ABSTINENCE ONLY SALVATION

The only hope for his salvation lies in complete abstinence. A person addicted to alcohol would never be satisfied with a minimum required dosage of liquor a day even if he could purchase it for a few cents at a Government-operated clinic. Certainly, he would be glad to take the alcohol so generously provided by the Government, but would promptly thereafter report to the nearest illicit source for an additional supply.

In many ways—and the leading medical authorities are in agreement in thisthere is a close similarity between addiction to alcohol and addiction to narcotic drugs. The same authorities likewise agree that there is only one cure in either case complete and unqualified abstinence.

Contrary to what the committee seems to think, the addict who received a daily shot in a Government clinic would not be satisfied with this, but would seek an additional supply from illicit sources. In other words, the Government clinic would merely fill the role of another drug peddler.

Because it sold at cost, it would help keep the illegal price down; but because it did not furnish all the addict's requirements there would still be peddlers catering to his wants.

This means that the addict would continue to be an addict and would still be obliged to resort to crime to obtain the money with which to purchase narcotics. The committee speaks of the legal administration at the clinic of an addict's minimum required dosage. Who is to decide what constitutes any one addict's minimum required dosage? The addict?

It would seem so, as no medical practitioner could ascertain the exact quantity of a drug which, administered, say three times a day, would stabilize the addict unless the person in question were confined under close supervision for several days in a hospital.

I don't think the committee proposes doing this. At any rate, even assuming they do, how next do they plan on increasing the minimum required dosage?

EVER-INCREASING DOSES?

They apparently overlook the fact that the body rapidly develops tolerance to narcotics and because of this an addict requires ever increasing doses of his drug of addiction.

Unless he does he derives no relief (which he terms "pleasure") from the underlying emotional instability which led to his becoming an addict in the first place. If he can't get the additional drug at the clinic, the addict will seek it elsewhere, of that we may be sure.

Will the clinic cater to the addict's wants by giving him ever-increasing doses of the drug until he reaches the saturation point and dies of acute narcotic poisoning?

Where, before the war Canadian addicts used opium and morphine, they are now almost 100 percent addicted to heroin, a drug so deadly in its habit forming characteristics that its medical use is forbidden throughout the United States and in all hospitals in this country operated by the Department of Veterans' Affairs.

Does the committee propose administering heroin to our addicts? I can hardly credit the thought. But if they do not, and resort to the considerably milder morphine or codeine, the addicts will most definitely not be satisfied and, more than ever, will seek to get "high" or "steamed up" on illegally procured heroin.

To be quite frank, I cannot visualize the Government of Canada as it is obliged to do by international treaty, including in its annual estimates of internal consumption to the United Nations Narcotic Commission an item covering the legal administration of morphine, much less heroin, to Canadian drug addicts. Insofar as heroin is concerned, the system of international control is so strict that countries, such as Canada, which do not produce it have to make a special request to the government of the exporting country.

Moreover, import certificates covering heroin can be issued only in favor of a government department and in this way the importing government assumes special responsibility in respect to heroin and undertakes to supervise strictly its subsequent distribution.

There are a number of other reasons I could advance, if space permitted, why the whole idea of Government-operated narcotic clinics is, in my opinion, quite impractical.

PSYCHOLOGIC FACTORS VITAL

However, of far greater importance is the fact that we should remember that we are not treating with ordinary every-day sick people when we are dealing with drug addicts. As one eminent authority, Dr. J. H. W. Rhein, puts it:

"Any effort to correct the evils of drug addiction must be based on a thorough understanding of the psychologic factors underlying the cause. The cause of development of the habit is inherent in the individual.

"The drug addict is a psychopath before he acquires the habit. He is a person who cannot face, unassisted, painful situations; he resents suffering, physical, mental or moral; he has not adjusted himself to his emotional reactions. The most common symptom that requires relief is a feeling of inadequacy; an inability to cope with difficulties. These conditions call for an easy and rapid method of relief which is found in the use of drugs."

Habitual criminals are psychopaths, and psychopaths are abnormal individuals who, because of their abnormality, are especially liable to become addicts.

To such persons drug addiction is merely an incident in their delinquent careers, and the crimes they commit, even though they be to obtain money with which to buy narcotics, are not directly attributable to the fact that they are drug addicts. More than 95 percent of all drug addicts are the criminal addicts whose addiction in its inception and in its continuance is due to vice, vicious environment, and criminal associations. Experience definitely shows that in nearly all cases the addict was a criminal before he became addicted.

That is the actual situation as it exists here in Canada and it is useless to draw comparisons with other countries which are not faced with a drug problem, as the committee does, and to say that such countries do not understand our concept of the criminal addict because their addicts "are not driven to crime in order to support their addiction."

One would gather from this statement that the committee believes that drug addicts were originally quite decent people who have been forced into a life of crime as a result of becoming addicted.

This is not so and the fact that in nearly all cases the addict was a criminal before he became addicted must be borne in mind if we ever hope to make a realistic approach to the solution of the narcotic problem in Canada.

It has been amply demonstrated in the past that addiction cannot be cured by the ambulatory method, that is, by the administration to the addict of gradually decreasing quantities of narcotics by a physician in his office.

This holds true not only for the main bulk of the addict population, which is made up of thieves, shop-lifters, prostitutes, forgers and such like underworld characters, but also for the tiny remaining noncriminal fraction.

Then how does the committee consider that its plan will, as it says, "rehabilitate the narcotic addict?"

I am afraid that the committee has accepted the negative view expressed by Jean Howarth in her column the day after the committee's report was published, which was to the effect that a drug addict can never be cured and will remain such till the day he dies.

The committee certainly has not proposed any all-out plan for curing drug addiction, nor has it gone so far as to suggest that the institution of Governmentoperated narcotic dispensaries will accomplish this.

From this one can only assume that they have little hope of being able to do anything for the addict other than letting him carry on with drugs supplied by the clinic.

In making the above statement I have not overlooked the c mmi tee's recommendation that a pilot medical treatment and rehabilitation center be established together with a comprehensive followup service. But they only plan on handling volunteers in this clinic.

Might I point out that this statement is not in accord with the experience of the United States Public Health Service at their narcotic hospital in Lexington, Ky.

FORCED COMMITTAL BETTER

Here it has been found that far better results in effecting cures are obtained in the case of prisoners who are compulsorily committed for treatment and subsequently released on parole, than in the case of the "voluntary committals" who enter the hospital of their own volition and may leave whenever they please.

The latter (and the same would hold true here in Canada) largely treat the hospital as a "rest center" where they may with a minimum of physical discomfort cut down their drug habits to a manageable level.

While a comprehensive followup service is essential, this will not work without compulsion. The history of institutional treatment of drug addiction by the Federal Government in the United States not only shows that compulsory treatment is much more effective than voluntary treatment, but also that the lack of completely satisfactory results in that country is largely attributable to the absence of stringent and legally enforceable parole regulations, with recommittal the penalty for their violation, governing all cases after release from

treatment.

In actual point of fact, a drug addict can be cured. However, due to the present lack of adequate provision in this country for the treatment of drug addiction, there is only one class of addict for whom there is any hope of a permanent cure.

These are the relatively few professional and businessmen who have families and business and social responsibilities. Such individuals, upon their release from a mental hospital. or private sanitarium, return to their daily work and surroundings freed from the contaminating influence of contact with other addicts; they usually are of superior mental attainments and have a definite incentive their home, families and business-to fight against any reversion to the habit.

In Canada there are today well over 150 members of one group alone who, although previously addicted, are now leading normal lives and have been doing so for periods of from 2 to 14 years. The successful results achieved in the Federal narcotic hospitals in the United States, and in this country when dealing with cases where there is no underworld association, proves conclusively the incorrectness of the general belief that a drug addict can never be cured.

CONCENTRATE ON ADDICTS

If we accept the proposition that the narcotic problem is capable of solution, and no right thinking man would wish otherwise, how then should we proceed? It is my definite considered opinion that drug addiction as we know it today, with all its attendant crime and evil, can be wiped out in Canada within a very few years if we are but willing to face the facts and attack the problem from a realistic point of view.

We can stop the drug traffic in Canada if we will do three things:

(1) Maintain international and domestic control over the legal traffic.

(2) Continue to wage war on narcotic smugglers and internal traffickers. (3) Cure and permanently control the drug addict.

It is the writer's contention that narcotic addiction must be regarded and treated in exactly the same manner as we now regard and treat the various forms of mental disease.

The only difference is that there are no "mild forms" of drug addiction which do not require institutional treatment.

Mental disease is not an ordinary ailment which can be treated at home or in jail. Society recognizes that the mentally ill must be forcibly confined and consequently we have enacted legislation providing for their committal to proper institutions.

In the old days lunatics were punished because it was believed their infirmity was self-imposed through deliberate association with evil spirits. But today we would regard as morally indefensible any attempt to punish an insane person, even though his infliction were self-imposed, as for example general paresis, which is a direct result of self-imposed vice, namely venereal disease. However, we have made no such progress when it comes to drug addiction. Yet the drug addict, even though he be a criminal who deliberately addicted himself, is essentially a psychopath whose addiction is actually due to his underlying mental instability.

If we are prepared to accept the proposition that there is a close similarity be tween insanity and narcotic addiction, then we should be willing to take the next step and provide the necessary legislation for the enforced committal and control of the drug addict.

It is the opinion of the writer that the Opium and Narcotic Drug Act should be amended to provide that a drug addict, after certification as such by 3 physicians, must be committed for a period of not less than 10 years to a narcotic hospital operated by the Federal Government.

The act should further provide that the first year of the 10-year committal period must be spent in the hospital as an an inpatient, but that after the expiration of the first year the addict would be eligible for release on parole.

71515-56-pt. 5-38

The narcotic hospital would be competently staffed and the emphasis would be on mental cure and rehabilitation and training for a useful occupation. There would be no suggestion of punishment.

The hospital would provide the very latest medical techniques for withdrawal of the drug of addiction and restoration of the patient to normal physical health. The second and more protracted stage of mental rehabilitation would be accomplished through up-to-date methods of psychotherapy designed to treat the underlying psychopathic condition which led the patient to become an addict and to reeducate and reconstruct his personality so that he can learn to adapt himself to his emotional reactions.

Combined with this treatment would be occupational therapy to insure that the patient's physical and mental energies were directed into channels best suited to his needs and most likely to make him into a useful and self-supporting member of society.

After the expiration of 1 year in the hospital the patient would be released, but only on parole and to outside employment. Unless the patient were willing to go to the job provided him and signed an undertaking to remain on that job and otherwise to abide implicitly by the terms of his parole, he would not be released. Such terms would provide that the parolee report regularly to the parole officer, that he not associate with members of the criminal classes or visit persons or places where there was any possibility of narcotic contamination, that he not change his employment or place of abode without prior report to and approval of the parole officer, and that he undergo periodical medical rechecks.

“LIFE” AFTER TWO RECOMMITTALS

Parole would continue until the expiration of the 10-year period, unless the individual violated the conditions of his parole, in which case a warrant would automatically be issued for his recommittal.

In the event an addict were recommitted on two occasions he would be classed as incurable and sent for life to a special institution reserved for such cases. There he would once more be physically cured and given an opportunity to follow a useful avocation, but permanently within the confines of the institution.

EXHIBIT No. 18

[Reprinted from Listen, A Journal of Better Living, vol. 8, No. 1, Washington 12, D. C.) NARCOTIC ADDICTION: WHOSE PROBLEM?

By Arthur K. Berliner, M. S.

Who is responsible for the subtle but unrelenting pressure on our national thinking for the legalizing of drug addiction?

THE ADDICT

Would such a step be the answer to the vicious racketeering which flourishes wherever illegal profits are to be gained from human misery?

Are those of us who want to restrict the use of narcotics to the physician's prescription merely a group of reformers who want to put a straitjacket on American principles of freedom, including the freedom to drink and the freedom to indulge in drugs?

I know of no organized plot to annul the Federal law, which since 1914 has outlawed the nonmedical use of narcotics. Nevertheless, narcotic addiction, a disorder as contagious as tuberculosis, may be given free rein if the voices of the confirmed addict and some armchair planners are to prevail over the experience of the past generation and the conscience of the American people. For it is the confirmed addict himself who is the most articulate advocate of legalizing the distribution and use of narcotic drugs, and he has the support of those who want to be "realistic" about this problem.

"After all," so the argument runs, “if we could go back to the days of drugstore opium, we would do away with the peddlers, the pushers, the racketeers, and the addict himself would not be driven to crime." But were those really the good old days? Why did the Government enact the Harrison Narcotic Act in the first place? Because addiction had shown a steady and alarming increase, with

women outnumbering men as users by a large margin. The law was passed as a measure of self-protection. Those who seem so concerned about the freedom to destroy oneself through narcotic addiction fail to recognize that, for the sake of the larger good, the community must have the freedom to outlaw as well as to sanction.

Since the act was passed, the number of addicts, according to the United States Public Health Service, has been cut by two-thirds, and men have replaced women as the principal users. Now that there is an upswing over the past 4 or 5 years, is this to be combated by unrestricted use of narcotic drugs?

Violence begets violence, and love teaches love. So every user is a potential (if not actual) carrier of the addiction disease. It may be part of a calculated plot to ensnare others, so that one's own habit may be supported; it may be an aspect of the perverted zeal with which the habitué seeks to share his lot with the nonuser, but the end result is the same. If the drug is made more easily available, nonusers will inevitably be exposed. New victims will be the result. These, in turn, will introduce others.

Not only must we continue every effort to crack down on the smuggling, illegal distribution, and sale of drugs, and redouble our attempts to salvage the victims, and some of them, at least, can be salvaged,-but we must work toward prevention in which lies perhaps our only hope.

Also, we must ponder this disturbing fact: Studies of institutionalized addicts reveal that approximately 1 in 5 was a chronic alcoholic or problem drinker before he became a narcotic addict. "Morphine became my hangover remedy, then I switched to it entirely," many users say.

Our hopes for a solution to this problem lie in the fact that addicts are made, not born. This means that a constructive program may be developed along several fronts to improve the situation. First, at all costs we must not yield on the matter of changing the legislative prohibitions which restrict the use of narcotics to the physician's discretion. In the hands of a competent and ethical practitioner morphine is a marvelous substance for the relief of pain and suffering, and no patient need fear it. But this is where is belongs, not as a freely used "medicine" which the addict could obtain cheaply, easily, and publicly.

And does anyone really believe that the "legal" addict could control the size of his habit any more successfully than can today's users? The latter, in spite of the constant vigilance of law-enforcement officers and the prospect of imprisonment and disgrace, continues his quest for ever larger doses, because he must. Repeated indulgence in narcotics produces dependence. The body soon becomes accustomed to this toxic substance, and abstinence brings on illness of an acutely uncomfortable nature.

Those criminals who drift into addiction by way of the underworld would also find another avenue to "easy money" by selling part of the supply which the American public would, under such a scheme, so generously furnish. The spectacle of clinics all over the country, staffed by members of the healing arts, and dispensing narcotics to addicts, would be ludicrous if it were not appalling. What chance to redeem the addict then? About as much as curing the chronic alcoholic by a combination of pious exhortations and a pint of whisky.

Another must in any overall program is continued strong law enforcement. Men are needed to guard the ports of entry, to track down the distributors, to detect the peddlers, and to apprehend the users. On the whole we are doing a magnificent job with what we have, but we do not have enough of them.

Is it too late for those who are already heavy users? The outlook is certainly not hopeless. Of those addicts who enter the United States Public Health Service hospitals at Fort Worth, Tex., and Lexington, Ky., every year, numbers of them are capable of the self-discipline, the degree of motivation, necessary for effective help. The Federal Government has for years recognized that institutionalization must be the origin of the cure process, for in an institution the addict can safely and surely be withdrawn from drugs, and necessary controls over his pattern of living can be established. Treatment means, in addition to physical deconditioning, the readjustment of the addict to a life without narcotics.

Anyone addicted for a period of time has gradually lost his capacity to gain satisfactions from work and from relationships with people. Here again the parallel with the alcoholic is striking. There are those who indulge hoping to cope more effectively with living, and those who do so in order to blot out the world of reality. In either case, as the addiction advances, the drugs more and more take the place of family, friends, jobs.