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no other nation faces anything remotely resembling our problem.
Where does the solution lie? Out of reach, for the moment, because we shall not undo 40 years of carefully wrought error overnight. Out of sight, also, at least in precise detail, because we have little reliable data to guide us. Butat least until they are fully explored-the road would seem to lead toward the following areas: (1) relief from persecution for the addict; (2) therapy programs through institutions, clinics," and aftercure followups; (3) provisions for incurables, through clinics or the individual practioner or both; (4) a forthright out-of-the-dark educational program on narcotics; and (5) a vigorous assault, with all the enforcement resources we can muster, on whatever is left of the peddlers' empire after we have freed the addict from his present bondage to it.
Sooner or later some responsible appraiser, probably Congress, will have to take a clear look at our narcotics problem and the plight of the addict. It is to be hoped that retelling this tale, of Dr. Behrman, who was rightly punished for the wrong reasons, and Dr. Linder, who was vindicated in vain, may hasten the advent of that happy day.
Mr. KING. In this context, then, again, and more broadly, I would urge that consideration be given to those persons and views that have been presented to the committee here tending to support a liberalization of the underlying law-enforcement pattern which will permit ultimately the medical profession to treat more directly with narcotic addicts, and as an interim measure that necessary liberalization in the law, and necessary appropriations and directives from Congress, be considered, to permit the public health authorities, both at the State and at local levels, to establish direct consultation and treatment facilities to the widest possible extent, to deal with the addict as a medical problem.
Now, this leads to the last point that I want to touch very briefly
You have already asked me to comment on the involuntary commitment pattern here in the District, and its relation to juveniles. I believe on the basis of the analysis I have submitted, that the entire philosophy underlying involuntary commitment may need reappraisal, but in any event, I would like to caution the committee strongly against something that seems to have happened in recent years, and that is the enthusiastic passing of voluntary-involuntary commitment acts through the country, with the support, not of the health authorities, but of the law-enforcement people, without any commensurate provision of treatment facilities.
So that, in effect, these laws-and I beg to differ strongly with the witness who stated earlier that the act we have in the District is unique or a model. Some 35 States have such laws, and some of them go back to the 1890's.
These laws have recently been used, and have been enacted to be used, as alternative ways to hound the addict off the streets, to imprison him in facilities that have no relation to treatment.
69 Such as the Federal hospitals administered by the U. S. Public Health Service, 58 Stat. 698 (1944), 42 U. S. C., sec. 257 (1946), the North Brother Island Hospital experiment in New York, and the proposed Seabrook Farm Unit in New Jersey.
70 A bill to create a Federal Bureau of Clinics, to develop this approach to the problem, is now pending in Congress: H. R. 2449, 83d Cong., 1st sess. (1953). The bill also includes alcoholics as beneficiaries of the same program. For discussion of clinic system merits, see Comment, Narcotics Regulation, 62 Yale Law Journal 751, 784-787 (1953).
This would perhaps be another function of narcotic clinics; it is contemplated, in connection with H. R. 2449, supra, note 70, that other Federal agencies, such as the U. S. Employment Service, would be called upon to cooperate in placing and rehabilitating addicts. 72 See Stevens, Make Dope Legal, Harpers Magazine, November 1952, p. 40.
So that if the committee does urge and favor involuntary commitment, then it certainly should emphasize and stress at the same time the importance of backing any commitment laws with complete and adequate programs for therapy.
Lastly, because some question might arise from what I have just said, I would like to add that I have been at both the installation at Lexington and at Fort Worth, and I regard those as model institutions. I think that the work they are doing there, within the limitations imposed on them, the primary limitation being that they do impose a prision-they do impose incarceration conditions, is absolutely superb.
Mr. MITLER. In other words, simply saying an addict is going to be sent somewhere for treatment doesn't establish they are going to get treatment. It is contingent on what happens when they get there. Mr. KING. Precisely.
Mr. MITLER. In other words, a lot of the as you have observed, do you know a lot of the so-called treatment centers just bear that title, but when they get there nothing happens?
Mr. KING. Well, some 35 States, I believe Dr. Chapman can give you the precise number, have involuntary commitment statutes for noncriminal addicts. Í have here a summary made by the Council of State Governments as of November 1956 of the treatment facilities that are available in these States, so that on the one hand you have, say, 35 States with laws which pull the addict into involuntary-into confinement for treatment; only 7 States purport to have any kind of treatment programs for narcotics addicts as such, actually 6 States and the Territory of Hawaii. The six States are Illinois, Maryland, Michigan, New York, Pennsylvania, and West Virginia.
Fourteen States have provisions of some sort for the incarceration of mental of narcotics addicts in their mental hospitals.
Now, understand this means not special treatment for narcotics addicts necessarily, but incarceration facilities in mental hospitals rather than in jails.
Those States are California, Connecticut, Delaware, Indiana, Kansas, Minnesota, Mississippi, New Hampshire, North Dakota, Ohio, Oregon, Texas, Washington, and Wisconsin.
Two other States, Florida and Massachusetts, permit noncriminal addicts to be sent to the State prison hospitals, in other words, to hospital facilities in connection with the prisons.
I think those figures, plus the fact that 23 States have no provisions, are a very important conditioning factor when you look at the involuntary commitment laws of the States.
Mr. MITLER. I have no further questions, Mr. Chairman.
Chairman KEFAUVER. Mr. King, I hope that the American Bar Association is continuing its interest in all of these related subjects. Can you tell us if it is?
Mr. KING. Well, this study that I mentioned, Senator, is a joint study which we hope will determine a position for both the American Bar Association and the American Medical Association, both professions.
As a result of the fine work that has been done here on Capitol Hill, they have been made increasingly aware of the importance of this problem and of the deep responsibility that both the doctors and the
lawyers have for assisting in finding a solution; and it is our hope that the work of this committee, which will ultimately report back to the board of governors of the American Bar Association and the board of trustees of the American Medical Association, will lead to some kind of joint position and clarification on the part of the two associations. I believe that specifically this narcotics problem and, in more general terms, problems relating to law enforcement, are of major interest to the American Bar Association, and I certainly would hope this is an interest that will never flag.
Chairman KEFAUVER. We are certainly very grateful to you, Mr. King, for your interest and help.
Mr. MITLER. Thank you very much.
Mr. KING. Thank you.
Mr. MITLER. Dr. Kolb?
STATEMENT OF DR. LAWRENCE KOLB, FORMER MEDICAL OFFICER IN CHARGE, UNITED STATES PUBLIC HEALTH HOSPITAL, LEXINGTON, KY.
Chairman KEFAUVER. Dr. Kolb, we are very grateful to you for being here with us. We are sorry that we have delayed your testimony so long.
Dr. KOLB. That is all right.
Chairman KEFAUVER. We consider you one of our most important witnesses in this entire hearing.
You are Dr. Lawrence Kolb?
Dr. KOLB. Yes.
Chairman KEFAUVER. Speak louder, Dr. Kolb.
Mr. MITLER. Could you give us your background, Dr. Kolb?
Dr. KOLB. Well, I entered the Public Health Service in 1909. I became a psychiatrist in the Service in 1915, served in various capacities. In 1920, I opened up a mental hospital for the Service in Waukesha, Wisc., for the treatment of mental cases. At this hospital we had a few addicts, not many.
In 1923, I was called to Washington to what is now the National Institute of Health, to study drug addiction for the Service. I studied drug addiction in the laboratory and in hospitals, in treatment, and I traveled throughout the eastern part of the United States to various places where there were addicts, to study them.
I studied at that time very carefully about 700 or 800 addicts. In 1928, I was relieved of that duty and went to Europe on a special mission for the Service; but while there, as a side issue, I studied the situation of drug addiction as it was handled in Europe, and I was rather amazed to find out the difference between their methods and our methods.
Mr. MITLER. What are the differences?
Dr. KOLB. The difference is that in Europe the addict is known to be a sick man, especially those addicted to the opium drugs like heroin and morphine, and the doctors are not harassed thereby when they prescribe for such addicts, nobody tries to put them in jail for it. There is no sneaking an informer in, trying to get them to prescribe for a fictitious addict, as is done here, and by which means so many of our doctors in this country have been sent to prison for doing that.
And, of course, in doing that here, they have become so terrorized at prescribing narcotics, the opiate drugs especially, that they have just shoved the thing aside, and it has become wholly a police problem here; whereas, as a matter of fact, it is 90 percent a medical problem. Mr. MITLER. Doctor, I didn't let you complete your background. Forgive me. I started to ask you a question.
Would you bring us up to date?
Dr. KOLB. On background, I returned to the United States and was for 2 more years associated at the Bureau of Public Health Service in mental health work; and then I went to Springfield, Mo., to open up the Department of Justice medical center, which was a new thing, and I opened up and operated that for 18 months.
They had some addicts there, but they were criminals, and it was not a major issue; mostly the treatment of criminally insane people. In 1935, I went to Lexington, Ky., to open up and to conduct the hospital that was opened there for the treatment of narcotic addicts. I did that for 3 years, and I was relieved from there in 1938 and came to Washington as Assistant Surgeon General in the Surgeon General's cabinet to be over the mental-hygiene program, and to have administrative control of those two hospitals.
Since that time, the administrative control has somewhat changed. I retired from the Service in 1945 early, and went to California and conducted there I was over the State mental hospitals as deputy director of the department of hygiene for 7 years.
Since that time, I have continued my interest in psychiatry, but I have more or less retired except for a short detail in Pennsylvania at a mental hospital.
Mr. MITLER. And you also wrote a recent article for the Saturday Evening Post?
Dr. KOLB. I wrote a recent article for the Saturday Evening Post in order to acquaint the general public with the facts about drug addiction, in order to point out here I think our policy has been entirely wrong, and has resulted in disease and death and crime that otherwise would not occur if we had what I think is a more rational and medical approach to the problem.
Mr. MITLER. Would you give us the highlights of your view?
Chairman KEFAUVER. How long is the article?
Dr. KOLB. This is 1,500 words. I wanted to offer it for the committee if you wish to have it.
Mr. MITLER. Because there is a lot in here about juvenile addiction,
Chairman KEFAUVER. Let's make it exhibit 11, I believe, and it will be printed in the appendix to the record.
(The article referred to was marked "Exhibit No. 11," and is as follows:)
LET'S STOP THIS NARCOTICS HYSTERIA !
(By Laurence Kolb, M. D.)
Drug addiction should be treated as an illness, not a crime, says this doctor, who offers a bold minority report on what he calls "the so-called drug menace."
Many years ago, when I was a stripling, I sat listening to a group of elderly men gossiping in a country store. They were denouncing the evils of cigarette smoking, a vice that was just coming in.
This store had on its shelves a jar of eating opium, and a carton of laudanum vials-10 percent opium. A respected woman in the neighborhood often came in to buy laudanum. She was a good housekeeper and the mother of two fine sons. Everybody was sorry about her laudanum habit, but no one viewed her as a sinner or a menace to the community. We had not yet heard the word "addict," with its sinister, modern connotations.
Since those days, public opinion has done a complete about-face. The "sin" of smoking cigarettes, in 50 years' time, has become a socially acceptable habit, while drug addiction has been promoted by hysterical propaganda to the status of a great national menace.
As an example, one prominent official has said that illegal heroin traffic is more vicious than arson, burglary, kidnaping, or rape, and should entail harsher penalties. Last May 31 the United States Senate went even further, in passing the Narcotic Control Act of 1956. In this measure, third-offense trafficking in heroin becomes the moral equivalent of murder and treason; death is the extreme penalty, "If the jury in its discretion shall so direct," for buyer and seller alike, whether addicted or not.
In my opinion, the lawmakers completely missed the point. For drug addiction is neither menace nor mortal sin, but a health problem-indeed, a minor health problem when compared with such killers as alcoholism, heart disease, and cancer.
I make that statement with deep conviction. My work has included the psychiatric examination and general treatment of several thousand addicts. I know their habit is a viciously enslaving one, and we should not relax for a moment our efforts to stop its spread and ultimately to stamp it our completely. But our enforcement agencies seem to have forgotten that the addict is a sick person who needs medical help rather than longer jail sentences or the electric chair. He needs help which the present Narcotics Bureau regulations make it very difficult for doctors to give him. Moreover, no distinction has been made, in the punishment of violators, between the nonaddicted peddler who perpetuates the illicit traffic solely for his own profit and the addict who sells small amounts to keep himself supplied with a drug on which he has become physically and psychologically dependent.
The Council of the American Psychiatric Association, in a public statement issued after the Senate passed its bill, declared that this and a companion measure introduced in the House, "represent backward steps in attacking this national problem." The association, after listing some of the points I have just made, concludes by remarking that "additional legislation concerning drug addiction should be directed to making further medical progress possible, rather than discouraging it. The legislative proposals now under consideration would undermine the progress that has been made and impede further progress. Thus, they are not in the public interest."
I was launched in this field of medicine in 1923, when the United States Public Health Service assigned me to study drug addiction at what is now the National Institute of Public Health. In 1935 I opened the Service's hospital for treatment of addicts at Lexington, Ky. Three years later I become Chief of the Division of Mental Hygiene, overseeing administration of the Lexington hospital and a similar institution at Fort Worth, Tex. And after retiring from the service in 1944, I continued to be active in psychiatry. So I know a great deal about addiction, and how perverse our attitude toward it has become.
Most addiction arises from misuse of marihuana, cocaine, alcohol, opium or opium's important preparations and derivatives-eating opium, smoking opium, laudanum, morphine, and heroin. Alcohol is a yardstick with which to measure the harm done by other drugs. The are 4,500,000 alcoholics in this country, and about 700,000 of them are compulsive drinkers who are on "skid road" or headed for it-gripped like opium addicts by psychological forces they cannot control. Until recent times, millions of people in Asia and Africa were habitual users of opium. Dr. C. S. Mei, a physician and Chinese Government official, told me in 1937 that there were about 15 million opium smokers in China. He was interested in the antiopium campaign because the slavish habit was lowering users' diligence and industry. But he remarked that opium smoking had little or no effect on health and no effect whatsoever on crime.
Addiction is far less common among Western peoples, chiefly because of our preference for alcohol. At the highest point of drug addiction in the United States, 1890-99, when all kinds of opiates could be bought as freely as candy or potatoes, there was only 1 opium addict for every 300 of the population. Today we have about 60,000 addicts in the United States-that is, about 1 in 2,800