In 1918, the Treasury Department established a Special Narcotic Committee, tasked with reviewing the scope of the drug problem in the United States. The Committee issued its final report, Traffic in Narcotic Drugs, in June of 1919. The product of a year’s worth of work by a committee which included reputable figures in the drug field, the report covered many aspects of the drug problem—but no part of the report drew more attention than the conclusion that the nation’s addict population numbered one million. To understand how that figure was obtained, we need to briefly review some very poor statistical analysis. And that’s part of the story. But the bigger story is that “one million addicts” took on a life of its own, a mythical number that long outlived the federal government’s own interest in its promulgation.
When we use a drug off label because it makes us feel good and we are tired of feeling bad, or calm nerves with a glass of wine, or have an extra shot of espresso to get through a long day, we are self-medicating. “I’d better figure out where to score some pot,” my friend said before beginning her treatment for breast cancer. People self medicate. Obviously.
EDITOR’S NOTE: Points is delighted to welcome Kim Sue, a previous contributor (check out her earlier posts here and here), medical anthropologist, and dual degree MD/PhD candidate at Harvard University. On the heels of Points’ recent posts about the difficulties of reconciling clinical and scholarly perspectives on addiction treatment and the media frenzy about the recent prescription opioid epidemic, Sue offers a historical and ethical reflection on having the power to dispense prescriptions.
I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.
Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.
But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.
Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”
Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.
Sam Quinones and I share an affinity for this startling fact: more Americans now die of drug overdoes than car crashes. I often say this when I am trying to convince someone that it’s important to study the drug wars; Quinones last week used the tidbit in the first paragraph of his New York Times opinion piece titled “Serving All Your Heroin Needs.”
In this article—and probably elaborated in his new book Dreamland: The True Tale of America’s Opiate Epidemic—the L.A.-based journalist writes about a new breed of Mexican heroin dealers who deliver drugs “like pizza” in cities across the Midwest. He uses a nickname for the dealers coined by a cop he knows: Xalisco Boys, for the poppy-growing region from whence they come to the United States looking for a fast buck.
I have no doubt the system of low-violence, customer-service-oriented drug dealing that Quinones has studied for several years is real. But the old chestnuts he hauls out in talking about the public health problems caused by the increased availability of heroin in smaller cities deserve comment. Read More »
EDITOR’S NOTE: The Harrison Narcotics Act of 1914 turns 100 years old tomorrow. The new federal law regulated traffic in opiates and cocaine and produced lasting effects for US and international drug policy (you can read the full text here). Today, four celebrated scholars offer 100-word reflections on first 100 years of the Harrison Act.
Recent Points inductee Kyle Bridge devoted some of his M.A. research to drug use trends and crime rates in Jacksonville, Florida. Here he presents a modified and abridged version of his work.
Since at least the early twentieth century, as regular Points readers will know, many Americans have associated illicit drug use with criminality or otherwise deviant behavior. This holds especially true in the last fifty years of U.S. history, and some politicians have made significant hay with the issue. Combating drug abuse was a prominent plank in Richard Nixon’s 1968 platform. “Narcotics are a modern curse of American youth,” he claimed in a campaign speech, and in his first term the President committed to an “all-out assault” on what he labeled “public enemy number-one.” National worries were based on a legitimate correlation: in 1969 users made up a significant portion if not the majority of criminal perpetrators in metro areas including Los Angeles, the District of Columbia, New York, and Boston.
As a student of history and lifelong Jacksonville resident (actually Callahan, a small town just north of the city), I was curious about the local dynamic of this association, and how it changed over time. The Jacksonville public regarded drug use with an unsurprising wariness, similar to Americans nationwide. Still, policing drug use warranted little attention in local politics until around 1995, almost a half-decade after crime rates peaked during the crack epidemic. In fact new attention to drug use surfaced three years into what would become an almost entirely consistent twenty-year crime decline. By the turn of the millennium, the drug arrest rate had jumped to 1,115.18 per 100,000, almost doubling rates from the height of the crack epidemic (never higher than 689.62).
“This pussy has teeth; no one should fuck me ever” — Margaret
I begin this post with exciting news: Slava Tsukerman and Anne Carlisle are collaborating on either a sequel to or a documentary about the making of Liquid Sky, the 1982 science fiction movie about Margaret, the new wave Edie Sedgewick-inspired club-hopping model who, assisted by her alien lover, kills with her cunt.
A summary is all but impossible, but here goes:
At a press conference on June 17, 1971 then President Richard Nixon informed his constituents of a troubling menace. “America’s public enemy number one in the United States is drug abuse.” Nixon also labeled those associated with drug abuse primary enemies of the state. “In order to fight and defeat this enemy,” Nixon charged, “it is necessary to wage a new, all-out offensive.” Sadly, this all-out offensive has been in full bloom under the modern War on Drugs while drug abuse—keeping in step—has also flourished.
Earlier that afternoon Nixon gave a special message to Congress, providing more details regarding the scope of the problem. Declaring the “tide of drug abuse” a “national emergency,” Nixon reminded Congress that, “narcotic addiction is a major contributor to crime.” Nixon continued, establishing what is now an oversimplified, rarely analyzed cultural truth: “Narcotic addicts do not ordinarily hold jobs. Instead, they often turn to shoplifting, mugging, burglary, armed robbery, and so on. They also support themselves by starting other people-young people-on drugs.” The addict, and the peddler—often doubling as the same shadowy figure—became cemented as cultural boogeymen. Addicts were either hooking our youth on dangerous drugs or committing other crimes to cop. Addicts, not society, caused the problem and bore the threat to public safety. Despite his well-documented fiscal commitment to rehabilitation efforts, Nixon’s public rhetoric designed to sway silent majority voters advanced the march towards an ethos of punishment and condemnation. For example, in his same message to Congress, Nixon asked for additional funds to support enforcement efforts “to further tighten the noose around the necks of drug peddlers.” To borrow from our Managing Editor Emily Dufton, Nixon, “transformed the public image of the drug user into one of a dangerous and anarchic threat to American civilization.”
Adam Wilson founded and edits the online newspaper The Faster Times and is a regular contributor to The Paris Review Daily. His fiction and nonfiction have found publication in numerous journals and magazines from The Paris Review and Meridian to the New York Times. Wilson contributed to the anthologies Dirty Words: A Literary Encyclopedia of Sex (2008); A Friday Night Lights Companion: Love, Loss, and Football in Dillon, Texas (2011); and Promised Lands: New Jewish-American Fiction on Longing and Belonging (2010). His first novel, the comic and bittersweet Flatscreen (2012), follows its young male protagonist through stoner slacking and drug-fueled antics as he fumbles toward establishing a post-high school identity. The National Jewish Book Council chose Flatscreen as a finalist for the 2013 Goldberg Prize for Outstanding Debut Fiction. Wilson also received the Paris Review‘s 2012 Terry Southern Prize for Humor for his contributions to the publication, including the marijuana-laced “What’s Important is Feeling,” which was selected for publication in Best American Short Stories 2012. He is a graduate of Columbia University’s creative writing MFA program and currently teaches at New York University and the Sackett Street Writers Workshop.
Two nuns and a penguin approach you at a bar, and you tell them you’re a writer. When they ask you to describe Flatscreen, how do you answer?
It’s about an unlikely friendship between a young, spiritually tested nun and a wheelchair-bound penguin who is addicted to Oxycontin and loves hookers.
Points is a blog primarily for drug and alcohol historians. What do you think this audience would find most interesting about Flatscreen?
Well, there’s certainly a lot of drugs and alcohol in the book! There are a lot of great novels about marijuana, cocaine, heroin, meth, and LSD (among others), but I don’t know of any others where the primary drug of choice is Oxycontin. I’m not sure my book sheds too much light on the drug itself–it’s mostly about other things–but if you’re looking for OxyFiction, I’m not sure where else you’d go.Read More »
Editor’s note: Today guest blogger and medical anthropologist Kim Sue offers her observations on how changing marijuana laws have slowly begun to impact the world of the opiate-addicted patients she studies–and the wider society’s assumptions about drugs and the reasons people use them.
I have been closely following the campaign for and roll-out of medical marijuana in Massachusetts as I conduct ongoing ethnographic fieldwork on opiate use and incarceration. Given marijuana’s prominent place in the historical, political, and cultural framings of the War on Drugs, it is critical to consider evolving legal frameworks and cultural attitudes toward the drug.
Last fall, advocates for medical marijuana managed to get it enacted via referendum. Read More »