Drug Addiction, Continued
To the Editor:
According to Edwin M. Schur’s rejoinder to my comment on his report “Drug Addiction in America and England” [“Controversy,” December 1960], we now seem to be in agreement that the narcotic laws of England and America are essentially the same. One difference, says Mr. Schur, is that in Britain doctors have almost complete professional autonomy to make decisions concerning the treatment of addicts. But American doctors have autonomy to administer narcotic drugs to patients within the tenets of proper medical practice, a field carefully delineated in the 1920′s under the firm leadership of the American medical profession. . . . It is farfetched and unfair to suggest that the Federal Bureau of Narcotics may have pressured the English into labelling the American-conceived “British system” as an American “invention.” . . .
Mr. Schur plays down the “police” aspect in England. At a recent United Nations meeting the English representative was asked why England’s opium smoking addicts, more numerous than in America, were not carried in its addict statistics. “Because they are in jail and no longer addicts,” was the reply.
Mr. Schur evades the issue on the addict count. He cites two references, neither in the census nor statistical field. I have great respect for Dr. Nyswander, [but] I doubt whether she would claim to be an authority on an addict count. . . . Mr. Schur finds our narcotic control system illogical and ineffective. (Strangely, Mr. Budner also refers to “absolute ineffectiveness.”) It seems to me that this is an illogical reference to a system concomitant with which the incidence of addiction and the individual rate of drug intake per addict has declined enormously. . . . In areas in New York, Illinois, and California centers of addiction are still a glaring, festering sore, but we must maintain perspective.
Mr. Schur also says our system is “barbarously inhumane,” an epithet which might better be reserved for people who recommend breaking down our safeguards to assure a continued free flow of narcotic poison to the addict and his as yet uncontaminated associates. Of course our system is not perfect. . . . We should have specialized hospital facilities near centers of contagion, and there should be follow-up procedures to require that the addict get the full benefit of everything that medicine can offer. . . . I should like to see Mr. Schur’s fine intelligence and facile pen employed in that direction.
M. L. Harney
Formerly Superintendent, Illinois Division of Narcotic Control; formerly Assistant to U. S. Commissioner of Narcotics; Assistant to Secretary, U. S. Treasury, for Law Enforcement, Retired.
Mr. Schur writes:
Mr. Harney maintains that American doctors have autonomy to administer narcotics “within the tenets of proper medical practice.” . . . It is true that our laws do not prohibit doctors from treating addicts; yet the interpretation and administration of these laws have quite effectively curtailed medical initiative in this area. Mr. Harney refers to the firm leadership of the medical profession in the 1920′s—that is, the AMA’s 1924 resolution urging a ban on ambulatory treatment. He fails to mention the following 1957 recommendation of the AMA’s Council on Mental Health: “The 1924 Resolution should be revised. Consideration should be given to broadening the Resolution to include a plan endorsing regulations somewhat similar to those currently in force in England.”
I only conjectured about American pressure to play down the British “system,” but frankly I cannot think of any other reason why British officials should deny its existence. I agree that there is a police aspect to the situation in England. Yet British officials do not insist that addiction is primarily a police problem, nor do they appear to harbor punitive attitudes toward addicts. True, one finds a different sort of person prevailing among addicts in Britain—but why is this so? Largely, I believe, because British policy prevents addiction from spreading.
Mr. Harney says the estimates of U. S. addiction which I cite are not “in the census or statistical field.” To my knowledge there are no census data on addicts; only the Bureau’s own figures, which surely may be open to question. . . . Mr. Harney asserts that present policies have reduced addiction, but even official figures indicate the persistence of a major social problem.
I would be curious to know what “safeguards” I recommend breaking down. At least Mr. Harney sees that the policies I advocate would assure a “continued” flow of drugs. For certainly addicts get their drugs now, under highly undesirable auspices and conditions. I too favor better treatment facilities, but even with follow-up procedures the prospects for long-term cure seem slight. And it is hard enough to permanently cure voluntary addict-patients; the government’s compulsory confinement approach only makes matters worse.