494 TRIMON
BOM.
. 1.
Shri
HAS PROHIBITION INCREASED DRUG ADDICTION?
A Preliminary Study
CORA FRANCES STODDARD
Executive Secretary of the Scientific Temperance Federation
Read at the Eighth Annual Meeting of the National Temperance Council, Washington, D. C., Sept. 20, 1920
M
ANY have been the claims that the prohibition of alcoholic beverages in
the United States would result, was resulting in an increased use of habit-
forming drugs, that to prohibit alcoholic liquors was simply to sweep from
the house one evil into whose place would rush seven worse devils. Foreign news-
papers have related that drug-using is increasing as a result of prohibiting alcoholic
beverages. Dire tales were told of drug addiction in the southern states under
prohibition, but the narrators forgot to say anything about drug addiction in north-
ern "wet" cities and states.
To ascertain what, if any, effect national prohibition was having on the use
of narcotic and habit-forming drugs, I sent in June, 1920, a questionnaire to the
Secretary of the State Board of Health of every state in the United States and to
the Boards of Health of all cities (88) of over 80,000 inhabitants. The larger
cities were approached because they are more likely to have definite information.
and because drug addiction as a rule is more common in city than in rural popuia-
tions, though it thrives in "slum" sections city or country.
The questionnaire asked for official statistics indicating in any way the preva-
lence of drug addiction, past and present, the extent to which drug addicts were
formerly alcoholic drinkers, whether inmates of institutions for treatment of ad-
dicts were increasing, or if new regulations had gone into effect recently which
might affect statistics.
Replies conveying information have so far been received from officials of 19
states and from officials of 20 large cities. Altogether the reports give glimpses
(that is all that is claimed for them) of drug addiction conditions in 29 states
which contain two-thirds of the population of the United States.
STATISTICAL EVIDENCE
They indicate a very great lack of accurate information as to exact conditions.
Some officials suggested other possible sources of information. These have not
yet been followed to the end so I present the data thus far obtained only as a pre-
liminary study. Limitations of space make it impossible to quote even briefly
from all replies, but extracts are given which are typical and represent all points
of view.
Even approximate figures as to the number of drug addicts are scanty. This
is of some significance as regards the stories that prohibition was increasing it.
Lacking definite statistics for comparison, the claim that prohibition increases the
number of drug addicts is without statistical foundation. Further, the trend of
the opinions and data presented in these replies from public officials is that pro-
hibition has not increased the use of drugs, and that where there seens to be an
increase since prohibition became effective, it is due to active enforcement of anti-
REPRINTED FROM THE SCIENTIFIC TEMPERANCE JOURNAL, SEPT., 1920
SAHVIATI NVÐIHOIN JO ALISHTAINI SEL
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narcotic laws and regulations. For instance, in New York, following a new law
of 1918 a regulation in 1919 required registration of addicts who wished to be able
to buy the drugs. This went into effect about three weeks after national prohi-
bition became effective in July, 1919. Officials then began to be able to register in
black and white the legal purchasers of drugs. Statistics thus obtained did not
record a result of prohibition of alcoholic liquors, but the development of a steady
campaign of several years against drugs.
4
The lack of comparable figures to prove that prohibition has increased drug
addiction is easily shown. The report of the United States Treasury Department
Commission quoted estimates ranging from 80,000 to 4.000.000 addicts for the
entire country. The Commission itself came to the conclusion that the total
number probably exceeded 1,000,000. Legislative investigations in New York
State (1917-1918) brought out expert opinion that, roughly speaking, there were
from 1,000,000 to 2,000,000 drug addicts in New York State, 50,000 to 100,000
throughout New York City-then a "wet" city in a non-prohibition state. Since
July 19, 1919, drug addicts have been required to register in New York. "While
records change daily," says the State Department of Drug Control, "they show
approximately 13,000 users in the state, besides probably 26,000 unrecorded cases
who obtain drugs from illicit sources." This makes a total of 39,000, only one-
third of the minimum number (100,000) estimated in 1917-1918. In New York
City, 7,100 persons registered up to July 9, 1920. Even making large allowance
for unregistered addicts there is a wide margin between this 7,100 and the 50,000
to 100,000 estimated three years ago which New York City health officials now
regard as probably greatly exaggerated.34 1 do not mean to imply that there has
been this actual decrease, but to point out that the figures of the pre-prohibition
period were estimates, and that as statistics become more exact we get a smaller
rather than a larger number. There is no statistical evidence in these reports that
prohibition has increased the number of drug addicts.
Pennsylvania State Health Department reports:
"We have no evidence at all tending to prove that Prohibition has increased the con-
sumption of narcotics except so-called exempt preparations. Some of the latter containing
alcohol, particularly paregoric, have been sold in very much greater quantities than before.
People accustomed to drinking alcohol buy paregoric for the alcohol and then gradually
become opium addicts as well. So far as we know, the purchases are made principally to
procure alcohol. . . . The matter is rapidly coming under control.
Another class of preparations, about one-third ether and two-thirds alcohol,
is being sold in small bottles by the truck load" in certain sections of l'ennsyl-
vania, and as yet there appears to be no Federal or State law for controlling them.
In 1918 about 2.000 arrests were made for offenses in which the prisoners were
drug addicts. It was roughly estimated that in 1919 this number would be in-
creased by about 500, "due to energetic enforcement of the anti-narcotic laze." 5
In Jacksonville (Florida) there were 1,073 registered addicts in 1914."
A census of addicts in 1919 found only 111. During the past year 55 more were
registered. The City Health Officer does not believe prohibition has caused a
great increase.
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Minnesota' has a few statistics in commitments to three state institutions :
Alcoholism
100
1918
1919
1920, June 8..
40
3
Drug Addiction
26
17
4
The Health Director of Kansas City, Missouri "thought for a time after
July 1, 1919 that drug addictions seemed to increase, but since January 1, 1920
there seems to be less than in the previous six months."
In the adjoining Kansas City of prohibition Kansas the Commissioner of
Health and Sanitation is "called by the police department to see almost every
dope fiend under custody. I don't see on the average more than one a month and
they are chased over here from Kansas City, Mo." At a meeting of the healtth
officers of Kansas in May, 1920, this question was brought up. "Several health
officers had been in office five years and had not seen a single 'dope fiend' during
that period. They are so rare that we have no provision for caring for them, and
the only way we can care for them is to have them adjudged insane and sent to
one of the insane hospitals. In three months as an interne at the Osawatomie
Hospital I did not see one."
10
The secretary of the Kansas State Board of Health adds the information
that most of the drug addicts in Kansas are transients especially passing through
the larger cities. Travelling inspectors of the Board began an investigation which
was still going on (June 7, 1920). In 177 towns of from 200 to 20,000 population
only 63 drug addicts had been discovered.
Rhode Island Board of Health" which has jurisdiction over all morphin ad-
dicts so that it "is in position to judge of the amount of morphin used," reports
under prohibition a steady though small decrease. May 1, 1918, the Police Clinic
alone had 191 patients. Jan. 1, 1919 Police Clinic and private patients numbered
192 whose daily average was 5.59 gr. morphin. Apr. 1, 1920 there were 160 pa-
tients with an average daily consumption of 5.22 gr. Both the number of patients
and the amount of morphin were decreasing. "This is surprising to us because
we had expected something of an increase in the number of addicts when the pro-
hibitory laws went into effect, but note with pleasure that this has not been the
" 11
case.
In Indiana¹ the state Health Commissioner thinks there is increased sale of
veronal, bromides, chloral, paregoric and patent medicines with a "kick."
Reports from other centers may be grouped.
13
14
"Arrests [in connection with drug addiction] falling off" (Rochester, N.
Y.). "No indication of increased use due to prohibition" (Philadelphia, Penn.,
General Hospital,26 Richmond, Virginia. Jacksonville, Fla., Montana, Ala-
bama). General statements without statistics of personal opinions of a "de-
cided decrease" come from Washington, D. C.,16 Nashville, Tenn.,18 New Hamp-
shire 19
DRUG ADDICTS TAKING TREATMENT
Evidence of the prevalence of drug addiction based on institutions treating
it vary as does the interpretation of its meaning. In each case where there has
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been an increase since prohibition of liquor, the officials point out that the in-
crease is not due to prohibition but to some feature of anti-narcotic drug laws
which either compel addicts to take treatment or lead them to do, so because of
the difficulty of obtaining the drugs. Where there is a decrease of no change
officials are not agreed as to the reasons. It may mean that addicts can get the
drugs illicitly and so do not seek treatment; it may reflect sometimes the same
influences that just now seem to prevent much increase in all public institutions;
it may mean actual improvement in the drug situation.
Pennsylvania reports a decrease in the number of addicts in private institu-
tions some of which have closed. There is an increase in public institutions
because officials have insisted on addicts taking treatment. The same is true in
New York City as to compulsory treatment.¹ In West Virginia •more addicts
have sought treatment because enforcement of drug laws has made it hard to get
the drugs.20
Buffalo, N. Y., treated in the City Hospital and the Drug Clinic (opened
Sept. 3, 1919), 420 addicts in 1919 and only 100 in the first six months of 1920.
There was a large increase in July and August, 1919, but this was due to
"a crusade against the addicts. A large number were arrested and sent in for
treatment." The health official comments:
-
"If we are to interpret the figures as they stand, it would seem that there was no in-
crease; if anything a diminution; but we have no way of knowing how many others are
obtaining the drug from peddlers. If our statistics correspond with other cities, they may be
of some value; otherwise we can simply study them and guess."
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13
At any rate they afford no evidence of increase in this former wet city.
Rochester, N. Y., reports "no increase," Milwaukee, Wis., "no material in-
crease."
Chicago (Ill.) House of Correction where "all drug addicts are sent for,
treatment" has the following statistics:23
1919
1920, May 1………..
I
··
150 cases av. per month 12.50
45 cases av. per month 11.25
"This would indicate that drug addiction is diminishing. The Health Department had
less than 25 applications from addicts for assistance in the past five months. Less than 700
cases were called to the attention of the head of the Federal Narcotic Division for the
district of Chicago during the past 17 months. A number of institutions for treatment of
these cases have closed. The use of all kinds of narcotics has decreased since July 1, 1919."
FORMER DRINKERS NOT BECOMING DRUG ADDICTS
This evidence can be more briefly given.
Providence, R. I.: "We fail to find a man among applicants for treatment
any formerly addicted to the free use of alcoholic beverages.'
" 11
Massachusetts¹: "Drunkenness and drug addiction not common in the same
person."
New York City Health Department during past year asked 1,403 drug pa-
tients how they became addicted. Of 1,247 who gave information only 12, about
1 per cent. came to it from alcoholic indulgence.25
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Philadelphia General Hospital asks each drug patient as to the effect of ina-
bility to get liquor upon his drug disease. "No connection whatever has been
found." 26
Of 55 cases registered at Jacksonville, Fla., this past year, only 2 had turned
from alcohol to drugs. "From the histories of persons registered it appears that
there is no relation between the drug addict and the habitual user of alcoholic
liquor." 6
27
In Kentucky it is thought that many liquor users do turn to drugs when
they have a chance, but there are no statistics. In Chicago investigations show
that practically all addicts begin with alcoholic liquors, but the statistics already
quoted do not indicate that prohibition has increased the number.
23
Los Angeles (Calif.) Narcotic Clinics found in its first 500 cases only 3 or
4 who took drugs after being deprived of alcohol.
13
14
Reports from several widely separated cities as Bridgeport, Conn., Roches-
ter, N. Y., Richmond, Va., and Milwaukee, Wis.,22 find no evidence that alco-
holic drinkers become the drug addicts, while in Canton, O., it is observed that
"those deprived of liquor seek not drugs but substitutes like Jamaica ginger,
raisin jack, etc." 30
Several health officials indicate that new drug addictions of the past year
rests on previous addiction. San Francisco having no statistics made inquiries.
from about a dozen addicts referred to the hospital since July 1, 1919, and found
that the use of cocain had increased but only as a supplement to morphin.31 El
Paso, Tex., says: "All drug addicts used drugs before July 1, 1919. Whisky
users, however, are still able to get limited amounts of whisky."32 The Pennsyl-
vania Chief of Drug Control thus expresses this phase of the situation:
"A large proportion of the people who become addicted to narcotics are of the class who
also drink liquor, but I am strongly of the opinion that the average man who drank liquor
before Prohibition is facing the proposition as a good sport and despises the drug addict.
Such a man would not think of substituting drugs for liquor. As regards the lower, especi-
ally the criminal classes, I have no doubt some of them will take cocain if they can get it
and can not get liquor, but they are the fellows who took cocain before when they could
get it. I can trace no connection between the use of liquor and morphin except among the
lower grade of the population."
29
DRUG ADDICTION SPREAD IN WET STATES
It is true that public attention was drawn to the spread of the narcotic drug
evil about the time that prohibition laws began to go into effect ten or twelve
years ago. But this appears to be a coincidence in time rather than a case of
cause and effect. Limitations of space forbid full details concerning this mat-
ter, but the truth appears to be that the drug evil, promoted by desire for finan-
cial profit, had long been spreading unobserved when its evil results began to
force themselves upon public attention, not only in the states where as it hap-
pened prohibition laws were going into effect but also in the "wet" centers. Dr.
Perry M. Lichtenstein, physician of the New York City Prison wrote in 1914
that "5 per cent. of the prisoners admitted in one year were drug habitués. The
increase in the number of people addicted has been extraordinary within the past
five years."

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Justice Cornelius F. Collins of the Court of Special Sessions writes":
"In all of our criminal courts defendants appeared unmistakably affected by powerful
drugs. Attention was called to men in an almost crazed condition. Probation officers indi-
cated an appalling growth of the drug habit. . . .It came upon New York in its virulent
effect almost with the suddenness with which a plague might break out. There were un-
doubtedly some who knew of and saw its approach, but the fact is beyond all question that
it was not generally known. As soon as laws were enacted with a view to checking the
evil, the extent of it was dragged to light. Cocain dens were raided and attention called
to the practice of drug orgies which were revelations even to well-informed police officials."
This was in "wet" New York at a time when great publicity was being given
to the use of cocain in the southern prohibition states.
HOW ADDICTION IS ACQUIRED
35
34
Further evidence that prohibition of alcoholic drinks has not been in the
past the chief cause of the spread of drug-using comes from further investiga-
tions which have shown that the use of drugs spreads chiefly through bad asso-
ciations and the appeal of commercialism. Of 3.262 drug patients in New
York City, 2,482 gave "associates" as the origin. "Drug addiction spreads
like a pestilence through association." The Treasury Department Commission
found that in 1,310 cases, 974 were due to association with other addicts. Dr.
Lichtenstein said many prisoners were induced by friends to try cocain which
soon led to addiction. The Los Angeles Narcotic Clinic reports: "It is com-
mon to hear that the first hypodermic dose was administered to the novice by the
addict. In the young this first step was taken in a spirit of bravado."
2
Drug addicts are comparatively youthful, which again indicates that the
habit is not usually built on antecedent alcoholism. Justice Collins points out.
that in New York City even before prohibition came into effect "between the
ages of 17 and 22 there was such a large number of heroin victims that the aver-
age age may be fixed at 22 years. It strikes youth particularly." Of 1,169 new
patients treated at the New York Narcotic Relief Station in one week (Apr. 10-
16, 1919) most of them were mere youths. A large majority of the patients at
the New York Health Dept. Clinic" "are under 25 and nearly one-third of them
are not out of their teens." 35 One boy began at the age of thirteen.36 "It is
easily understood," says the Health Department Bulletin indicating this fact,
"what a large share idleness and bad companions have in starting the use of nar-
cotics—often, perhaps, taken from a morbid desire to imitate what they think is a
practice of the 'under world,' 'gunmen,' and 'gangsters.'"

THE FINANCIAL URGE
Behind all these conditions the greatest influence in the spread of drug addic-
tion is the financial interest. In many parts of the country were discovered con-
ditions similar to those thus described by Dr. Lichtenstein in 1914:
“Individuals have come to the conclusion that selling 'dope' is very profitable. They
have sent their agents among gangs frequenting our city corners, instructing them to make
friends and induce them to take the drug. Janitors, bartenders and cabmen have been
employed to help spread the habit. The plan has worked so well that there is scarcely a
pool-room in New York that may not be called a meeting place of drug fiends. The drug
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has been made in candy and sold to school children. The conspiring individuals, being
familiar with the habit-forming action of the drugs, believe that the increased number of
'fiends' will create a larger demand for the drug and in this way build up a profitable
business."
This desire for profit from an illicit trade probably explains the secret and
long unobserved spread of drug addiction, and the present smuggling from Can-
ada and Mexico which complicates law enforcement and makes it difficult to get
statistics of the extent of the evil. As in the case of alcoholic liquors an aggres-
sive traffic sought for profit the wrecking of human lives. In time the results
began to appear in the courts in both "wet" and prohibition sections. As soon
as legislation was directed against the traffic it dragged the conditions out into
the light of day.
SUMMARY
The admittedly incomplete evidence of this preliminary study of the question
whether prohibition is responsible for increased drug addiction may be thus
summarized:
1. The questionnaire showed there are no dependable or extensive statis-
tics of the pre-prohibition period as to the number of drug addicts. Statements
that prohibition increased drug-using are, therefore, without statistical foun-
dation.
I
2. Present statistics, though still meager, and observations of public offi-
cials give practically no indication whatever that the former alcoholic is sub-
stituting drugs for liquor. Where liquids containing these drugs are used as
substitutes they were primarily taken for their alcohol, or where use of certain
drugs has increased it is added to previous use of drugs.
3. Statistics of the causes of addiction show that the number of drug ad-
dicts who became such as the result of alcoholic indulgence is negligible. Most
authorities see little or no connection between them.
4. The drug evil spread secretly for years little noticed, finally manifesting
itself with virulence in "wet" states as well as in "dry" states. Apparently the
exposure of conditions was coincident with the spread of prohibition, not the
result of prohibition.
5. Bad associations and the urge of an illicit traffic seeking to profit by the
sale of the habit-forming drugs are the most potent causes for the growth of the
evil.
Some suggestions were made as to what further should be done to check the narcotic
drugs. These are reported here to complete the survey, without attempt to discuss their prac-
ticability: (1) Education of youth and of the general public as to the dangers in narcotic
drugs; of physicians, as to the danger of prescribing them especially to neurotic patients.
(2) Prevention. Make it impossible for physicians to prescribe indiscriminately; revoke
licenses to practice of physician-addicts; prohibit the manufacture of heroin: restrict further
importation and sale of cocain and morphin; limit importation of opium to 20,000 pounds a
year; impose severe penalties for dealing in and distributing these drugs; enforce strictly all
present laws, especially the Federal Harrison Drug Act, and then enact further laws if needed:
give the Federal Government exclusive power to import, manufacture, dispense and sell:
eventually enact national legislation placing the manufacture of narcotic and dangerous habit-
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forming drugs under the same restrictions and control as are now required for sera, vaccines,
etc. (3) Cure. For chronic addicts, provisions for care in institutions; Federal requirement
of such provision; Federal supervision of private institutions for treatment; thorough physical
examination and correction of physical defects before treating addicts for drugs; a proper
policy for supplying addicts even at cost price to cut out illicit peddlers; internment of the
vicious class of addicts in correctional institutions after they have been relieved of addiction ;
proper assistance to non-vicious addicts by health or voluntary associations; if study of situa-
tion proves it to be necessary, institutional care in state farms where curable cases can be kept
oversight for a safe period away from former surroundings, and incurable cases be kept
under necessary restraint and control, as these do not belong in either an asylum or a jail.
This necessarily incomplete review shows that the drug evil is serious and that as yet its
extent has not been sufficiently realized. It reveals the need of further study and informa-
tion, the importance of thoroughly enforcing all existing laws against harmful drugs. Many
public officials are alert and doing their best. Legislation is being tested. Properly and
promptly followed up, the drug evil ought to be brought under control reasonably soon.
SOURCES
'Ole Salthe, Bureau of Food and Drugs, N. Y. City, July 9, 1920.
Traffic in Narcotic Drugs," Report of the Special Commission of Investigation,
appointed by the Secretary of the Treasury (U. S)., June, 1919.
"Justice Cornelius F. Collins, N. Y. City Court of Special Sessions, in Monthly Bulletin,
N. Y. City Dept. of Health, Jan., 1919.
"Walter R. Herrick, N. Y. State Dept. Narcotic Drug Control, June 16, 1920.
"Thos. S. Blair, Chief Pennsylvania Bureau of Drug Control, June 7, 1920.
"Wm. W. MacDonell, M. D., City Health Officer, Jacksonville, Fla., June 17, 1920.
Chas. E. Smith, Jr., M. D., Sec'y. Minnesota State Board of Health, June 8, 1920.
E. H. Bullock, M. D., Health Director, Kansas City, Mo., June 11, 1920.
'L. B. Gloyne, Commissioner of Health and Sanitation, Kansas City, Kans., June 7, 1920.
10S. J. Crumbine, Sec'y. Kansas State Board of Health, June 7, 1920.
"B. U. Richards, Sec'y. Rhode Island State Board of Health, June 19, 1920.
12J. N. Hurty, M.D., Sec'y. Indiana State Board of Health, June 14, 1920.
1Geo. W. Goler, M.D., Health Officer, Rochester, N. Y., June 9, 1920.
14C. C. Hudson, M.D., Health Officer, Richmond, Va., June 23, 1920.
15W. F. Cogswell, M.D., Sec'y. Montana Dept. Public Health, June 28, 1920.
"W. C. Fowler, M.D., Health Officer, Washington, D. C. (Police records), Aug. 10, 1920.
"S. W. Welch, M.D., Alabama State Health Officer, June 7, 1920.
18 Olin West, M.D., Sec'y. Tennessee State Board of Health, June 7, 1920.
19
1G. M. Whitcher, Federal Prohibition Director, New Hampshire, June 14, 1902 (personal
opinion).
S. L. Jepson, M.D., West Virginia State Commissioner of Health, June 7, 1920.
21W. S. Goodall, M.D., Buffalo, N. Y. Supt. of Hospitals and Dispensaries, July 1, 1920.
"E. V. Brumbaugh, M.D., Deputy Commissioner of Health, Milwaukee, Wis., June
18, 1920.
23
John D. Robertson, M.D., Commissioner of Health, Chicago, Ill., June 22, 1920.
Hermann C. Lythgoe, Director Division of Food and Drugs, Massachusetts State Dept.
Public Health, June 8, 1920.
Weekly Bulletin, N. Y. City Dept. of Health, May 3, 1919.
Joseph C. Doane, M.D., Chief Resident Physician, Philadelphia (Penn.) General Hos-
pital, June 25, 1920.
Milton Board, M.D., Director Bureau of Venereal Disease, Kentucky State Board of
Health, June 11, 1920.
28
W. H. Bucher, M.D., in charge of Narcotic Drug Clinic, Dept. of Health, Los Angeles,
Cal., Aug. 13, 1920.
29
Eva Hugo, R.H., Supervisor of Clinics, City Dispensary, Bridgport, Conn., June 12, 1920.
30 John A. Kappelman, M.D., Health Commissioner, Canton, Ohio, June 9, 1920.
31
1. C. Hassler. Health Officer. San Francisco, Cal., Aug. 10, 1920.
32Hugh White, M. D., City Health Officer, El Paso, Texas, June, 1920.
32
S. Dana Hubbard, M.D., Acting Director Bureau Public Health Education, NY. City.
"The N. Y. City Health Clinic and Differing Viewpoints on Narcotic Drug Addiction" in
Monthly Bulletin of Health Dept., Feb., 1920.
34
Royal S. Copeland, M.D., Health Commissioner, N. Y. City: "The Narcotic Drug Evil
and the N. Y. City Health Dept." in Weekly Bulletin of Health Dept., Feb. 21, 1920.
35
Ellen N. La Motte: "The Opium Monopoly," Macmillan Co., 1920.
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