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DRUG EVIL NOW THE TARGET OF FIERCE ATTACK
by Edward Marshall
NEW YORK TIMES - Sunday, February 9, 1913 Section IV, page 2, whole page
On the Eve of a Decisive Battle Against It at Albany, Charles B. Towns, One of Its Arch Foes, Tells How Our Present Laws Make It "Criminally Easy" to Become a Morphine or Opium Fiend.
The battle against drugs has crystallized before the legislature at Albany in the introduction in both houses of a bill which, it is confidently believed by its supporters, will at least approximate a solution of the troublous problem. This bill has already been endorsed by the Kings County Medical Society; the New York County Medical Society, it is believed , will have endorsed it prior to the publication of this article.
The bill was drawn by Charles B. Towns, a New Yorker and an expert of international reputation, whose writings on the subject of drug-habit perils in The Century Magazine and elsewhere have attracted much attention during the past year; whose treatment for drug habits, pronounced the most effective yet devised, has been freely given to the medical profession by its discoverer; who has studied drug and liquor addictions for twelve years to the exclusion of all else, travelling as far as China in his search for facts, and whose work has won unqualified indorsement from such distinguished medical men as Drs. Cabot of Boston and Lambert of New York.
He went to China on the suggestion of the State Department in 1908, to make a demonstration of his plan for treating opium-habit victims, with a view of showing beyond question its practicability. He opened three hospitals in China, at his own expense=AD=8Bone in Peking, one in Tien-Tain and one in Shanghai=8B=8B and successfully treated something like 4,000 patients. It wa= s after this extraordinary demonstration that he put the climax on his work by presenting gratis, to the medical profession, without reservation, the formula which, up to that time, he had kept secret because he held it to be in the experimental stage. He was present at the opium conference in 1909. In all he has been eleven months in China. The ineffectiveness of existing legislation has been generally recognized, and each effort to improve upon it has been subject to like criticism. In this proposed law, known as the Boylan-Kerrigan bill, it is believed that the old troubles have been done away with.
I talked with Mr. Towns upon an Albany-bound train last Wednesday, as we were going up to a committee hearing, thus supplementing a study of his plan which has extended over something close to a year.
"Nothing could be more gratifying than the fine support the medical profession is giving this proposed legislation," he told me. "No honest doctor wishes things to remain as they now are, and the proportion of dishonesty in the profession is very small, indeed.
"It has been criminally easy to acquire the drug habit and criminally easy for those who have acquired it to obtain the drug with which to feed their appetite. Ninety per cent. of drug victims suffer through misfortune, not through fault. Drug taking is acquired as a form of dissipation only in the 'underworld' and for the 'underworld' I feel small concern. The greater number of victims is made up of those who have been led into the habit, or who have turned to it, as a means of easing pain; therefore the average drug habitue is much more to be pitied than the victim of the drink habit.
"A large proportion of voluntary drug users started with small doses, with no thought but of saving themselves misery arising from some physical ailment. An even larger percentage has undoubtedly been led into the habit by the administration to them of the drug by their physicians for what they thought legitimate purposes and under what they thought a real necessity.
"Comparatively few physicians have recognized the fact that it is unsafe for sufferers to know what will ease pain. The conservative physician uses very little morphine. One, of eminence and enormous practice, assures me that, in his prescriptions, he does not average half a grain a year; another, of like eminence, told me he had never gone beyond two grains a year in his whole practice.
"Therefore a very small proportion of drug habitues begin to take the drug through legitimate medical prescription for a necessary purpose, and among the small proportion for whom drugs are legitimately prescribed is a large number who, had the proper medical treatment been directed at the cause of the disorder, rather than at the pain, which is only a symptom, would never have been given a grain of any habit-forming drug.
"Opiates do not remove the cause; they merely blunt the agony of the disorder's manifestation by inhibiting the body's functions.
"Thus 90 per cent. of the opiates medically used are used without valid excuse. Among the something more than three thousand cases of drug addiction which I have studied in this country, at least three-quarters received their first dose of the drug when there was no sufficient reason for its administration.
"But the first dose taught them that drugs would ease their pain. The succeeding process was inevitable. When again pain came, again they turned to drugs, sometimes without, the knowledge of their doctors. Presently the habit was inevitably fastened on them=8B=8Band they had joined the ranks of = the unnecessarily ruined.
"It may be at once admitted that there are cases in which continuous pain from an incurable disorder would be inevitable if drugs were not administered. In such cases it should be made easy for the sufferer to get his drug. No good purpose can be served by forcing him to suffer without the possibility of relief. To furnish opiates in such cases as promptly as is possible is only ordinary human mercy.
"But these cases are uncommon. In almost every other instance drug administration should be surrounded by such safeguards as will make it practically impossible for it to begin.
"My entrance into the legislative field was due to my discovery that the physician who began to protest against drug use was likely to be instantly and bitterly attacked by the manufacturer of instruments and by wholesalers of the dangerous drugs. One of these men was drawing his income from the manufacture of the gun, the hypodermic syringe; the other was obtaining his through the manufacture of ammunition, the drug itself. They wished no interference with their selfish war upon society. And they were very powerful. they did not find it difficult to harm doctors who opposed them seriously.
"It occurred to me that if it could be possible to stop the sale of guns the sale of ammunition would automatically decrease, for a large share of the habit-forming drugs consumed are taken hypodermically.
"The result of this very simple course of reasoning was the drafting of a bill making it illegal to sell a hypodermic syringe except on the prescription of a physician. That bill was passed and now stands as a law upon the statute books of New York State. Before it was enacted anyone could sell hypodermic syringes. They were freely offered to the purchaser, not only in the least important and least reputable drug shops, but even in the department stores, where they took their turns at price reduction and, upon occasion, were announced for bargain sale.
"That law has done some good, undoubtedly, but it has by no means solved the problem. It very quickly became evident that legislation must go further, and , in consequence, the bill now in debate was drafted. It will probably become a law at this session of the New York Legislature, and I have assurances that it will be accepted as a model for legislation in several other States."
"But where do existing laws fail?" I inquired.
"Existing laws which at first seemed so desirably drastic, but which in practice have proved almost valueless, hold no one responsible," was the reply. "One man should be held responsible=8B=8B the physician.
"The reputable doctor feels no fear of suffering through this: the man who does declares himself unworthy by the mere acknowledgement that he feels fear. No habit-forming drugs should be administered without real need, no subterfuge should be accepted as excuse; the use of opiates to cover ignorance should be rigorously prevented.
"I have no desire to throw the burden and expense of medical attendance upon any one; I am not favoring the doctor at the expense of the druggist; I am trying to protect all honest men=8B=8Bthe honest doctor and honest druggist among them=8B=8Bbut, most of all, the honest and entirely helpless sufferer. He tragically needs protection. In safeguarding him lies that protection for society itself, which at present lacks and which must get, if it is not to suffer greatly.
"In the proposed legislation the effort has been made to put the drug traffic upon an absolutely honest basis, where the public thought it long since had been placed, but where it never has been. The belief that it already had been carried to the doctor and there held, rigidly, has been a popular error.
"The almost universal theory has been that drugs could only be obtained upon a prescription given by physicians, and the natural and usually correct assumption that physicians know their business, are men of a high class and will give out habit-forming drug prescriptions only when they are completely justified, has given the public a fine sense of security. But unfortunately, there are weaknesses in this scheme of protection, weaknesses which practically nullify it.
"Up to a few years ago, in New York State, a patient coming into the legitimate possession of a drug prescription, signed by a physician, could use it and re-use it, until it was worn out, and then get from the druggist a fresh copy of it, as effective as the original had been. Thus, without the intent or even knowledge of the doctor who provided it, the prescription might and a prescription often did, produce a 'fiend.' This is now theoretically possible in New York State, but it is not even theoretically impossible in most other States. Although the greater number of physicians are reliable and high-class men, and although most of them are competent, so far as competence can be acquired in schools, the value of the clause was practically destroyed because of them.
"And even among doctors, blacksheep will occur, as they occur in all professions. Often those who do most harm in the promotion of drug habits are themselves drug victims. With health and character undermined by heavy doses, little can be expected of them in the way of mental stamina or moral force.
"My attention has been called to more than one case involving druggists anxious to sell quantities of habit-forming drugs at high profit, who have employed physicians of this kind to furnish required prescriptions to all comers who might ask for drugs and would otherwise be refused unless the law were violated.
"Another danger lies in this condition: druggists have no way of knowing whether or not prescriptions handed to them to be filled have really been written by physicians. Any 'fiend' can forge the name of a physician with very little chance of exposure, or, without incurring even that small risk , he can invent the name of a fictitious doctor and use that on a prescription blank which any printer will innocently furnish to him at small cost per hundred. There is no length to which habitues will not go to satisfy their crave for the drug which has a hold on them, there seems to be no limit to their ingenuity.
"But this plan requires no bravery and very little cleverness. It has become a common practice. It must be remembered that the law as it now reads permits a pharmacist to dispense habit-forming drugs on the prescription of any doctor whatsoever, resident at any distance from the scene of the sale, citizen of the State or not, known or unknown to the pharmacist. No investigation by the druggist is required that would plainly impose a hardship on him.
"Nor is there any restriction now placed by law on the amount of morphine, for example, which can be purchased by the retail druggist; no report is asked of him as to the distribution which he makes of what he buys. To-day in New York City I could buy enough morphine of either wholesale or retail druggists to form the cargo of a ship size without entailing any violation of the law upon the part of those who sold it to me.
"If I went to the same printer who provides the 'fiends' with 'fake' prescription blanks and had him print me letterheads announcing me as a retail druggist , or setting up a man of straw as a retail druggist, I could send to the wholesalers my orders, written on the printer's product, and receive the drug in wholesale quantities by the next day's delivery. Should I send my order to a wholesale druggist in, say, Philadelphia, the chance that he would ever learn that he was shipping to a person not legitimately engaged in retail drug sale would be infinitesimal, and the wholesaler could not be punished for delivering the drug to me, even if it could be proved that he knew I was no druggist. And I could not be punished for my subterfuge. Thus the so-called restrictions which now surround the sale of drugs are found not to restrict, in fact.
"The only way in which a penalty could be inflicted on me would arise through my being discovered to be engaged in the illicit sale of the supplies I had purchased. I could present them to my friends among drug takers without fear of punishment. I could drug myself to death and no one, save my family, would have the power to stay my hand.
"And if a provision prohibiting sale, except when a physician's prescription is presented, amounts to nothing, other conditions are as lax. The importer reports only to the Customs Service on the drugs which he imports, and such reports are followed merely by the payment of the legal duty. The manufacturer reports to no one, for while the tobacco factory is surrounded by restrictions, the drug factory is not.
"There are fewer safeguards around morphine than there are around beer. Its production is unhindered and conducted without supervision; its manufacturer does not even pay a license fee to the city, State, or Nation. He is as free to make his poisons as a hatter is to make his hats. The contents of the workman's pipe are guarded by far more effective legislation than the contents of the 'dope fiend's' hypodermic.
"While the world has an idea that it has met and mastered this great problem it has done nothing with it. How utterly this is the case was illustrated recently in my own experience. A lady who had incurred the morphine habit through the administration of the drug to ease the pain of illness, was cured of it. While she had been taking morphine she had bought the drug in quantities of $25 worth at a time from a certain well known wholesaler. Having been relieved of the necessity for taking it, her orders to this wholesaler ceased, of course.
"Not more than one week had elapsed after the passage of the date when, according to the old routine, her order for a new supply would have been in his hands, when she received a letter from the dealer asking why she no longer favored him with her custom.
"This was done quite frankly, in the normal way of normal business. The firm did not wish to lose a customer. It indicated careful business management. It was as if a regular purchaser of onions or spool-thread had ceased, without an explanation, to send in orders to the previous source of her supply. The house was looking after its legitimate trade. Nothing could more clearly illustrate the worthlessness of the restrictions now surrounding traffic in the habit-forming drugs.
"Recently a man came to me who had become a victim of the heroin habit. He was a traveling salesman and he was in really bad shape. I asked him how he had been getting his supply of the drug.
" 'Nothing could be easier,' he answered. 'When I've run out I've simply dropped a note to the Philadelphia branch of a New York drug house, signed my own name with "M.D." after it, giving my own address, inclosed the necessary postal order and received the drug, in 500 tablet lots, sent promptly. No one made the least objection.'
"Nor could anyone make legal objection!
"I asked the man how he had acquired the habit and his answer was about the same as that which I have had from hundreds. One day while he was on the road and troubled by a bad cold in the head a friend had recommended certain pills which he instructed the inquirer to crush and use as snuff. He did so. The result was comforting. In a short time he was saddled with a habit which might well have wrecked him.
"Are these episodes not proof that the so-called restrictions which now theoretically surround the sale of habit-forming drugs are wholly farcical? You can say, without reserve, that nothing has been really accomplished through all the opium conferences, although intense thought was devoted to the effort to make them of practical utility, and that practically nothing has been gained through all the legislation which incumbers the statute books in every State.
"In spite of these things the sale of habit forming drugs has steadily, alarmingly increased; it has grown until its magnitude is such that it constitutes a National threat. These are not the words of an enthusiast. Any reputable physician who has made a study of the situation will indorse them.
"And the most pitiful detail of it all is that many drug victims remain in total ignorance of the fact that they are being chained to a deplorable habit until it has so fastened on them that to shake it off, without assistance is impossible.
"It is surely true that presently this Government must adopt Federal legislation which will minimize illicit importation and regulate legitimate importation. Had the international understanding, proposed at The Hague Conference, been agreed to, foreign manufacturers could have sold only to such American buyers as were authorized by our authorities to make purchases of habit-forming drugs and our Government would have been advised of all sales made. That would have stopped smuggling.
"But the grand total of drugs smuggled is a minor matter when compared to the appalling total of drugs manufactured in excess of the requirements of necessity, here at home, quite legally, and as legally distributed to work their dreadful harm. No man has to smuggle smoking opium in order to secure it for his pipe or his customers. He can manufacture it in the united States. A large part of that used here is thus created.
"I am also hopeful that the bill which I have drafted will do something very definitely important as a starter toward the necessary regulation of the startling evil. It proposes, first, that the State Board of Health, or some other especially authorized body, shall prepare and furnish to all druggists and other retail dealers in the habit-forming drugs a special form of order blank, safeguarded against forgery, upon which all orders sent to wholesalers, manufacturers, and importers must be written if the drug is to be obtained. Of these orders the sender must keep a carbon copy, open to some authorized inspection; the receivers must preserve the original blank, similarly open to inspection. By this means the wholesaler and manufacturer will for the first time be compelled to make accounting of their wares.
"The next provision of the proposed law calls for a special form of prescription blank, made into books and serially numbered, to be furnished upon application to physicians who are registered in New York State by the same board which guards the wholesale traffic. The physician using this will be required to preserve carbon copies of all blanks which he fills in, and upon the special form he must affix his own name and address and the name and address of the patient for whom the drug is ordered.
"Each druggist must provide a special file for blanks of this sort, which shall be open to inspection at all times. No prescription can be refilled and any prescription made out in due form but not filled within ten days becomes null, void, unsalable. No druggist can give copies of a prescription of this sort to any person bringing one in to fill.
"Up to this point the wholesalers has been regulated for the first time in the history of drug legislation; and the retailer is not only regulated, but protected.
"The retail druggist, it must be remembered, is protected against thefts; his clerk's honesty, general character, and health are safeguarded, and his own pocket in protected. Hospitals and other public institutions which use large quantities of habit-forming drugs are by this bill insured against financial loss through theft and against scandal due to drug degradation in the character of their employees. Two physicians in the employ of public institutions and victims of the drug habit have been among my recent patients. Had this bill been upon the statute books they could not have become addicted imagine, therefore, the protection which the law would give to inmates of such institutions!
"I have discussed the bill with many druggists. One said to me the other day= :
" 'To the honest retail druggist such regulation would be a boon. It would safeguard his stock and protect him and his customers from the incompetence and possibly dangerous irresponsibility of clerks suffering from the effects of various narcotics. A drug-taking clerk is as great a menace to his boss as a definitely criminal clerk would be; he is a frightful menace to his employers customers. He is, indeed, a public peril. His name is legion now. This bill would eliminate him if made into law and properly enforced.'
"The proposed legislation is merely an enforcement clause for the existing law, which, although upon the statute books, is, as I have pointed out, farcical at present. The doctor is held responsible for what prescriptions he may issue, as the druggist is for those he fills. And provision also has been made against leakage from the doctor's private stock, hitherto unsafeguarded and in safeguarding that we shall safeguard himself against the use of drugs.
"A most important feature of the bill is that it does not permit individual physicians to assume the personal responsibility of administering habit forming drugs to patients for a period longer than three weeks, which I have found to be the average limit of safety. Longer administration means the probability of the establishment of habit.
"My reasons for inserting this clause were twofold, first to remind the physician of the danger point in drug administration, and, second, to better enable the physician to control a patient when he has become a drug habitue through some physical trouble which has led to the administration of narcotics to ease pain. Many a doctor has regretfully seen patients to whom he had occasionally given a 'hypodermic' in emergencies go, when he refused them new injections, to some less scrupulous source of supply=8B=8Ba= nd to their ruin.
"The moment a man becomes addicted to a habit-forming drug and knows it, just that moment he is ripe for plucking by all sorts of 'home cures,' sanitarium boarding houses and sanatarium hotels, as well as by cure-alls whose promoters' business is not to help those who apply to them for help, but to keep them on their list as long as they possess a dollar or their friends and relatives remain willing to be deceived and robbed or to pay high prices for the sequestration of the unfortunates for unscrupulous purposes. Such cases may be listed as sanitarium assets until their obituaries have been written.
"I have established the fact that a week, at most, offers ample time in which to determine, through definite medical treatment, whether or not a patient is a hopeless case. If he is hopeless, then he should be given his drug in some simple, inexpensive form and way, without being victimized.
"There we have the bill as it now stands before the Legislature, and about as it will stand before many Legislatures in various States before the present year is passed. When uniform State legislation has been secured along such lines and when regulations have been adopted by the Federal Government controlling inter-state traffic, then we shall have mastered one of the greatest evil which has ever existed in this country, one of the greatest threats which ever menaced civilized society, an evil so tremendous that those who are familiar with it cannot guess the final harm it may do, an evil which at present is spreading with such speed that the whole fabric of our national life is menaced by it."
It should, perhaps, be added that the crusade which Mr. Towns is carrying on against drug selling and drug taking is wholly at his personal expense. He has rejected many offers of financial help, although his consultations with others interested in the battle against drugs have been continuous through a period of years.
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