PROHIBITING THE IMPORTATION OF OPIUM FOR THE MANUFACTURE OF HEROIN fd vv1 U , S . ZH; HEARINGS i . . V-- ^ BEFOBB THE COMMITTEE ON WAYS AND MEANS HOUSE OF EEPRESENTATIVJS H. R. 7079 A BILL PEOHIBITING THE IMPORTATION OF CRUDE OPIUM FOR THE PURPOSE OF MANUFACTURING HEROIN APRIL 3, 1924 96182 WASHINGTON GOVERNMENT PRINTING OFFICE 1924 COMMITTEE ON WAYS AND MEANS House of Representatives SIXTY-EIGHTH CONGRESS, FIRST SESSION WILLIAM R. GREEN, Iowa, Chairman WILLIS C. HAWLEY, Oregon. ALLEN T. TREADWAY, Massachusetts. GEORGE M. YOUNG, North Dakota. JAMES A. FREAR, Wisconsin. JOHN Q. TILSON, Connecticut. ISAAC BACHARACH, New Jersey. LINDLEY H. HADLEY, Washington. CHARLES B. TIMBERLAKE, Colorado. HENRY W. WATSON, Pennsylvania. OGDEN L. MILLS, New York. JAMES C. McLaughlin, Michigan. CHARLES C. KEARNS, Ohio. CARL R. CHINDBLOM, Illinois. FRANK CROWTHER, New York. JOHN N. GARNER, Texas. JAMES W. COLLIER, Mississippi. WILLIAM A. OLDFIELD, Arkansas. CHARLES R. CRISP, Georgia. JOHN F. CAREW, New York. WHITMELL P. MARTIN, Louisiana. PETER F. TAGUE, Massachusetts. HENRY T. RAINEY, lUinois. CORDELL HULL, Tennessee. CLEMENT C. DICKINSON, Missouri. JOHN J. CASEY, Pennsylvania. CiATTON F. Moore, Clerk CONTENTS Statements of — Blue, Dr. Rupert, United States Public Health Service 28, 30 Brewster, Sidney W., assistant superintendent and deputy warden, Reformatory Prison, Harts Island, New York City 45 Porter, Hon. Stepherr G., a Representative in Congress from the State of Pennsylvania 1 Richardson, Dr. Charles W., Washington, D. C 10 Squires, Dr. Amos O., chief physician, Sing Sing Prison, Ossining, N. Y 19 nr Digitized by the Internet Archive in 2017 with funding from Columbia University Libraries https://archive.org/details/prohibitingopiumOOunit PBOHIBITINGf THE IMPOETATIOH OP OPIUM FOE THE MANUFACTUEE OF HEEOIN Committee on Ways and Means, House of Representatives, Thursday, April 3, 1924. The committee met at 10 o’clock a. m., Hon. Willis C. Hawley presiding. Mr. Hawley. You may proceed, if you are ready, Mr. Porter. I might state, this is a hearing on H. R. 7079, introduced by Mr. Porter, proposing amendments to the act of January 14, 1914, and amendments thereto, prohibiting the importation of crude opium for the purpose of manufacturing heroin. Mr. Porter, we will be glad to hear what you have to present. (The bill referred to is as follows :) [H. R. 7079, Sixty-eighth Congress, first session] A BILL Prohibiting the importation of crude opium for the purpose of manufacturing heroin Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That subsection (b) of section 2 of the act of February 9, 1909, as amended by the acts of January 14, 1914, and May 26, 1922, entitled “The narcotic drugs import and export act,” be further amended by the addition of the following sentence: “Provided, That no crude opium may be imported for the purpose of manu- facturing heroin.” STATEMENT OF HON. STEPHEN G. PORTER, A REPRESENTA- TIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA Mr. Porter. Mr. Chairman and gentlemen of the committee, I shall content myself with a very brief opening. I merely desire to state that heroin is made by the use. of acetic acid on morphia. Morphia, as you know, is the active principle of opium. Opium has been recognized from time immemorial as a narcotic. Its value or the value of its derivatives, in medication, has been recognized for centuries; in fact, it has often been said that the practice of medicine without the aid of opium or its derivatives would be a very unhappy calling indeed. For a century and upwards the profession has been trying to find a substitute for morphia, a substitute that would not have the distressing after affects which morphia produces, especially the danger from habit forming. Many substitutes have been proposed, but they have all resulted in failure. In 1898 a German chemist subjected morphia to the action of acetic acid and produced a drug called “heroin,” It was widely advertised as the long-sought-for substitute for morphia, but within two years, as I expect to show you, the men who discovered the 1 2 PROHIBITING THE IMPORTATION OF OPIUM remedy warned the world that it was a very dangerous drug and habit forming. It was advertised extensively especially throughout the United States, and the testimony to be offered will disclose that it is the most dangerous of all the habit-forming drugs; some authorities going even so far as to claim that it causes an organic change in the nerve cells. That it is responsible for a large amount of crime is hardly open to question. I have before me replies to a questionnaire which I sent out to many of the penal institutions of the country which will confirm this statement. I shall be quite brief, so far as the testimony is concerned, and content myself with offering a number of official orders and opinions of many noted physicians and criminologists. I might add that the medical profession looks upon heroin as a very dangerous drug and a comparatively useless drug. The Army, the Navy, the Public Health Service, the Veterans’ Bureau, and the American Medical Association have all condemned its use on the ground that it is entirely too dangerous and has no medicinal value that can not be supplied by codein or other drugs. The first order is of December 2, 1916, circular letter No. 102, by the Public Health Service ; Treasury Department, Bureau of the Public Health Service, Washington, December 2, 1916. BUREAU CIRCULAR LETTER NO. 102 DISCONTINUE THE USE OF HEROIN Medical officers, acting assistant surgeons, and others concerned: In view of the fact that the great increase in the use of heroin at present con- stitutes a considerable menace to public health in the United States, it is desired to set an example and to signalize to the general public the danger which may accrue from its use. Heroin as a palliative in certain respiratory affections serves no purpose which can not be accomplished by other agents fully as effec- tively and without the attendant possibility of grave disaster. You are therefore directed to discontinue dispensing heroin and its salts at relief stations of the service, and to send all the stock of these drugs now on hand to the purveying depot, 1414 Pennsylvania Avenue NW., Washington, D. C., either by parcel post or by freight on Government bill of lading. Rupert Blue, Surgeon General. Mr. McLaughlin. What is the date of that? Mr. Porter. That was the first one, December 2, 1916. On February 2, 1924, the United States Navy issued the following order : BY UNITED STATES NAVY February 2, 1924. I have the honor to inform you that further issues of heroin to the United States naval service have been prohibited. Surgeon General, United States Navy. The United States Veterans’ Bureau on March 10, 1924, made the following order: UNITED STATES VETERANS’ BUREAU CIRCULAR NO. 38 Medical and Rehabilitation Service, March 10, 1924- Subject: Heroin. This bureau does not approve of the administration of heroin to any of its beneficiaries. This decision is based on the best medical authority. Heroin PROHIBITING THE IMPORTATION OF OPIUM 3 shall not be issued in future to any member or unit of the Veterans’ Bureau, and such stocks as may be on hand shall be forwarded to the nearest supply depot. George E. Ijams, Assistant Director. On December 29, 1923, the Medical Department of the United States Army^issued^the following order: BY UNITED STATES ARMY December 29, 1923. This oiBce does not approve of the administration of heroin to any member of the military personnel. Such stocks of heroin as may be on hand at posts, camps, stations, or medical supply depots will be destroyed and dropped from the stock record account on certificates of the medical supply officer. Heroin is no longer issued for use of the Medical Department of the Army. M. W. Ireland, Surgeon General, United States Army. Mr. Watson. Have you reports of medical investigations as to the use of the drug? Mr. Porter. That testimony will be presented later. On March 25, 1918, the Secretary of the Treasury, Mr. McAdoo, appointed a committee to investigate the traffic in narcotic drugs. The committee filed quite a voluminous report and, I desire to say, a very valuable one. I found it quite helpful in the investigation which we have been making in regard to all of the habit-forming drugs. I desire to call the committee’s attention to two statements in that report. Mr. McLaughlin. Is that printed as a document? Mr. Porter. Yes; it is a Treasury report of June, 1919. On page 24 of the report I find this statement:’ 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. This valuable report was filed in 1919. The committee, of which the Hon. Henry T. Rainey was chairman, concluded the report with this statement: It is the opinion of the committee, based on the results of its investigations, 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 one of the other alkaloids of opium with the same therapeutic results, and with less danger of creating habituation. Therefore, consideration should be given the subject of absolutely prohibiting the manufacture, sale, distribution, or administration of this most dangerous drug by the States and municipalities. Respectfully, B. R. Rhees, M. D., Henry T. Rainey, Member of Congress, Chairman. Reid Hunt, Professor of Pharmacology, Harvard University. B. C. Keith, Deputy Commissioner of Internal Revenue. A. G. Du Mez, United States Public Health Service, Secretary. Clerk to Committee. Dr. Alexander Lambert, of New York, is a noted authority on this subject. I did not think it necessary, unless the committee so desires, to call him to testify, because I have a statement from him on the subject which he has confirmed by letter, which I submit herewith for the record. 4 PROHIBITING THE IMPORTATION OP OPIUM (The letter referred to is as follows:) February 11, 1924. Dr. Alexander Lambert, New York, N. Y. My Dear Doctor Lambert: It is my purpose within the next few days to introduce a bill prohibiting the importation of opium into the United States to be used for the manufacture of heroin. I have before me a memoranda on inter- national control of heroin giving the opinions of many reliable authorities that the use of heroin should be prohibited. You are quoted as follows: “Heroin cuts off the sense of responsibility in the moral sense much quicker than morphine. It destroys the sense of responsibility to the herd. Heroin addicts will more quickly commit crime and with no sense of regret or responsi- bility for it. The herd instinct is obliterated by heroin, and the herd instincts are the ones which control the moral sense in the sense of responsibility toward others and the environment in general. Heroin obliterates responsibility the same as cocaine, and it makes much quicker the muscular reaction, and therefore is used by criminals to inflate them, because they are not only more daring but their muscular reflexes are quicker.” I am writing a similar letter to all of the other authorities quoted in the memo- randa and if you are correctly quoted I intend to insert your views in the record and thus avoid the necessity of inconveniencing a great many people who other- wise would be asked to testify. If you desire to add anything to what you have already said on the subject, I assure you the committee would be glad to have the benefit of such addition. A prompt reply will be appreciated, as the hearings will begin the early part of next week. Very truly yours, Stephen G. Porter, Chairman Foreign Affairs Committee, House of Representatives. New York, N. Y., February IS, 192^. Hon. Stephen G. Porter, Chairman Foreign Affairs Committee, House of Representatives. Dear Mr. Porter: I am in receipt of your letter, and corroborate the quo- tation which you make from my writings on heroin. I am always glad to help you in any way in this matter. Sincerely yours. Alexander Lambert. Mr. William McAdoo, police magistrate of New York, has written a number of articles on the subject, and a man who has been thrown in contact with drug addicts perhaps more than any other official in the country, with the possible exception of the officials of Sing Sing prison in New York and the Toombs Prison, New York. My letter and his reply are as follows : February 11, 1924. Mr. William McAdoo, Chief City Magistrate, New York, N. Y. My Dear Mr. McAdoo: It is my purpose within the next few days to intro- duce a bill prohibiting the importation of opium into the United States to be used for the manufacture of heroin. I have before me a memoranda on inter- national control of heroin giving the opinions of many reliable authorities that the use of heroin should be prohibited. You are quoted as foljows: “We committed last year from this office about 900 drug addicts and I should say that 98 per cent are users of heroin. Very rarely do we run across a case where the addict is taking morphine or cocaine.” I am writing a similar letter to all of the other authorities quoted in the memo- randa and if you are correctly quoted I intend to insert your views in the record and thus avoid the necessity of inconveniencing a great many people, who other- wise would be asked to testify. If you desire to add anything to what you have already said on the subject, I assure you the committee would be glad to have the benefit of such addition. PKOHIBITING THE IMPOBTATION OF OPIUM 5 A prompt reply will be appreciated as the hearings will begin the early part of next week. Very truly yours, Stephen G. Porter, Chairman Foreign Affairs Committee, House of Representatives. City of New York, City Magistrates’ Courts, February 13, 1924- Hon. Stephen G. Porter, Chairman Foreign Affairs Committee, House of Representatives, Washington, D. C. My Dear Mr. Porter: Certainly you can quote the statement made by me as to the fact that 98 per cent of drug addicts are using heroin. An addict using morphine or cocaine is so rare as to attract attention. A few weeks ago two comparatively young men came into this office self- complaining and asking to be committed to the addict colony on Piker’s Island, , which is conducted by the city of New York. I send herewith a description of them taken from a book of mine which is now in the hands of the printers. Note the fact that these two men went deliberately down to Mexico to get cheaper and unadulterated heroin and that the heroin they bought down there had the label of large American drug manufacturers on the bottles, as if it had been exported into that country, with possibilities of being smuggled back into the United States. I am quite convinced that if the United States will distinctly prohibit the manufacture of heroin, or a similar drug under any name, other nations will follow the example or else have to tacitly admit that the drug is made for addicts and not for medicinal purposes. The great problem with regard to drug addicts, in my judgment, is to prevent recruiting the ranks of the present large menacing and dreadful army of addicts; in other words, to make it as nearly as practical impossible for the young man or woman who has not yet taken the first dose of heroin to procure the drug. The clutch of the drug is so strong that it is pitiable to see the condition of the beginners, especially when they are young in years. Very sincerely yours, William McAdoo, Chief City Magistrate. Two young men, native stock, southern born, drug addicts for several years, find that heroin can be bought more cheaply in Mexico than here; go down there and attempt to work in the oil fields; get as much of the drug unadulterated for $2 as would cost $15 or $20 up here; dose themselves heavily but fail in their work; are found by a charitable American who paid their fare on the steamboat to New York; arriving they came directly to this office on a raw, cold Decem- ber day, dressed in suits that looked at first sight like pajamas, collar of the jackets held up to their necks by safety pins; tan of a southern sim superimposed over pallid and emaciated faces, giving them a very sickly appearance; say the drug is freely peddled in Mexico and is bought m bottles bearing the stamp of well-known manufac- turers in this country. Dr. Herman N. Bundeson, commissioner of health of Chicago, says in reply to my letter: I think criminologists the world over will tell you that the violent crimes are the ones that are committed by heroin addicts. (The letters follow:) February 11, 1924. Dr. Herman N. Bundesen, Commissioner of Health, Chicago, III. My Dear Doctor Bundesen: It is my purpose within the next few days to introduce a bill prohibiting the importation of opium into the United States to be used for the manufacture of heroin. I have before me a memoranda on 6 PEOHIBITING THE IMPOETATION" OF OPIUM international control of heroin givhng the opinions of many reliable authorities that the use of heroin should be prohibited. You are quoted as follows: “I think criminologists the world over will tell you that the violent crimes are the ones that are committed by heroin addicts.” I am writing a similar letter to all of the other authorities quoted in the memo- randa and if you are correctly quoted I intend to insert your views in the record and thus avoid the necessity of inconveniencing a great many people, who other- wise would be asked to testify. If you desire to add anjdhing to what you have already said on the subject, I assure you the committee would be glad to have the benefit of such addition. A prompt reply will be appreciated as the hearings will begin the early part of next week. Very truly yours, Stephen G. Porter, Chairman Foreign Affairs Committee, House of Representatives. City op Chicago, Department of Health, February IS, 192 4-. Hon. Stephen G. Porter, Chairman Foreign Affairs Committee, House of Representatives, Washington, D. C. My Dear Mr. Porter: Replying to your letter of February 11, I beg leave to advise you that I am inclosing herewith a copy of our bulletin, recently issued, on “The menace of dope.” I think that this will give you a fairly clear idea of our attitude in this matter. You are at liberty to use any material you may wish from this pamphlet. Thanking you for the magnificent work which you are doing in the control of this serious menace to our Nation, and with kindest personal regards, I beg to remain Very respectfully yours. Herman N. Bundesen, Commissioner of Health. Mr. Chindblom. What mental effect has the drug upon the ■ addict that is alluring to the addict ? Mr. PoKTER. The drug affects no two people exactly alike. It is like liquor in that respect. Dr. Lambert, in the hearings on H. J. Res, 453, February, 1923, describes the effects of addiction as fol- lows; Doctor Lambert. Yes. The Chairman. Which of these drugs, heroin, morphine, codeine, or cocaine, is the most destructive on human life? Doctor Lambert. What do you mean by destructive of life — which will kill the quickest? The Chairman. Yes, sir. Doctor Lambert. Heroin is the strongest. It is about three times as strong as morphine. Cocaine and heroin are the most dangerous; if you try to kill a person, both can kill very quickly. The Chairman. Assume a person has acquired the heroin habit, is it more injurious to his health than the cocaine or morphine habit? Doctor Lambert. No; cocaine brings an insanit}^ — an acute insanity — with it. But heroin and cocaine both inflate personality. Cocaine is not a narcotic; it is a pure stimulant. Heroin inflates the personality the same way as small amounts of alcohol and will give a sense of inflated, happy personality, large ideas, and great assurances of wished-for accomplishments, and absolute assurance that one’s own personality is ever^'thing that one wishes. Cocaine does that same thing with the wishful ideas of promises coming true. That is particularly contained in cocaine, and heroin also has this effect. The Chairman. What is the immediate cause of death of addicts to these drugs? Doctor Lambert. Heroin and morphine paralyze the respiratory center, and cocaine will paralyze the .heart. The Chairman. Will you state to the committee your opinion as to the effect of addiction on the health of the addict? PROHIBITING THE IMPORTATION OF OPIUM 7 Doctor Lambert. First, in small doses, for a while it stimulates the person- ality; it stimulates the sense of personality; it stimulates the ideas, and then it produces sleepiness and inhibits actions. Morphine produces dreamy care- lessness to one’s environment, a blocking off of disagreeable memories. There is failure of elimination in the human body of its decomposition products. It produces the dreamy sense of dodging of responsibilities and desire to be let alone, and absolute indifference to environment, to responsibilities, and to others. Heroin cuts off the sense of responsibility, in the moral sense, much quicker than morphine. It destroys the sense of responsibility to the herd. Heroin addicts will more quickly commit crime and with no sense of regret or responsibility for it. The herd instinct is obliterated by heroin, and the herd instincts are the ones which control the moral sense, in the sense of responsi- bility toward others and the environment in general. Mr. Cooper. I was not here when the examination began. Are all of the drugs named in the Porter resolution habit-forming drugs? Doctor Lambert. Yes; every one of them. Mr. Cooper. Then, in that sense they are dangerous habit-forming drugs. Doctor Lambert. Yes. Mr. Chindblom. A species of exaltation? Mr. Porter. Yes. I might say here, I do not want anyone to believe for a moment that I look upon these addicts as vicious per- sons. I do not. Addicts are the victims of misfortune over which but few of them have had any control, as addiction rarely occurs through viciousness except in the cases of habitues of the so-called '‘underworld,” and perhaps many of these have been reduced to this social condition as the result of addiction. They are the most grateful of patients, and frequently commit minor offenses so that they may be committed to an institution in the hope of being cured of their affliction. Mr. Crim, Assistant Attorney General, stated : We have cases where these meu call up and say, “I am a drug addict. I am going to sell some opium down on the corner of such and such a street at such and such an hour, and if you will go there you can apprehend me. I want to go to jail. I am afraid of myself.” They are not admitted to hospitals because their craving for the drug renders them beyond control. They are frequently the victims of nostrums and quack sanitariums, and should be the objects of compassion rather than be termed as "dope fiends. ” I trust the day is not far distant when the necessity for construct- ing and maintaining an institution for the treatment and care of these unfortunate people is recognized, which would result in many being cured of the affliction. Mr. Hawley. Do you know the number of them ? Mr. Porter. Well, it is a disease of secrecy. It is impossible to ascertain with any degree of certainty the number. The Treasury report which I referred to fixes the number at approximately 1 , 000 , 000 . Mr. Oldfield. Can they be cured? Mr. Porter. The accepted treatment is known as "tapering off” — that is, the gradual reduction of the amormt used until the patient is able to abstain from its use — but this is a long and tedious treatment requiring strict surveillance of the patients long after they have left the hospital or sanitarium, and, as stated by the representative of the Salvation Army, the peddler, who has tem- porarily lost a customer, usually persuades his physically weakened victim to renew the drug habit. 8 PROHIBITING THE IMPORTATION OF OPIUM Complete recoveries are few and the phrase “once an addict alwa 3 ^s an addict” in its essence is literally true, until we provide a more humane method of treatment than the prison cell. Mr. Treadway. Have you any record, any statistics, of the pei- centage of the importation of opium that goes to the manufacture of heroin ? Mr. Porter. No; I think it is comparatively small, because a great many physicians are afraid to use it as I shall show later — I doubt if 5 per cent of the physicians are using it at all. Mr. Treadway. How would you carry out the provisions of this act? For instance, would it not be possible for anybody importing opium to say it was to be made into morphia or the other forms of opium, and then turn it over to the manufacturer of heroin? Mr. Porter. That is possible. Mr. Treadway. Hov/ would you safeguard that? Mr. Porter. By the splendid Jones- Miller law, creating the Nar- cotic Control Board, by which the privilege of handling these drugs is so valuable that the manufacturers will not take the risk of violat- ing the law. Mr. Hawley. Is the illicit manufacture easy? Mr. Porter. No. Mr. Garner. If I understand the object of this bill, it is to make it a crim.e to manufacture heroin in this country? Mr. Porter. Yes. Mr. Garner. So that when you find it is manufactured, you trace it back and detect the manufacturer and punish him? Mr. Porter. Yes, sir. Mr. Garner. And destroy the opportunity of getting it? Mr. Porter. Yes, sir. Mr. Garner. That is the object of your bill? Mr. Porter. Yes, sir. Mr. Dickinson. So far as your bill is concerned, there are only two lines in it, and how can you determine — I believe that question, practically, has been asked — how can jmu determine^that it is im- ported for the purpose of manufacturing heroin? Mr. Porter. We can not, but we have a control over the manu- facturer. A pharmaceutical laboratory costs anywhere from $500,000 to two or three million dollars, and the owners of that establishment which imports opium would not for a moment take the chance of converting morphia from that opium into heroin and thereby incur the risk of losing their license to operate. Mr. Dickinson. Are your regulations regarding the sale of crude opium in this country sufficient to prevent it being sold to parties who will manufacture heroin? Mr. Porter. Yes, sir; they could not do it, anyhow. There are only about eight establishments in the country properly equipped to manufacture heroin. It is entirely unlike the making of liquor. Mr. Mills. Mr. Porter, under the present law all opium imported has to be labeled? Mr. Porter. Yes, sir. Mr. Mills. And they have to certify that it is to be used for proper medicinal purposes. Now, what you would require here is for them to go a step further and certify that they would see that any opium imported by them would not be used for the purposes of manufac- PROHrBITING THE IMPORTATION OF OPIUM 9 turing heroin. You do not anticipate any difficulty in the enforce- ment of the law, do you ? Mr. Porter. Oh, no. Mr. Oldfield. As a matter of fact, this opium that is imported into this country is followed from the time it gets into the country on down through the laboratory to the physician, to the hospital, to the consumer? Is that right? I was on a subcommittee once about this matter with Mr. Hadley. Mr. Porter. Our difficulties in the United States are not due to drugs which come into the country legitimately. Mr. Martin. It is very easy to hide, is it not? Mr, Porter. Yes; that is true. It should be of interest to know that $5,000 worth of morphia, codeine, heroin, or cocaine may be safely concealed in an ordinary suitcase; that in a hollow cane of average thickness $2,000 worth may be secreted. It was stated in your committee that on a steamer crossing the Pacific some one happened to examine a particular bamboo chair and found that its hollow bamboo was filled with morphia. The sundry and varied manners and forms in which traffickers ply their illicit trade would prove interesting reading and be striking evidence of the ease with which the drugs are transported from country to country. The vendor of them finds it comparatively easy to bring his goods into the United States through our extensive seacoasts and immense boundaries. Even our penitentiaries and jails are invaded by the traffickers, who find wdthin their walls market for these vicious drugs, payments for which is made by the prisoners issuing I. O. U.’s to friends on the outside. The testimony conclusively shows that habit-forming narcotic drugs, by reason of their extraordinary nature, will overcome aU barriers, even the bars of prisons, or, as stated by Sir John Jordan, the noted British authority on the subject and member of the opium advisory commission appointed by the council of the League of Nations, "Whenever and wherever opium is produced, it will reach the consumer.” Mr. Tilson. Will you answer this question, Mr. Porter? At the present time it is la-mul to import crude opium, is it not? Mr. Porter. Yes, sir. . Mr. Tilson. Under proper regulations ? Mr. Porter. Yes, sir. Mr. Tilson. Now, if at the present time you discover that this crude opium is being used for the purpose of manufacturing heroin, have you the right to proceed against that person or to forbid them having a permit thereafter, or something of that kind? Mr. Porter. We have both remedies under the Jones- Miller law. Mr. Mills. But the manufacture of heroin is not illegal to-day? Mr. Porter. No; not to-day. Mr. Tilson. Does this make it illegal to manufacture it? Mr. Porter. Yes, sir. Mr. Tilson. Well, it says it shall not be imported for the purpose of manufacturing heroin. Mr. Porter. Yes. Mr. Tilson. But does it go far enough and make it illegal? If it is not already illegal to manufacture heroin, does this make it illegal? Mr. Porter. Certainly, it does. 10 PROHIBITING THE IMPORTATION OF OPIUM The Chairman. Mr. Porter, I think possibly you do not quite understand the. question. You make it illegal to be imported for that purpose, and you provide under the act, as I understand it, for a penalty for its being imported for that purpose. Mr. Porter. Yes. The Chairman. But I doubt whether we could constitutionally inhibit the manufacture. I think that is what Colonel Tilson was getting at. Mr. Tilson. Yes. Mr. Porter. That is the reason the bill is in this form. Mr. Tilson. That is what was in my mind. Mr. Hadley. This is the situation, is it not: That the Federal Narcotic Control Board would have the power at this time to prevent the importation if it were not for this outstanding element of possible medical use? Mr. Porter. Yes, sir. Mr. Hadley. There is that element in it. As I understand it, your statement is that — basing it also upon medical authority — since there are other narcotic drugs that serve the same useful purpose, if there is any, as this drug, and since its effects are so much more deleterious that its manufacture ought to be prohibited. Mr. Porter. Yes. Mr. Hadley. Therefore, the Narcotic Control Board, if this law is passed as you propose it, would supervise under its regulations very rigidly the question 'of fact as to whether it is being imported for the manufacture of heroin. Mr. Porter. Yes, sir. Mr. Hadley. And if so, the importation would be prohibited. If, perchance, the importer falsified the purpose of importation it would come in, but they would pursue it upon the showing of the importer, to its ultimate destination, and if there was a failure to carry out the original purpose, then in that case they would revoke the license of the manufacturer. Mr. Porter. That is exactly it. Mr. Hadley. Isn’t that the situation? Mr. Porter. That is a correct statement of the entire matter. Now, Mr. Chairman, may I ask to slep aside for a moment? Doctor Richardson is here. He has some appointments, and I would like you to hear his testimony. The Chairman. As I understand, it is very necessary that Doctor Richardson should leave in a short time, therefore we will hear him now. STATEMENT OF DR. CHARLES W. RICHARDSON, WASHING- • TON, D. C. Doctor Richardson. Mr. Chairman and gentlemen, I represent the executive committee of the board of trustees of the American Medical Association. This question of heroin habituation and its production yearly of enormous numbers of new criminals is one of the most important moral questions that is up before the American Government at the present time. We find that in some of the States — ^I will ordy mention one, and that is the great State of New York — there is used PEOHIBITING THE IMPORTATION OF OPIUM 11 for criminal purposes — that is, the production of habitues — over 76,000 ounces of heroin each year, whereas, the 14,000 physicians in the great State of New York only prescribed 58 ounces of heroin, either in its own form or in preparations. You can draw your con- clusions from this one instance. The Chairman. Doctor, can you state why heroin is used by those who have become addicted to the habit of using some form of opium, rather than any other form? Is it more convenient or is it more easily obtained, or what is the reason ? Doctor Kichardson. The reason is simply this: Heroin contains, physiologically, the double action of cocaine and morphia. It pro- duces the excitation of cocaine, with the sedative effects of morphia. It is more agreeable to take; it is not followed by the nausea, as is so often caused by morphia, nor the marked depression afterwards. Mr. Hadley. Doctor, can you state approximately, in the ab- sence of curative treatment, how long it takes a patient to run his coiu’se, how long he can withstand the reaction ? Doctor Richardson. Well, that is something that I am not par- ticularly acquainted with, but I will tell you this, that most of the habitues of heroin run between the ages of 17 and 25 years. That is by statistics so far, and that must mean that after 25 or 28 — I think 17 to 28 — most of them are either dead or out of the way somewhere. Mr. Hadley. And, aside from the length of time that it takes to run its course, how long does it take to dethrone their responsibility? Doctor Richardson. Almost immediately. Mr. Hadley. Right away? Doctor Richardson. Yes, sir; almost immediately. That is one of the things it does, dethrone their moral responsibility. It ^ves them an exalted impression of their own importance, and criminals by using it obtain this result. Mr. Hadley. So that no business transaction of any kind would be really dependable after they had entered upon this course? Doctor Richardson. No, sir. Mr. Watson. May I ask you a question? What effect does this drug produce that can not be obtained by cocaine or morphia? In other words, can you name a case where heroin will be used to very great advantage over other derivatives from narcotic drugs? Doctor Richardson. You mean medicinally given? Mr. Watson. Yes. Doctor Richardson. Well, I can answer that very readily. Mr. Watson. I asked this question because I have a letter here from a very prominent physician in Philadelphia advocating the use of heroin. Doctor Richardson. I can answer that question very readily, sir. Heroin when first introduced was supposed to be an unusually valu- able drug in certain conditions, especially where morphine as a sedative was required. ‘For instance, in my work in medicine it was largely used to allay cough — it is very valuable in that work — and in this administration many of us have observed that our patients demanded more of the drug. They were forming the habit, and I want to tell you, that in nearly eight years I have not written a prescription for heroin. The Chairman. You have found other drugs that would take the place of it? 12 PROHIBITING THE IMPORTATION OF OPIUM Doctor R 1 CBLA.RDSON. Absolutely. Sometimes they produce head- ache and nausea, but they have the physiological effect. The only thing about heroin is that it is more pleasant to take. Mr. Hadley. From your knowledge of the profession, would you say that the profession generally takes that view of the relative merits of these drugs? Doctor Richardson. May I read you one or two actions here? Mr. Hadley. I would like to know what the attitude of the profession is. Doctor Richardson. I want to state, in answer to that question, that the three services of the Government, the Army, the Navy, and the Public Health Service have discontinued its use. The Public Health Service in 1916 ordered the discontinuance of the prescribing of heroin by the officers of that service. Mr. Garner. That is the Public Health Service of the United States? Doctor Richardson. Yes. Doctor Blue gave the order. December 29, 1923, General Ireland issued an order that heroin should cease to be given to members of the Medical Corps of the United States Army, and all officers and posts where heroin or its derivatives or preparations were held were ordered to either destroy it or return it to the depots. In February, 1924 — February 8 I think it was — the Surgeon General of the Navy, Admiral Stitt, issued a similar order, that heroin was detrimental to the men of the service and that it should all be turned in to the medical supply depot. Mr. Hawley. And there is no public authority of the United States now that prescribes its use? Doctor Richardson. No; not in any of the services. Mr. Treadway. Has your association formally passed on this bill. Doctor? Doctor Richardson. Yes, sir; and I am here to represent them. Mr. Treadway. By their official action? Doctor Richardson. Yes; by resolution of the house of delegates. Mr. Treadway. We have some very strong protests here from Pennsylvania. Doctor Richardson. I know you have. You wiU have some very strong protests from anywhere against anything you want to institute for the benefit of manMnd and humanity. Pardon me, Mr. Tread- way, for speaking so bluntly. The Chairman. Well, I think you are entirely correct. Every movement of this kind always meets with some objection. Mr. Hadley. I recall that there were some protests two or three years ago against complying with The Hague convention obligations that were given some consideration here, and notwithstanding those protests— I happened to be on the subcommittee — we voted and this committee approved and Congress passed a very restrictive act. Mr. Chindblom. In what way has the American Medical Associa- tion passed on this? Mr. Porter. The doctor has the record there. Mr. Chindblom. Was it by resolution by the association? Doctor. Richardson. Yes, sir; representing 90,000 physicians in this country. The Chairman. Will you read that please. Doctor? PROHIBITING THE IMPORTATION OF OPIUM 13 Mr. Chindblom. At what meeting was that adopted? Doctor Richardson. At the New Orleans meeting 1920. This was unanimously passed by the house of delegates. The house of delegates is the law-creating body of the American Medical Associa- tion. Mr. Chindblom. How many members are there in the house of delegates ? Doctor Richardson. There are 136. There is one delegate to each 800 physicians. Each State or Territory that has not 800 physicians sends a delegate, notwithstanding. Mr. Chindblom. Now let us hear the resolution. Doctor Richardson. The resolution reads: That heroin be eliminated from all medicinal preparations. And that it should not be administered, prescribed, nor dispensed, and that the importation, manufacture, and sale of heroin should be prohibited in the United States. Mr. Young. It could not be stronger than that. Doctor Richardson. It could not, and that is our feeling to-day. Mr. Watson. You stated that morphine produced sickness, nausea? Doctor Richardson. Yes, sir. Mr. Watson. But heroin does not? Suppose a patient came to you and said, “1 can not take morphine, but I prefer taking heroin because I do not have the after effects of nausea,” would you then be willing to give heroin to that patient? Doctor Richardson. No, sir. There is another alkaloid which is nearly as good as morphia, and that is codein. Mr. Watson. What is that derived from? Doctor Richardson. Opium. The Chairman. Doctor, let me read you a telegram that has come to me. In a somewhat milder form I have received a number of letters and telegrams: Hon. William R. Greene, Chairman Ways and Means Committee, Washington, D. C.: I urge you to oppose passage bill 7079 limiting importation of opium to prevent manufacture of heroin. It is about time that ignorant laymen ceased foolishly limiting physicians in the legitimate practice of medicine. Kindly use your whole influence to prevent further encroachment upon physicians’ rights. Dr. DeWitt H. Sherman. Mr. Hawley. I suggest that you read the answer. The Chairman. At the suggestion of Mr. Hawley I will read the answer: Dr. DeWitt H. Sherman, Buffalo, N. Y . Mt Dear Sir: Replying to your telegram just received, I would say that Congress, realizing that it is composed of “ignorant laymen,” so far as the use of opiates is concerned, acts only upon the best expert advice obtainable. My committee will shortly have a hearing upon the bill to which your telegram refers, and I will send you a copy of this hearing. I do not know what will be done with the bill, but if we do report it. it will be because we have taken the advice of persons supposed to be the leading lights in the medical profession. Very truly yours. I imagine the gentleman who sent that telegram probably had not considered the matter very carefully and inspired some others, but I have some letters and commimications that seem to have been more 96182—24 2 14 PROHIBITING THE IMPORTATION OF OPIUM carefully considered than the one I read first. Here is a letter from J. Leslie Davis, of Philadelphia. This is rather long and I will not read it in full, but he says in his letter: It is my honest belief there are certain indications for the use of heroin where its effect can not be obtained or approached by any other substance. A specific, and exceedingly important indication is that of acute affection of the middle ear. In affections of a character that very rapidly follow, their first symptoms are apt to be followed by serious or virulent exudate in the middle ear cavity, which has usually required the incision of the drum membrane for its evacuation. Then he goes on further to state that he has found that the use of heroin in small doses has been an effective measure in checking these things. Doctor Richardson. May I answer that question? I know Leslie Davis very well. I hope he does not practice what he preaches in that letter. If he does, he is not a good otologist. Mr. Treadway. Now, let me ask in that connection, is that not directl^r in line with your practice ? Doctor Richardson. Absolutely. Mr. Treadway. And you undoubtedly have a great many such operations as he refem to there ? Doctor Richardson. Yes. Mr. Treadway. And you do not find it necessary to give heroin? Doctor Richardson. No, sir; I never give it. I open the abcess and evacuate the pus and that quiets the pain. Mr. Watson. May I read four lines here? I do not like to bring up an argument before physicians, but I have a letter from Dr. H. A. Hare, professor of therapeutics, Jefferson Medical College. In the last paragraph he writes: May I add, that to absolutely prohibit the existence of this drug is a very sweeping piece of legislation, which, while protecting persons who are more or less degenerate, would deprive a multitude of worthy people of an efficient pain-relieving remedy. And with the permission of the chairman, I would like to introduce that letter into the record after the doctor has finished his remarks. Doctor Richardson. You wish me to answer that? Mr. Watson. You have already answered it, I believe. Doctor Richardson. Yes. I am a classmate of Dr. Hobart A. Hare, and I know him very intimately. May I answer that question, Mr. Chairman? The Chairman. Very well. Had you any answer to make to that? Doctor Richardson, Yes; three of the largest drug firms of America are located in Philadelphia. [Laughter.] Mr. Porter, kir. Chairman, I was about to inquire if the large majority of these protests do not come from Philadelphia. Mr. Hawley. From Pennsylvania. The Chairman. From Pennsylvania, I think, although here is one from St. Paul and one from New Orleans and St. Louis. Doctor, I have frequently heard it said by persons who had some familiarity with, police work that the police officers had found that addicts to the use of opiates were now almost uniformly using heroin and that it had become in that way a very dangerous drug. Do you know anything about the results of any such investigations ? Doctor Richardson. I know it is a fact, sir. Most policemen in charge of the narcotic groups feel that addicts to heroin are increas- PROHIBITING THE IMPORTATION OF OPIUM 15 ing very rapidly in number, and addicts to opium and cocaine are decreasing. Mr. Garner. I think Mr. Porter placed in the record this morning a statement to the effect that probably 98 per cent of the addicts are now using heroin instead of other drugs. Mr. Porter. In addition to that statement, I have here Doctor Squires, physician of Sing Sing prison, who is very familiar with this subject, so far as the criminal element is concerned. Mr. Garner. Doctor, speaking about the difference of opinion between you and some of your intimate friends as to the therapeutic effects of heroin, is it not a fact that doctors and lawyers and most professional men have some difference of opinion on nearly every subject that comes before them? Doctor Richardson. We are aU human, sir. Ml’. Hawley. Doctor, have you anything further to present? Doctor Richardson. I am through unless you want to ask me some further questions. Mr. Hawley. Are there any further questions to ask the doctor ? If not, we are very grateful to you for your statement. Mr. Chindblom. Just one observation — it appears that the move- ment against the use of this drug actually started in a Federal depart- ment, the United States Public Health Service? Doctor Richardson. Yes; primarily, but the medical profession was awakened to the necessity. The Public Health Service started it, but the Public Health Service made more headway with it simply because they could control their men more directly than the medical men in general can control their patients. Mr. Chindblom. The action of the medical profession came four years later? Doctor Richardson. Yes, sir. Mr. Chindblom. And the action of the Army and Navy seems to have come seven years later? Doctor Richardson. Yes, sir. Mr. Young. What proportion of the doctors have authority or license to use heroin ? Doctor Richardson. Any graduate of medicine has the right to use anything in medicine. Mr. Young. All doctors may prescribe it? Doctor Richardson. Yes, sir. Mr. Hadley. Doctor, you are familiar with the state of existing legislation on the narcotic subject? Doctor Richardson. I think I am; yes, sir. Mr. Hadley. Having that in mind and having reference to this bill, is it your opinion that if enacted as proposed it will meet the situation effectually to which you object? Doctor Richardson. I think it will, because, as you know, heroin is a derivative of morphine, and if you diminish the amount of mor- phine in this country through opium admitted you have got to give way somewhere, and it is easier for them to manufacture morphine and other derivatives than it is to illicitly manufacture heroin. If the law prescribed that opium should not be used for a certain pur- pose, no honorable firm — and I believe there are a great many of them — would dare use that opium for the illicit manufacture of mor- phia, to be converted into heroin. 16 PROHIBITING THE IMPORTATION OF OPIUM Mr. Treadway. Along that line, Doctor, admitting that there are great quantities smuggled into the United States, if it is smuggled, in the form of crude opium, is the process of transforming it into heroin such a difficult one that whoever was illegitimately doing so would not continue to produce heroin if this law was enacted ? Doctor Richardson. I do not know enough of the pharmaceutical methods of the preparation of it to answer that question, otherwise I would try to answer it. We are going to have illicit smuggling unless the other countries of the world, the great producers, manufac- turers will join with us. We will do out part if they will do their part. Great Britain, France, Germany, and Japan. Mr. Treadway. I believe you said that the addicts are transferring from the other forms of opium to heroin. Doctor Richardson. Yes, sir. Mr. Treadway. In large percentage ^ Doctor Richardson. Yes, sir. Mr. Treadway. The reason of that is the pleasanter effect of the drug? Doctor Richardson. And the less unpleasant after effects. Mr. Treadway. The less unpleasant consequences ? Doctor Richardson. Yes, sir. Mr. Tilson. Would you go so far as to wipe this drug out of existence altogether? Doctor Richardson. Absolutely. Its use has been abandoned now by the three services of the United States Government and by resolution of the American Medical Association, and any man who is a member of the American Medical Association and prescribes heroin, is violating his regulations. Mr. Tilson. So, in your judgment, it should be universally outlawed ? Doctor Richardson. I have no use for it in medicine. Here are four of the great organizations which would administer drugs that have proscribed the use of it. What other use have you for it except injthe arts and for the addicts ? Mr. McLaughlin. Have you any information on the action being taken by State legislatures to forbid the manufacture or distribution of this drug? ^Doctor Richardson. No, sir. rjJMr. •McLaughlin. I ask that because, as stated by our chairman a few minutes ago, the Congress of the United States can not control the manufacture of these things in the States, nor their sale or use. The Congress can forbid their importation; can forbid their trans- portation in interstate commerce, but only the States have power and it is complete power to forbid and prevent the manufacture. A State can forbid the use by physicians; can forbid the sale by manu- facturers and druggists; can forbid the sale by druggists to physicians; can do all those things, not one of which can be done by the Federal Government. Federal authority in the matter is very limited indeed. It would seem to me that in this situation, serious as your testimony indicates it is — ^and I credit it fully. Doctor — that something should be done through the legislatures of the States. There is a miscon- ception of the power of the Federal Government. Doctor Richardson. I recognize that, sir, but I can not teU you the legal methods of getting around it. That is for you gentlemen to decide. PROHIBITING THE IMPORTATION OP OPIUM 17 Mr. McLaughlin. We have a good deal to do if we look after our own matters here and keep within the limits prescribed for us, and gentlemen like you who are so well informed and so capable of prop- erly disseminating useful information, it might be incumbent on some of you gentlemen — I say that in the proper spirit — to being this matter to the attention of State legislatures. Doctor Richardson. If you stop the importation of the crude drug for the manufacture of morphine into heroin the American Medical Association will look after the legislatures of the States. Mr. Crisp. The only way morphine gets into this country is by importation, and Congress is the only power that can prescribe and prohibit the importation into the United States. Is not that true? Doctor Richarson. Tes, sir. Mr. Porter. Morphine has already been prohibited. Mr. Tilson. But the fact is it does come in illegally. It gets into this country in spite of the law. Now should we not go further and appeal to the States, which have plenary power in the matter of manuiacture and distribution in the States, and get the States to go further than the Federal Government has the right to go under the Constitution ? Mr. Garner. Well, let us see if that is necessary. If you prohibit the importation of opium for the purpose of making heroin, and it is a crime to import it, and it is imported and you make heroin out of it, the manufacture of that is violating the law. Doctor Richardson. Yes, sir. Mr. Garner. And you imprison him or fine him, as the case may be. You do not need any State law to get that man any time, unless you want a double penalty, a double set of officers looking after that 1 particular crime. Mr. McLaughlin. But, Mr. Garner, it may be made unlawful to import it, but it is nevertheless imported, and this Congress has no power to forbid the manufacture of an article from that importation if that article reaches the country. Mr. Garner. All right. Now, some manufacturer, we will say, imports crude opium, and he uses that for the purpose of manufac- turing heroin. He violates the law. It is a circumstance showing he could not have possibly gotten that crude opium otherwise than by violating the law when he makes heroin. Mr. Hadley. Then we have a statute, do we not, under which the Control Board can cancel his license? In any event he would be subject to the penalties for fraudulent importation. Mr. Garner. I do not know what the law is in reference to that, but I know this looks to me like a very effective impediment to the manufacture and distribution of heroin. Mr. Oldfield. We have a commission that controls it absolutely. Mr. Crisp. Have you any idea as to the percentage of opium that is imported into this country, that is used in the manufacture of heroin ? Doctor Richardson. I could not tell you. The Chairman. Let me suggest to the members of the committee that probably this is just the best place to discuss the legal questions. Of course, we will have to go over the legal questions before we I finally dispose of the bill, and on that part. Doctor, some of us feel I a great deal more competent than we do on the medical part, as to 18 PEOHIBITIIS G THE IMPORTATION OF OPIUM which we have, of course, no special knowledge. We are not entirely “ignorant laymen” on the legal features. Mr. Tilson. I think it will not be amiss to suggest to the doctor that through his very influential association they might even go farther, go into the States and get such help in enforcement and eradication of this deleterious drug as can be gotten only from the States. The Chairman. I think that is a very proper suggestion, because the police powers — which is a signification that I do not need to stop to explain at this time — the police powers belong entirely to the States, and Congress can only exercise such authority in connec- tion with the importation of the articles as is necessary to enforce the import regulations. Mr. Garner. I want to suggest that the chairman correct his remarks and strike out the word “ entirely — police powers are “entirely” controlled by the States. There are certain subjects of which the Federal Government takes cognizance. The Chairman. That depends, Mr. Garner, upon a constitutional question. Mr. Hawley. I would like to ask you one question. Doctor. You stated the American Medical Association has 90,000 members. What proportion is that of the entire medical profession of the United States ? Doctor Richardson. I guess about 80 per cent. Mr. Treadway. And, of course, included in that 90,000 are these associations protesting against the action of the National Association? Doctor Richardson. Yes. Mr. Chindblom. I would like to ask one question. Is there any difference in the dosage, the quantity of the drug used in the case of heroin and the other opiates? Doctor Richardson. Oh, yes. Mr. Chindblom. Is the dose used in the case of heroin lesser or greater than that of other drugs? Doctor Richardson. It is a smaller dose. Mr. Chindblom. That, of course, makes it easier to handle it. Doctor Richardson. Yes, sir. Mr. Crisp. Is it more expensive, doctor? Doctor Richardson. I do not know about that. The Chairman. If there is nothing further, the Doctor is desirous of leaving, and we thank you very much. Doctor. Mr. Watson submitted the following letter from Dr. H. A. Hare, of Philadelphia, Pa. : Philadelphia, April 1, 1924- Hon. Henby G. Watson, House of Representatives, Washington, D. C. Dear Sir: I understand that H. R. 7079, which will prohibit the importation of opium for the manufacture of heroin and also forbid the importation of heroin comes up before the Ways and Means Committee on Thursday morning next, at 10 o’clock. In my opinion this drug is an exceedingly useful one, performing a function that no other drug will perform under certain circumstances. The Harrison narcotic act, if properly enforced, is entirely adequate to prevent the abuse of heroin, and the mere fact that heroin is used as a habit-producing drug does not justify its entire prohibition anymore than would entire prohibition of cocaine or morphine be justified. May I add, that to absolutely prohibit the existence of this drug is a very sweeping piece of legislation, which, while protecting persons who are more or PROHIBITING THE IMPORTATION OF OPIUM 19 less degenerate, would deprive a multitude of worthy people of an efficient pain-relieving remedy. Yours very truly, Hobert a. Hare, Professor of Therapeutics, Jefferson Medical College. Mr. Porter. I would like permission now to call Doctor Squires. STATEMENT OF DE. AMOS 0. SQUIEES, CHIEF PHYSICIAN, SING SING PEISON, OSSINING, N. Y. Mr. Porter. How long have you been practicing medicine, Doctor? H Doctor Squires. I have been practicing 25 years this spring. Mr. Porter. And what special employment have you at the present time? Doctor Squires. I am chief physician of Sing Sing prison, New York State. Mr. Porter. How long have you held that position? Doctor Squires. I was there first 24 years ago, when the resident physician was in Europe. I was consultant there for 12 years, and I have been there now since 1916, with the exception of, I think, seven months. Mr. Hawley. What is your official position? Doctor Squires. I am chief physician of Sing Sing prison. Mr. Porter. About how many prisoners are there in Sing Sing prison at the present time? Doctor Squires. We have a constant population of approximately 1,300. We receive 70 per cent of all the men who are convicted of the crime of felony in New York State. We received last year about 900 new ones; the year before some 1,457. I will say offhand that we receive approximately 1,200, on an average of 1,200 new men every year. Mr. Chindblom. What is the annual turnover? Doctor Squires. We transfer from Sing Sing to three other penal institutions. Auburn, Dannemara, and Great Meadows, but being so near New York and taking our criminals from the metropolitan district, we receive 70 per cent of all the felons of the whole State of New York. Mr. Chindblom. So these transfers affect the population? Doctor Squires. Yes; they keep the population down. Mr. McLaughlin. You receive only those who are convicted of felonies ? Doctor Squires. Yes, sir; with a minimum sentence of one year to natural life or the death penalty. Mr. Treadway. One thousand three hundred is the total capacity of the institution ? Doctor Squires. Yes. Really, our capacity is much less than that. We only have 900 cells, but we have two improvised dormitories that house two or three hundred, and I have generally 70 or 80 in the hospital. Mr. Watson. What is the average age? Doctor Squires. Twenty-four years. We get them as young as 16, and as far advanced as they may be when they commit a crime. The average age is 24. 20 PROHIBITING THE IMPORTATION OF OPIUM !Mr. Porter. During your service at this prison have you had occasion to make a study of drug addiction ? Doctor Squires. I have. Mr. Porter. Do you believe that the manufacture of heroin should be prohibited ? Doctor Squires. I do. Mr. Porter. Now, will you state to the committee — because, I will say, that the doctor has a profound knowledge of the subject — will you state to the committee your reasons in support of this bill? Doctor Squires. Prior to 1919 the question of drug addiction was not of very great concern to us in the prison, as it has been during the last few years. In fact, in 1917, out of the total number received at Sing Sing prison, less than four-tenths of 1 per cent were drug addicts. In fact, prior to 1919, for an average of six years, our drug addicts would only equal about 13 a year. In 1920 it increased over 100 per cent over that average. In 1922 it increased over 500 per cent over that average, and in 1923 it increased over 900 per cent. So to-day 1 out of every 11 men who is admitted to Sing Sing prison is a drug addict. They are what you might call criminal drug addicts. Mr. McLaughlin. This drug is used by women, too, is it not? Doctor Squires. Yes, sir; but we do not house women. They go to Auburn direct. Ninety-six per cent of the men who come to us who are drug addicts are heroin addicts; less than 1 per cent are cocaine. In fact, cocaine is almost — ^well, we sometimes go a year without seeing a cocaine addict. The other 3 or 4 per cent are those who take heroin and morphine together. I found that the age of the heroin addict in prison is younger than our average age. Our average age of the general population is about 24 years, and the drug addict is 23 years. Mr. Treadway. To what do you ascribe that tremendous in- creased percentage in the last few years? Doctor Squires. That there are more using it on the outside, more of the criminals using it. Mr. Treadway. To its being easily obtained? Doctor Squires. Yes; and I think that to-day there is more drug peddling than ever before. I have had men come to us who are imprisoned there, who have told me they have made as much as $125 a week peddling drugs. Mr. Garner. Doctor, what do you attribute the increase in the peddling of drugs to? Doctor Squires. I really do not know what would cause it.. They teU me, those who are drug addicts, that they were handed a sample package, a great many of them, and after they found out the effect of it, they have gone on and taken it. There is no question but what enviromnent and bad associations is one of the big factors in men starting to using the drug. It has a tremendous hold upon them, however. We have men who come to the prison for a period of years who are drug addicts, and while they are there I am satisfied they do not get any of it, because we are very careful; in fact, a man in prison to-day is not permitted to have a visit from any member of his family unless he first goes into an adjoining room and strips, takes all his clothes off; his clothes are searched; he goes in and has his visit, and after the visit he goes back into the room, takes all of PBOHIBITTNG THE IMPOBTATION OP OPIUM 21 his clothes off, so that we use every precaution to stop smuggling of drugs into the prison, and I have no knowledge of any being in t&re to-day. But we know that 50 per cent of the men who are addicted to drugs come back to us. . The Chaibman. Doctor, might not this increase be explained somewhat by the nature of the effect of the drug as it has been ex- plained here, producing such an exhilarating effect at the time, and the aftereffect not being as disagreable as other opiates? Might that not to some extent explain the increased use? Doctor Squibes. Yes; I think that curiosity on the part of some men of criminal tendencies has increased the number of drug addicts. I mean that one of his friends or pals who has taken the drug and has spoken to him saying that it has such a delightful influence, and I think a great many of them start in that way. Mr. Tilson. Do you not think we might just as well face the fact and say that the difficulty in getting alcohol has caused a great increase in the drug addictions? Doctor Squibes. I do not know. Where I live it is not so difficult to get. [Laughter.] Mr. Tilson. I think the doctor is right in that regard, but is it not possible that some prefer to take it rather than alcohol ? Doctor Squibes. The effect of heroin is very much more severe on the body and mind than alcohol is, and there is less hope for a man who is an addict getting well than for the man who is an alco- holic getting well. Mr. Hadley. Doctor, you said that the average age of the addict was 23? Doctor Squibes. Yes; of those admitted to us. Mr. Hadley. Twenty-three for the addicts ? Doctor Squibes. Yes. Mr. Hadley. That would not correspond to the average age of addicts of liquor, would it? Doctor Squibes. Well, I do not know about that. Of course, I think the addicts of liquor to-day are very much younger than they used to be. My observation is that there are more young people — and I am speaking now as a professional man who takes care of patients — that more young people take alcohol to-day — I mean as to age — than they did some years ago. Mr. Porter. May I add, for the information of the committee, that during the hearings on the House resolution last year I asked every physician the question which you have asked, and the majority opinion was that prohibition had had no material influence on in- creasing drug addiction. Mr. McLaughlin. Doctor, I believe you made a statement to the effect that 50 per cent of the prisoners addicted to the use of these drugs come back to the prison ? Doctor Squires. Yes, sir. They take up the habit after they leave the prison and commit a crime, and we receive them back again. That is what I mean. Mr. McLaughlin. Can you tell us anything as to the State of mind or body of those who return, which gives evidence that they have continued to use the drug? Doctor Squires. The physical depreciation as the result of heroin, both physical and mentM, is enormous. The health of men who come 22 PKOHIBITING THE IMPOETATION OP OPIUM to US, who are drug addicts, is depleted to the extreme, and their mental equipment has been more or less disturbed, and I believe that if a man takes it for a number of years, a large percentage of them, depending entirely on the man himself, because you know as well as I that drugs affect different people in a different way — there are some types of individuals who I see in my hospital, who are per- manently injm-ed by the use of heroin, and those are the ones that will go out and commit crimes and come back to us as drug addicts. Mr. Porter. Pardon an interruption, hut the reason they commit the crime is their frenzy to get money with which to.buy more drugs, is it not? Doctor Squires. A large percentage of them; yes. Mr. Porter. It is not a desire to commit a crime, but the desire to get money with which to buy drugs? Doctor Squires. A large percentage of our men are there for grand larceny, because the taking of the drug is a very expensive luxury.* Mr. Porter. Do you recall that case in your State where four or five addicts went into a bank and shot the cashier and clerk? Doctor Squires. Yes. Of course that is a rather common crime. Mr. Porter. They were all addicts ? Doctor Squires. Yes. And the drug addict, they tell me, will spend as much as $48 a day to secure these drugs from the drug g eddler. The drug is adulterated with sugar or milk, and they ave to buy a lot in order to satisfy their craving. The Chairman. As I understand it then. Doctor, they commit crimes in older to get money to buy this drug? Doctor Squires. Not all of them; no. Some of them do. The Chairman. In some instances they do? , Doctor Squires. Yes. The Chairman. Now, right in that connection, I would like to ask another question. Do they commit crimes while they are under the influence of the drug — that is, does the drug create such a state of mind that they are more reckless? Doctor Squires. Yes; some of them never would commit the Clime if they were not in the state of intoxication due to the drug. Others will take it when they are more themselves, hut the craving is there and they will commit the crime in order to get the money in order to satisfy their craving. Mr. Porter. Doctor, can you tell the committee the percentage of the gunmen in New York who commit crimes of violence, who are addicted to the use of drugs ? Doctor Squires. I could not tell you that. Mr. Porter. Well, a great many of them are? Doctor Squires. A great many of them are. A man who takes heroin is particularly reckless. Mr. Crisp. What percentage — you stated it but I did not catch it — what percentage of the inmates of the prison are drug addicts? Doctor Squires. Of those admitted at the present time or last year, one out of every eleven, or 900 per cent increase over the average of six years prior to 1919. Mr. Chindblom. Nine or ten per cent? Doctor Squires. Yes; about 9 per cent. I can give you every year for several years. Mr. Crisp. I wish you would put that into the record. PROHIBITING THE IMPORTATION OF OPIUM 23 Doctor Squires. In 1917 there was four-tenths of 1 per cent of the total admissions who were drug addicts; in 1918 it was 1 per cent; in 1919, 1.2 per cent; in 1920, 2.2 per cent; in 1921, 6.5 per cent; in 1922, 9.1 per cent. Last year there was a falling ofl to 7.2 per cent, but the first six months of our fiscal year, which closes the 31st day of December last, it had increased again to 9 per cent. Mr. Watson. Have you evidence that men distribute candy with morphine in it, to children for the purpose of getting them to become addicts ? Doctor Squires. I have no personal knowledge of that. Congress- man, although that has been told me. Mr. Watson. That statement has been made, but it is very diffi- cult to believe. Doctor Squires. I have no authentic knowledge as to that. I did have a man in prison recently who admitted to me that he made an average of $125 a week peddling ‘‘dope.” Mr. Chindblom. You say that 50 per cent of the addicts come back to the prison? Doctor Squires. About 50 per cent. Mr. Chindblom. What percentage of the average run of prisoners come back? Doctor Squires. Oui* statistics show that 54 per cent of all the men that are admitted to Sing Sing prison have been convicted of a previous offense. They have either been in prison or got a suspended sentence. The last report of the State Prison Commissioner of New York State showed that out of those paroled from Sing Sing Prison, 91 per cent make good. Mr. Chindblom. Now, most of these men have had a preliminary incarceration in a local jail? Doctor Squires. Fifty-four per cent. Mr. Chindblom. No; I mean before they are tendered to the peni- tentiary^, they have had a previous incarceration in the Tombs or some jail, some county jail, or somewhere? Doctor Squires. Fifty-four per cent of our admissions have, yes. Mr. Chindblom. Well, all of them, practically, have? Doctor Squires. No. Mr. Chindblom. But they have been under aiTest. Doctor Squires. No. Mr. Mills. He means pending trial. Doctor Squires. They are all arrested, of course. Mr. Chindblom. What I am getting at is is this: They have already all been arrested, and a large proportion of them have been unable to furnish bail and have been compelled to languish in a local prison pending trial? Dr. Squires. Yes. Mr. Chindblom. Now, have you any information to the same effect as that which has been brought to me, that in these local prisons, in the county jails and the city jails and the lock-ups, there are men who peddle, who sell, these opiates, and really it is in those places where a great many of them acquire the habit? Doctor Squires. I do not know about acquiring the habit, but I do believe this, although I have no absolute information, that there are some institutions of confinement where men stay, where it has 24 PEOHIBITING THE IMPOETATIOH OF OPIUM been reported to me that they have secured the drug while they were in the jail. Mr. Chindblom. They are not as careful, they can not be as careful, as they ought to be? Doctor Squiees. I have no personal knowledge of anyone having acquired the habit there for the first time, but men who are drug addicts when they are arrested tell me frequently that they are able to procure drugs in the local jail prior to coming to Sing Sing. In fact, I know that is true, because some are brou^t to us who have been in jail waiting transfer to Sing Sing Prison, who are very much under t^e influence of drugs, so I know they have had it before arrival. Ml’. Hawley. Do you know what percentage of those committed to reformatories are drug addicts? Doctor Squiees. I do not know, but they get more of them than we do. Mr. Poeter. I have those records here. Doctor Squires. They get more of them than we do. Mr. Porter. Doctor, in your testimony before the Foreign Affairs Committee in February, 1923, you made this statement: The most prevalent drug used is heroin. Probably 75 per cent of the drug" users admitted to prisons take heroin. Doctor Sqltres. That should have been 96 per cent. Mr. Porter. In another place you testified: I believe that the large per cent of the men who are convicted of~ 3rime, who are drug addicts, would not have committed the crime if they had not been influenced by the drug habit. I have never seen a user who did not desire to be free from the habit; in fact, one of the most grateful patients that a physician has to deal with is the drug addict. Doctor Squires. That statement holds good to-day. Mr. Porter. That has been your experience, that they want to be cured of the habit ? Doctor Squires. They are, as the report says, the most grateful patients we have to treat. Mr. Hadley. In that connection. Doctor, you say that after the prison term, when they go out they fall into the habit again, after several years of incarceration? Doctor Squires. Yes, sir. Mr. Hadley. After they have had several years of treatment they go out, apparently cured, and yet they retain this desire and some- times lapse again into the habit? Doctor ScuiREs. Yes. That is due in a measure to the terrible influence that it has on the mentality, which to my mind is more or less permanent in some types of individuals. Mr. Ttlson. What treatment do you use? Do you use the “ taper- ing off” process? Doctor Sqttires. Sometimes, and sometimes not. We- use the tapering off or the gradual withdrawal of the drug in the case of those who have either organic or mental conditions which make me think that they should have that treatment. Most of them, however, I immediately withdraw the drug from. I do that because they get a very severe reaction, and I base that treatment on the thought that inmates have told me, who are drug addicts, that the remembrance- PEOHIBITING THE IMPOETATIOH OP OPIUM 25 of the withdrawal of the drug has been so vivid that it is a great deterrent to their taking up the d?ug the second time. We have never had any serious results from our treatment in that way. If we find that we can not do it, we give the gradual withdrawal, but if we can, I much prefer the immediate withdrawal of the heroin and substi- tuting some mild sedative, like bromide or some other drug of that •character, and in fact when they are coming to us with more than the one drug addiction, like morphine and heroin, of course we would, of necessity, cut out one of them. Mr. McLaughlin. Others who have testified have stated at more length than you have that the use of heroin induces a criminal state of mind. Doctor Sqihkes. It makes them reckless, and it inflates their personality. They are a good deal like a patient with paresis; the world is theirs, as it were. It inflates their personality to the extent that it makes them have a feeling of grandeur. The Chaieman. And do they in a measure lose their sense of right or vTong? Doctor Squiees. They do, indeed. They do not regard the prop- erty or person of another. But, as I say, just as you can expect that the influence upon any individual depends upon that individual, the same thing holds true with any drug. There are some people who take heroin and would not commit a crime at all, and there are others that it makes it easy for them to become criminals. Mr. Chindblom. Is there any real or frequent danger of fatal results from the total withdrawal of heroin? Doctor Squiees. I have often read. Congressman, of such results, hut we have never had any experience with such. I have often read where they commit suicide or do themselves bodily harm. We have never had it in our cases. Mr. Oldfield. Is there present great pain and suffering? Doctor Squiees. As a result of the vdthdrawal? Mr. Oldfield. Yes. Doctor Squiees. The greatest distress is the upsetting of the stomach, nausea and vomiting. They can not retain anything on their stomach. It is really quite pitiful. Mr. Ceisp. How long after you take them off of this drug, heroin, take the drug away from them, how long does the craving remain for the drug? Doctor Squiees. I would say, offhand, that the intense craving probably would last, maybe for a couple of weeks, but just so you get them so that they can take nourishment, they are all right. Of course you purge them quite severely, but it is perfectly wonderful how they will gain in weight. I have had men who were drug addicts who were greatly emaciated and would gain an average of 10 pounds a week for a period of 30 days. The Chaieman. Is there any antidote. Doctor? Doctor Squiees. I do not think so. You have got to treat them as the case presents itself. As I say, you can not treat any two of them alike, but if a man comes with us who has tuberculosis or some- thing like that, we never withdraw the drug in his case except grad- ually, but if he is a type which we study and make up our minds that he is one who can stand the withdrawal, we withdraw it and give him bromides or other sedatives, and he gets through it all right. 26 PEOHIBITING THE IMPOETATION OP OPIUM Mr. Porter. Doctor, you have described the suffering of the addict when the drug is withdrawn. Now, assume that the addict is free and he is unable to get the drug, is be not in a state of mind whereby he will commit almost any crime in order to secure money to buy the drug? Does that not explain the large increase of crimes of violence on the part of addicts ? Doctor Squires. I think, as I said before, that drug addiction produces a mental depression, I mean a lack of poise, which in some is more or less permanent, and they are more likely to come back with the habit than those who are of stronger mind. The craving, I have been told by those who are addicts, is tremendous, and as they get back with their old associations it is easy for them to pick it up again. Mr. Hadley. Doctor, do you agree with Doctor Richardson’s statement, which I understood to be to the effect that this drug serves no purpose which would not be better served by other drugs? Doctor SqmRES. I feel so. I have never used heroin. We have never had a grain of it in the prison hospital. I have never prescribed it on the outside of the prison. I am satisfied that we could do very well without it. Mr. Hawley. You found no case that would not yield under treat- ment, to other kinds of treatment? Doctor Squires. I have not. And I really believe that this reso- lution is about the only way that it can be stopped, by stopping the manufacture. Mr. Chindblom. In the event that the legal use or obtaining of it were stopped, and you would get cases which required a tapering off, could you use other drugs for that tapering off process ? Doctor Squires. I would not use heroin anyway for tapering off. As I say, I have never had a grain of heroin in the prison hospital, and even if j’^ou taper off, you taper off with something besides heroin. Heroin is three times stronger than morpliine. Mr. Chindblom. Then heroin would not be needed even for the taj^ring off process ? Doctor Squires. No; I never use it. As I say, we have never bought a grain of heroin in all the years I have been in Sing Sing prison. Mr. Porter. Just one other question, Doctor. The addict gener- ally starts with a small dose? Doctor Squires. Yes, sir. Mr. Porter. And it gr&duall}^ increases ? Doctor Squires. Increases, because he has to increase to get the same results. You vdll find that some of them really take more than they really ought to take, or should take, because they are afraid thej^ will not get enough. The amount that they take is really tre- mendous. We have had men with us who give a history of taking as much as 80 grains a da)". I would say that the average dose of heroin among addicts is from 15 to 25 grains. Mr. Hawley. What is the toxic dose? Doctor Squires. That depends on j'-our make-up. The medicinal dose is one-twentieth to a sixth of a grain. I would hesitate to take a grain, although I might take it and get away with it. Mr. Chindblom. Do you happen to know the commercial price of heroin ? PEOHIBITING THE IMPORTATION OF OPIUM 27 Doctor Squires. I have not the slightest idea of the commercial price. I have never purchased it. Mr. Chindblom. Of course the price by illegal sellers would be way beyoud the commercial price. Doctor Squires. There is a considerable waste to it, of course, especially with those who snuff it. You can see that there would be. In other words, a man buys quite a little heroin, and if he snuffs it he loses more or less in the air, and it drops from his nose. Mr. Treadway. Is that a very general way of using it ? Doctor Squires. Yes. Mr. Treadway. The principal way? Doctor Squires. No; but it is one of the very frequent ways of using it, by snu ffin g it. And among the criminals it is no uncommon thing, if they can not get a hypodermic needle, to take an ordinary pin and poke a hole in their arm and take the heroin and rub it over the hole. We find that very common. Mr. Dickinson. Is it ever taken by capsule in the mouth? Doctor Squires. Yes; you can take it internally, hypodermically, or snuff it. It is a very convenient drug to take. Mr. Dickinson. But you can take it by capsule in the mouth just like morphia? Doctor Squires. Yes, or in tablet form. You can buy the heroin powder and put it in a capsule, or you can have the heroin tablet made. Mr. Dickinson. And swallow it ? Doctor Squires. Yes. Mr. Treadway. In what form is it generally peddled ? Doctor Squires. In powder. They sell it in powder. They have what they call “decks,” heroin put up in so many little powder papers. Mr. Porter. Doctor, what is the condition of the arms and legs of an addict who has used it hypodermically for two or three years? Doctor Squires. These addicts — we are so cautious about this to-day, it being such a common thing in prison, that when a man arrives at the prison, the very first day after he has taken his. bath he is brought to the hospital and stripped, so that we can go over him to see ivhether he has any old scars of hypodermic needles on his arms or legs or body. Of course, those who have been snuffing it might get away with it and I would not notice it. It is a very difficult thing to tell whether a person is an addict if he hasn’t got the scars, providing he only tak&s a little bit of it, as long as he gets a sustaining quantity of it. It is when it is removed from a man or he gets too much that the medical man has a chance to detect it. You can see how that would be. But these men who have scars — and I would say offhand that probably 95 per cent of them have some time or other used the hypodermic needle or used a pin, and of course, not being careful in the sterilization, they get up an abscess. Only recently we had a man come in who had 14 great big abscesses on various parts of his body, which neces- sitated my opening the day he arrived. He had evidently bor- rowed a needle and did not have it sterilized, and, of course, neces- sarily it got contaminated and these big abscesses formed. But we have got men in the prison on whom there isn’t hardly a square inch of their body that is not an old scar of an abscess, not only the 28 PROHIBITING THE IMPORTATION OF OPIUM extremities, but their abdomen, and they often have them in their back, where some friend has injected the drug in their back to get a place where they did not have a previous sore. The Chairman. Is that all you care to say. Doctor? Doctor Squires. That is all, I believe. Mr. Porter. I would like now to have you hear Dr. Rupert Blue. STATEMENT OF DR. RUPERT BLUE, UNITED STATES PUBLIC HEALTH SERVICE Mr. Porter. Doctor Blue, how long have you been conected with the*United States Pubhc Health Service? Doctor Blue. Nearly 32 years. Mtr. Porter. You are now stationed in Paris, I believe. Doctor Blue. I am at present on leave of absence, but I expect to retimn to Paris in a short time. Mr. Porter. Have you made a study of heroin and its uses ? Doctor Blue. To some extent; yes. Mr. Porter. Will you state to the committee your views in regard to this resolution? Doctor Blue. Mr. Chairman and gentlemen of the committee, I am heartily in favor of the bill. If enacted into law, it will suppress the manufacture of the most harmful of all habit-forming drugs. During the past decade the heroin habit has spread over a vast section of the country, particularly among the younger generation of the large cities. Adequate measures should be introduced at once for the suppression of this evil. As far back as 1916 the Public Health Service, as stated by Mr. Porter, prohibited the use of heroin in the United States marine hos- pitals and dispensaries under its control, and recalled all supplies of the drug that had been issued by the purveying station. This action was based on the belief that the administration of the drug was dan- gerous and that the need for a respiratory sedative in medicine could be met by the employment of codeine, which can be used with less d.anger of creating habituation. In discussing the situation with prominent medical men, the conclusion was reached that elimination of the drug would not inconvenience physicians nor deprive patients of a useful remedy in disease. It is gratifying to note that similar action has been taken by the medical departnaents of the Army and Navy and the Veterans’ Bureau. That the suppression of dangerous and unnecessary drugs is interesting the world is reflected in the action of the International Office of Public Health at Paris. Mr. Porter. You are connected with that office as the repre- sentative of the United States? Doctor Blue. Yes, sir; I am the American delegate. In April, 1923, upon the suggestion of the American delegate, this representa- tive body of medical men issued through the French foreign office a circular letter to the signatory powers requesting information rela- tive to the advisability of suppressing heroin. Up to October last replies had been received which indicated that the majority of the States would vote in the affirmative. The Italian delegate presented the results of the inquiry made in Italy. Of 58 physicians to whom PBOHIBITING THE IMPOBTATION OF OPIUM 29 the questionnaire had been sent, 30 voted in favor of the suppression and 18 against. The question of the suppression of heroin has also been considered by a comittee composed of members of the Opium Commission and the medical section of the League of Nations. In 1923 this com- mittee adopted the following resolution: In view of the fact that a question is being raised as to the possibility of pro- hibiting the manufacture of heroin, the subcommittee thought it might give its opinion from the medical point of view and might state that the mixed sub- committee, composed of technical experts, agrees, having regard to the small therapeutic value and harmful effects of heroin, to advocate the prohibition of its manufacture. This resolution will be considered by the advisory committee of the league at its next meeting. In 1920 the Surgeon General of the Public Health Service forwarded a questionnaire on heroin to some of the leading physicians and surgeons of the United States. Sixty-six physicians replied to the question as to whether heroin could be replaced in medical science by the substitution of codein or morphine. Of this number 46 voted in the affirmative and 20 in the negative. Mr. Hawley. You think that is a fair average of how the medical profession generally would vote, or would there be a stronger opinion in favor of the suppression? Doctor Blue. I think if the facts which have been brought before your committee to-day were generally known, the profession would be pretty nearly unanimously disposed towards its suppression. Mr. Hawley. You think they would follow the conclusions of the American Medical Association? Doctor Blue. Yes, sir; in this connection it should be stated that some authorities oppose the prohibition of the drug on the ground that since the use of all opiates by addicts is now forbidden by law, it is very doubtful if the interdiction of heroin would have any notice- able effect in diminishing its use. That is a very strange idea. They also assert that the amount used at present is the smuggled article, and that it is not understood how its interdiction would in any way interfere with smuggling. These views are evidently based upon a misconception of the meaning of the present movement. It is the hope of physicians, both at home and abroad, to secure the prohibition of manufacture by international agreement, and thereby to eliminate the drug from the field of therapeutics for all time. Besides, it is not at all certain that all heroin used by American addicts is smuggled from abroad. Mr.- Treadway. Can you tell uS right there. Doctor, how difficult it is to irianufacture heroin from opium? Doctor Blue. No, sir. I have no special knowledge of pharma- Mr. Treadway. It seems to me this question of smuggling would be involved in the ability of smugglers to transfer the opium to heroin. Mr. Porter. May I suggest this, that there is very little smuggling of opium, because it does not pay to do it. It is more profitable to smuggle morphine and heroin into the United States. There is no inducement to make heroin from opium. The Chairman. Have you several more witnesses, Mr. Porter? 96182—24 3 30 PROHIBITING THE IMPORTATION OP OPIUM Mr. Porter. No; the doctor is my last witness, except I have some documentary evidence. The Chairman. The reason I spoke was, I would like to go into executive session on another matter before we adjourn this morning, and I thought if you had more witnesses we would set a further hearing this afternoon. Mr. Porter. That would be entirely satisfactory, if you will fix the time. The doctor can complete his testimony and we can come back this afternoon. The Chairman. You would not be able to conclude by 12 o’clock? Mr. Porter. No. Mr. Treadway. Mr. Porter, may I suggest, just as corroborative evidence, that the appearance of the representative of the office of the Surgeon General of the Army and the Surgeon General of the Navy might be worth while, or do you think it is unnecessary ? Mr. Porter. I will leave that entirely to the committee. I have here the official action of the Army and Navy prohibiting the use of the drug. Mr. Tilson. They both issued general orders on that. Mr. Porter. Yes; they are in the record. Mr. Crisp. I don’t see how they can supplement anything. The Chairman. We will suspend this hearing at this time and go into executive session, and for the information of the audience I will state that executive session means that only members of the committee are present. We will resume the hearing at 2 o’clock this afternoon in my office in the Capitol. (Whereupon, at 12 o’clock noon, the committee recessed until 2 o’clock p. m. this day.) after recess The committee reassembled, pursuant to the taking of recess, at 2 o’clock p. m. The Chairman. Mr. Porter, you may proceed. Mr. Porter. Mr. Chairman, I would like the committee to hear Doctor Blue, former Surgeon General of the United States Public Health Service. Doctor, will you give the committee a definition of heroin? STATEMENT OF DR. RUPERT BLUE, FORMERLY SURGEON GENERAL UNITED STATES PUBLIC HEALTH SERVICE— Resumed. Doctor Blue. Heroin, diacetyl-morphine, as its name implies, is an artificial aklaloid obtained from morphine. It w^as discovered by a German chemist in 1898. For some years it was believed that an agent had been found that could be used as a substitute for morphine without causing constipation or creating a habit. It resembles morphine in its general effects, but acts more strongly on the respiration, and is therefore more poisonous. While heroin does not cause constipation, it does undoubtedly create habituation even in a greater degree than any other drug. It is used chiefly to allay cough in certain diseases. Some author- ities claim that in addition to its general effect heroin inflates the personality and exaggerates the ego to a dangerous extent. PROHIBITING THE IMPORTATION OF OPIUM 31 It may be of interest to quote the opinions of a few technical ex- perts on this subject. Mr. Porter. We would like very much to have those. Doctor Blue. Doctor Richardson this morning gave here the opinion of the experts of the American Medical Association, as formu- lated by a committee appointed by that association to study the narcotic drug situation in 1920. Doctor Bastedo, of the Medical Department of Columbia Univer- sity, concludes, after an exhaustive investigation and prolonged study of these drugs, that heroin is not an effective or safe substitute for morphine or codeine. In a number of tests codeine proved superior in its power to allay cough, to overcome pain, and to pro- mote sleep. Like morphine, heroin is the cause of a vicious habit. Professor Cushney, of Edinburgh, states that the advantages claimed for heroin (action on respiration,) by its advocates, have not been confirmed by an impartial investigation. Mr. Porter. Cushney is one of the leading authorities of Great Britain, is he not? Doctor Blue. Yes; he is a professor at the University of Edin- burgh, Scotland. The Viennese expert. Professor Knaffe-Lenz, says that — Heroin is incomparably more poisonous than morphine, and the therapeutic dose is not appreciably smaller than the toxic dose. For this reason German pharmacologists warned physicians from the beginning against the use of this remedy, and pronounced it to be not indispensable. It therefore does not satisfy the requirements of a substitute for morphine. He goes on to state that it is much more suitable for abuse than morphine, and produces physical collapse more rapidly than that drug. In view of these facts, heroin has never been em- ployed to any great extent in Germany or Austria, and is hardly used at all in nursing homes and public hospitals in those countries. Mr. Hawley. Why is it a more dangerous habit-forming drug? What is the physiological reason for that ? Doctor Blue. I might enumerate the causes of addiction, in reply to that question. In considering that phase of the problem, I would place the excessive production of narcotic drugs, the association with addicts, and persuasion by drug peddlers, as the chief causes. Mr. Hawley. Are those the causes that lead to its use? Doctor Blue. Yes. The small dose and bulk facilitate smuggling and secret addiction. Mr. Hawley. Why is it the most dangerous habit-forming drug? What is the reason for that ? Doctor Blue. It produces physical and mental collapse more rapidly than any other habit-forming drug. Mr. Hawley. Does it create an appetite for itself? Doctor Blue. Yes. Authorities say that a dangerous drug is one which produces a marked tolerance leading to an increase in dosage, craving for the effects of the drug, and disregard of the dis- agreeable after effects. Heroin possesses all of these properties. Mr. Crowther. In what way does it differ from the derivative, codeine? Codeine is used in one proprietary preparation, I think, very extensively. How does it differ in the method of preparation? Doctor Blue. As to the physiological effects? Mr. Crowther. Yes. 32 PROHIBITING THE IMPORTATION OE OPIUM Doctor Blue. It is not exactly the same; codeine is very much weaker in its action and is not so likely to lead to habituation. Mr. Porter. Is it a pure alkaloid? Doctor Blue. Yes. Mr. Porter. But heroin is the most powerful and most dangerous? Doctor Blue. Yes. Mr. Croavther. Codeine is a pure alkaloid? Mr. Porter. It is one of the minor alkaloids of opium. Doctor Blue. There are authorities who claim that the use of ^ codeine does not lead to a habit. 1 Mr. Crowther. I think that might be true" because I have known of its use for many years and by a great many people, and it did not seem to create any habit. Doctor Blue. While that may be true, I believe that whenever the more potent drugs have been thoroughly controlled, that addicts will take to codeine. Mr. Crisp. Does the use of heroin shorten the life of the addict; that is, does the addict of heroin finally die quicker than the addict of morphine? Doctor Blue. The drug being more poisonous, I think it does shorten the life of an addict more rapidly than would morphine. Mr. Hawley. The gentleman who appeared before the committee this morning representing the medical service at Sing Sing indicated that an addict of heroin was practically a useless citizen; that his moral sense was gone, that all sense of responsibility was gone, and that he had lost all the essential qualities of manhood. From your observation, do you agree with that statement? Doctor Blue. I am not an authority on that phase of the problem, but am strongly inclined to agree with the doctor. The Chairman. As I understand you, you do consider heroin a very much more dangerous drug than codeine? Doctor Blue. I do. f Mr. Oldfield. More dangerous than morphine, cocaine, or any | of those drugs? | Doctor Blue. Yes. That is true. f Mr. Hawley. Some witness this morning said, I think, that { heroin is three times more powerful than morphine. V Mr. Crowther. Snuffing is the favorite method of the addicts ? ,• Doctor Blue. Yes; it depends on the drug. ; Mr. Crowther. I am speaking of heroin. The Chairman. That was the testimony this morning — that that was the more common method of using it. Is there anything further you desire to elicit from this witness ? Mr. Porter. Nothing further, Mr. Chairman. The Chairman. Have you any more witnesses? Mr. Porter. No; but I have some documents I desire to put in the record, and I ask the indulgence of the committee while I quote a few extracts from some of these documents. Dr. S. Dana Hubbard, director of the bureau of public health education of New York, said, in a letter to me of February 13, 1924: I feel that in medical practice heroin is a dangerous drug, and, if possible to be obtained by drug addicts, it is even more dangerous, as it combines the stimulating qualities of cocaine with the sedative effects of morphine. PROHIBITING THE IMPORTATION OF OPIUM 33 Attached to his letter to me is a statement by the department of health, 505 Pearl Street, New York City, entitled, “Is heroin a neces- sary drug ? ” If the committee desires, 1 will read it. Mr. Hawley. I suppose the conclusions are negative ? Mr. Porter. It is very strongly negative. It says; Department of Health, New York City. SHOULD THE MANUFACTURE OF HEROIN BE INTERDICTED? It is our opinion that interdiction is indicated owing to the promiscuous and improper use of this drug by the addict and the rather infrequent use of this drug in general medical practice. The narcotic clinic operated to study first-hand drug addiction by the depart- ment of health of New York City demonstrated that of 7,464 narcotic drug addicts over 90 per cent of them were addicted to the use of heroin. In 69 per cent of the total clinic applicants the drug habit had been acquired through evil associates. The vast proportion of these were all under 30 }^ears of age. The A. M. A., house of delegates, expressed the opinion of physicians through- out the United States, as follows: “That heroin be eliminated from all medical preparations. “That heroin should not be administered, prescribed, or dispensed by physi- cians. “That the importation, manufacture, and sale of heroin should be prohibited in the United States.” This resolution is now three years old, and there has not been a single protest- ing resolution from any associated doctor or medical organization. It, there- fore, must be the conclusion of the profession regarding this action. The recent report of special deputy police commissioner of New York City regarding three 3 'ears’ experience in scrutinizing the “dope” evil is also corro- borating, at least statistically. Of 9,637 persons arrested in the three past years 6,892 were addicted to heroin or cocaine, singly or combined. The average age of the addicts in 1921 was 25 j’ears, while in 1923 it ranged between 27 and 28 years. This official, also a phj’sician, also reports, that only 2 per cent of those arrested can trace their addiction to medical treatment. The major causes were found to be “curiosity', morbidity', and criminal association.” Hence we maj' conclude that 98 per cent of nearly 10,000 drug addicts acquired their vice through curiosity, morbidity, and criminal association and that 71 per cent of the total were users of heroin. PUBLIC SERVICE AND HOSPITAL USE INTERDICTED In the United States Army the use of heroin has been interdicted b\' order of the Surgeon General. In the United States Navy the use of heroin has been interdicted by order of the Surgeon General. In the United States Public Health Service, the use of heroin has been inter- dicted by order of the Surgeon General. The health commissioners of Chicago and New York City simultaneously expressed themselves: “Stop the use of heroin in all hospitals. It serves no purpose that other agents can not accomplish as effectivehq and without the attendant possibility’ of disaster.’ ’ Of 236 hospitals, institutions, and sanitaria, more than 50 per cent have re- quested their medical staff to comply with the request of the health commissioner regarding heroin. Prof. E. G. Janeway', Bellevue Hospital, 1892, advised his house staff against the use of heroin, praticularl.y stating that heroin used in penumonis was invari- ably followed by' a fatal result. Prof. Alfred Loomis, New York University, professor of medicine, taught his students to “beware of so insidious and baneful a drug which more often was a menace than a help.” Professor Thompson, New York University, professor of materia medica, taught that “it -was a dangerous and unnecessary drug.” 34 PROHIBITING THE IMPORTATION OF OPIUM Prof. A. A. Smith, Bellevue, professor of materia medica, informed his class of students that heroin was uncertain and not dependable and was more often a danger than a help. Professor James, professor, Columbia, informed the writer some years ago that he had never had occasion to use the drug and was inclined to think it was super- fluous and that being used as it was by addicts it was a menace. Professor Lambert, Bellevue Hospital, an expert of over a quarter of a century on habituation, is opposed to the therapeutic use of heroin. THE GRAVE DANGER OF HEROIN The appalling feature of drug addiction is that heroin makes addicts quickly; that its victims are mere children in years and experience; that through insuffla- tion, ingestion, or subcutaneous injection its effect is well nigh instantaneous. The physiological effect of heroin is to benumb the inhibitors and make of moral cowards brutal, brainless men, without fear and without conscience. Lambert expresses the effect by stating that it “inflates the personality and exaggerates the ego.” There can be but one, or should' be but one, answer to the question — heroin should be totall\- and absolutely abolished by all nations. It will always be necessary to fight the use of opium and its derivatives in drug habituation, but this war will be made easier by the absolute annihilation of this baneful and useless drug. Heroin is the drug used by addicts of over 95 per cent of New York’s under- world (criminal classes), according to the statistics of the police and prison sta- tistics, and the unfortunate part of the situation is that less than 1 per cent of these miserable creatures acquire the habit through illnesses. Heroin is not a necessity in either medicine or art. All of its useful qualities can be easily and safely replaced by other alkaloids of opium. It is earnestly hoped that everyone will become interested in this effort to awaken the public — here and abroad — to the necessity of preventing the manu- facture of heroin. This in the interests of social welfare and economic safety from criminal imposition. The only way to successfully fight this peril is through legislation forbidding its manufacture, and, by international agreement with all nations participating, not only to forbid the manuhrcture but to prevent importation from or exporta- tion to any land. The heroin question is not a medical one, as heroin addicts spring from sin and crime. It is a social problem where the medical and pharmaceutical and allied professions can do much to aid in solving this serious problem. Society in general must protect itself from the influence of evil, and there is no greater peril than that of heroin. S. Dana Hubbard, M. D. Mr. Crowther. Is it recognized in the United States Pharma- copoeia, and is it in a general way dispensed, on prescriptions, by our physicians ? Mr. Porter. No. Heroin was discovered in 1898; it was adver- tised all over the world as a substitute for morphine. But in three or four years the medical profession discovered that it did not have the qualities it was said to have and it has gradually fallen into disuse. The Army, the Navy, the Public Plealth Service, and the Veterans’ Bureau all have forbidden its use, and the American Medical Associa- tion has declared against its use. Mr. Hawley. One witness said that only 50 grains had been pre- scribed in New York State. Mr. Porter. Yes. Judge Collins, of New York, is a very well informed man on the subject. PROHIBITING THE IMPORTATION OF OPIUM 35 I have a letter from him in which he says: February 11, 1924. Judge Cornelius F. Collins, New York, N. My Dear Judge Collins: It is inj- purpose within the next few days to introduce a bill prohibiting the importation of opium into the United States to be used for the manufacture of heroin. I have before me a memoranda on International Control of Heroin giving the opinions of many reliable authorities that the use of herpin should be prohibited. You are quoted as follows: “A study of the statistics in New York County alone indicated that, while the evil in so far as the use of morphine, cocaine, and opium was a serious one, the whole three of them put together were not nearly as serious as the growth of the heroin habit. The heroin habit has grown to extremely large proportions in a way that was absolutely appalling, distressful not only to the well-being of those addicted, but to the well-being of the State, because, if per- mitted to continue in the degree in which it has taken root, it would threaten very dire results and conditions which would call for general public activity.” I am writing a similar letter to all of the other authorities quoted in the memoranda and if you are correctly quoted I intend to insert your views in the record and thus avoid the necessity of inconveniencing a great many people, who otherwise would be asked to testify. If you desire to add anything to what you have already said on the subject I assure you the committee would be glad to have the benefit of such addition. A prompt reply will be appreciated as the hearings will begin the early part of next week. . Very truly yours. Chairman Foreign Affairs Committee, House of Represejitatives. New York, February 15, 1924- Hon. Stephen G. Porter, Chairman Foreign Affairs Committee, House of Representatives, Washington, D. C. My Dear Congressman: I am in receipt of your communication of February 11, 1924, relative to the proposed bill prohibiting the importation of opium into the United States to be used for the manufacture of heroin. I am correctly quoted in your communication, and am forwarding to you a monograph from which the quotation was taken. It was written while I was a judge of the court of special sessions and chairman of the drug evil committee of the State associa- tion of magistrates. Permit me to call your attention to a further quotation on the same subject on pages 9, 12, and 13 of the monograph. I believe that there is a general consensus of opinion in the medical profession that heroin could be discontinued without interfering seriously with the treatment of disease. In other words, heroin has no function that can not be supplied by other opium derivatives. I assume that jmur bill will provide for the prohibition of the importation of heroin as such, as well as opium to be used for the manufacture of heroin. . I would be very happy to be of any further service to you in this connection. Faithfully yours. Cornelius F. Collins. Mr. Crowther. Is heroin manufactured in this country? Mr. Porter. Yes. Mr. Crowther. Who manufactures it ? Mr. Porter. All of the pharmaceutical chemists. Mr. Crowther. Did we not have a bill at one time to prevent its manufacture ? Mr. Porter. To prevent its importation. Mr. Crowther. This bill is to prevent the importation, is it not? Mr. Porter. No; this bill is to prevent the importation of opium to make heroin. All of the alkaloids are prohibited, and thev can only bring in the raw material, the cocoa leaves or opium. 36 PROHIBITING THE IMPORTATION OF OPIUM Do not forget this, gentlemen: There are dishonest physicians, just the same as there are dishonest people in all walks of life. There are dishonest physicians who will prescribe this drug if its manu- facture is not prohibited, and price would be no object. Mr. Hawley. In addition to that, it was discovered not long ago that fake colleges are issuing fake medical certificates. The peo;^e who have taken those certificates would have no conscientious objections to dispensing a drug like this. I desire to insert in the record the reports which I have from a niunber of penal institutions in this country, for the purpose of showing the rapid increase in crimes committed by addicts. I have here a report from the Leavenworth prison. Of course, that being a Federal prison, and many of these cases being tried in the Federal courts, it is natural to find a higher percentage of addicts at Leavenworth than in the State prisons. The report shows an alarming increase. United States Penitentiary, Leavenworth, Kans., November 10, 1923. Hon. Stephen G. Porter, Chairman Committee on Foreign Affairs, House of Representatives. Sir: In compliance with your request of date October 26, 1923, relative -to number of prisoners and drug addicts in this institution, I am submitting the following: Aver- age popu- lation Pris- oners re- ceived Viola- tion drug act Drug addicts Aver- age popu- lation Pris- oners re- ceived Viola- tion drug act Drug addicts 1914... 1, 019 463 15 3 1919 1,895 1,300 57 72 1915 1,160 936 15 12 1920 i;890 1, 147 94 64 1916... i, 664 1, 116 48 47 1921 l' 721 1,205 247 64 1917 1, 677 '705 31 29 1922 2,242 l', 686 498 263 1918 1, 613 1, 144 53 50 1923 2,473 1,482 717 299 From July 1, 1923, to October 31, 1923, we received 417 prisoners. Of this number 138 was for violation of the Harrison Narcotic Act and 41 admitted they were habitual users. Respectfully, W. I. Biddle, Warden. Mr. Hawley. Have you made any inquiry into the number of addicts committed to the reformatories in the several States for first offenses, and do you know what proportion of prisoners in institutions of that kind are addicts ? Mr. Porter. No; I do not. I have here a report from the city workhouse of St. Louis, Mo. : City Workhouse, St. Louis, Mo., H. N. Morgan, superintendent Number of prisoners or inmates in institu- tion for the year Number of addicts in same year 1914 2,809 140 1917 2,775 166 1918 2,603 260 1919 2,079 304 Number of prisoners or inmates in institu- tion for the year Number of addicts in same year 1920 1,472 176 1921 1,730 242 1922. 2,074 311 1923 1,800 324 PROHIBITING THE IMPORTATION OP OPIUM 37 This report shows a steady increase, to which I have already called your attention. In the Atlanta Penitentiary there are Federal prisoners only. They had no report for 1914 or 1917. Their figures are given in percentages. In 1918, it was 11 per cent; in 1919, 6 per cent; in 1920, 8 per cent; in 1921, 15 per cent; in 1922, 20 per cent; in 1923, 18 per cent. This report shows that one-sixth, or perhaps one-fifth, of the crimes committed by men sent to the Atlanta Penitentiary were com- mitted by addicts. If •you couple that with the facts shown in the former testimony, which is to the effect that heroin is the drug used in at least 90 per cent of the cases, it makes out a very damaging case against heroin. United States Penitentiary, Atlanta, Ga., A. E. Sartain, warden Number of prisoners or inmates in institu- tion for the year Number of addicts in same year Per cent Number of prisoners or inmates in institu- tion for the year Number of addicts in same year Per cent 1914 453 1920 1,492 128 8 1917 . 812 1921 1,508 235 15 1918 1,216 134 11 1922 1,707 352 20 1919 tm 71 6 1923 1,847 336 18 Mr. Crisp. While the statistics are appalling, and I am heartily in sympathy with the bill, is it not true that the penitentiaries at Leavenworth and Atlanta would have a higher percentage of that class of prisoners because the prosecutions of the violations of the Harrison Narcotic Act are tried in United States courts and the prisoners are sent to those penitentiaries ? Mr. Porter. That is correct. Then there is another feature which you should take into consideration. We should not caU these unfortunate people drug fiends. My in- vestigation has been a very thorough one, and it convinces me that 95 per cent of them are victims of misfortune. As Doctor Squires told you this morning, the addicts want to be cured, and yet, curious as it may seem, the addicts always want to make addicts of other people. I venture to say that 10 per cent of the addicts in the penal in- stitutions have gone there voluntarily, or have committed some minor offense so as to be sent to a penal institution in the hope that the restraint would cure them of the habit. . Mr. Treadway. In that connection, are there many addicts in private institutions, not penal institutions ? Mr. Porter. Yes; but I have no means of getting those figures. Mr. Treadway. No doubt there are many of them. Mr. Porter. Yes. Mr. Hawley. Have you made inquiry as to the number of addicts m insane asylums ? Mr. Porter. No. Mr. Hawley. Does this drug produce insanity? 38 PROHIBITING THE IMPORTATION OF OPIUM Mr. Porter. Undoubtedly. Doctor Blue. Oh, yes. Mr. Hawley. Do you know whether any investigation has been made as to the percentage of inmates in the insane asylums who became insane by reason of drug habits'? Doctor Blue. 1 do not think there are any statistics available on that subject. Undoubtedly there are persons made insane by the use of these poisonous drugs. Mr. Chindblom. Many of the State institutions classify the inmates according to the causes of insanity. There may not be general statistics on that subject, but I am sure you can get that information from the reports of the various State institutions. Ml’. Porter. Take the Kansas State .Penitentiary in the Middle West, and you find the record there not nearly so bad as the ones I previously referred to. In 1914 there were 21 addicts out of 734 prisoners; in 1923 there were 42 addicts out of 1,138 prisoners. Kansas State Penitentiary, Lansing, Kans., A. V. Anderson, warden Number of prisoners or inmates in institution for the year Number of addicts in same year Number of prisoners or imnates in institution for the year Number of addicts in same year 1914. 734 21 1920_ - - - 617 32 1917 736 26 1921 748 30 1918. 626 28 1922 . - 998 38 wre 466 24 1923 1, 138 42 Note. — The best we can do to give you the number of drug addicts will be to refer you to Table No. 9 of the biennial report we are sending under another cover. The prison department, State of New York, reports as follows: Prison Department, Albany, November 27, 1923. Hon. Stephen G. Porter, Chairman Committee on Foreign Affairs, House of Representatives. Dear Sir: I inclose questionnaires which have been filled out at the various prisons under this department, as requested in your circular letter of October 26. Yours very truly, C. F. Rattigan, Superintendent. Auburn State Prison, Auburn, N. Y ., E. S. Jennings, warden Number of prisoners or inmates in institu- tion for the year Number of addicts in same year Number of prisoners or inmates in institu- tion for the year Number of addicts in same year 1914 716 1920 685 11 1917 671 2 1921 675 27 1918 827 4 1922 999 23 1919 509 10 1923 - - 546 27 PROHIBITING THE IMPORTATION OF OPIUM 39 Sing Sing Prison, L. E. Lawes, warden Numtei' of prisoners or inmates in institu- tion for the year Number of , addicts in same year ! Number of prisoners or inmates in institu- tion for the year Number of addicts in same year 1916 940 10 1920 1,490 33 1917 1,071 1, 197 1,073 4 ! 1921 1,414 1,450 93 1918 11 i 1922 132 1919 13 1923 910 55 Nb figures are available tor years prior to 1916. Clinton Prison, Dannemora, X. Harry M. Kaiser, warden Number of prisoners or inmates in institu- tion for the year Number of i addicts in ' same year Number of . prisoners or inmates in institu- tion for the year Number of addicts in same year June 30 — June 30 — 1914 1,418 1920--- 969 1917 1,227 1921 1.207 128 1918 ■ 1)311 1922 1, 380 146 1919 1, 171 1923 1,381 City Workhouse, Minneapolis, Minn., S. 0. Lockwood, M. D., superintendent Number of prisoners or inmates in institu- tion for the year Number of addicts in same year / j Number of prisoners or inmates in institu- tion for the year Number of addicts in same year 1914 5, 577 60 ! 1921 2, 907 84 1917.*. . 5, 515 59 ' 1922 4, 398 108 1918 3, 148 60 1 1923, to and including 1919.. 2,376 49 I Nov. 13 3,682 87 1920 1, ,542 60 i The New York State Drug Control Commission made a careful investigation of this matter, and I have two excerpts from their report which I would like to put in the record, as follows: New York City is peculiar in its form of drug addiction, for over 90 per cent of its drug users are addicted to heroin, the strongest and most powerful of habit- forming drugs, the most detrimental in its effect upon the users, and the habit which is most difficult to combat. (P. 6, Report of New York State Drug Con- trol Commission.) In the recent New York City drug clinic, out of 7,464 addicts treated from April 10, 1919, to January 16, 1920, 69 per cent were under 30, 39 per cent under 24. (P. 16, Report of New York State Narcotic Drug Control Commission.) RESOLUTION OF THE AMERICAN MEDICAL ASSOCIATION The house of delegates of the American Medical Association, at its seventy- first annual session, at New Orleans, in 1920, adopted the following resolution; “That heroin be eliminated from all medicinal preparations, and that it should not be administered, prescribed, nor dispensed; and that the importation, manu- facture, and sale of heroin should be prohibited in the United States.’’ William C. Woodward, - Executive Secretary, Bureau of Legal Medicine and Legislation. 40 PROHIBITING THE IMPORTATION OF OPIUM I would like to read into the record from pages 9, 12, 13 excerpts from an article by Judge Cornelius F. Collins, justice court of special sessions, city of New York (December, 1918) : The drug committee was continued last year. After the legislature had ad- journed and a study of the conditions was made it was learned that instead of the drug evil decreasing it had, on the contrary, increased, and a very deplorable state of affairs existed throughout the State, and particularly to a very baneful extent in the city of New York. A study of the statistics in New York County alone indicated that while the evil in so far as the use of morphine, cocaine, and opium was a serious one, the whole three of them put together were not nearly as serious as the growth of the heroin habit. The heroin habit has grown to extremely large proportions in a way that was absolutely appalling, distressful not only to the well-being of those addicted, but to the well-being of the State, because if permitted to continue in the degree in which it has taken root it would threaten very dire results and conditions which would call for general public activity. A studjr of the facts indicated that the heroin habit strikes praticularly the youth. While a great deal has been said of addiction on the part of children, it is quite negligible. In the children’s court a drug addict is quite rare. At the age of 16 even there were no drug addicts for three months in special sessions. Yet, as if nature drew the line, from 16 years of age on they were quite common. Between the ages of 17 and 22 there were such a large number of heroin victims that the average age of victims may be fixed at 22 years, and that average age is made up in the period of five or six years — that is, the years between 17 and 22 — thus showing that it strikes the youth particularly. We know, all of us, the horrible examples of those conditions. We see young men almost destroyed, absolute shadows of their former selves, with will, memory, and understanding impaired, “the pale youth” Markham describes combating in frenzied fancy their “Phantoms that fling wild laughter and wild tears into the crater of the wasted years,” with no normal sense of right or wrong, with a pronounced atti- tude to embrace the wrong, even though contrary to the nature of the individual. At least one-tenth of the whole of the business of the court of special sessions of New York County is made up of drug addicts, those possessing the drug or hav- ing dealt in it in some way. This means 10 per cent of all the cases coming into our court, a large part of which do not involve moral turpitude. In addition to the number of these addicts, as such, come quite a large number charged with larceny, assault, unlawful entry, and the like, who are nevertheless addicts, so that it is safe to say that in 20 to 30 per cent of the cases coming into the court of special sessions involving moral turpitude the culprits are given to drug addic- tion in some form or other. This is such a horrible situation that it brought home to all of us the absolute necessity for the doing of something which meant business in the attempt to control this evil. We men throughout the State who daily see the procession of these pale youths, victims of the drug habit, may be said to be men who are not unduly worked up over anything. We are somewhat like an undertaker, inured to the corpse. On page 13 he says: Heroin is undoubtedly the most pernicious, both as to the number of its vic- tims and the difficult 3 ’ of overcoming its ravages. It seems that the habit is more quickly acquired in the use of this drug and and as pointed out has been most lamentably the tempting bane of the youthful victim. Yet this drug was unknown until a few years ago and on its introduction was claimed to be a non-habit forming drug. Some experts have forcibly contended that it could, without any injury to medicine, be entirely discontinued. The victims of cocaine and heroin have habits of short duration as compared with morphine addicts. The addicts of opium, as such, do not seem to be any greater in number than has obtained for years. In fact this evil seems to be on the decrease even amongst our Chinese population. The causes of the formation of the opium habit, etc., therefore, did not call for special inquiry. As to methods and efficacy of the treatment of addicts there was, as heretofore stated, a wide divergence of opinion. Pains were taken by the committee to obtain the judgment of all who had made a special study of the question and particularly of those who had practical experience and an opportunity was af- forded to some addicts to give their point of view. Even among addicts there was pronounced disagreement. A number testified to an intense desire to be PKOHIBITING THE IMPOBTATIOK OP OPIUM 41 •cured and that they had on frequent occasions made an effort to be cured without success, trying doctors, alleged cures and nostrums, and in some instances un- dergoing hospital or sanatorium treatment. Some of them acted like individuals to whom hope was lost and many distressing and woeful experiences were related. Quite a few individuals appeared who testified they had been addicts, were treated in public institutions and believed themselves entirely cured. Their appearance corroborated their testimony, and their statements as to return of health, gradual and substantial increase in weight, restoration of physical activity, general mental awakening and firm desire to make good, were inspiring. Two conclusions may be drawn safely as to which there does not appear to be serious conflict; one, that there is no known specific remedy for the cure of drug addiction; two, that the cocaine habit more readily responds to treatent than the narcotic habit, and given that the sufferer from cocaine reasonably follows intelligent medical direction, relief from acquired habit may without great diffi- culty be attained, whether treatment is sought of the general practioner or by sanatorium or institutional methods. Mr. PIawley. It seems to me it will be valuable to have the statistics showing the number of young people committed to State reformatories, who are addicts if you can get us that. « Mr. Porter. I am trying to get that through a retired marine officer who is in charge of one of those institutions in New York. Mr. Treadway. I move that Congressman Porter be allowed to put in the record whatever he desires, which bears on this subject. (The motion was agreed to.) Mr. Porter. The resolution passed by Congress February 26, 1923, declared that the true intent and meaning of the Hague opium convention was that production of the raw materials should be limited to strictly medicinal and scientific needs. That had always been controverted by certain nations owning colonies in the Orient. At Geneva we got them to accept our construction. The resolution passed in the last Congress is therefore the accepted construction. In November we return to Geneva with a plan to enforce the con- vention in accordance with this construction and interpretation. Mr. Hawley. And the passage of the bill is an essential factor in j connection with that plan? j Mr. Porter. Yes. In case this bill is passed the United States I will be in a much stronger position to urge other nations to do like- I wise. I am printing all of the various documents connected with the narcotic problem, with the idea of having all the United States’ , activities between two covers, as an official document for use at the conference. In the last conference we printed a brief showing the attitude of the United States which was quite useful. Mr. Hadley. There is one question I would like to ask you on The Hague treaty limiting opium to actual medical and scientififc uses. It has been very well established that as far as medical uses are concerned, heroin is of no practical service that can not be as well or better rendered otherwise. But nothing has been said about the scientific phase of it at all. That being the form of the treaty, is it claimed that heroin has any scientific use? If it has not, then the passage of the bill would not contravene the terms of the treaty. Mr. Porter. I have asked a good many people why they use the word “scientific” and I have not been able to get a satisfactory answer. Mr. Hadley. I reached that conclusion when we had this matter under investigation in connection with the Jones- Miller bill, and I 42 PROHIBITING THE IMPORTATION OF OPIUM asked you that so we would be clear upon it, and if anyone claims it has a scientific use, in view of the provision of the treaty, we ought to know it. Mr. Crisp. Doctor Blue, do you know of any scientific use to which it can be applied ? Doctor Blue. Some of the alkaloids of opium are used in chemi- cal and physiological laboratories, in making certain tests and in animal experimentation. The quantities used, however, are very small and need not be considered. Mr. Hadley. Would they use it in the form of heroin, or are there other alkaloids? Doctor Blue. No; we have other alkaloids. Mr. Hadley. Then this would not be an exclusive necessity for that purpose? Doctor Blue. No, sir. Mr. Porter. When the hearings were held on the resolution last year the resolution received the indorsement of many fraternal or- ganizations, such as the Grotto, the Moose, the Eagles, the Elks, the Salvation Army, the American Red Cross, the Order of Independent Americans, the Order of the Eagles, labor organizations, and many others. There is just one more point I want to refer to. About three or four years ago wide publicity was given to the statement that the per capita consmnption of opium in the United States per annum was 36 grains. Apparently the author of this estimate based his calculation on the total imports of opium for the year 1919 without considering the large quantities of opium imported for purposes of reexport, or the important facts that the purchasers of commodities do not recognize the fiscal year, and that the price of opium during that period was quite low, which resulted in heavy buying for future use. For the purpose of correcting this erroneous statement I desire to insert in the record a letter from Mr. Edwin L. Neville, representative State Department advisory committee, Federal Narcotics Control Board, showing that the amount of opium in terms of morphine content is only seven-eighths of a grain per capita per annum. Inasmuch as Persian and Turkish opium con- tain between 9 and 12 per cent of morphia, the correct consumption of opium per capita per annum in the United States is about 8 grains. Department of State, Washington, February 13, 1934. Hon. Stephen G. Porter, House of Representatives. My Dear Mr. Porter; Referring to your inquiry in regard to reports to the effect that the per capita consumption of opium in the United States was stated to be 36 prains per annum, I must say that I am unable to understand the basis upon which such calculation is made. The amount of opium and its derivatives used under the laws of the United States is given in full in the reports of the Commissioner of Internal Revenue and works out, in terms of morphine content, at about seven-eighths of a grain per capita per annum. It is possible that the persons who made this calculation of 36 grains used the total import figures for periods antedating the recent amendment to our import and export law, when large quantities of opium were imported for purposes of reexport, a practice which does not now obtain. It is well known, of course, that opium derivatives are smuggled into the United States as well as into most other countries. The extent of the smuggling is, of course, a debatable question. I am unable to understand, however, how the figures could total 36 grains, even if the amount of smuggling for surreptitious use in this country reached a figure PROHIBITING THE IMPORTATION OF OPIUM 43 several times that of the legitimate consumption — a situation which seems- improbable. Sincerely yours, Edwin L. Neville, Representative State Department Advisory Committee, Federal Narcotics Control Board. Mr. Collier. Just before the Harrison Narcotic Act was passed^ was there not testimony given to Congress to show that the United States was using more opium, relatively, that is, opium and its- derivatives, than any country in Europe, or was that true? Mr. Porter. I have never read the testimony. Mr. Collier. Our statistics have been more accurate? Mr. Porter. They were, with this exception. Here is a copy of an article written by Sir John Campbell in which he said the amount was 36 grains, and it is not anywhere near that. The Chairman. How much is it? Mr. Porter. It is a little over 8 grains of opium. Mr. Collier. There has been a general decline since the enactment of the Harrison Narcotic Act? Mr. Porter. I do not think anybody can answer that question. There is no way of ascertaining the amount of these drugs smuggled into the United States except that the amount is appalling. We must limit the production at the source by international agreement before this smuggling — the root of all the trouble — can be stopped. Mr. Collier. It has been a good while since I heard it in the Hear- ings we had on the narcotic bill, but my recollection now is that there was a good deal of testimony to the effect that a great deal of addic- tion was caused by using patented headache medicines which were j found to contain entirely too much cocaine, and that of late years the j practice of putting those remedies on the market by reason of the ! passage of the law, had stopped, and that a great many of those reme- I dies apparently were harmless but in reality did a great deal of damage, j Mr. Porter. Yes; but you must remember this. You have heard 1 the doctors describe the horrible agonies of the addict when the drug was withdrawn from him. Take, if you will, an addict on the streets of Washington without money; he can not get the drug; he is suffering the tortures of the damned, and will in his frenzy commit any crime on the calendar to I get money, with which to buy the drug. That accounts for the increase in the number of addicts who are being convicted and sen- tenced to penal institutions in many instances for crim.es of violence, j This is the menace to the public. The Chairman. What control over the manufacturer, if any, is there at present? Mr. Porter. You will have complete control, as this bill is based on the principle that the profits derived from violating the law do not offset the danger of losing the license to manufacture. I The Chairman. If any of these manufacturers should import : opium, taking it for granted that this bill should be passed, and pro- ceed to manufacture heroin from it, the privilege of manufacturing would be. taken from them? I Mr. Porter. It would be taken away from them; yes. I Mr. Collier. I have had some physicians tell me of different I instances where an addict is given, by a physician, so many grains of morphine every day, enough to kill four or five ordinary men, and I 44 PEOHIBITING THE IMPOKTATION OE OPIUM think in some instances they claim it is absolutely necessary to give them that morphine. Doctor Blue. While undergoing a cure. Mr. CoLLiEE. Perhaps so. Is the same practice pursued in con- nection with the cure of a heroin addict ? Doctor Blue. It is the same. Mr. Colliek. You still give him the heroin? Doctor Blue. I want to say that I believe in absolute withdrawal of the drug of addication, except in rare cases of heart and lung diseases. I do not believe in tapering off. Mr. Collier. You would stimulate them in some way, would you not? Doctor Blue. The absolute withdrawal method has given the best results, and has been found to shorten the course of treatment. Mr. Porter. I want to call attention to one other matter. This bill is somewhat of a departure from legislation of this kind. I felt inclined to follow the tax principle, such as was followed in the oleo- margarine cases, but I was afraid of that because no matter how high you put the tax, the addict would get the drug. I trust the committee will give considerate attention to this question. I recognize that Congress has no right to prevent the manufacture of heroin by direct legislation; that is exclusively a right of the States. We have a right, of course, the right to control interstate traffic, but that would be a futile remedy because the peddlers can carry upwards of 150,000 worth of these drugs in a copuple of trunks. So we are really forced to adopt this extraordinary remedy, namely, the prohibition of manufacture. The Chairman. You think that is all that is necessary in connec- tion with this particular matter ? Mr. Porter. Yes. ^Ir. IVIiLLS. You consider that the effect would be the same? Have you considered framing legislation to prohibit importation except for certain specific purposes, stating it in the affirmative instead of in the negative? Mr. Porter. No; I had not thought about that. Ml-. IVIiLLS. I assume we have a perfect right to prohibit the impor- tation of anything which we believe to be harmful. We clearly have that constitutional right. Mr. Porter. Yes. Mr. Mills. What I am wondering is whether, perhaps, we might be better off if we prohibited the importation of opium, unless it is used for certain specific purposes. Mr. Porter. The trouble is you could not enumerate all the pur- poses. You would have to take in such things as morphine, codeine, paregoric, Dover’s powders, and other preparations. Mr. Mills. You would have to enumerate so many articles? Mr. Porter. Yes. Ml-. Hawley. There might be some new article developed abroad that would be very useful and less habit-forming than those now in use, some derivative of those now in use. Mr. Mills. Has anyone made a request to be heard in opposition? The Chairman. No one has requested to be heard in opposition, but there are a number of letters from doctors in opposition. I think we got a wrong impression from one statement made this morning. PKOHIBITTNG THE IMPORTATION OF OPIUM 45 So far as I know, the manufacturers have not interested themselves in this matter, but the clerk tells me that the representatives of some of the manufacturers were in attendance upon the hearings this morning, and that they expressed themselves, on behalf of the manu- facturers, to the effect that the manufacturers considered this a matter for the medical profession to settle, that they were only interested in manufacturing such drugs as the medical profession considered to be of beneficial use. I assume that would be the case anyway with the reputable manufacturers — and so far as I know all of them are — they would not want to manufacture any drug that had little, if any, beneficial use, and, as a rule, was highly injurious and dangerous. Mr. Mills. With the statement you have just made in the record, that will correct any false impression that may have been created. The Chairman. None of the manufacturers has asked for a hear- ing, and none of them has expressed himself to me or to the clerk in opposition to the bill. Mr. Porter. Mr. Chairman, with your permission I will put in the record a letter from the commissioner of the department of correction of the city of New York, and then I will ask you to hear briefly from Major Brewster, of the reformatory prisons, Harts Island, N. Y. (The letter referred to is as follows:) City of New York, ' Department of Correction, April 3, 1924- Hon. Stephen G. Porter, House of Representatives, Washington, D. C. Dear Congressman Porter: I am sending Maj. S. W. Brewster, from the reformatory prisons, Harts Island, to represent the department of correction, New York City, before the hearing now being held oh your resolution in con- nection with the narcotic drug evil. As you doubtless know, the department of correction of New York City handles more cases of drug addiction than any other correctional or hospital department in the world. I take pleasure in advising you that we are backing the efforts you are making, and you can be sure that we will cooperate with you in every way and furnish jmu, and your committee, with any information on the subject you may desire. Very sincerely yours, Fred’k a. Wallis, Commissioner. P. S. — In my opinion no measure is too radical or severe that would prohibit the manufacture and sale of habit-forming drugs. Medical and scientific use should be under strict governmental control. Heroin must be siieedily suppressed. F. A. W. STATEMENT OF MR. SIDNEY W. BREWSTER, ASSISTANT SUPERINTENDENT AND DEPUTY WARDEN OF THE RE- FORMATORY PRISON AT HARTS ISLAND, NEW YORK CITY Mr. Porter. Kindly state your full name, residence, and occu- pation. Mr. Brewster. Sidney W. Brewster, major. United States Marine Corps, retired; assistant superintendent and deputy warden reforma- tory prison. Harts Island, New York City. Mr. Porter. How long have you been connected with that institution ? 96182—24 4 46 PBOHIBITTNG THE IMPOETATION OF OPIUM Mr. Brewster. I have been with the department of correctiori between seven and eight years, and at the reformatory prison at Harts Island three years. Before that at the naval prison, New York, N. Y. ; Mare Island, Calif.; and Cavite, P. I. ^Ir. Porter. You are not a medical man? Mr. Brewster. No, sir; I am not. Mr. Porter. What are your duties at the reformatory prison? Mr. Brewster. Deputy warden and in charge part of the time. I have also been in charge of the New York City reformatory. New Hampton, N. Y., and women’s workhouse, Blackwells Island. I also have some special duty with the commissioner. Commissioner Wallis sent me down to appear before the committee to represent our department. The department of correction. New York City, handles more cases of drug addiction through their coming into contact with the law than any other prison, hospital, or sanitary department in the world. I have our records for the year 1923 to present. Mr. Porter. In the performance of your duties have you come in contact with persons suffering from drug addiction? Mr. Brewster. I have come in contact with a large number of cases. Mr. Porter. Will you kindly state in your own way your obsei'vations in regard to this matter, with special reference to the use of the drug heroin ? Mr. Brewster. I am speaking now from the prison standpoint. Mr. Porter. Yes, that is what we want. Mr. Brewster. Approximately 60 per cent of the inmates at the reformatory prison at Harts Island, and 100 per cent of the inmates at Biker’s Island, where they go first for the cure, are drug addicts; and about the same proportion at the penitentiary as Harts Island. At the Woman’s Workhouse, Blackwells Island, practically all prostitutes committed are drug addicts. Sixty to 80 per cent of all committed here are drug addicts. Of those drug addicts, from 90 to 95 per cent use heroin. Thirty or 40 years ago, from records left by Police Inspector Thomas Byrnes, addiction in those days was chiefly opium smoking, with occasionally a morphine addict; the addiction was then chiefly in the underworld. At the present time, while a very large percentage of criminals are drug users, drug addiction has spread to an alarming extent to all walks of society and to those who rarely come in conflict with the law. It is impossible to state the number of drug addicts in the United States, but from estimates based upon incomplete records of the amount of drugs illegally used, the number would be approximately 1,000,000. Some authorities give a higher estimate; a few a lesser one. • Cocaine was brought to this country first about 1880, and heroin about 1900, although the use of heroin did not become very great until about 1911 or 1912. Along in the late nineties, when the United States and State authorities endeavored to suppress opium smoking, drug addiction became more active along the line of mor- phine, together with cocaine. About 1912 heroin, which up to that time had been supposed not to be a habit-forming drug, began to be evidenced. In 1910 or 1911 and up to four or five years ago in the underworld the drug chiefly used was morphine and cocaine, morphine being PKOHIBITTNG THE IMPORTATION OF OPIUM 47 'I termed a necessary drug and cocaine a luxury. In the last four or i' five years heroin has gradually succeeded morphine and to quite li some extent cocaine. The reason for this is that heroin is approxi- I mately three times as powerful as morphine; and further, the addict in taking heroin gets some of the effects which he ordinarily would f get from cocaine. Mr. Porter. He seems to get the joint effect of cocaine and morphine ? Mr. Brewster. Yes, sir. Some addicts in the criminal world and also in what we call the sporting world used to use morphine and cocaine in conjunction.* For instance, we had a case some time ago of an actor who used cocaine to stimulate or as he expressed it “to jazz up” in the morning. That would keep him awake until long past midnight. Then he would want to go to sleep and the cocaine would keep him awake, so he would take a shot of morphine to go to sleep. Then along about 11 or 12 o’clock in the morning again he would get up feeling rotten, and he would take a shot or a sniff of cocaine and be ready for rehearsal in whatever work he had to do. Now, at the time of the Rosenthal murder in New York, in which Police Lieutenant Becker was implicated, two or three of the men who fired the shots were under the influence of cocaine at the time. At the present time, in one of the most recent crimes of violence, the Diamond case, in New York, which involved the robbing and murder of two bank messengers in broad daylight, two of the actual , perpetrators of the crime were under the influence of heroin. That shows the condition. In man\^ cases the leaders of the various gangs of gunmen do not use narcotics themselves but when they send out members of the gang on a crime to commit murder or robbery they see that they are well charged before they go. Mr. Porter. With what? Mr. Brewster. Usually with heroin, although cocaine is still used. There is still a large amount of cocaine used. It is a luxury drug. I Cocaine, strictly speaking, is not a habit-forming drug in the same j Avay that opiates are. I Mr. Porter. And to a certain extent it is easier to cure? i Mr. Brewster. It is easier to cure. But it docs not develop a habit or what we call the withdrawal symptoms occurring in opium I addiction and which are very conspicuous. j Mr. Porter. But it is still treated as one of the serious addictions ? I Mr. Brewster. Yes, sir. The police records for 1923 show that there were approximately 6,000 arrests in New York City in connec- . tion with drugs, or in which drugs were a factor. The department i of correction received from the courts in the year 1923. 2,349 males i and 314 women, making a total of 2,663 which were confined and treated during the year. This is about 10 per cent more than the year 1922, and the increase would undoubtedly have been mucn ■ larger, except at the present time the State laws on drugs have been ' repealed, and the only means by which we can control drug addiction in New York City is through the sanitary laws. We did have a drug ■ law in the State, but that has been repealed and now we have to rely , upon violation of the sanitary laws. Now, of these cases just mentioned, under section 135 of the sani- i tary code of New York City, which covers persons self-committed ; for a cure, we received 427 people, 370 men and 57 women ; the balance 48 PROHIBITING THE IMPORTATION OF OPIUM being committed under the other section, section 133 of the sanitary code (possessing or selling drugs) . Now, of the 427 persons who were self-committed, 176 of these persons had previous convictions or sentences for possessing or selling drugs, under section 133. One hundred and sixty-seven of these self-committed persons had served previous sentences for offenses other than drugs, misdemeanors, and^ felonies. Of these same self-committed persons, 210 were committed the first time for a cure, 114 the second, 48 the third, 31 the fourth time, 10 the fifth time, 9 the sixth time, and 5 the seventh time. I might* state, on the question of self-committed persons for the cm-e of drug addiction, that they are generally from the underworld. You can hardly expect a person suffering with drug addiction who holds a responsible position in society or business, to come to you and ask to be self-committed to an institution of our kind. We do not get that type at all. Mr. Porter. Doctor Squires has testified that they are the most gratefid of patients, and all evidence an intense desire to throw off the habit, and therefore voluntarily allow themselves to be put under the restraint in the hope of being cured of the disease. Is that substantially correct? Mr. Brewster. That happens in a great many cases. Of course, those are the ones who come for the cure voluntarily. Those cases not voluntarily committed have to take the “cure” in which the gradual reduction treatment is given. We usually get them off the drug in five to seven da 3 ^s, according to circumstances. Any drug addict prefers the gradual reduction treatment to what is called by them “cold turkej"” where the drug is stopped at once. Mr. Porter. How would a habitue of the underworld of New York go about it to have himself committed to jmur institution for treatment ? Mr. Brewster. If he went to the judge of general or special sessions he could be committed; or, as manj' times happens, he is picked up for some other chai'ge and then afterwards discharged by the magistrate or judge, but decides at that time to take the cure. We have had cases, however, where they were in very bad shape from wanting the drug, and they were committed so that their suft’ering Avould not be so hard at the time, because we put them on a reduc- tion treatment. The first thing we do when they enter our insti- tution, if they are suffering, is to give them a shot. Mr. Porter. Perhaps there is also another reason for putting them under treatment when they are suffering from withdrawal symptoms due to inability to secure the drug, and that is the danger that they will commit some crime in an effort to secure money with which to buv the drug. Mr. Brewster. That is undoubtedly true. In my judgment, that is the serious point in the whole matter. Much of the crime in New York City and thoughout the whole country is committed to get mone}^ to procure narcotic drugs. Mr. Porter. Describe briefly the mental and physical condition of an addict suffering from the withdrawal of the drug? Mr. Brewster. You mean in the process of what we call our “cure” ? Mr. Porter. No; not exactly. You have seen cases where the drug has been abruptly withdrawn from a confirmed addict for, say, PROHIBITING THE IMPORTATION OF OPIUM 49 four or five days. Are you sufficiently familiar with that class of cases to describe the mental and physical condition of the addict during those four or five days? Mr. Brewster. Well, that is rather hard to describe in medical terms. Mr. Porter. I mean just as a layman would describe it. Does it require any restraint ? Mr. Brewster. Yes; they require restraint. They are very nervous. Mr. Porter. Is there nausea ? Mr. Brewster. Nausea; vomiting; profuse sweats. They are, you might say, almost like a caged animal sometimes. Mr. Porter. And mentally ? Mr. Brewster. Mentally, I think they are in almost as pitiful a condition as a person with delirium tremens. There are times when they will do anything to get the drug. Mr. Porter. Now, from your experience as a criminologist, do you believe that many of the crimes of violence committed in and about New York City are due to addicts who are unable to secure the drugs, and in their frenzy commit these crimes for the purpose of securing money with which to buy the drugs? Mr. Brewster. In my opinion, I think there are a large number. Mr. Porter. Am I correct in this conclusion? That the purpose of the confirmed criminal in taking heroin before perpetrating a crime of violence is to relieve himself of all moral restraint ? Mr. Brewster. That is my opinion; and that is also true of cocaine. I would say this, that users of morphine, while they do commit crimes, they are usually not crimes against the person: they are not usually crimes of violence. They are such crunes as theft, forgery, or something along that line. The man who uses heroin is a potential murderer, the same as the cocaine user; he loses all consciousness of moral responsibility, also fear of consequences. Mr. Porter. Now, the testimony seems to indicate that a great many of the heroin addicts are quite young ? Mr. Brewster. That is true. Mr. Porter. In the table which you have presented for the use of the committee, do you show the ages ? Mr. Brewster. I have not in those tables. I can get you some data on it. Mr. Porter. Could you add that to the tables you have already supplied ? Mr. Brewster. Yes, sir. I got up this data hastily. Mr. Porter. Roughly, what is the age of these addicts; between what ages do they range ? Mr. Brewster. We have them as young as 16. I have known of cases where they were much younger, but they are comparatively few. Mr. Porter. Were they sent to the institution? Mr. Brewster. No, sir. We do not get them under 16. We have cases of men and women who are 60 or 70 years of age, but they are very few. I remember one case of a former well-known jockey — I do not recall his name now — who was 70 years old and who had used morphine for over 40 years, but that is very much the exception. Drug addicts usually die early, either from overdose of drugs, tuber- 50 PROHIBITING THE IMPORTATION OF OPIUM cular troubles, or other troubles with which drug addiction has prob- ably some connection. The use of opiates stops a number of the bodily secretions and it has an effect on practically all the various organs. Mr. Porter. The medical testimony seems to indicate that the constant use of these drugs finally weakens one of the essential organs of the body, and due to the failure of that organ to function, death follows. Is that about correct? Mr. Brewster. Yes. Mr. Porter. Now, an addict to morphia may, if he is cautious and careful and does not take an overdose, live many years; but an addict to cocaine or heroin has his life very materially shortened? Mr. Brewster. That is so. Mr. Porter. Have you stated the percentage of these inmates who are addicted to heroin? Mr. Brewster. It is approximately at the present time between 90 per cent and 95 per cent. Mr. Porter. And in 1900 there were no heroin addicts? Mr. Brewster. There were no heroin addicts in 1900. It was first noticed about 1911 or 1912, when some of the sanatoriums treat- ing alcoholism noticed that drug addiction was getting to he quite a proposition. About this time the prisons and correctional institu- tions found that they were getting to have a problem on their hands. But it has only heen in the last six or seven years that heroin has really come to the front as it is now. Mr. Porter. At the present time heroin has practically taken the place of morphia and cocaine? Mr. Brewster. That is in the underworld, although there are some that will take cocaine and heroin. Morphine, heroin, and cocaine are used illegally outside the criminal world. The spread of habit-forming drugs the last few years has been alarming, and specially since the war. Mr. Porter. And also some that take cocaine and morphia? Mr. Brewster. Cocaine and morphia, and occasionally we get a codeine addict, but that is a very rare thing. We also get a few opium smokers. Ml’. Porter. Roughly speaking, what percentage of the inmates of the institution are between the ages of, say, 16 and 25? Mr. Brewster. Fully 50 per cent to 60 per cent. Now, the reason that we get so many more cases of drug addiction in our New York City institutions instead of Sing Sing Prison in the other State institution is because we have to handle those cases through the violation of the Sanitary Code of New York City, which provides for misdemeanors. Sing Sing gets the professional criminal. We do get a good many felony cases, though, at our penitentiary, Black- wells Island, about 425 last year. Mr. Porter. In case an addict starts with a small dose, but the demands of the system compel him to increase the dose from time to time until he is taking enough at one dose to cause the deafti of from 10 to 50 normal persons; assuming this to be the fact, do you know what result would follow in case one of these addicts had ceased using the drug for, say, 6 months or a year, and then relapsed and took one of the large doses which he was accustomed to take during the period of his addiction? What would be the result? PROHIBITING THE IMPORTATION OF OPIUM 51 Mr. Brewster. It would kill him. I had a case come under my personal knowledge a few weeks ago. The tolerance which is built up by the habitual use ol opiates is apparently lost very soon after the addict is take off the drug. The immunity that they seem to have against opium, or that they get through the use of it, leaves them quite soon. Most prison authorities who come in contact chiefly with the underworld addict, believe that there is no cure for drug addiction as long as the addict can procure the drug again when he leaves the institution. Of course, questions of tempera- m.ent, personality, and environment enter into the matter to som.e extent. I know that some of these men who are discharged from our institution after being taken off the drug and have not used it for some time, do not immediately go back, and it is possible that there are even some who never go back; but our records and ex- perience show that the prognosis is very poor, especially if the addict has been using drugs for any considerable time or in quantity or goes back to his old environment. This prognosis, however, does not apply to the same extent to people who, in the better walks of life, have financial means with which to take care of themselves. In those cases there are permanent cures, particularly if the drug addiction is not of too long duration, or too deep seated, that family or other troubles do not produce a mental state in which the person will say to himself “what’s the use’’ and return to drugs as a tem- porary relief. The term “permanent cure” is rather misleading, as any former addict might return to opiate addiction under unfavorable conditions. Undoubtedly some do not. Our treatment or “ cure ” consists of taking the addict off the drug by the gradual reduction method, and by elimination as fast as pos- sible of the poison within his body. He is then built up by the administration of proper food and light exercise or work until he returns to good physical shape. Whenever his case is complicated by other disease, that disease is also treated. Another phase of drug addiction is this : Up to the present time we have only looked at it from several angles, and there is a great deal from a medical standpoint that we do not know at the present time. I have always felt that there should be more complete study and research work by the medical profession along the lines of the work being done at the Rockefeller Institute for certain diseases, and also at Johns Hopkins. Mr. Porter. I have been working on a plan of this kind for a long time. It is based on the principle that it is comparatively useless to effect a cure of an addict and allow him to return to his old environ- ment, and without full opportunity to recover his mental and physical strength. The result of most careful investigation has con- vinced me that the overwhelming majority of addicts acquire the habit through unskillful medication and the recklessness of use; that the element of viciousness seldom enters into the matter. The better opinion seems to be that they are victims of an acute disease which finally becomes chronic and that they should receive the same treat- ment as a person suffering from any other malady, such as tubercu- losis or typhoid fever; that there should be two institutions main- tained, one where the addict can go volimtarily, the other where he can be sent by order of court, where these unfortunates can be prop- erly cared for. 52 PROHIBITING THE IMPORTATION OF OPIUM As matters now stand, no matter how earnestly and sincerely an addict may desire to be cured of his malady, he has no place to go to secure the necessary restraint except to a penitentiary, jail, or work- house, where the confinement, instead of building him up physically so as to throw off the craving for the drug, has a tendency to increase the craving by the debilitation due to such confienment. Mr. Brewster. You are speaking now of the noncriminal type? Mr. Porter. Yes. Mr. Brewster. I believe what you have said is absolutely correct. The question will never be entirely settled until there is a limitation on the production of opium by international agreement, and even then, the opium and its various derivatives will have to be put under Government control to see that it gets into the proper hands. That is, limitation as to the quantity peeded for medicinal and scientific purposes.' In my opinion, although heroin may have some medicinal value, there are other drugs which can be used which are not habit- forming drugs; and the slight use to which heroin might be put is counterbalanced a hundred or. even a thousand times by the harm it does and the vicious results of its use. It is- my opinion that the manufacture of heroin should be prohib- ited and prevented by law and that most stringent efforts should be made to keep it from being smuggled into this country. I would also recommend that more severe laws be enacted throughout the country to punish drug peddlers and drug smugglers, or anyone from manufacturing narcotics drugs illegally. At the present - time in New York State, in the cases that come to us for selling drugs, they only get a sentence of not over three years, which usually means that they are discharged at the end of 2 or 2^ years, and sometimes less. These persons should get, in my opinion, a sentence of from 10 to 20 years. After all, a man who deliberately sells drugs for the purpose of making money does so with full knowledge of the fact that he will cause the death and moreover the degradation of many people, and he should be classed as a murderer. In addition to relentless prosecutions of violators of the drug laws, more stringent laws — and long sentences for drug peddlers, a campaign of education should also be inaugurated. A large amount of research work should be done by chemists, and the medical profession to clear up many points not understood or are subjects of controversy at the present time. The certainty of a heavy penalty if caught would undoubtedly deter the drug peddler from seeking new customers as he now does in a brazen manner. (Mr. Brewster submitted the following:) DEPARTMENT OP CORRECTION, NEW YORK CITY Data in regard to persons committed to our institutions in connection with drug addiction Received from courts (males) 2, 349 Received from courts (females) 314 Total 2, 663 Note. — This includes 1,292 persons committed to the workhouse, the balance of the cases being committed to the penitentiary and the New York City Reform- atory and city prisons. ■ Drug addicts convicted of felonies and transferred to Sing Sing Prison or the New York State Reformatory at Elmira and Federal eases are not included in the above figures. PROHIBITING THE IMPORTATION OF OPIUM 53 Table 1. — Showing the number of persons received at the workhouse, W. I., during the year 1923, wider sections 133 and 135, Sanitary Code, showing the number received each month Men Women Total, sections 133 and 135 Section 133 Section 135 Section 133 Section 135 January _ . 55 48 12 5 120 February 67 30 18 8 123 March _ . . . 106 37 14 3 160 April 75 15 4 2 96 May.- --- 55 32 7 5 99 June 66 28 9 4 107 July.. 52 29 3 91 August - 48 36 23 8 115 September 40 39 5 6 90 October 54 25 12 2 93 November ...... 27 17 5 103 December 52 24 14 6 95 723 370 142 57 1,292 Table 2. — Showing the number of persons received at the workhouse, W. I., . during the year 1923, for drug treatment under section 135, Sanitary Code (self- committed for cure), and under section 133, Sanitary Code (possessing or selling drugs), and the number of previous sentences each had served in one of our insti- tutions for various offenses [1,292 were received — 1,093 men, 199 women] The following table shows that over 70 per cent have previous records: Men Women Total Total, sections 133 and 135 Sec- tion 135 Sec- tion 133 Sec- tion 135 Sec- tion 133 Sec- tion 135 Sec- tion 133 Received... 370 723 57 142 427 ■ 865 1,292 First time ; ... ... 101 235 13 32 114 267 381 Identified '... 269 488 44 110 313 598 911 Second time ... 70 164 8 28 78 192 270 Third time.. . ... 61 120 8 20 69 140 209 Fourth time. = .. 37 77 7 11 44 88 132 Fifth time . ... 30 48 5 12 35 60 95 Sixth time . ... 27 39 15 31 54 85 Seventh time 15 17 3 7 18 24 42 Eighth time ... 11 10 2 8 13 18 31 Ninth time... ... 11 7 1 3 12 10 22 Tenth time 3 1 2 5 1 6 Eleventh time ... ... 1 3 1 1 2 4 6 Twelfth time. ... . 3 2 1 3 3 6 Thirteenth time ... 1 1 1 1 2 Fourteenth time.. ... . ... . .. 1 1 1 Fifteenth time ..... .... ... . 1 1 1 1 2 Eighteenth time *....: 1 1 1 Twentieth time . ... ... . .. 1 1 1 Total ....... . 269 488 44 110 313 598 911 Repeat (per cent) 73 68 71 73 69 71 ' Total identified more than once, though not in same year. 54 PBOHIBITING THE IMPORTATION OF OPIUM Table 3. — Showing the number of persons received at the workhouse, W. I., during the year 1923, for drug treatment under section 135, Sanitary Code {self-committed addicts for cure), also showing the rhumber of times each had been received at one of our institutions for cures, possessing or selling drugs, or for other offenses, misdemeanor, and felony (427 persons were received — 370 men, tu women] Number having received cures and number of cures each has received Number having served previous sentences for possessing or selling under sec. 133 Number having served previous sentences for offenses other than drugs, mis- demeanor, and felony First time... ........ 210 115 Second time.. . . . 114 40 29 Third time . . 48 6 23 Fourth time 31 9 13 Fifth time .... 10 5 Sixth time . . 9 1 Seventh time . . ... 5 1 Eighth time .... in Ninth time ... . . 1 Twelfth time. 1 Thirteenth time 1 Sixteenth time 1 Total 1 427 2 176 ^ 167 > Of the 427 shown as self-committed drug addicts, 210 received the cure the first time, 217 recei-ed the cure two or more times, aggregating 845 cures at an approximate cost of $253,,500 to this city alone for cures, we having no knowledge of cures taken elsewhere, * Of the same 427 shown as self-committed drug addicts, 176 have served previous sentences for possessing or selling drugs, aggregating 280 sentences. 3 Of the same 427 shown as self-committed drug addicts, 167 have served previous sentences for offenses other than drugs (misdemeanor or felony), aggregating 438 sentences. ■Vote.— Over 70 per cent of all drug addicts have had previous instutitional experiences. Table 4. — Showing the number of persons received at the workhouse, W. I., during the year 1923, under section 133, Sanitary Code (possessing or selling drugs), also showing the number of times each had been received at one of our institutions for cures, possessing or selling, or for other offenses, misdemeanor, or felony [865 persons were received — 723 men, 142 women] Number received under sec. 133 and number of times each had served for same offense Number having received cures previous and cures each has received Number having served previous sentences for offenses other than drugs mis- demeanor, and felony 484 185 151 232 79 96 13 32 30 3 32 19 1 13 2 1 11 1 3 Eighth time.. . 2 1 1 1 1 Nineteenth time . - - - i ‘ 865 2 260 » 327 > Of the 865 committed under sec. 133, Sanitary Code (possessing or selling), about half have served previous sentences for the same offense, aggregating 1,479 sentences. 2 Of the same 865 committed under sec. 133, Sanitary Code (possessing or selling), 250 have received the cure previous, the number of cures aggregating 361 at the approximate cost of $108,300 to the city, we having no knowledge of cures taken elsewhere, 3 Of the same 865 committed under sec. 133, Sanitary Code (possessing or selling), 327 have served pre- vious sentences for offenses other than drugs (misdemeanor or felony) aggregating 756 sentences. Note.— 70 per cent of these also show previous institutional experiences. PKOHIBITIKG THE IMPOKTATION OF OPIUM 55 To give an idea of the individual record and the offenses for which these self- committed addicts are received, I show a few cases in brief, as case No. 139738 — first time received for felony; second, third, fourth, and fifth times received for misdemeanor, etc. Case No. 139738, 7 times: First time for felony, second, third, fourth, and fifth times for misdemeanor, sixth time for possession, seventh time for cure. Case No. 81778, 10 times: First, second, third, and fourth times for cure, fifth time for felony, sixth and seventh times for cure, eighth time for possession, ninth time for felony, tenth time for cure. Case No. 92231, 11 times: First and second times for misdemeanor, third time for felony, fourth and fifth times for possession, sixth time for misdemeanor, seventh time for possession, eighth and ninth times for cure, tenth time for possession, eleventh time for cure. Case No. 68573, 8 times: First time for possession, second time for felony, third and fourth times for cure, fifth and si.xth times for felonj'^, seventh time for possession, eighth time for cure. Case No. 81778, 11 times: First time for possession, second, third and fourth times for cure, fifth time for misdemeanor, sixth and seventh times for cure, eighth time for possession, ninth time for misdemeanor, tenth time for cure, eleventh time for possession. Case No. 80921, 9 times: First, second and third times for cure, fourth and fifth times for misdemeanor, sixth time for possession, seventh time for mis- demeanor, eighth and ninth times for cure. Case No. 63185', 9 times: First and second times for misdemeanor, third, fourth and fifth times for cure, sixth time for misdemeanor, seventh time for cure, eighth time for possession, ninth time for cure. Case No. 76037, 9 times: first time for misdemeanor, second time for posses- sion, third and fourth times for misdemeanor, fifth and sixth times for cure, seventh and eighth times for possession, ninth time for cure. Case No. 91604, 10 times: First, second, third and fourth times for cure, fifth time for misdemeanor, sixth time for cure, seventh and eighth times for misdemeanor, ninth and tenth times for cure. The above are just a few cases picked at random. We have hundreds of similar cases. (Whereupon the committee adjourned.) X V o<- ; ''n'i-i I' ) ''''."rr:T;iu‘j,wi u-.r; ..irnaiiWK'^ ■ ,, . Jt; ?if:Ofli s-'jti)! 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