaps I should state it in this way: They take it to escape the abstinence symptoms, that is the terrific nervousness, pain, and so on, that will come on every 4 or 5 hours if they do not have it, so that when they do have it, they behave just like anybody else.

Senator BUTLER. And they are not more easily led into crime or other criminal ways?

Dr. Howe. Well, not particularly. You take in the other countries, as I state later on, the criminal addict is unknown. In England-I have got papers here from Walker-

Senator BUTLER. You would say the alcoholic is much more of a potential threat to society than the addict?

Dr. Howe. No question about it. That goes without question. Senator DANIEL. Well no, Doctor, you might have said something a moment ago that you did not mean exactly as it was said, that the drug addict, when he had his heroin or his morphine, that he then is restored to a normal situation as far as he is concerned, and, therefore, he can go about his business just as anyone else.

Dr. Howe. That is right.

Senator DANIEL. Now, is that an accurate statement?
Dr. Howe. That is right.

Senator DANIEL. Well, previously I thought you had said that a person under the influence of the drug to that extent, enough to make it comfortable, would be relieved of the fears that other people would have in their mind concerning various matters?

Dr. Howe. That is right.

Senator DANIEL. So that, therefore, the drug addict may be restored to normality, so far as he himself is concerned, but as compared with other people he certainly would be in an abnormal position as far as his mind is concerned; would he not?

Dr. Howe. No. We don't think that because a person is comfortable and is not worried about things that that is abnormal; that is what we are all striving for, but most of us try to get that position without drugs.

Senator DANIEL. Now, I believe you previously said, though, that a person in that state was relieved of many of the fears that ordinary people would have.

Dr. HowE. That is right.