History of American Drug Policies
This paper is about the history of the non-medical use of drugs. It is interesting to note than in the early 1900s there were far more people addicted to drugs in this country than there are today (Whitebread, 1999). Estimations reveal that between two and five percent of the entire adult population of the United States was addicted to drugs in 1900.
There were two main reasons for this dramatic level of drug addiction (Whitebread, 1999). The first was the use of morphine and its various derivatives in legal medical operations. People received morphine as a painkiller during an operation and after the operation. They often came out of the hospital addicted to morphine. In addition, the use of morphine in battlefield operations during the Civil War was extensive. As a result, many Union veterans were addicted to morphine. The popular press frequently referred to morphinism as the “soldier’s disease.”
The second cause of the high level of addiction in the early 1900s was the growth and development of what is now known as the “patent medicine” industry (Whitebread, 1999). As late as 1900, in rural areas where medical resources were scarce, it was typical for salesmen to travel the countryside offering cures of all sorts. However, they failed to tell their customers that many of them were up to fifty percent morphine by volume. Therefore, they worked for most people, in the sense that morphine takes away all types of aches and pains.
For these reason, almost all addiction at the turn of the century was accidental (Whitebread, 1999). People were involved with drugs they did not know that they were taking and did not understand the consequences. Thus, there was more drug addiction than there is now and much of it was accidental.
In an effort to address this problem, the 1906 Pure Food and Drug Act was passed (Whitebread, 1999). This law has done the most in this country to reduce the level of drug addiction. However, it is not a criminal law. The act did three things:
1). It created the Food and Drug Administration in Washington that must approve all foods and drugs meant for human consumption. The very first impact of that was that the patent medicines were not approved for human consumption once they were tested.
2) the Pure Food and Drug Act said that certain drugs could only be sold on prescription.
3) the Pure Food and Drug Act, (and you know, this is still true today, go look in your medicine chest) requires that any drug that can be potentially habit-forming say so on it’s label. “Warning — May be habit forming.”
The labeling requirements, the prescription requirements, and the refusal to approve the patent medicines effectively put the patent medicine business out of business and reduced that major source of accidental addiction.
Since then, numerous policies have been put in place to control drugs in the United States. For example, the first criminal law at the Federal level to criminalize the non-medical use of drugs was the Harrison Act (Whitebread, 1999). This paper aims to provide an effective look at the history of drug policies in the United States.
The history of the United States policy towards drugs can best be reviewed by examining supply reduction, the reduction and control of the supply of drugs through legislation, law enforcement, interdiction, sentencing, and incarceration.
There are many different points at which the history of supply reduction in the United States may have begun (Harrison, Backenheimer and Inciardi, 1999). The year 1906 marked the Congressional passage of the Pure Food and Drug Act, which prohibited the interstate transportation of adulterated or mislabeled food and drugs. However, this policy did not prohibit or outlaw the use of cocaine and opiate drugs. Rather, it created standards of quality and truth in labeling and did lead to the demise of much of the patent medicine industry since the ingredients of such medicines now had to be revealed (Inciardi, 1992, p. 15).
A key legislative act concerning drugs occurred in 1914 when Congress approved the Harrison Act, which became the standard and the basis of narcotic regulation in the United States for the next 50 years (Harrison, Backenheimer and Inciardi, 1999). This act was based upon the constitutional authority of the Federal Government ‘to raise revenue and to tax and regulate the distribution and sale of narcotics. The Harrison Act aimed to make illegal the non-medical use of morphine and cocaine. Under the terms of this law, all people who imported, manufactured, produced, compounded, sold, dispensed, or otherwise distributed cocaine and opiate drugs were required to register with the Treasury Department, pay taxes, and record all transactions (Harrison, Backenheimer and Inciardi, 1999).
While this act was defined as a revenue act, the Harrison Act served to criminalize the approximately 200,000 users of narcotics in the United States (Harrison, Backenheimer and Inciardi, 1999). As a result, many citizens were suddenly labeled addicts. Doctors could no longer write a narcotic prescription for these addict patients for the purpose of maintenance. A later law stated that a narcotic prescription for an addict was illegal even when the intent was part of a ‘cure’ program. This decision was reversed in 1925 but, by that time, doctors were wary of prescribing narcotics to addicts and an illegal drug distribution chain had become well established.
By 1920, an illegal drug economy was prominent the United States, making money mainly from sales of cocaine and heroin distribution (Harrison, Backenheimer and Inciardi, 1999). In 1922, the Jones-Miller Act was passed to address this issue. The act issued fines of up to $5,000 and jail time for any person found guilty of participating in the illegal importation of narcotics. However, the legislation had little effect on the illicit drug marketplace except to increase the price of heroin and cocaine (Harrison, Backenheimer and Inciardi, 1999).
The 1920s also marked the culmination of alcohol prohibitionist efforts. During the previous two centuries, support was increasing for prohibition, and by 1900, there was a great deal of noise on the topic (Recreational Drug Information, 1999). The Womens Christian Temperance Union, anti-saloon leagues, and allied anti-alcohol crusaders aimed to convince Americans that the downfall of the country lay in continued use of alcohol.
The Eighteenth or Prohibition Amendment passed both houses of Congress in 1917, and was ratified by three-fourths of the 48 state legislatures a year later (Recreational Drug Information, 1999). From 1920 until 1933, the manufacture, sale, and consumption of alcohol was prohibited in the United States. As with tobacco, the opiates, and cocaine, legislation did not create a general climate of abstention. And where there were many willing consumers, supply was still able to keep pace with demand.
Alcohol was still available during Prohibition (Recreational Drug Information, 1999). People still got drunk, still became alcoholics, and was still popular at parties Drunken drivers were still a frequent menace on the highways, and the courts, jails, hospitals, and mental hospitals were still filled with drunk people. However, instead of drinking alcoholic beverages manufactured under state and federal standards, people now drank rotgut, which was often contaminated. The use of methyl alcohol, a poison, because ethyl alcohol was unavailable or too expensive, led to illness and death.
In addition, even seedier speakeasies replaced disreputable saloons (Recreational Drug Information, 1999). There was a shift from relatively mild light wines and beers to hard liquors — less bulky and therefore less dangerous to manufacture, transport, and sell on the black market. Young people — and especially respectable young women, who rarely got drunk in public before 1920 — were now staggering out of speakeasies and stumbling down the streets.
While the saloons had legal closing hours, the speakeasies stayed open night and day. Organized crime syndicates now controlled alcohol distribution, establishing power bases that still survive. Also, marijuana, a drug previously little used in the United States, was first popularized during the period of alcohol Prohibition.
Despite rigid federal efforts to enforce the Eighteenth Amendment, the alcohol prohibition concept was unenforceable (Recreational Drug Information, 1999). Americans and their European forebears had been drinking for centuries and were unwilling to stop. The Twentieth Amendment repealing prohibition passed Congress in February 1933. The requisite number of states ratified it in less than one year’s time.
The Twenty-first Amendment gave individual states the power to retain statewide alcohol prohibition, and made it a federal offense to ship alcoholic beverages into a dry state (Recreational Drug Information, 1999). However, by that time, the states, too, had learned how impossible it was to keep people from drinking. One by one, each repealed its local anti-alcohol legislation, with Mississippi the last state to give in — in 1966.
Until 1920, when Alcohol Prohibition was legislated, there were few accounts of marijuana in the media and those that did exist showed marijuana to be smoked recreationally (Harrison, Backenheimer and Inciardi, 1999). After prohibition was legislated, marijuana markets began to appear in a few cities, particularly New Orleans and New York (Brecher, 1986, p. 14). Soon, Congress passed the Marijuana Tax Act, which was signed into law in 1937. Like the Harrison Act, the Marijuana Tax Act placed marijuana into the same category as the cocaine and opium drugs. It was now illegal to import marijuana into the United States (McWilliams, 1991). However, this law was ineffective in curbing marijuana use (Brecher, 1986, p. 14).
By the early 1940s narcotic addiction had significantly reduced in the United States (Harrison, Backenheimer and Inciardi, 1999). However, this was not the result of legislative initiatives. Instead, it was because World War II was cutting off the “supplies of opium from Asia and interrupt the trafficking routes from Europe” (Inciardi, 1992, p. 24).
Several other legislative efforts in the supply reduction department served to establish more severe penalties for violations of drug laws, and tighten controls and restrictions over legally manufactured narcotic drugs (Harrison, Backenheimer and Inciardi, 1999). The Manufacturing Act created a system of licensing manufacturers and quotas for classes of drugs. In 1961, the United States became one of fifty-four nations to participate in the Single Convention on Narcotic Drugs, which aimed to modernize and coordinate global narcotic control.
In the 1970s two more laws were passed to control drug abuse (Harrison, Backenheimer and Inciardi, 1999). The first was the Racketeer-Influenced and Corrupt Organizations law (RICO) and the other was the Continuing Criminal Enterprise (CCE) statute. Both aimed to forfeit ill-gotten gain, the removal of the rights of drug traffickers to any personal assets or property – including real estate, cash, automobiles, and jewelry, -obtained by or used in a criminal enterprise or act.
In the 1980s, four major antidrug bills were passed (Harrison, Backenheimer and Inciardi, 1999). All four were in the supply reduction arena. The first was the Comprehensive Crime Control Act of 1984, which expanded criminal and civil asset forfeiture laws and increased Federal criminal sanctions for drug offenses. The second was the 1986 Anti-Drug Abuse Act, which enabled treatment and “restored mandatory prison sentences for large-scale distribution of marijuana, imposed new sanctions on money laundering,” and other demand reduction components (BJS, 1992, p. 86). The third was the 1988 Anti-Drug Abuse Amendment Act, which increased the sanctions for crimes related to drug trafficking and developed new Federal offenses. The fourth was the Crime Control Act of 1990, which focused on supply reduction and law enforcement, increasing the appropriations for drug law enforcement grants to states and localities, and strengthening forfeiture and seizure statutes (BJS, 1992, p. 86).
The first pressures for drug policies in the United States started after the Civil War, which had spurred the separation of drug manufacturers from drug prescribers and drug dispensers (Mayo, 2000). Because traveling medicine salespeople were selling dangerous, addictive, and phony patent medicines, there was a definite need for legislation. Many of today’s pharmaceutical companies began with the shady shops of that time, but still, most drugs were imported from Europe. At the time, the America was a dumping ground for substandard and contaminated drugs from Europe.
Harvey Wiley of the U.S. Department of Agriculture started testing food products for adulteration in the 1870s (Mayo, 2000). He became chief chemist of the Department of Agriculture in 1883. In 1890, Congress passed a law to stop importation of dangerously adulterated food or drink. The President had the power to order a proclamation prohibiting such products from entering the country.
In 1906, Harvey Wiley wrote the Pure Food and Drug Act, praising President Teddy Roosevelt (Mayo, 2000). The act was aimed to stop shady practices in the food and drug industries described in Upton Sinclair’s book, the Jungle. One of the worst references in this book is to the lard industry, where if workers fell into a lard vat…” sometimes they would be overlooked for days, until all but the bones of them had gone out to the world as Durham’s Pure Leaf Lard.” Clearly, there was a need for legislation.
The 1906 Pure Food and Drug Act developed harsh penalties for certain acts of misbranding and adulteration (Mayo, 2000). The act required the identification of narcotics. It developed quality standards based on monographs published in the U.S. Pharmacopoeia, and took many dangerous products off the market. Unfortunately, the U.S. Supreme Court weakened the act in a ruling saying it did not prevent false health claims, only false labeling. The 1912 Shirley Amendment tried to correct this loophole, but left another. It required a prosecutor to prove a deliberate intent to defraud the public.
The Shirley Amendment failed to control the marketing of new drugs, devices and cosmetics (Mayo, 2000). However, it was firmly in place for thirty-two years until the drug industry once again faced consumer advocates that demanded resolution of the industry’s unethical practices. Two writers, Kallet and Schlik, wrote a book called 100,000 Guinea Pigs, and founded Consumers Research. Ruth Lamb wrote American Chamber of Horrors, which caught the public’s attention. Lamb had been secretly hired by the Department of Agriculture to write a book that would stimulate the passage of legislation. These books drew attention to examples of poisonous cosmetics, contaminated foods, and false drug advertising.
Unfortunately, it was ultimately a national tragedy that resulted in new drug policies. In 1937, the Massengil Company marketed a new product, sulfanilamide elixir, which is an antibiotic that is insoluble in water (Mayo, 2000). Massengil chemists dissolved the drug in ethylene glycol instead. No toxicity testing of the product, containing what we now call automotive antifreeze, was conducted and little was generally known about its toxicity. Over a hundred people were killed before the government pulled the product from the market. Still, the only power the government had to do so was in a technical labeling violation: the drug product was a solution, not an elixir (e.g., it did not contain alcohol).
The resulting Food Drug and Cosmetic Act of 1938 required that proof, in the form of a New Drug Application was required to be submitted to a new department called the U.S. Food and Drug Administration (Mayo, 2000). Those marketing new drugs had to show safety for intended use in the form of an NDA.
Congressional hearings in the 1950’s and 1960’s raised the public’s interest regarding excessive drug costs, poor competition, price controls and patent protection (Mayo, 2000). In this period of major industry growth and the rapid introduction of key drugs (including penicillin, the sulfonamide antibiotics and tetracycline, the first antihistamines, cortisone, and tranquilizers), the FDA and many clinical investigators were harshly criticized for inefficiency and dishonesty. However, again, it would take a national tragedy to bring about new policies.
Thalidomide was discovered in West Germany and sold over-the-counter as a tranquilizer until 1961, when it was recognized as causing a type of polyneuritis in adults (Mayo, 2000). The drug become associated with an outbreak of phocomelia, which is also known as “seal limbs.” By that time, over a thousand “flipper babies” were born with disfigured appendages. The drug was distributed worldwide, except in the United States. The Merrell Company had been conducting U.S.. experiments since 1960 but had not gained marketing approval. An FDA Medical Officer had insisted on further proof of safety before granting marketing approval to Merrell. In so doing, the FDA limited the number of phocomelia babies in the U.S. To only a few cases.
The 1962 Kefauver-Harris Amendments (to the 1938 Food Drug and Cosmetic Act) forced pharmaceutical companies to provide evidence of safety and efficacy (Mayo, 2000). Numerous acts have been passed since 1962, but the Kefauver-Harris amendments, and the FDA regulations promulgated from them, mainly govern drug research and development to this day.
The 1962 amendments had a major impact on drug development (Mayo, 2000). On a positive note, the act required that the FDA be informed before a company begins human testing, thus eliminating the old method of starting clinical trials on the basis of animal toxicity tests. This policy enabled the FDA to license and inspect drug manufacturers. It also prevented the use of generic names that were vague and hard to remember, a practice the manufacturers used to reduce generic substitution. However, it could be argued that this legislation has increased the time it takes for a new drug to reach the marketplace, has substantially increased research expenses and retail cost, and has limited the breadth of drugs as companies target their research and development investment only at the most promising and potentially profitable, candidates.
After the 1960s, the U.S. focused mainly on harm reduction policies, According to DuPont and Voth (2000): “In theory, harm reduction is a public health philosophy that seeks to lessen the harms caused by both drug abuse and drug policies. In practice, harm reduction means promoting and implementing pragmatic measures that help save the lives of people who use drugs and that reduce the pain of suffering people.”
According to Drucker (1999): “Current harm reduction practice is a response to two fundamental observations about drug use. First, it has been well documented that individuals in existing addiction treatment programs rarely achieve total abstinence. Second, for most users of most drugs, controlled use without treatment is the norm. The harm reduction approach holds that, over time, controlled use of all drugs is an achievable goal — even for those people who have become chemically dependent.”
The Harm Reduction model for a drug policy is one that is widely used today and has replaced many models of the past. However, it is an ineffective policy (Santamaria, 1999). Some of its apparently successful programs, such as needle and syringe exchange programs and methadone maintenance services are ones that need to be critically reviewed.
There is a major need for adequate treatment services for the truly addicted, for good primary prevention programs, for early intervention and appropriate restrictive laws with good diversionary programs (deter and treat) (Santamaria, 1999). Control of supply and control of demand are very important and rescue from the drug subculture is key to a successful intervention. In conclusion, the United States needs to address the contributing factors that create an at risk population and a population that needs to rediscover the real meaning of living in a human society.
Today, it is unnecessary to dismantle restrictive drug policies. Instead, a strong national policy should aim to reduce the harm of drug use through harm prevention (for example, by building drug-prevention programs) and harm elimination (by developing broader interdiction and rehabilitation efforts). This new policy should improve efforts to reduce the use of alcohol and tobacco as well as currently illegal drugs. In this light, this policy should take aim at especially vulnerable persons in the community, with a major emphasis on the young.
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