favv/ IIlTtl c^S Digitized by the Internet Archive in 2017 with funding from Columbia University Libraries https;//archive.org/details/trafficinnarcotiOOunit FOREWORD. In publishing the report of the Special Narcotic Committee the department does not vouch for the accuracy of the figures given nor assume finality for the conclusions arrived at. A careful reading of the report will make clear the reasons for this statement. Complete and accurate statistics of the extent of drug addiction have never been compiled and are not now available. In vieAV of the scattered sources of information and the fragmentary statistics secured, the report of the committee probably presents as comprehensive a survey as is possible under the circumstances of the problem from the humanitarian as well as from the administrative viewpoint. The importance of securing accurate data regarding the extent and growth of the traffic in narcotic drugs is coming to be more keenly apjDreciated by all authorities and in the near future it is hoped that far more complete data Avill be made accessible to iuA’estigators. This report is presented to the public in the hope that it will enlist the interest and cooperation of all official and social agencies in. working out the best program for effecth^e administration of the antinarcotic laws and for the rebuilding of those unfortunate persons afflicted with the narcotic habit. To the end that our man power may be properly protected from this growing evil, all interested individuals and organizations are urged to furnish information regarding unsatisfactory conditions in their respective communities and to submit suggestions for the better enforcement of these laAvs. ( 3 ) .friro7/.'T5TO'r MtHfiimoO -.ito'j'tiiX rjif'VH|8 iM-rt tuKf.’t ai-Jt r};a.uhUdiif[ aT ion iwa-tj wI-J 7;> ; '>;:r 'iot H'-imv ^oii ?')<)[> )ffii!h«-{>r* 5.0 yrtijom {uVnAo A .1;! fv)7rn,:Art 'i.rijf'ntoy ^rfi -lol ololqrn'O .lo-jiffO-fnlH «jiif •}t»5 f'ooais'rr 7d1 Tii-.I > .r/fi:iu lii'.7 hofj’vr odJ •t.'jv'ijt n-fttci noi>'>i5)iM; j^inh }o .oili 5‘> ijni! fjonsitfjTa odl 5o vAi ' dI. .jld/ifif , mi v/od ^vn ;vii! l.rif: - fiM‘)7 an ^rnT^-rof vjdjsfio'iq 7ii1 h> J-di jov '.ffi jsio'il ut'tliJo'fij orl) 5o a-riyi Nd t iolxof dMra^iui *;i ?(: Jnio(I 7 /'MV .'(Vtori.faiiiimbjs '>iU inoii aji \h'rf ai; inu-Ui iiiHiaiiKf biii! jn'>t/7 '>fli wdil'-uo'-rt atJi'M)'. )r; uni fic)'):-' 'io o‘)nf!)'iuquu .‘ul'J' vjow>{ O'loi:! -h) v>J ^iii’uro-; af oijoo'jjwi ur diltsfl idi ic. .liuqod' af ;»i -m,!'*!. uIj of opts- adfii-iorfijn: ilc; 'qj, ,ai<>J7ifi oldi li; tliniti .; ' Jir^ (;jnli ^iviqufn^ -rioiif ■ds)' tnii) ;* 8 ifn'-> ilivA ti lads dqnff ddr nf ofil ot JyjJa'yv({ ai tfoq'rr aiffl /li Spiouo'lift lRi'«)a jjfUi luiorflf) ilti iioitu'ipqoo’'* IjHp i-Dipidi sdt ')Jt .5o rioxtB'iiaf.ffiailx; 'i'>T oos'qjj.viq .tafxf odr nir.'i-iovr anoai-x'i oaud.' 'io •QafJdiKdn adJ 105 i'Ho a-.viif .oitoouaiituR T)v/oq jiRfft Tfo Jiidt bffo sih o'i .ti'.fRd yitoo'iftn odt d.Jivx boiodlrii ffd .livo jjjiivxoT^ aid] loo'rt y;iin(o'K| od VBfii noit(uino5ro daifiiol ot b-yu; .-.p .arioiJBiiii ;;<*•!<» hoR vbjfdH'viljni eoidil'ouiuioo o'.djooq.-.^i ijod f ai aii'.'i r’ot /pl'^.'lTwiiri i .awojl oa 3 i[; 1o Jiioni>>-xo'i.i‘J 7'di7d odi lol Siioi 'aoijyua ihadfty o) Imn 0'> • ,qr„ REPORT OF SPECIAL NARCOTIC COMMITTEE. Washington, D. C., April 15, 1919. The Secretary of the Treasury (Through the Commissioner of Internal Revenue). Sir: The special committee appointed by your predecessor on March 25, 1918, to investigate the traffic in narcotic drugs has com- pleted its work and the findings thereof are embodied in the following report which the undersigned have the honor of submitting herewith. The committee’s investigations have been as thorough and extensive as possible with the facilities at hand and the time allotted to the work, and it is thought that the data herein presented convey with a fair degree of accuracy the conditions of the traffic in these drugs pre- vailing at the present time. As not all narcotic drugs are habit forming or of importance in the sense understood b}^ the committee, and as some of the habit-form- ing drugs commonly spoken of by the laity as narcotics are not nar- cotics in a medical sense, the committee has limited its investigations to the traffic in opium, its preparations and habit-forming alkaloids, and coca leaves, their preparations and habit-forming alkaloids. These are the drugs which are definitely covered by the Harrison Act and are most pernicious from the standpoint of habit formation. The nature and scope of the committee’s activities are definitely stated in the outline which was drawn up at the beginning of the committee’s labors, a copy of which was submitted to your predecessor. For the purpose of securing information relative to the different phases of this traffic, as described in the above-mentioned outline, the committee has used every means at hand. Certain data were obtained through the efforts of individual members of the committee. Other information was secured through questionnaires addressed to indi- viduals or institutions likely to be in possession of the same, and by consultation with individuals interested in the problem of drug addic- tion. Still other information was secured through the efforts of the internal-revenue agents. All information thus obtained was care- fully weighed and that portion which, in the opinion of the com- mittee, appeared to be of value has been used as the basis of this report. In further compliance with the request of your predecessor, the recommendations of the committee for changes with a view to improv- es) 6 ing the present laws and regulations governing the sale and use of these drugs have been appended. These recommendations are based on the conditions set forth in this report and are, therefore, thought to be particularly pertinent. CO:^nvtERC'R IN NARCOTIC DTJTJC.8. The extent of the commerce in narcotic drugs in the United States can not be accurately estimated because of the fact that up until the present time the laws and regulations governing their sale, and use did not make provisions for tracing these drugs from the importer to the ultimate consumer. Some idea of the magnitude and ramifi- cations of this traffic may, however, be obtained from the following table : Reffistratwns under the Harrison Narcotic Law, year ended Juno 30, 1918. Phy-sicians 125, 005 Wholesale dealers 831 Dentists 42, 240 Manufacturers 888 Veterinarians 10,399 Importers 76 Hospitals, etc 3, 799 Educational 13S Retail dealers 48, 196 Miscellaneous 258 Total 233,491 Neither can the value of this commerce be accurately estimated, as the crude drugs are in greater part manufactured into the more costly medicinal preparations and alkaloids. A minimum estimate can, however, be arrived at by computing their value on the basis of the retail price of the crude products. Thus, the average yearly con- sumption of opium for the. period 1910 to 1915 was 491,013 pounds. At the present retail price of $40 per pound, the total value would- be $18,841,720. The average yearly consumption of coca leaves for the same period was 1,048,250 pounds. At the present retail price of $1 per pound the total value would be $1,048,250. The grand total would, therefore, represent a value of apf»roximately $20,000,000. From the information at hand, it is concluded that the larger part of these drugs pass directly from the hands of the importer to those of the manufacturer, where they become a part of medicinal jirepara- tions, or are manufactured into alkaloids. The following data com- piled by the Bureau of the Census give a fair idea of the extent of these operations in 1914, except that they do not shov/ the total quan- tities of alkaloids produced. Of 4,092 manufacturers making patent and proprietary medicines and compounds and druggists’ preparations, 382 . reported the use of opium in their preparations, 300 I’eported the use of morphine or its derivatives, 138 reported the use of heroin, 142 reported the use of diacetyl morphine (heroin), and 136 reported the use. of cocaine or its derivatives — a total of 1,098. The quantities of these materials used are as follows: 'Narcotics used 'by manufacturers during 19H. Opium Morphine, or derivative. Heroin Diacetyl morphine Cocaine, or derivative- pounds 118, 282 -ounces 316, 130 do 13, 039 - do 23, 859 do 414, 255 A very considerable quantity of these drugs, however, is secured by the wholesaler, who disposes of them to the retailer (principally druggists, physicians, dentists, and veterinarians, although they are also handled in the form of exempt preparations and proprietary remedies bj^ grocers and department stores), and eventually they reach the consumer through these channels. The foregoing statements applj" only to the legitimate traffic in these drugs. In addition, there is the so-called “ underground ” traffic, which is estimated to be equal in magnitude to that carried on through legitimate channels. This trade is in the hands of the so-called “ dope peddlers,” who appear to have a national oi’ganizatian for procuring and disposing of their supplies. For the most part, it is thought that they obtain their supplies by smuggling them from Mexico or Canada, although smaller quantities of these drugs are obtained from un- scrupulous dealers in this country or by theft. Smuggling is also practiced to a considerable extent on the Atlantic and Pacific coasts, where the drugs arrive on ships hailing from Europe and the Orient. That considerable quantities of these smuggled drugs are exported from this country for the purpose of reentry through illicit channels appears to be indicated by the following data showing the increase in the exportation of opium, morphine, and cocaine to Canada in recent years : Imports of opium ami morphine into Canada from all sources, and from the United States, years ended Mar. 31, 1013-1918.^ Description. 1913 1914 1915 1916 1917 1918 Total imports; Crude opium .pounds - . Powdered opium do — Morphine ounces . . From the United States: Crude opium pounds. . 5,117 301 2,035 917 116 5 4,436 287 4, 487 904 157 207 7,284 267 259 1,823 14 59 1,741 170 15, 495 1,351 15, 423 6.59 52, 215 2,413 62 16, 496 12,471 51 27, 520 Morphine. . .*. ounces . . 12, 393 * 9, 838 > Data obtained from “XJnrevised monthly statements of imports for consumption and exports of tlio Dominion of Canada,” compiled by the customs department, Ottawa. • Computed on the basis of the importation of 17,682 ounces at a preferred tariff. This illegitimate traffic has developed to enormous proportions in recent years and is a serious menace at the present time. It is through these channels that the addict of the underworld now secures the bulk of his supplies. OPIUM AND COCAINE CONSUMED. The consumption of narcotic drugs in this country has steadily in- creased from the date of their introduction. This is strildngly brought out by the following table. Average annual consunipHon of opium, hy decades, for the period 1860 to 1015, inclusive. Dectide. Population. Average amount ot opium (9 per cent mor- phine) en- tered for consumption annually. Average amount of opium (smoking) entered for consumption annually. Average amount of opium (both kinds) en- tered for consumption annually. 1860-1869 31.000. 000 33.000. 000 50. 000. 000 63.000. 000 76.000. 000 92. 000. 000 Founds. 110,305 192, 002 328, 392 513, 070 480,009 471,013 Pounds. 24,7ft> 48,701 85,988 92,463 148, 168 Pounds. 135,110 240,704 444,380 605, 533 628, 177 1870-1879 1880-1889 1890-1899 1900 1909 1910-1915 This table shows further that, whereas the population of the XTnited States was two and a half times as great in 1900 as in 1860, the amount of opium entered for consumption annually was approxi- inatelj' five times as great. This is particularh' significant in view’ of the fact that the use of large amounts of synthetic somnifacients, such as chloral hydrate, sulphonal, trional, veronal, etc., during the last 25 years would be expected to have diminished to a great extent the use of opium or its alkaloids for legitimate medical purposes. This would indicate that the use of opium and its alkaloids for other than legitimate medical purposes has constantly increased. Cocaine w'as fu-st introduced into this country about 30 years ago, and at the present time the annual consumption of coca leaves, from which cocaine is obtained, amounts to 1,048,250 pounds. This condi- tion prevails in spite of the fact that there are now’ in use a dozen or more synthetic substitutes which w’ould naturally be expected to diminish the amount of cocaine used in proportion to the extent to Avhich these substitutes are employed. This fact shows that there is undoubtedly a large quantity of cocaine used for illegitimate pur- poses, namely, for the satisfaction of addiction. Imports C)f coca, leaves, .cocaine, egonine, and satis and derirutives into the United States, fiscal years ended June 30. 1011-1016. Description. 1911 1912 1913 1914 1915 1916 Coca leaves pounds. . Cocaine, egonine, salts, and derivatives ounces. . 1,226.771 4,031 l,I79.5fO 2,004 1,175,780 3,715 711,564 3,290 1,048,312 179 947,537 4,275 9 It has been stated that about 90 per cent of the amount of these drugs entered for consumption is used for other than medical pur- poses. While this statement is probably extreme, a comparison of the per capita consumption in this country with that of other coun- tries indicates that this country consumes from thirteen to seventy- two times as much opium per capita as is consumed by other coun- tries, the records of which were available. The following table brings this out more clearly : Per capita consumption of opium hy United States and certain foreign countries. Country. Population.! Total annual consumption. Consump- tion per capita. ■16.000,000 33.000. 000 60.000. 000 5, ,600, 000 40,000,000 6.000,000 Pounds. 3,000-4,000 6.000 17,000 2,000 Grains. 1 2 2^ 3 Franco. 17,000 3,000 470,000 Sh 92,000,000 36 ' The population is that given for 1910. As the average dose of opium is 1 grain, the amount consumed in the United States per annum is sufficient to furnish 36 doses for every man, woman, and child. When it is considered that the greater por- tion of our citizens do not take a single dose of opium year after year, it is manifest that this enormous per capita consumption is the result of its use for the satisfaction of addiction. The amount of cocaine which can be produced from the coca leaves imported annually is approximately 150,000 ounces. This is suffi- cient to furnish every man, woman, and child of the countiy with 2^ doses. It is estimated that only 25 per cent of this is used in legiti- mate medical or dental practice. Therefore, 75 per cent, or 112,500 ounces of cocaine which is manufactured in this country is used for illicit purposes, and this does not include that quantity which is smuggled into this country, of which no estimate can be made. INFORMATION OBTAINED FROM REPLIES TO QUESTIONNAIRES. In order to make a thorough and complete survey of narcotic drug addiction in all its phases, the committee formulated seven question- naires, embodying questions covering the important points on which it appeared desirable to secure information. Each of these question- naires was so arranged that it would bring forth the information which the persons addressed might possess, and at the same time be best adapted for the compilation of the statistics given. The first two were preliminary questionnaires, one addressed to all physicians registered under the Harrison Narcotic Act, requesting 118256°— 19 2 10 data as to the number of addicts under treatment by them at the time, and the other questionnaire was addressed to druggists, requesting a statement showing the number of narcotic prescriptions filled by them and the quantities of certain preparations containing narcotic drugs which were exempt under section 6 from all of tlie provisions of the original act. ADDICTS UNDER TREATIMENT BY PHTSICIANS. Replies were received from ap 2 :)roximately 30| jier cent, of the physicians registered in the different States, and these showed that there were under treatment at that time a total of 73,150 addicts. On the basis of 100 per cent replies, if the same average was maintained, there were under treatment at the time this questionnaire was sent cmt a total of 237,655 addicts. The following table, shows in detail by States the number of addicts reported under treatment, the per- centage of rejilies receiA ed from jihysicians, and the estimated num- ber on the basis of 100 per cent replies. NuDiber of addicts rcitoitcd by fihijsukuts. States. Addicts reported. Per cent of physi- eiatrs replying. Estimat- ed num- ber of ad- dicts for 100 per cent replies. States. Addicts reported. Per cent of physi- cians repiying. E.stimat- cd num- ber of ad- dicts for 100 per cent replies. 739 11, C90 ; Nebraska 339 GSi 536 10 30 33 Nevada 50 275 183 Arizona 353 (') .353 Nen' HatnspUire... 1,363 39-1 3.460 1.250 1,895 New Jersey 2,274 5, 900 912 271 3,338 New Mexico 413 *413 584 GO '974 New York 12, 365 33J 37, 095 974 1.740 North Carolina 2; 211 27| 8! 077 ittti 42 395 Norlh Dakota 153 163 913 District olColumbia 443 42 1 , 05.5 Ohio 4,161 614 6,749 882 25j 3,425 Oklahoma 2,422 4,500 2.2'i2 58^ 3,865 Oregon 369 16j ’7W) 99 (i)' 99 i’ennsylvania 3.791 3G| 10 202 7 4 S75 Rliodc Island 548 S80 lilinois 2. 274 27 1 8,218 South Carolina 73 (‘) 73 1.540 IS! 8.438 South Dakota 175 16} 1,045 1. 158 45-1 2,456 Tennessee 5.366 8,180 1. 477 77i 1,918 Texas 498 21’ 2,371 1.012 42l 3,972 Utah 4,375 Louisiana 1.110 4 17; 020 Vermont 612 34 i!554 427 39 1 1,081 Virginia 2, 566 65} 584 3,931 MaiTland. 1.0G2 42'' 2, 530 AVashington 1,373 2,3-17 Massachusetts 2,272 161- 13,770 i West V&ginia 1.642 7l| 2,286 Micliigan.’. 2, 752 474 5,757 Wisconsin 422 D) 422 1.249 69-:^ 1.802 60 60 100 o.ny fii Missouri 9. SiP.9 14| 26! 958 Total 73,150 305 237,655 Montana 10 2,000 ‘Per cent replying can not be giTcn, as collectors siimmarised lire data and did not fornish tlie num- ber of reports. NARCOTIC PKESGRIPTIONS FILLED BY DRUGGISTS. Answers to the preliminary questionnaire addressed to druggists, of Avhom 52 jier cent rejilied, show that there was a total of 9,511,938 narcotic jU’escri^itionB filled Avithin one year. On the basis of 100 per cent replies, if the same conditions prevailed in the different sections 11 of the country, there was filled during this period a total of 18,299,- 397 pi’escriptions containing narcotic drugs. The following table gives in detail the infoi’mation obtained upon this point by this ques- tionnaire : 2^uml)er of narcotic prescriptions dispensed, as reported hij druggists. States. Narcotic prescrip- tions reported. Per cent of drug- gists re- plying. Esti- mated number of pre- scriptions for 100. per cent replies. Alabama 264,443 47A 540, 124 Alaska 1,427 72J 1,965 Arizona 28, 1S7 (') 28, 187 Arkansas 141, 903 781 180, 708 California 270,334 100 270,334 Colorado 87,234 60| 143, 792 Connecticut 151,857 735- 207, 455 Dclavrare District of Colum- 23,650 44i 53,446 bia 88, 676 441 200,963 Elorida 132,019 621 181,059 Georgia....... 311,226 64i 490, 273 Hawaii 551 (D 551 Idaho 2,794 24 99,785 Illinois 454, 761 274 1, 659, 711 Indiana 188,005 731 256,837 Iowa m,909 724 153,721 Kansas 150, 297 781 191,217 Kentuckv 213,434 661 • 320,151 Louisiana 227,681 871 261, 102 Maine 50,612 23| 213,853 Maryland 281,809 441 643, 636 Massachusetts 401, 180 811 492, 246 Michigan 201, 418 53 .*5 373, 688 Minnesota..... 157, 126 92 170,789 Mississippi 130, 447 47rit 271,593 Missouri 253, 782 674 374,309 States. Narcotic prescrip- tions reported. Per cent of drug- gists re- pl.viug. Esti- mated number of pre- scriptions for 100 per cent replies. Montana 4,612 24 169, 000 Nebraska, .v 88,420 75 117, 893 Nevada 2,997 100 2,997 Ne>,v Hampshire 23, 267 23§ 98,311 New Jersey 389,073 674 565, 584 New Mexico 23,097- (■) 23,007 Ne^v York 1,381,646 50 2,763, 292 North Carolina..... • 313,048 m 462, 632 North Dakota 38, 612 32 120, 662 Ohio 361,886 • 75J 480, 370 Oklahoma 148, 075 56 264,419 Oregon S2, 351 734 109, 470 Pennsylvania 1,012,223 424 2,365,007 Rhode Island 85,019 734 118, 877 South Carolina 138, 533 0) 138, 533 South Dakota 39, 285 32 122, 765 Tennessee 322,583 67| 476, 137 Te.vas 65,429 8 817, 862 Utah.. 433 24 15, 464 Vermont 26,855 23J 113, 472 Virginia 229, 881 37 621,300 Washington 103, 237 72\- 146, 332 West Virginia 130, 881 764 171,813 Wisconsin 169,549 76i 221, 632 Wyoming 6,674 60j 11,001 Total 9,511,938 52 18,299,397 1 Per cent rcpljang can not be given, as collectors summarized the data and did not furnish the num- ber of reports. NARCOTIC PREPARATIONS DISPENSED WHICH ARE EXEIMPT UNDER THE LAW. In addition to the above information, the druggists were requested to furnish a statement of the quantities of the exempt preparations dis- pensed — Bateman’s Drops, Godfrey’s Cordial, paregoric, etc. The replies received showed that a total of 1,294 gallons and 175,858 bot- tles of Bateman’s Drops had been sold by 52 per cent of the druggists who replied. Estimated on the basis of 100 per cent replies, there was a total of 2,508 gallons and 312,934 bottles of this exempt prepara- tion sold by druggists within one year. Th ese druggists also reported the sale of 1,274 gallons and 228,344 bottles of Godfrey’s Cordial. On the basis of 52 per cent replies, this indicates a total of 2,584 gallons and 441,056 bottles of this prep- aration sold within the same period. Sales of paregoric were reported as follows; 77,383 gallons and 10,012 bottles. Basing the estimate of the total upon the 52 per cent of druggists who replied, there was sold a total of 143,328 gallons and 18,435 bottles of paregoric within one year. 12 For detailed statistics of the sales of these various preparations, see the following tables. Bateman’s Drops, Godfrey's Cordial, and pareyoric dispensed, as reported hy druggists. BATEMAN’S DROPS. States. Per cent replying. Alabama Arkansas Delaware District of Columbia. Florida Georgia Illinois Indiana Iowa Kan.sas Kentucky Louisiana Maryland Miofiigan Minnesota Mississippi Missouri Nebraska New Jersey New York'. North Carolina Ohio Oklahoma Pennsylvania South Carolina Tennessee Tc.xas Virginia Wasiiington AVest Virginia AVi-sconsin Total 7sF 44} 44} 62} 64i 27| 73} 72} 66 | 87} 44} 5^*5 92 47t-\ 67} 75 07} 50 67 :} 73j 56 42} (') 675 8 37 72} 52 Reported to Number for 100 per collectors. cent, estimate. Gallons. Bottles. Gallons. Bottles. 27 3 20 17 103 5 7 1 4 5 14 1 1 25,781 876 1,089 391 10, 418 31,254 1,001 1,185 89 791 6,958 39 5,444 10 84 375 1,545 6 57 54,372 4 1,110 45 2,461 883 20 16,749 159 48, 455 17 3,653 9 1,818 122 1 1,065 6 10,437 5 44 31 12,264 29 91 2 790 1 2,278 8 174 7 267 53 218 12 36 303 10 2 10, 591 8,410 587 2,345 10,440 7,440 61 26,719 3 21,902 16 259 14 394 70 509 12 53 819 21 4 15,653 11,164 1,048 5,460 10, 440 10,981 762 72,213 4 28, 755 20 1,294 175,858 2, 508 312,931 GODFREY’S CORDIAL. 47A- (') 78-^ 100 83 11,042 18 175 24,552 18 13,969 130 16 10,966 136 20 GOr 26 42 73} 1 15 1 20 43} 27 543 CO 1,227 2, 290 44} 62} 2 1,016 4 18 6, 839 28 10, 995 27,353 35, 372 17, 460 719 64^V 48 17, 643 9,692 12,785 524 74 27} 26 95 73} 24 32 72t 78J 2 1,654 13,549 5ti3 2 2, 104 20,323 640 20 30 S7l G 44} 8U 53A 47-1^ 62 8,734 181 140 19,737 222 15 10,361 2,465 8,042 21 28 19,222 5, 198 2 ' 4 G7f 7 10 11,861 28 75“ G7.1 (') 50 30 35 45 52 42 42 22 5,578 18,362 20,749 5,587 44 11, 150 27, 138 35,509 9, 977 17,717 G7^ 221 326 751 183 243 5G I’ennsylvania 42} 83 7,583 194 ' Per cent replying can not bo given, as oolleotors summarized the data and did not furnish the number, of reports. 13 Bateman's Drops, Godfrey's Cordial, and paregorie, efc.— Continued. GODFREY’S CORDIAL— Continued. States. Per cent replying. Reported to coliectors. Number for 100 per cent, estimate. Gallons. Bottles. Gallons. Bottles. Tii 0) 32 e7j 8 23j 37 72? 76J- 76i 130 11,781 12 21, 295 730 12 4,491 40 8,308 194 177 11,781 37 31,432 9, 125 51 12, 138 55 10, 909 254 14 14 39 57 309 1 12 1 835 1 16 1 Total 52 1,274 228, 344 2, 486 441,056 PAREGORIC. Alabama Alasica Arizona Arkansas California Colorado Connecticut Delaware District of Columbia. Florida Georgia Hawaii Idaho Illinois Indiana Iona Kansas Kentucky Louisiana.. 4.. ...... Maine Maryland. . .'. Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hamp.shire New Jersey New Mexico New \ ork NorthCarolina North Dakota Ohio Oklahoma Oregon Peiuisylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Total 47A 5,904 1,344 12,451 2,834 72? 1 2 (’) 143 143 784 2,091 92 2, 663 111 lOO 2,048 2,048 60i| 45 74 7.34 1,383 1,889 .364 72 '823 162 457 1, 032 62? 1,586 2,909 2,549 4,677 644 4,108 3,224 6,369 4, 999 (') 40 40 7 2o0 m 2,303 888 8,412 3, 240 73? 2,654 6 3,628 8 72? 411 564 78^- 484 615 66? 1, 746 60 2,619 90 2,390 332 2, 740 381 231 826 3,470 44i 2,814 6,3.59 8U 3,404 4,176 i;o2o 24 1,892 44 92 382 415 47A 905 326 2,013 770 67^ 608 896 94 4 144 75^ 336 448 100 194 194 23| 327 1,381 67i 3,185 4,739 (') 96 96 50 9,038 18, 076 673 3,062 133 4,525 196 32 85 265 75| 3, 929 56 153 273 73^ 342 466 42f 8,637 84 20, 179 190 73^ 586 800 (1) 1, 126 1, 120 32 208 67i 2,741 236 4,046 348 8 52 650 2* 4 144 23I 220 920 3,127 24 8, 451 65 72? 505 10 696 14 76J 895 228 1,175 300 76? 389 508 60§ 18 29 52 77,383 10,012 143, 328 18,435 * Per eent replying can not be given, as collectors summarized the data and did not furnish the number of reports. 14 In ©xplanation of tiie abore figures, it- may be stated that they do not include the sale of other exempt j>i-eparations which were made up by drug-gists and of which no record was kept, nor do they show the sales of the same or similar prei^arations by grocers and other whole- salers and retailers who, in certain States, are permitted to sell these exempt preparations Avithout restriction. In addition to the above-mentioned questionnaires, the committee sent out fi^'e othei-s, as follows: rOniCE STATISTICS ox ABDICTION, Questionnaire No. 1 was addressed to the chief of police of each of the 1,263 cities in the United States Imving a population of 5,000 or more. Keplies were received from 760, of Aidiicli ZSS contained cer- tain infonnation, while 372 reported that they had no available records or data,. This represents replies of approximately GO per cent to the questionnaires, but only about 32 per cent contained any in- formation. Tlie police officials in 31 cities reported an iaca-ease in nareotic drag addiction, ivhile 287 cities reported a decrea^. The inci-eases re- ported were from the larger cities, while the decreases occurred in the smaller cities. Of those reporting an increase, 8 gave as a cause for this condition, prohibition; 8, association with other addicts; 6. because of free use of drags by physicians ; 4 reported increase due to immigration; 2 ascribed the increase to the creation of addicts by vendoi-s because of the large profits; while 1 re-iiorted it due to lax laws. Of those reix)rfcing a decrease in addiction, 80 ascribed tliis to the Harrison iiai-cotic iaAv; 62 stated it was due to the difficultj^ in pro- curing drugs; 26 to the laws in general; 24 gave as a reason State laws; 12 ascribed the decrease to the actnity of police officials; 11 said it was due to the high price of drugs ; 11 on accoimt of prohibition ; 11 because of death of addicts; 9 because of pmsecutions for violations of laws; 9 because of restricted .sales; 9 because of en\igi*atiori of addicts to other pails; 5 to treatment and cure of addicts; 2 to actii’^- ities of the State board of pharmacy; 1 because of refusal of physi- cian to prescribe drugs, and 1 because of the selective draft. The causes for drug addiction in the order of their frequenc}'’ were gii'en as follows; Use of physicians’ prescriptions, association Avith other addicts, prohibition, use of narcotic drugs for chronic diseases, curiosity to learn the effects of the drug, prostitution, use of patent or proprietary medicines, use of certain narcotic drugs as a stimulant, idleness, and use by dentists. With respect to the order of frequency in which the different drugs were used they reported as folloAA's; Morphine, cocaijie, heroin, opium, laudanum and jiaregoric, and codeine. 15 These officials also reported the arrest of 5,534 persons addicted to the use of drugs in 1916; 5,628 in 1917; and 5,443 in 1918. The population of the cities represented by these officials was 26,514,361, or approximately 25 per cent) of the total population of the country. If the same record of arrests prevailed throughout the smaller cities and rural districts, the number of addicts arrested, based on the population of the entire countiy, Avould be 21,772 for 1918. The offenses for which arrests of addicts were made are given in their order of frequency as follows; Larceny, burglary, robbery other than larceny, vagrancjq prostitution, disorderly conduct, assault and battery, drunkenness, murder, and forgery. In further explanation of these arrests it is stated by 46 officials that morphine was used by persons committing violent crimes; 46 stated that cocaine was used by persons committing violent crimes; 18 reported heroin, and 4 re- ported opium as the drug used by such persons. With respect to the lesser crimes, 62 officials reported morphine as the drug used by such persons, 23 reported cocaine, 14 opium, 13 heroin, 18 paregoric, 2 laudanum, 1 codeine, and 1 yen shee. These police officials also reported 1,800 drug peddlers doing busi- ness in the United States at the present time. A number of these officials stated that they knew it to be a fact that peddlers secured their siipi^lies by smuggling from Canada and Mexico. Others stated that smuggling from other countries, stealing, and through pi-e- scriptions written by unscrupulous physicians constituted the chief means of securing these drugs. The occupations of the peddlers were given as follows: Gamblers, taxicab drivers, domestics, solicitors, messengers, vagrants, lunch room helpers, pool room employees, porters, laundrymen, etc. STATISTICS FROM PEXAL INSTITUTIONS. Questionnaire No. 2 was sent to a total of 3,271 wardens of State, county and municipal prisons and reformatories, to which 762 re- plied. Of these replies 126 contained certain information, and 636 were returned with the statement that no records had been kept and, therefore, no information was available. The total number of re- plies received represents 23 per cent of the questionnaires sent out, but the number containing information represents only 3.9 per cent of the total sent out. The census report of 1910 shows the number of inmates of penal or reformatory institutions on January 1 of that year and during the year 1910 to have been 630,406. Figures showing the total number of inmates confined in such institutions during the years 1916, 1917, • and 1918 Avere not available, but the replies to the questionnaire shoiv that there were 1,376 addicts in 1916, 2,176 in 1917, and 1,861 con- fined in such prisons during 1918. These figures would apparently 16 indicate thpl; only a small percentage of persons incarcerated in penal institutions are addicted to dinigs, but this is an assumption which is partly negatived by the fact that only a very small percentage of such institutions kept an}’" records relative to drug addiction. The following table gives information relative to the drugs used by addicts who were inmates of these institutions. Classification of addicts in above institutions according to drug of addiction. Drug. 1916 1917 1918 Total. Drug. 1916 1917 1918 Total. Gum opium Smoking opium Morphine Heroin Codeine Laudanum 5 76 431 588 4 6 53 101 648 829 7 2 29 83 626 508 4 8 87 260 1,705 1,925 15 16 Paregoric Cocaine Cannabis or hashish . Total 3 100 10 5 144 19 12 133 20 20 377 49 1,223 1,808 1,423 4,454 The officials of these institutions reported the predisposing causes of addiction as follows : Low mentality in 198 cases, nervous diseases in 55 cases, chronic or painful illness in 49 cases, and other predispos- ing causes in 125 cases. The manner in which the habit Avas acquired was reported to be as follows: Through direct administration by physicians in 64 cases, through physicians’ prescriptions in 240 cases, through self-medica- tion or the use of proprietary remedies in 18 cases, through association Avith other addicts in 974 cases, through other ways, including the white-slaA'e traffic in 42 cases, and through surgical operations in 23 cases. The order of frequency of addiction according to nativity was giv'en as follows: American, Italian, Irish, English, Eussian, JeAvish. French, Negroes or Chinese, Mexican or Austrian, German or Ca- nadian. The reports of these officials also shoAv that there Avas no connection betv'een occupation and addiction, although they reported that the occupations of addicts in the order of their frequency are: Waiters, waitresses, chemists, paper hangers, laundrymen, laundresses, paint- ers, cooles, mechanics, chauffeurs, tailoi’s, salesmen, laborers, prosti- tutes, and vagrants. STATISTICS OBTAINED FKOJI ALMSHOUSES. Questionnaire No. 3 Avas sent to 2,464 superintendents of State, county, and municipal almshouses; 584 to superintendents of State hospitals; 471 to superintendents of insane asylums; 1,582 to county and municipal hospitals, making a total of 5,101 institutions. Only 1,520 replies Avere received, or approximately 30 per cent, of the total • number mailed. Of these, only 330 contained information, or, in other Avoids, only about 6 per cent of the institutions gave any information 17 of value to the committee. These replies showed that 1,774 addicts had been treated in these institutions during 1916, 1,535 during 1917, and 1,449 during 1918. With respect to the drug of addiction. 111 were reported as using gum opium, 157 smoking opium, 3,072 morphine, 900 heroin, 30 co- deine, 75 laudanum, 123 paregoric, and 24 cocaine. As predisposing causes for addiction, low mentality or arrested de- velopment was mentioned in 924 cases, nervoits diseases in 266 cases, chronic or painful illness in 590 cases, surgical operations in 160 cases, and unclassified causes in 595 cases. In respect to the request for information relating to the manner in which addiction was acquired, direct administration by ph3''sicians was reported in 280 cases, through physicians’ prescriptions in 364 cases, through self-medication and the use of patent or proprietary remedies in 206 cases, through association with other addicts in 1,275 cases, and through other ways in 355 cases. The relative frequency of addiction in the above cases with respect to nationality was given as follows; American, Canadian, Irish, English, German, Scotch, Russian, French, Italian, Chinese, Mexi- can, Armenian, Swiss, and Swedish. The occupations of addicts in order of their frequency wei’e given as follows: Housekeepers, laborers, clerks, physicians, salesmen, nurses, pharmacists, actors, prostitutes, waiters, cooks, sailors and soldiers, horsemen, barbers, butchers, bartenders, draftsmen, teachers, and unemployed. The institutions wliich replied to the question relating to diseases from which the addicts were suffering, reported that 40 were suffer- ing from rheumatism, 45 from cancer, 62 from asthma, 159 from heart disease and nervous troubles, 106 from tuberculosis, 148 from venereal diseases, 71 from chronic diseases unclassified, and 56 from insanity. Of the total number of institutions replying, 79 stated that they gave special treatment for narcotic drug addiction. The average length of time of treatment of an addict is reported as being 2 years lOJ months. The average daily cost per capita for treatment and maintenance was stated to be $1.29. HEALTH OFFICEIJS’ REPORTS. Questionnaire No. 4 was addressed to 3,023 State, district, county, and municipal health officers. To this questionnaire, 983 replies were received, or 33 per cent of the total number sent out. Only 777 of these, or 26 per cent of the total, contained any information of value to the committee. Most of these officials replied to the effect that 18 they kept no records of the number of drug addicts, nor had they any means of securing such information. The number of addicts reported by the officials replying was given as 5,271 in 1916, 3,542 in 1917, and 2,877 in 1918. The officials in 14 cities and counties reported an increase in drug addiction. The cause of the increase \Yas given as immigration in 4 reports, prohibition in 3 reports, lax laws in 2 reports, and war conditions in 1. Officials in 627 cities and counties reported a de- crease in number of addicts during this same period. The cause for decrease was given as the Harrison narcotic law in 317 reports, ina- bility to obtain drugs in 145 reports, laws in general in 46 reports. State and Federal laws in 36 reports, deaths in 23 reports, treatment and cures in 21 reports, cooperation of physicians in 20 reports, emigration in 12 reports, prohibition in 8 reports, high cost of drugs in 7 reports, efforts to prohibit sales in 6 reports, cooperation of authorities in 5 reports, employment in war work in 3 reports, prose- cution in 3 reports, and environment in 2 reports. The predisposing causes of drug addiction in order of their fre- quency as stated in these reports are chronic diseases, prostitution, mental troubles, nervousness, and neurasthenia. The ways in which the habit was acquired, stated in the order of their frequency, are as follows: Through physicians’ prescriptions, use of drugs for chronic diseases, prohibition, association, use of patent medicines, prostitution, as a means of producing stimulation, and through curiosity. In reply to the question relative to the nature of drug addiction, 425 health officials stated that the physicians in their communities regarded it as a disease, while 542 reported that they regarded it as a vice. With respect to the treatment of drug addiction, 88 health officials reported that physicians in their community followed special pro- cedures in the treatment of addicts, while 351 reported that the phy- sicians followed the procedure commonly known as the reduction treatment. These health officials also stated that 192 cities and coun- ties over which they had jurisdiction make provision for the treatment of addicts in almshouses and penal institutions. PRIVATE HOSPITALS AND SANATORIA. Questionnaire No. 5 was sent to 4,568 superintendents of private hospitals and sanatoria. Eeplies equal to 36 per cent of the total sent out were received. Only 227 of these questionnaii’es, however, con- tained any information of value to the committee. Most of them re- plied that no records were kept, or that the records of the institution were not arranged in such manner as would give the information desired. 19 The replies received showed that 506 addicts were being treated in these institutions during the year 1910, 551 during 1917, and 624 in 1918. Of the total number of patients treated by these institutions for the three-year period, 27 used giun opium, 21 smoking opium, 1,05_6 morphine, 297 heroin, 28 codeine, 17 laudanum, 55 paregoric, aird 28 cocaine. As predisposing causes for drug addiction, low mentality or ar- rested development was given in 102 cases, nervous diseases in 195 cases, chronic or painful illness in 180 cases, surgical operations in 154 cases, and other predisposing causes in 200 cases. With respect to the manner in which addiction had beeii acquired, direct administration by physicians was given in 133 cases, the use of physicians’ prescriptions in 93 cases, self-medication in 117 cases, asso- ciation with other addicts in 205 cases, and in other v/ays, including the white-slave traffic, in 270 cases. The nationality of addicts, where such information was given, is reported as American in 94 instances, German in 10, Irish in 8, Eng- lish and Scotch in 6, Jewish in 5, French in 4, Austrian in 3, Kussian and Grecian in 3, and Mexican in 2. The occupations of addicts in the order of their frequency are re- ported as follows : Housewives, laborers, physicians, salesmen, actors and actresses, unemployment, business men, nurses, farmers, office workers, professional men and women, prostitutes, pharmacists, “dope” peddlers, mechanics, merchants, gamblers, newspapermen, and printers. The diseases of addicts other than that of addiction are reported as venereal in 109 cases, tuberculosis in 1-1 cases, nervous troubles in 198 cases, insanity in 66 cases, lung diseases other than tubei'culosis in 39 cases, abscess and cancer in 84 cases, stomach troubles in 5 cases, and heart disease in 7 cases. These private institutions reported that the, average length of time of treatment of opium addicts was 61 weeks, morphine addicts 7 weeks, and cocaine addicts 6 weeks. The average cost per cajaita for treatment and maintenance is given as $5.21 per day. Of the total number of addicts treated in these institutions, 74 per cent are stated to have been benefited to some degree, and 61 per cent are said to ha’^ e been permanently cured of their addiction. SU3IMAKr. Tra-fjic in ncircotic drugs . — Statistics compiled by the Department of Commerce show that the quantities of narcotic drugs imported into this country steadily increased from the date when the first entries wer« reported until our chief sources of supply Avere shut off as a result of the present war. In 1915 the quantities of these drugs con- sumed in this country amounted to approximately 490,000 pounds of opium and more than 1,000,000 pounds of coca leaA^es. These quan- 20 titles of opium and coca leaves, in their crude state and in the form of manufactured products, were supplied to the public through a total of 233,491 individuals and institutions registered under the Harrison Narcotic Act. The minimum value of these drugs com- puted on the basis of retail price of the crude material Avould be some- thing over $20,000,000. The actual cost to the consumer, Avhile it greatljT^ exceeds this amount, can not be estimated at the present time. When we take into consideration the fact that various investigators have stated that only from 10 to 25 per cent of the quantities of these drugs imported is actually needed to supply the demand for legiti- mate medical purposes, we can arrive at some idea of the quantities of these di’ugs consumed by addicts and the amount of money ex- pended for the satisfaction of their addiction. The foregoing represents only the extent of this traffic as carried on through legitimate channels. In recent years, especially since the enactment of the Harrison law, the traffic by “ underground ” chan- nels has increased enormously, and at the present time it is believed to be equally as extensive as that carried on in a legitimate manner. This traffic is chiefly in the hands of so-called “ dope peddlers,” who obtain their supplies by smuggling from Canada, Mexico, and along the Atlantic and Pacific coasts. Extent of drug addiction . — The number of individuals addicted to the use of opium, its preparations or alkaloids, and coca leaves, their pi'eparations and alkaloids, in the United States has, at varioiis times, been estimated to be from 200,000 to 4,000,000. These estimates must, however, be looked ujDon as mere guesses in most cases because of the fact that there have been no means available for reaching an accurate estimate in the past. The following table shows the num- ber of addicts in the United States, or parts thereof, as estimated by a number of different investigators who have made a more or less extensive study of the situation. I^uiiihcr of addicts, as estimated iij various observers. Observer. Year. Number of addicts. United States or parts thereof. Per cent of popu- lation. Kinds of addicts. 1912 1,000,000 887 United States 1.0 50 per cent morphine. All drugs. C. E. Terrv 1913 Jacksonville, Fla . . 1.31 1915 269,000 5,000 United States .27 Do. Do 1915 Tennessee • 22 Do. M 7 AVilhprt 1915 175; 000 80,000 4,000,000 United States .175 Opium. Cocaine. Do 1915 do .08 1915 4.0 Opium-cocaine. Opium. All drugs. 1910 100, 000 do .1 J. R. Campbell Massachusetts committee on 1916 1 15 ; 000 New York State. . .16 habit forming drugs. 1917 60,000 Massachusetts 1.6 Do. George H. Whitney. 1917 100,000 New York State. . . 1.0 Do. Earnest F. Bishop 1918 200,000 do 2.0 Do. Do 1918 100,000 New York City. . . 1.8 Do. L. S. Hinckley 1918 2,000,000 United States 2.0 Do. > Children. 21 Owing- to the lack of laws and regulations making it compulsory for the registration of addicts throughout the country or the keep- ing of any records as to their identity, it has been impossible for the committee to obtain information which woidd give the exact numbeu of addicts in the United States at the present time. It is believed, however, that a fairly accurate estimate of their number can be made from the information which the committee has obtained. At- tempts to accomplish this have been made as follows : The number of addicts reported by the health officials replying to questionnaire No. 4 was 105,887. As this number represents the addicts reported by only 26 per cent of the health officials from which this information was requested, it may be assumed that had all the health officials replied the total number would have amounted to approximately 420,000. This number, however, appears to be much too low, in view of the fact that the ph)^sicians of the country are estimated to have had about 237,000 addicts under treatment during this same period, and only a small portion of the total num- ber of addicts present themselves for treatment. Addicts of the “underworld,” for instance, secure most of their supply through illicit channels and rarely, if ever, consult a physician. It appears that a more accurate estimate of the total number of addicts may be obtained from the data secured by those investigators who have made an intensive study of drug addiction in certain re- stricted communities. For example, the health officer of Jaclcson- ville, Fla., reported 887 addicts in that city in 1913. This number represents 1.31 per cent of the population. Upon this basis the total nimiber of addicts in the United States, in 1918, taking the estimated population as 106,000,000, would be 1,388,600. In reply to questionnaire No. 4 sent to health officers of States, counties, and municipalities, the health officer of New York City reported a total of 103,000 addicts, which is equivalent to 1.8 per cent of the population. On this basis, there would be 1,908,000 addicts in the United States. Information in the hands of the committee indicates that drug addiction is less prevalent in rural communities than in cities or in congested centers. It would, therefore, be unfair to estimate the number of addicts in the entire country on the basis of the figures obtained for New York City. Furthermore, it is the opinion of the committee that an estimate based on the number of addicts in a small city like Jacksonville, Fla., would not be representative for the entire country. Taking these facts into consideration, the com- mittee is of the opinion that the total number of addicts in this country probably exceeds 1,000,000 at the present time. ..With respect to the increase or decrease in the number of addicts within the last year, the following statements can be made: In re- 22 sponse to the question Has narcotic dru^ addiction increased or de- creased in the past few years? which inquii’y was directed to 3,023 health officers and 1,263 chiefs of police, 962 expressed an opinion. Forty-eight stated that there had been an increase and 914 reported a decrease. Taking into consideration the population of the cities or counties reported by the officials giving these opinions, it is found that in practically every instance the increase reported was from the largest cities, and in particular in those cities where more than the usual attention is being directed to the eradication of drug addiction. Thus each of the 20 following cities, having an aggregate population of approximately 10,000,000 people, have reported an increase: San Francisco, Calif.; Wilmington, Del.; Macon, Ga. ; Louisville, Ky. ; Bi’ockton, Mass. ; Detroit, Mich. ; Kansas City, Mo. ; Elmira, N. Y. ; New York City, N. Y. ; Utica, N. Y. ; Yonkers, N. Y. ; Charlotte, N. C. ; Muskogee, Okla. ; Oklahoma, Okla. ; Toledo, Ohio ; Portland, Oreg. ; Harrisburg, Pa. ; Chattanooga, Tenn. ; Knoxville, Tenn. ; and Nashville, Tenn. Keplies in which a decrease in the number of addicts were re- ported were received chiefly from rural districts or smaller cities Avhere little or no attention has been given this subject, so that it is quite possible that the opinions expressed by the officials resident in these places are at variance with the conditions as they actually exists What effect, if any, nation-wide prohibition muII have on the situa- tion could not be definitely determined by the committee. The con- sensus of opinion of those interested in the subject appears to be to the effect that the number of addicts will increase as soon as the pro- hibition laws are, enforced. These opinions are based, for the most part, on the theory that drinkers will seek a substitute for alcohol and that the opiates and cocaine will be found to be most satisfactory for this purpose. This opinion apparently receives some support from investigations made in some of the Southern States, where pro- hibition has been in effect for some years. It has been noted that in these States the sales of narcotic drugs and cocaine, and especially the sale of preparations exempt under section 6 of the Harrison Act, such as Bateman’s Drops, Godfrey’s Cordial, and paregoric, have greatly increased during this period. Whether or not this condition will become general when national prohibition becomes effective is a question which can not be answered at the present time. Etiology of addiction . — The investigations of the committee have led to the conclusion that addiction to the use of these habit- forming drugs is not restricted to any particular race, nationality, or class of people. Anjmne repeatedly taking a narcotic drug over a period of 30 days, in the case of a very susceptible individual for 10 days, is in grave danger of becoming an addict. And, when addiction has been established, it is impossible for the individual to discontinue the 23 use of the drug without outside assistance. These statements are supported by the opinion of medical men who were consulted on the matter and by reports which have appeared in medical journals. The more important findings of the committee w^hich have a bearing on the subject of the etiology of drug addiction are as follows ; Data assembled b}'^ the committee show that the habit of using opiates or cocaine is acquired through association with addicts, through the physician, and through self-medication with these drugs, or patent or proprietary preparations containing the same. The first two ways in which addiction is acquired are of about equal importance at the present time, the last being of lesser importance in the light of the replies received to the questionnaires sent out. With respect to this phase of the subject, the committee finds that addicts may be divided into two classes, namely, the class composed principally of addicts of the tindemmrld and the class which is made up almost entirely of addicts in good social standing. The addict of the underworld, in a large majority of cases, ac- quii-es the habit of using these drugs through his or her associates. This is pi’obably due to the fact that addicts of this class make u.se of heroin and cocaine most frequently, these drugs being employed as a snuff. It is therefore an easy matter to treat a companion to a sniff of the “ dope.” In addition, these drugs are made use of by “ white slavers ” in securing and holding their prey, and by prostitutes in entertaining their callers. "With respect to the addict of good social standing, the e^ddeuce obtained by tiie committee points to the physician as the agent through whom the habit is acquired in the majority of cases. Some, however, become addicted to the use of the.s8 dnxgs through self- medication, while a few first indulge as a social diversion. The drugs used by addicts in order of their frequency, as shown in the replies to ail forms of questionnaires sent out by the committee, are as follows: Morphine, heroin, opium (all forms) and cocaine. Codeine, laudanuni, and paregoric are reported as being used in about equal amounts, but to a lesser extent. In recent years the use of heroin has greatly increased, and in some communities it is at present used more extensively than any of the other drugs. This is believed to be due to the ease v/ith which it can be taken, it being usually emplo}'^ed as a snuff, and to the fact that the habit is acquired by association in a large, majority of cases. It is at present legarded by manj'^ as the most dangerous of these drugs from the standpoint of habit forma- tion and the creation of new addicts. - The committee has obtained no information to show that there is any relationship between the age of indi^'iduals and susceptibility to addiction. The range of ages of addicts was reported as 12 to 75 years. The large majority of addicts of all ages was reported as 24 using morphine or opium or its preparations. Many of the older ad- dicts were reported to have acquired the habit when still in their teens. Most of the heroin addicts are comparatively young, a large portion of them being boys and girls under the age of 20. This is also true of cocaine addicts, many of them, according to reports, being mere children. The statistics compiled by the committee show that the greater part of the addicts in this country are American born. It is a rare occurence to find an addict among the immigrants on their arrival in this country, although some of them become addicted to the use of these drugs after taking up their abode in this country. Of course this statement does not apply to the Chinese and certain other nationalities of the Oi’ient. In the replies received to questionnaires sent out by the committee, practically every nationality was reported. These replies, however, did not show any relationship between na- tionality and extent of addiction among the foreign born. Contrary to general opinion the committee finds that drug addic- tion is not more prevalent among females than males. Eeports obtained from some i^arts of the country show that the females out- numbered the males, while in other sections, officials rej)orted a pre- ponderance of males. Taking all factors into consideration, it appears that ding addiction is about equally prevalent in both sexes. The information collected by the committee does not show any direct relationship between any specific occupation and drug addic- tion. Addicts are found engaged in all lines of work. It has been stated that the percentages of addicts is greatest among peoiole engaged in the practice of medicine or closely related occupations, such as the practice of pharmacy, dentistry, and nursing. The com- mittee was, however, unable to confirm this report. From the sta- tistics collected it appears, however, that a large portion of the addicts are not engaged in occupations which call for hard labor, and that many are not employed at all or work intermittently. This is especially true of cocaine and heroin habitues. E-jfect of addiction on health . — The committee is forced to conclude from its investigations that the habit-forming drugs herein men- tioned produce a marked phj^^sical and mental deterioration in indi- viduals addicted to their use. The constant use of narcotics, such as opium, its preparations and alkaloids produces a condition in the human body which is beginning to be looked upon by physicians as a disease. This diseased condition requires the repeated administration of the drug of addiction to keep the body functioning normally or the institution of medical treat- ment. The mere withdrawal of the drug induces such fundamental disorganization and such painful disturbances that addicts are driven to any extreme to procure more of the drug with which to allay their 25 suffering. For years, individuals addicted to the use of opiates may apj)ear quite normal to the ordinary observer, but close attention will usually reveal signs of diseased conditions as evidenced by variability of moods, waxy complexion, emaciation, diseased condition of the I'espiratory organs, heart, and kidneys. Continued addiction brings about sexual sterility and thus reduces the birthrate among this class. If impregnation occurs during a period of abstinence from the dnig, and the mother later begins using the drug again, the child when born becomes addicted through the mother's milk. The effect of cocaine is somewhat different. While it causes a more rapid physical and mental deterioration than the opiates, the changes produced are not as profound, and the drug may be completely with- drawn without danger of serious results following. In addition to the systemic effects of the use of cocaine, individuals addicted to this drug often show a perforation of the nasal septum as a result of the local action of the ding when it is used as a snuff'. This condition has also been observed in heroin addicts, this drug being usually taken in the same manner. The committee also finds that insanity is not in- frequently a result of the use of cocaine in the case of addicts. In cases where any of these drugs are taken hypodermically, there is freqently noticed abscesses, scarring, and disfiguration of those parts of the body in which the needle was inserted. In general the physical deterioration which results from the continued use of any of these drugs brings about a diminution in the power of resistance so that the addict falls an easy prey to some other ailment, and thus very seldom reaches old age. Effeet of addiction mx morale . — From information in the hands of the committee, it is concluded that, while drug addicts may appear to be normal to the casual observer, they are usually indi\dduals weak in character and will, and laclring in moral sen.se. The opium or morphine addict is not always a hopeless liar, a moral wreck, or a creature sunk in vice and lost to all sense of decency and honor, but may often be an upright individual except under circum- stances jvhich involve his affliction, or the procuring of the drug of addiction. He will usually lie as to the dose nece,9sary to sustain a moderately comfortable existence, and he will stoop to any subterfuge and even to theft to achieve relief from the bodily agonies ex- perienced as a result of the withdrawal of the drug. There are many instances of cases where victims of this disease v^ere among the people of the highest qualities morally and intellectuallj', and of the greatest value to their coinmnunities, who, when driven by sudden deprivation of their drug, have been led to commit felony or violence to relieve their misery. Addiction to the use of cocaine produces a much more rapid de- terioration of mental powers and moral sense. It is this class of 26 addicts that most frequently commit moral wrongs and crimes of violence. Among the addicts of the underworld, practically all show a low mentality, a lack of decency and honor. This condition, lioweA^er, is not entirely due to the effect of these drugs as might be inferred, but is largely the result of degeneracy due to environment and association. Relation of drug addiction to crime. — The committee finds that the drug habit has some bearing on the question of crime. Eeports from officials of prisons and reformatories show that a number of the in- mates are drug addicts. In 1916, the addicts in the city prison (Tombs) at Manhattan constituted 5 per cent of the total number of prisoners. There is, howeA'er, a great A'ariety of evidence on this subject which has not yet been made clear. The users of opium and morphine are seldom seen in the courts for brutal crimes. The offenses committed by them in the order of their frequenc}^ as indicated by replies to questionnaires sent out by the committee are larceny, burglary, A’agrancy, forgery, assault, and violation of the drug laws. They are frequently aiders or abettors of crimes, but less commonly the leading actors in criminal conduct. In cases where addicts haA^e committed violent crimes, it is re^^orted that they Avere users of cocaine or heroin. These are also the drugs , which are most frequently used b}^ prostitutes and those engaged in ' the “ AA'hite-slaA'e traffic.” These drugs appear, therefore, to be the ■ most obnoxious. Economic aspect of drug addiction.— VilrAo, the committee has been unable to secure sufficient data to enable it to formulate a statement which will convey exact knoAvledge of the economic phase of drug addiction, it is belieA^ed some idea of the economic loss to the country sustained through addiction maj" be gained from the cost of the drugs used by addicts and the loss through unemployment of those addicted. It has been computed by the State food and dnig commissioner of one of the States having stringent regulatory laAvs that the aA’erage annual ex])enditure for an addict to satisfy his addiction amounts to $61.18. Upon this basis of cost of drugs alone, the addicts of this country annually pay oA'er $61,000,000 for the satisfaction of addiction. The figures obtained by the committee vary as to the aA^erage per- centage of addicts regularly employed, employed part of the time, and not employed at all. But it is concluded from a careful analysis of these figures, as Avell as those obtained by other investigators who haA’e made a study of this problem, that at least 25 per cent of the addicts are not steadily employed in gainful occupations. This Avould represent at least 250,000 unemployed addicts in the United States. At a conservative estimate this Avould represent the loss in Avages of $150,000,000 annually. These figures, hoAvevei*, do not in- 27 dude the cost of drug addiction to individuals as a result of loss through theft and burglary, nor the cost to the States and municipali- ties in the suppression and punishment of crime, and the care and treatment of those Avho eventually become a charge upon the com- munity. CONCLTJSrONS AND RECOIMMENDATIOXS. From the data obtained the committee is convinced that there is a nation-wide use of narcotic drugs for other than legitimate medical needs, and that such use for the satisfaction of addiction has mate- rially increased in certain sections of the country despite the vigorous efforts exerted in the past four ye^irs in the enforcement of the Fed- eral antinarcotic law, and in the enforcement of the laws of the States and municipalities which have enacted such for the control of habit- forming drugs. Furthermore, it is apparent from the replies to questionnaires sent out that there has been no definite or concerted action on the part of the majority of the State and municipal govern- ments to suppress the illicit traffic and use of habit-forming drugs, and that there has been but little, if any, attempt made to secure accurate information concerning the problem of drug addiction as a basis for the enactment of proper legislation and i-egulation. The replies to the questionnaires sent out to State, county, and municipal officials show that a great majority of these officials kept no records and therefore had no information upon the subject. This condition is believed to be due principally to a lack of knowledge of the serious- ness of the situation. In many cases it is no doubt partly due to the more or less general acceptance of the old theory that drug addiction is a vice, or depraved taste, and not a disease, as held by modern inves- tigators. This attitude has had the effect of holding these unfortu- nate creatures up to public scorn, and thereby lessening any interest in their welfare. Eecords having a bearing on any and all phases of drug addiction are of sufficient importance to Avarrant immediate action for the purpose of remedying these conditions. Inasmuch as the Harrison antinarcotic law has recently been amended by Congress in accordance Avith the suggestions made by the committee in its preliminary report, it is believed that the present Federal statute confers the necessary power for the effective control of the manufacture, sale, distribution, and administration of narcotic di'ugs, and it is the opinion of the committee that no further national legislation is necessary for this purpose at this time. It is, hoAvever, the opinion of the com.mittee that there yet remain several phases of the narcotic problem Avhich merit the consideration of the Con- gress. One of the more important of these is the question of the responsi- bility for the care and treatment of addicts Avho, by reason of the 28 amended statute, ■will find it difficult, if not impossible, to obtain the supplies of drugs necessary to maintain their normal condition due to habituation. The enactment of legislation on the part of the National Government covering this phase of the problem, likewise the passage of similar measures by the States and municipalities, is deemed urgently necessary. There also remains the international aspect of the opium traffic which should receive immediate consideration. If this and the other countries represented at the international opium convention are to effectually control the traffic in opium and other habit-forming drugs, some concerted action is necessary. It is, therefore, recom- mended that this country, through the State Department, take up this matter with the other powers which were signatory to the inter- national agreement entered into at The Hague in 1912 with a view to persuading such GoA’ernments to enact the necessary legislation to carry out the terms of The Hague protocol. Otheinvise, the task of this country of suppresing the illicit traffic in habit- forming drugs will be rendered much more difficult. Pending the ratification of The Hague opium com^ention by the various powers and the enactment of necessary legislation to carry out the terms thereof, it is urgently I’ecommended that the United States Government take up with the Governments of the Dominion of Canada and Mexico the subject of more effective control of the manufacture and exportation of narcotic drugs therefrom for the purpose of securing their cooperation with this Government in the suppression of the smuggling of such drugs from one country into the other, which now affords the principal source of supply for the illicit traffic in these drugs. It is also recommended that educational campaigns be instituted in all parts of the United States for the purpose of informing the people of this country, including the medical profession, of the seri- ousness of drug addiction and its extent in the United States, and thereby secure their aid and cooperation in its suppression. It is also recommended that both public and private medical or- ganizations which have research facilities be requested to undertake studies to determine the nature of drug addiction with the view of improving the present forms of treatment or evolving some new and more efficient method of handling these patients. The latter state- ment is made in view of the fact that at the present time there are numerous forms of treatment for drug addiction, none of which appear to have been given a thorough trial b 5 '^ the medical profession, as a whole, or to have receiA’^ed the unqualified support of those members of the profession who have had no financial interest in the matter. 29 It is the opinion of the committee, based on the results of its inves- tigations, that the medical need for heroin, a derivative of morphine, is negligible compared with the evil effects of the use of this alkaloid, and that it can easily be replaced by one of the other alkaloids of opium with the same therapeutic results, and witli less danger of creating habituation. Therefore, consideration .sliould be given the subject of absolutely prohibiting the manufactm'e, sale, distribution, or administration of this most dangerous drug by the States and municipalities. Eespectfully, •Hekry T. Rainev, Meraoer. of Congress^ Chainnan, Reid Hunt, Professor of Phannacologg^ II iw card University. B. C. Keith, Deputy Commissioner of Internal Revenue. A. G. Du Mez, United States Public Ueulth Service., Secretary. B. R. Rhees, M. D., Clerk to C ommittee. o