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ment insurance benefits mailed by the State of New York. Another large percentage represents payments made to relief recipients by the New York City Department of Welfare. Other stolen checks include those issued in payment of salaries to Government employees, social security benefits, pension payments, veterans' allowances, income tax refunds, etc. Most of the stolen checks are cashed in small stores operated by independent merchants, who ultimately suffer the financial loss for cashing such checks.

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Age and sex of drug addicts included in above statistics

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us and giving us this information.

Mr. BARBATI. It was a pleasure, Senator.

Senator DANIEL. Thank you.

We will stand in recess.

(Whereupon, at 6:30 p. m., the subcommittee adjourned.)


Contents: Exhibits 1-30, inclusive


[Reprinted from New York State Journal of Medicine, Vol. 55, No. 3, Feb. 1, 1955] A PHYSICIAN'S BLUEPRINT FOR THE MANAGEMENT AND PREVENTION OF NARCOTIC ADDICTION

Hubert S. Howe, M. D., New York City

To understand the problem of drug addiction, it is necessary to recognize the distinct characteristics of three classes of addicts. There are, first, persons who have become addicted as a byproduct of treatment for serious medical diseases; second, doctors and nurses who have taken to the use of narcotics to relieve the strain of their exhausting duties, and, third, addicts who have become involved through the agents of organized crime.

It is this third group with which this paper is primarily concerned, and that is what we mean when the term "addict" is used unless the context otherwise indicates. The latter group presents by far the most complex problem and has been the object of a rising tide of public anxiety. As report has followed report, there has been a growing realization of the personal debauchery suffered by the addicted individual and the danger to the entire community from the crimes which invariably follow in addiction's train. It is generally recognized that an addict is under extreme compulsion to obtain his drug, but fewer people perhaps understand the economic strain under which he is put by the necessity of his having to patronize the available channels of illicit trade. Evidence from thousands of case studies underlines the now undisputed fact that in order to pay for his narcotic drug, the addict must regularly engage in crime. In fact, the physical, emotional, and economic demands of his habit are so great that he has no real opportunity for honest labor, and so addiction becomes not merely a habit, but an all-controlling way of life. Addiction is his habit, but his education is for the practice of crime.


In the world.-Narcotics have a long history. In the Assyrian medical tablets of the seventh century B. C., the juice of the poppy is enthusiastically praised. The Sumerian idegrams, which date from about 4000 B. C., describes the poppy as the "Plant of Joy." Homer states that Helen of Troy "cast into the wine a drug to quiet pain and strife and bring forgetfulness of every ill." In the Ebers Papyrus of Thebes of 1552 B. C., opium mixed with another substance was recommended for quieting children whose crying distracted their mothers. This was doubtless the first appearance of "Mrs. Winslow's Soothing Syrup!"

The Arabs recognized the mercantile value of opium, and during the tenth and eleventh centuries the Mohammedans distributed opium to all known portions of the world. For the past two hundred years China has been the greatest opium consumer, Western countries being largely responsible since they organized and promoted the far eastern opium trade.

History of the Use of Narcotics in the United States.-In the early portion of the nineteenth century opium was freely prescribed by physicians. There was practically no other satisfactory remedy for pain or relief from the myriad of symptoms grouped under the appellation of "nervousness." The hypodermic method of administering morphine was discovered by Alexander Wood in 1843

1 Presented at the 148th Annual Meeting of the Medical Society of the State of New York, New York City, Session on Legal Medicine, May 14, 1954.


and was introduced in this country by Fordyce Barker in 1856. In 1880 Dr. H. H. Kane, of New York, stated: "There is no proceeding in medicine that has become so rapidly popular; no method of allaying pain so prompt in its action no plan of medication that has been so carelessly used and thoroughly abused; and no therapeutic discovery that has been so great a blessing to mankind, as the hypodermic injection of morphia." In this period physicians used morphine more and more generously in the belief that the relief of pain or discomfort was their first duty and undertook other medication designed to effect a more permanent relief as soon as the most distressing symptoms had passed away. The patient, experiencing the miraculous relief of the hypodermic treatment, frequently demanded continued administration or obtained the relief himself at the nearest pharmacy, thus drifting into a state of addiction. During this period narcotic drugs were as freely accessible as aspirin is today. There was little public knowledge concerning their sinister properties, and their use became a common practice.

In 1882 there were an estimated 400,000 addicted individuals in this country.” Since this number was nearly 1 percent of the population, the public became alarmed. Books and articles explaining the horrors of addiction were written, and many institutions for its treatment came into existence. Through the education of the public and greater care exercised by physicians, the number of persons addicted decreased so that by 1914, with almost double the population of 1882, there were an estimated 150,000 to 200,000 addicts.' As a result of popular agitation, the Harrison Narcotic Law was enacted by the Federal Government in December 1914. This law effectively stopped the unrestricted sale of opiates by drugstores and made it illegal for physicians to furnish narcotic drugs to addicts.

Unfortunately, however, it provided the necessary setting for a flourishing, illicit traffic in narcotic drugs. From this point on, the character of the narcotic problem profoundly changed. We exchanged one type of evil for another. In 1918 a commission appointed by the Secretary of the Treasury estimated that there were one million drug addicted persons in this country. Thus, it will be seen within four years time there were five times as many affected individuals as before the passage of the Harrison Law. There was, however, a radical change in the method of obtaining opiates by addicts. The closure of the legiti mate channels brought into existence an illicit traffic of tremendous proportions. Thus, virulent criminality was added to what was formerly simple immorality. At the present time no one knows for certain how many addicted individuals there are in the United States. United States Commissioner of Narcotics Anslinger in his recent book ' estimates that there is about one addict for each 3,000 of the population. This amounts to an estimate of somewhat over 50,000 addiets in the country as a whole. In my opinion this is a very conservative estimate. A spokesman for the United Nations has estimated that the amount of illicit drugs falling into the hands of authorities is probably less than 10 percent of the total amount of the illicit trade. If the seizure of over 4.000 ounces in 1952 amounted, as estimated, to 10 percent of the traffic, enough was smuggled in that year to supply over 180,000 addicts. Whatever the number may be, it is well established that it is increasing. During the last eight years the number of narcotic offenders committed to city correctional institutions in the city of New York has increased each year. There has been no sign of decrease or leveling off at any time. From 1946 through 1953 the number increased over 1,200 per


Some authorities believe there has been a carefully organized underworld campaign for the distribution of narcoties since “Lucky” Luciano was exiled to his native Italy. Others have noted efforts of the enemy to infiltrate and addict United States troops operating in foreign theaters of war or occupation, while still other observers have noted a marked increase in supplies crossing the Mexican border, allegedly from Communist sources.

It is also well established that the type of individual becoming addicted has greatly changed. During the pre-Harrison Law period addiction was usually contracted as a result of what would now be considered improper use of narcotic drugs in illuess and because of their unrestricted availability in pharmacies.

Kane. H. H.: Drugs That Enslave. Philadelphia, Presley Blakiston, 1881.

3 Report of the Mayor's Committee for the Rehabilitation of Narcotic Addicts, Detroit, 1953. pp. 43. 59.

Ansinger, H. J.. and Tomkins. W. F.: The Traffic in Narcotics, New York, Funk & Wagnalls Co., 1953, p. 263.

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In that period addicts were mostly older persons. Prices of narcotics were low, and most addicts were able to support themselves by legitimate means. Their associates were mainly law-abiding citizens. They and their families suffered a severe inconvenience by their addiction, but, in general, they were not forced to criminal acts either by criminal associates or by the expense of the habit. At present, however, the new addict generally starts as an immature youth. Adolescent children, with their natural curiosity and desire to experience new sensations, are the logical prey of the narcotic merchant who offers them free merchandise. Their sales resistance is lowered by an utter lack of knowledge of the devastating slavery the drugs induce. Among girls addiction has been a strong inducement to prostitution, and, conversely, madams have induced addiction among their girls to insure their continued adherence to their profession and also to confiscate their earnings in exchange for the drug.

The situation of the individual addicted as an adolescent under present conditions is far different from the pre-World War I type. The cost of his narcotic need is high, seldom less than $5,000 per year. He becomes addicted before he has acquired any skills by which he can earn any such amount of money by honest means. Addiction of the adolescent is particularly unfortunate also because the use of the drug deprives him of his normal emotional development. It impairs the normal maturation of his sex life. Moral values are warped before they have been normally formed, and he is rendered relatively incapable of benefiting from any educational training he may receive because of the time and effort necessary to satisfy his habit and also as a result of the sedative and emotional effects of the drug. If the adolescent addict seeks legitimate employment, he finds either no opportunities at all or very unattractive and unremunerative ones. Employers do not want him. He tends to drift away from his unaddicted friends and at last is ostracized by them and finds himself mainly in the company of criminals. He can earn the money required by his habit only by becoming a pusher himself or by resorting to theft or other criminal pursuits. He knows no life but crime and feels a bond with no one but criminals. In addition to all these complex forces he lives in an atmosphere of compound fears.

These fears are of three basic types. Fear of not being able to obtain his narcotic drug, fear of being apprehended for his criminal activities, and, finally, fear of the persons who supply his drug. This latter fear stems from the fact that by delivering an overdose to an addict the supplier can cause the addict to kill himself. The user has no way of determining the amount of the dose until after it is too late. This simple fact imposes a stern discipline over the slavery the drug induces.

Here, then, we find economic and social compulsions leading to crime and the sternest of all human disciplines the power of the pusher to inflict torture by withholding the supply or death by delivering too much. Furthermore, this is a day-to-day, hour-by-hour compulsion which is never absent. One can hardly conceive a stronger, more constant incentive to crime.

A pound of heroin purchased abroad for from $500 to $1,000 will cost the addicts in this country about $384,000 after dilution with milk sugar. The Federal Bureau of Narcotics has estimated that the underworld revenue from the sale of narcotic drugs to addicts in this country amounts to a sum of $275,000,000 each year.'

The New York Herald Tribune of January 3, 1954, reported the case of an addict named Charles Townsend :

"A nineteen-year-old narcotics addict admitted today that he had killed four men and staged 150 robberies in the last few months to get money for drugs.

"Townsend was seized last night with another man for questioning about narcotics purchases and told of the murders when questioned."

The Federal Bureau of Investigation Uniform Crime Reports for 1952 disclosed the fact that persons under twenty-one were responsible for 37.2 per cent of arrests for robbery, 46.9 percent of arrests for larceny, 61.7 percent of arrests for burglary, and 68.6 per cent of arrests for auto thefts. What percentage of these crimes against property were committed by individuals addicted to narcotics is unknown, but it may be safely estimated that they comprise a large proportion. It must be clearly recognized, however, that addicts are of many types. Although the present pattern seems to indicate that most addicts commence the use

Report of the Mayor's Committee for the Rehabilitation of Narcotic Addicts, Detroit. 1953, pp. 43, 59.

of narcotics in youth, it would be a serious error to believe that they are all youths at present. Some are newly addicted, while others have been addicted for many years. Their mental makeup varies as much as in any other class of diseased humanity. Some are educated; many are ignorant. Some have valuable skills; others have none. Some are deeply addicted; others are not. could be clearer than that the same pattern of treatment will not succeed for all Like other diseased persons, a high quality of individual judgment must be applied in the solution of their physical, emotional, social, and economic needs.



Governmental reaction to the problem of addiction has been to enact laws to curtail the supply. The most famous of these was the Harrison Act, passed in 1914, which closed all legitimate sources of supply for addicts, and the JonesMiller Act of 1922, closing loopholes in the Harrison Act. The Boggs Act of 1951 mainly increased the penalties for infraction of narcotic laws. Numerous State laws have also been enacted, and in practically all cases their purpose has been to make more effective the objectives of the Harrison Act. In recent years also a number of international agreements have been made in an effort to curtail the illegal supply of these drugs. These international agreements, however, have not been so effective as they might otherwise have been. This is due to the fact that in some countries the revenue from the opium trade is still a very important factor in the national economy. Some of the illicit sources of opium supply include China, Burma, Malaya, Thailand, Iran, India, Turkey, Japan, Lebanon, Italy and Mexico.

In spite of the efficient organization of the Federal Bureau of Narcotics it must be recognized that their assignment to enforce the antinarcotics acts is extremely difficult and this difficulty falls into two classifications. First is that of apprehending the persons involved, and the second is to obtain convictions. The principal produce of the illicit trade is heroin. This drug is of small bulk and light in weight and so is easily concealed. It may be brought in by ship, airplane, or automobile, or it may be delivered by foot across our long and relatively unguarded frontiers. The Seafarers International Union, for instance, while conducting some education among its members on the dangers of drugs, will not permit its members voluntarily to submit to search of person and effects by the enforcement authorities patrolling for drugs. It is impossible for the Bureau of Narcotics and the Bureau of Customs to perform more than spot checks of the many docking ships and their crews. A ship may remain in port for many days, and the members of the crew may come and go many times during that period. Methods of concealment of drugs exist in great variety, and the number of persons who are willing to take a chance for large gain is so great that the odds do not favor enforcement in this type of smuggling.

The difficulty of obtaining conviction is also important. The Constitution of the United States guarantees to the people the right to be secure in their persons, houses, and effects against unreasonable searches and seizures and specifies that no warrants may be issued except upon probable cause and upon describing the things to be seized. The constitutions of the various states reaffirm this right. In effect this has meant that searches for narcotics cannot be conducted without a warrant, which, by the time it is issued might be too late to acquire evidence or to save evidence from destruction, or to place anyone under arrest. Drugs seized in an arrest without a warant are not admissible as evidence in court because they are illegally acquired. As a result of this and other legal technicalities guaranteed by the Constitution, the evidence is frequently insufficient, and the case dismissed.

In the face of such difficulties the experience has been that the supply of narcotic drugs simply has not been shut off during the forty years in which the Harrison Act has been on the statute books. There have, however, been a number of very important effects of these statutes. First, of course, all legal channels of supply for addicts have been cut off. Second, as a practical matter, the Harrison Act eliminated physicians as an agency for attempting narcotic cure because of the fact that such efforts, in the opinion of the physicians, left them in danger of being regarded as infringing the provisions of the law. The third effect of the statute was to create a profitable opportunity of great magnitude for law breakers who serve the illegal market.

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