Program #4 Drug Abuse

Why

we.

It is impossible for us to say we took a walk along time of day

to educate that huge effect 20 years hence is going to dig them into

action. And from each other to get them. As they

see the case in cigarette smoke. I'm me can't you see

so you see stuff.

This drug they talk about drugs was what they are and

how they affect modern man produced for radio by the

American University broadcast center in collaboration with the

National Institute of Medical Sciences Unit of the National

Institutes of Health. In our discussions with

authorities on drugs and there you will explore where drugs come from

how they are discovered. The natural substances provided by nature

and the synthetics invented by man. We'll examine why

people take drugs of all kinds and the effects of drugs on 20th

century society. We'll investigate the latest developments in

pharmacological research ways in which the federal government is concerned with

drugs and drug use. Drug laws why we have them and whether

they are beneficial. These and other questions facing us all in

this drug age.

On today's program how should our society use drugs.

Patricia Wakeling talks about drugs and society with Donald Miller chief

counsel for the Bureau of Narcotics and Dangerous Drugs of the Justice Department.

Bernard Barber professor of sociology at Barnard College of

Columbia University and Walter Modelo professor of

pharmacology at Cornell University Medical College. First

Mr. Miller explains what the phrase drug abuse means in his

terms.

Drug effects and consequently drug abuse

are what we call drug abuse are greatly influenced by the type of the drug

the quantity the frequency of the dosage the

elimination from the body and the pharmacological

response and the development of tolerance and dependence.

Just to mention a few. A social response of course is measured

in terms of ethic moral and

legal and other consequences with far less in mind I suppose here

is the best definition I can give to drug abuse. It's the uncontrolled

taking of a central nervous system stimulant or depressant

substance a habit forming drug or perhaps and

hallucinogenic substance without any ostensible

medical or healing function.

Dr. Vogl What do you say to that.

Well I agree very much with the way in which Mr. Mellon has put

the interrelatedness of the pharmacological psychological

and the sociological aspects of what might be defined as

drug abuse. I guess I should like to stress somewhat more strongly than he

does the amount of play that there is the amount of variability

that there is in the psychological and the sociological dimensions.

The committee of experts of the drug dependency commission of the World

Health Organization has recently recognized this quite explicitly it

defines seven different types of drug dependence

as a specific type for each of these drugs or classes of

drugs and indicates quite clearly that. The book

pharmacological the psychological and the sociological dimensions may

vary and correspondingly the definition of drug abuse I should like

to see. Like I asked to

vary somewhat more than we do at present the psychological and the

sociological definitions of drug abuse. But perhaps we can come back to that later.

And your thoughts Dr. Maddog.

I think that as in the case of all drugs one

has to think in terms of First of all what harm it does the individual

and even more important what harm it does society.

Now in those terms our society has made

some serious errors and it is also permitted the use of some

drugs that does man no good but doesn't harm

society or society in particular and it then permits some habit forming

drugs which seem to be relatively innocuous. We permit the use

of alcohol which is harmful to the individual

causing I think more deaths to people who use

it. Then any other drug causing more

deaths to innocent people on the highways than any other cause of

automobile accidents. And so for our society in

general is concerned it causes more disability than any other single drug

incapacitating between two and a half and five million people to varying degrees.

So here we have a drug which society has accepted which is harmful to everyone

concerned. We permit the use of tobacco which so

far as we know harms only the individual who uses it

and after some considerable

argument some hundreds of years ago we permit the use of caffeine which so far as we know

is neither harmful to the individual and the usual doses which we

regularly take and certainly not harmful to society. So here

are three drugs habit forming which people take compulsively which

have different types of effects and which we

consider problems I think are more important than the nature of the

pharmacologic effect.

Well we use coffee and nicotine and alcohol these days for hedonistic

purposes. Why not others such as example no Ana what's wrong with this.

This time this is what I'm asking about what I'm asking you since there's nothing wrong with it except the

term itself.

We live in a society where unfortunately still the term has quite invidious

connotations. If you redefine that word somewhat if you

indicate that it may have a variety of psychologically and socially functional

purposes if you don't use hedonism as I say Well obviously all of

these agents these chemical agents some of which we call drugs and some of

which we don't. I was again it's an interesting matter. It could be

defined in one of those limited and useful purposes is quite

likely psychologically and socially desirable.

I take it that that was what Dr. Modell was going to start to say well I want to have it

brought out that the fact that something is really enjoyable.

In no way suggests that it shouldn't be you know but we are in a country which

descends in part from the good old Puritan thinking and tradition and all of this instead Thank

God. Yes yes but a better way of accepted certain drugs which are certainly

not in the puritanical traditions and that we are really pulling against ourselves.

I think the only way we can consider the problem rationally it's

to forget our ethic and to forget legalistic

attitudes and to think only of how harmful it is so our community and our society.

Could I say this one I think perhaps with the exceptions of those drugs that

we have mentioned alcohol and tobacco I think our society has concluded

that drugs should be productive of relief. And

that it should not be permitted to sociologically or

psychologically disable a person purely for

hedonistic purposes. This is the thing that I think our laws are aimed at. Public

health majors. I hope we are not still and acting all is based on for

moralistic purposes.

I take issue with one of the phrases that Mr Miller has just used he says our

society has concluded. I like to take issue with that on the

grounds that large numbers of people in our society including

legislators and including most members of my own profession sociologists

who are supposed to be knowledgeable on these grounds are actually quite ignorant of a great

many of the essential facts about these matters. That is

the present what I call police and punitive approach

to these matters is not the only possible one. Even many

as I say legislators and knowledgeable social scientists though have

concluded that this is the only approach partly because there is not any

large an active group pushing the opposite point of view which is a point of view

I should like to see as I think they should be called dangerous drugs.

A good many of them opium and its various synthetic forms and

especially heroin which is the most dangerous but also the

amphetamines and the barbiturates and a series of others. These are dangerous drugs when

overused but the question becomes of whether they may not have

mild positive affects and even more important this is what I should like to

stress. Do we not do more by the present

policy of this police unit of policy than we

would by a kind of medical rehabilitative approach. I

should like to suggest that there is a strict analogy here to the case of

alcoholism. It is a serious problem and has been a serious problem. There is

still a serious social problem it will continue probably to be. But

as a result of the Prohibition amendment we discovered that a police punitive approach only makes matters

worse. We have I think accepted a policy

now where we so to speak cut our losses when we try to do the best we

can with Alcoholics Anonymous and psychotherapy and various other kinds of techniques none

of which work very well but at least we do not do a variety of social harms we don't

induce police corruption we don't induce disrespect for the law on the part

of young people we don't have various kinds of racketeering. We don't induce a

large amount of petty crime for people to get the alcohol all the

narcotics. Overall I think despite the fact the situation

is bad we have better off. I should like to see us change toward that kind of

policy for these dangerous drugs.

The problem of the drug addict in the society is a controversial area.

Mr. Miller defends the record of the Justice Department in dealing with the addict

whatever.

He supposedly stood for in the past I think I've always considered

myself a moderate in the field I still do. Nevertheless I don't think

I will stand by and allow any indication to go through that. A

law enforcement agency perhaps was the cause of this whole problem or whatever the Bureau of

Narcotics stood for in the past. I don't think they were doing anything but

carrying out the sum total of knowledge and belief and experience on the part of

of many many many groups not just merely the whims of Doc grand

slam here. I think our experience was based on a certain amount

of intellect a certain amount of scientific data and certainly based

on medical judgment the best medical judgment that we had at the time

and the best medical judgment that was being fed to us. If we made a mistake in the

past society made a mistake not the Bureau of Narcotics.

I wonder if I could say something if I said I don't like to see Mr.

Armstrong or go on the scale that I might add.

He is not the late rather than Harvard and I know what you want. I'm

tentatively pursuing the same policy.

I think that he did much to keep modern

thinking and modern advances in the treatment of our

control of addiction and in the spread of addiction

especially from being introduced. I don't think that you are right Mr.

Miller in saying that he followed the advice of every medical systems society

in the United States because he was still in office when the New York State Medical Society

with Dr. Barry Barry then president suggested that we follow the English

system in some sort of modified way not in order to

prevent illicit traffic. In heroin

especially but in narcotics and Mr. Honest thinker would have no part of it

now. I would also like to point out that the people had nothing to do with it.

The people of the United States there were no wires in no way

advised and since it was an administrative matter they didn't

actually vote for it. And in addition to that there are other countries in

the world not not not not now talking about the World Health Organization but there are other countries in the

world important countries like England which were taking other views of the matter.

And the Bureau of Narcotics would have nothing to do with it. I would not

consider it seriously. So I don't think it is

really presenting the case fairly to say that the

people of this country were perfectly willing to accept this status quo

that they didn't even know that anything could be done about it they weren't advised and they weren't

asked. I don't think that the medical profession there was any medals either.

But certainly the bureau Bureau of Narcotics did not welcome any

suggestions from the outside it did not take them seriously.

Well I think you are. Probably indicating which medical

bodies you assume to be the representative medical bodies.

And no I merely think that we have exhibited such

complete failure that it was long ago advisable to

try something different.

One other point I'd like to stress very strongly that

there has been a considerable ignorance I think the public was kept ignorant

but it has seemed to many people that from the

narcotics bureau this flow at our center of

energy and out a strong tide of misinformation which spread to

the public opinion elites that as the newspapers and the

legislators so that even today I stress that as even today it's my

opinion that it's those groups that are most misinformed that would be

my guess. I wish I could have a public opinion poll to test my

guess that if you took a public opinion poll in the United States at the present time

the man in the street would vote for a fundamental change of policy. He

knows he is I think much more tolerant of this much more aware of the

desirability of having a police of having a social policy rather than a police

punitive policy. Let me give an example the sort of thing I mean.

When the local police agents for example typically its

sheriffs that go around and police officers go around to high schools to speak

the kids are turned off as they put it because there is this

police punitive approach to them seems and reasonable to watch.

The result is they think that somebody is kidding them somebody is putting them on they know

that has no scheme of foreign devils to subvert the American public part

of the tone in which all of this has been put and the result of it is then a

kind of of counter-reaction kind of

foolish almost opposition to authority. Instead of seeing that these

days drugs are dangerous under certain conditions the results the spin that they swing to

the opposite extreme and they then try things not knowing what the

possible dangers are I.

Take out that point a little bit and bring in another one which is partly what you were

saying. You know drug taking today among the majority of young people

I would suggest to you is but a form of protest.

Like people of the time they are dissatisfied with what the previous generations

has done I think they also don't want to use the same drugs we want to see and they're

looking for they're availing again against drugs they are not using alcohol for

example and in the Ravel to use their youth there is not

the heroin taking but there is a new group stimulant drugs and

they have been taking LSD and are the most important takers of LSD.

But here I think there is an important example of how

effective communication about potential dangers can

be used with Alice. LSD has dropped off considerably I

think you'll agree. In recent year or so and that

coincides very closely with the publicity given to the possible

effects of LSD on chromosomes and on

its possible effect of producing defective

offspring. It is true that they found other drugs

and they have a great deal of sophistication in synthetic

chemistry so that it's a matter of keeping up with the

young people to find out what they are taking from month to month that

they are good candidates and they were ere they were able to make the LSD when they

wanted it but they're not making it so much they are making a variety of amphetamine like drugs and they

do it rather well and they can keep up with it

but I think that is part of the protest now.

It is impossible for us to say today what the long term I

factor of a drug is going to be what its effect 20 years hence is going to be when we don't

have any information about it. And if we wait till they get hooked

as they are in the case of cigarette smoking then the

potential for producing cancer or any serious effect will not

stop them because they are already hooked. I think the only reason why the

use of LSD has dropped

and I mean assuming that it's a result of the publicity given to its possible

effect on genes. It has been that LSD is not

truly addictive drug it was not addictive in the same way that tobacco

is habit forming.

Among the new methods of treating the drug addict is the methadone maintenance

program developed by Dr. Vincent dollar in New York.

The heroin addict is transferred to the less harmful but still addicting

drug methadone. Mr. Miller explains his objections to this

approach.

I think there are three factors I'd like to point out once again

considering myself a moderate although I'm beginning to have my doubts.

But one thing about methadone maintenance and well I won't call

that a give away program because I accept methadone maintenance programs as are being

carried out now from the from the old discussion about giveaway

programs. But let's talk for a minute about giveaway programs. And

there's where I have some problems. When you accept this as a

defeatist it's completely a different defeatist thing. You

decided that society cannot do anything about an addiction problem

and now it's time to give it away. While the drugs to the

addicts that we've got to condone his addiction

I don't think methadone maintenance necessarily does it. As I understand methadone maintenance it's the

attempt to get certain motivated individuals back into the

to the square community do in fact reorient him in his

thinking and in you know his way of life to re-educate him perhaps to help

his family so that he no longer has the pressures and no longer has the old

drives that he once had so far as going out and finding friends that have narcotic

drugs and spends half of the day shoplifting and things of that sort. It is a way

for doctors to pull a person in to begin to manipulate him or

handling in a in a proper medical atmosphere. But when we're talking

about give away programs that would just simply set up clinics to hand out drugs

day after day to everybody walks and I don't know if there's anyone here that would

a spouse such a proposal I star isn't there.

To do that with tuberculosis drug.

No no I would like to take it up in terms of addiction. I think that you're

forgetting the fact that more important than the addict. It is the

fact that the man addicted to heroin is a source of

communication of this terrible disease that in order to

pay for his habit a large number of them sell the drug and get others

hooked. And what is more important than whether or

not we placate these addicts whether we not

can. But whether we satisfy their habits by giving them

heroin if we need to. What is more important than that is that it is just

as in the case of alcohol where we did retreat that way.

Consider it a social calamity. They cry that

a peripheral effects of this disease as being more

important to us as a CE community than the fifty thousand or whatever number of

thousand of heroin addicts there are in New York who are burglarizing the city

continuously and creating more and more addicts because that's a source of

funds. Now if we condone or do whatever you want to

say about their addiction and give them these drugs so that they don't have to

burglarize if they don't have to draw more people into their circle then in

that way we are accomplishing a great deal. And if you want to

call it condoning I'm going to condone but I don't think that the give away program

has an advantage over the punitive one the punitive one hasn't racked it hasn't worked in

any kind of addiction that we've ever tried it in. And there is every reason to believe that it never

will work.

I think we've made quite a lot of progress in recent years.

Everybody keeps.

Throwing brick bats at the whole Bureau of Narcotics about what it stood for and perhaps me

because I'm symbolical of the old Bureau of Narcotics now

but yet I still don't want to back off from what I feel is a fairly sound

philosophy. Certainly it's the prevailing philosophy in the United States and indeed

every country in the world lets It's the philosophy of AMAA It's the

philosophy of the National Research Council it's the philosophy of the World

Health Organization it's the philosophy of the public health officials of all the countries in

the running those things that have people have been a sitting there for 30 years when it is not the

case.

And even if it were the case I can point out that past I was condemned by the French

Academy before I was not a case in Great Britain. Yes it is. Yet

the fact that there are groups against it doesn't mean that they're right.

Well the case in Great Britain is as you well know is becoming very

Americanised.

No it's not in a very small way even by the most extreme thing is that I can

find would you people again are exaggerating and pushing. There

are some Canadians and some Americans the Canadians incidentally have a more punitive policy so

they have a more serious problem than the British do although they're the same

social stocks in a way. Many of those people are going to Great Britain.

And even if it were true that of the so to speak

that we were Americanizing these other places it's not a desirable kind of

thing to do. It is. Maybe

people thought a more punitive policy they're away from their present policy.

I think you're talking like this that if we could in our society

give approval to tolerance and dependence.

Then we would do away with a whole lot of the problems involved with narcotic addiction we don't

need we wouldn't have a narcotic tolerance any more than we approve of tuberculosis

or diabetes or cancer but we try different ways of

approaching it and we don't persist. If we've got any sense in

pushing methods that haven't seem to get any but the difficulty with a program is

that you said that everything is fail and nothing else will work so let's

try a give away program we have the pre-college if we had started this we never would have

developed a methadone maintenance approach.

You are making an assumption that you have no right to a med and I don't think Dr. Dhar would have

would have accepted either. There is no reason

why if we had a get away program Dr. Dole wouldn't have conceived that his way of

dealing with the problem to his method of dealing with the problem became

important because of the fact became much more urgent because of the fact that we

didn't have a get away program. But implicit in what you said is an admission

that if we had a giveaway program we wouldn't have the social problems we now have.

One thing that to me listening to you people really has been pointed out

is in fact one of the purposes of this whole series of programs and that's where you

need a great deal more knowledge about the effects of drugs. I mean you are making

your comments Mr. Miller based on certain beliefs and certain knowledge that you have

these two gentlemen making their comments somewhat different comments based on

their beliefs and the knowledge and the research that they have than they have done and they are

more honest diametrically opposed. And the more knowledge that we get the

more these ways of thinking will come together.

On today's program Patricia Wakeling talked with Donald Miller of the Justice

Department. Bernard Barber of Barnard College and Lanfear

Modelo of Cornell University about drugs and society.

On the next program in the series the round of the pharmacists get this drug.

Used for radio in collaboration with the National Institute of general medical

sciences a unit of the National Institutes of Health.

This is the national educational radio network.