When clinics gave away heroin Policy: Supplying addicts in the interest of public health and safety is not a new idea and has been tried -- in this country, in this century.

Sun Journal

June 29, 1998|By Scott Shane | Scott Shane,SUN STAFF

A photo caption in yesterday's Sun Journal, showing drug addicts in line to receive free heroin at a clinic in the 1920s, erroneously placed the clinic in Boston. It was in New York.

The Sun regrets the error.

Appalled at the crime and degradation resulting from drug addiction among the inner-city poor, public health officials take a radical step: They open a clinic where addicts can come and get their heroin free.

The year is 1919.

"The Clinic has served a humanitarian purpose in that it has provided a place for a careful physical examination, advice as to needed medical treatment and careful oversight of the progress of the drug disease," wrote New York's health commissioner, Dr. Royal S. Copeland, in January 1920.

FOR THE RECORD - CORRECTION

The Worth Street Clinic, then open for just eight months, had served 7,000 addicts, cut out the "wicked profiteering" of illicit drug suppliers, improved addicts' health and reduced crime, the doctor asserted. And it was not alone: From 1919 to 1925, some 40 clinics across the United States legally supplied addicts with heroin, morphine and cocaine.

History, that great recycler, may be preparing to stage an updated version of that experiment.

Drug-policy reformers met recently in New York City to hear about the claimed success of a three-year Swiss program of "heroin maintenance." Baltimore's health commissioner, Dr. Peter Beilenson, and drug-abuse experts at the Johns Hopkins University raised the possibility this month of a research trial aimed at luring hard-core addicts into treatment by offering them heroin.

Politicians rushed to denounce the idea. They may not have known it, but their objections, too, were an echo of the past.

In 1920, busloads of tourists stopped to gawk at the young men standing in New York's "dope line." Patients conned doctors out of extra doses, which were resold on the street. Plans to wean addicts from drugs by gradually reducing doses failed.

In March 1920, health authorities, under pressure from the federal government, closed the New York clinic after less than a year.

"Physicians should not be permitted, under the guise of treatment, to prescribe narcotics for such indulgence," they wrote. "The only hope is cutting off the supply of drugs as completely as possible."

Nearly eight decades later, the old ambition to "cut off the supply of drugs" remains the core of American narcotics policy. But the drug supply has never been bigger, and some public health officials are again tempted by the radical idea of providing addicts with heroin.

Most Americans assume drug abuse began with the rebellious youth culture of the 1960s. But the problem, and the debate over solutions, are far, far older.

"People say, 'Go look at the Swiss experience,' " says David N. Nurco, a veteran Baltimore drug-abuse researcher. "I say the Swiss should look at our experience."

Nurco remembers interviewing in the late 1970s an elderly addict -- a safecracker by trade -- who had received narcotics from the New York clinic in 1919.

"He said that for him, it was a good thing," Nurco recalls. "But he said the clientele ruined it. They'd steal the typewriters and the rugs. They'd send their girlfriends in to get extra drugs."

Given the scale of drug abuse today, it may come as a surprise that the rate of opiate addiction in the United States at the turn of the century was probably at least as high. Then, an estimated 250,000 Americans out of a population of 76 million were dependent on opium, morphine and heroin, which existed in over-the-counter medications, according to Dr. David F. Musto, a drug historian at Yale University.

Indeed, opium and morphine addiction were so widespread that when heroin was first put on the market by the Bayer Pharmaceutical Co. exactly a century ago, in 1898, some doctors enthusiastically promoted it as a cure for addiction to the older drugs.

Bayer chemists had developed diacetylmorphine chiefly as a cough suppressant for victims of pneumonia and tuberculosis; they named it "Heroin" from the German word for "heroic," applied to powerful drugs.

But by 1903, medical journals were questioning Bayer's claim that heroin was not habit-forming. By 1910, police were reporting recreational use of heroin, chiefly by young white men, mostly in New York, near Bayer's supply houses.

In 1914, Congress banned non-medical narcotic use with the Harrison Narcotic Act. But lawmakers failed to clarify whether doctors could legally maintain a patient indefinitely on heroin or other drugs. A class of unscrupulous "dope doctors" emerged, living off addicts by writing as many as 200 prescriptions a day for heroin, morphine and cocaine.

In 1919, at the urging of government lawyers, the U.S. Supreme Court clarified the law by ruling that such addiction maintenance was illegal. Police moved swiftly to shut down the prescription mills, cutting off the drug supply for thousands of addicts.

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