Attempts to
Legislate Opioid Use
By the early 1900's opioid medications for pain treatment were being refined, at the same time several countries and organizations were trying to control their distribution and use. The Pure Food and Drug Act of 1906 required medicines containing opioids to indicate their presence on the label. The Harrison Narcotics Tax Act of 1914 attempted to put strict controls on these and other drugs. A sort of Yellow Peril pushed through this legislation as most Americans believed opioid addiction was principally a problem among the Chinese and white criminal underclasses. The Harrison Act regulated the manufacture, distribution and prescription of opioids, cocoa and their products rather than prohibit them. The Act allowed physicians and dentists to only dispense opioids during the course of their professional practice. They, and pharmacies, were required to keep records.
It is of key importance to note that the Harrison Act laws were and are enforced by the U.S. Department of the Treasury. Treasury believed that addiction was not a disease, and therefore an addict could not be a patient. Dispensing opioids to an addicted person was not within the course of professional practice, and thus this precluded any legitimate role for doctors and dentists to offer medication-assisted treatment for Americans with drug addictions, including treating the drug addiction.
Many towns and cities had established Operating Treatment Clinics where morphine was dispensed as a replacement therapy for heroin, including the Dept. of Health in NYC. When the Supreme Court in 1919 upheld Treasury's interpretation of the Harrison Act, the Treasury Dept. started closing them via a mixture of inspections, legal pressure, etc. However, in the 1920s crime associated with illicit opioid use increased across the US. In 1929 Congress established and funded two "narcotics farms" in Texas and Kentucky and they saw their first patients in 1935. They offered detoxification with social, medical, psychological and psychiatric services to both general patients and Federal prisoners. Patient-to-staff ratio was low, around 2-to-1, but the atmosphere was still prison-like. Follow-up studies saw relapse rates of 93% and 97% within five years. Another residential program, Riverside Hospital for adolescents with addiction disorder opened in 1952, but also showed a high relapse rate (≥86%) in 2955, and the facility closed in 1961.
There was an interesting legal experiment in the 1960s due to fear about addiction-related crimes in New York and California. Civil Commitment procedures allowed citizens "in imminent danger of becoming addicted" to be confined in rehabilitation settings without having committed or being convicted of any crime. In California, the commitment could be for up to three years. In California, there was a voluntary process to commitment that included a medical exam, or a person could be committed for three years if arrested on a misdemeanor as an alternative to a jail sentence. New York gave up quickly on this experiment due to the expense and poor results. California's follow-up show only one out of six participants were successfully abstinent following treatment.
The Departments
Federal Narcotics Control Board and the Narcotic Division were established to enforce the Harrison Narcotics Tax Act of 1914 and the Narcotic Drug Import and Export Act of 1922 (also known as the Jones-Miller Act). These bureaus were consolidated into the Federal Bureau of Narcotics (FBN) under the Treasure Department in 1930. The FBN’s main focus was “fighting” opium and heroin smuggling–remember these were the days of Eliot Ness who joined Treasury in 1927 working for the Bureau of Prohibition in Chicago. Ness formed his famous incorruptible team–the Untouchables–of nine men from 50 agents in the Bureau to go after Al Capone (who famously tried to bribe Ness), ultimately arresting him for tax evasion.
The Food and Drug Administration had the Bureau of Drug Abuse Control which was merged with the FBN in 1968 to form the Bureau of Narcotics and Dangerous Drugs (BNDD) again under Treasury. The BNDD became the current Drug Enforcement Administration (DEA) which remains under Treasury. The DEA’s history goes back to the era of Treasury agents carrying Tommy guns to rout out illicit bootleggers and Chinese drug traffickers. It’s little wonder about their sometimes heavy-handed approach in charging into doctors’ offices to carry our their searches often based on “tips” from anonymous sources. The conflict about whether opioid abusers are patients or criminals plays out in the conflicting roles of the FDA and DEA, adding to the confusion of everyone involved.