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6 Healing Vision and Bureaucratic Reality To criminalize opiate addiction with the stroke of a pen was one thing; to process and manage addicts as they were swept up in arrest and moved through the court system and into jail or prison was quite another. Addicted prisoners presented a problem to the law enforcement system at every jurisdictional level. If actively addicted at the time of arrest, they went into withdrawal in jail cells. If imprisoned for any length of time, they were likely to try, often with success, to smuggle drugs into their jails or prisons. Frequent recidivism made nuisances of addicts brought repeatedly to courts for arraignment or sentencing. Courts sometimes attempted to offload the problem by sending addicts to state institutions, such as the California State Narcotic Hospital at Spadra, but managers of these institutions complained that these seasoned addicts undermined the therapeutic mission of hospitals designed to treat curable (that is, earlierstage ) addicts.1 At the federal level, enforcement of the Harrison Narcotic Act had similarly affected the inmate population. In April 1928, of a total of 7,598 federal prisoners, 1,600 were addicted to opiates.2 The wardens of the three federal prisons (including Leavenworth, where Clifton Himmelsbach had developed his addictiveness assay) did not share Lawrence Kolb’s view that addicted prisoners could be adequately detoxified and housed in prisons. In 1928, when Congressman Stephen Porter (R-Pa.) introduced legislation to authorize the creation of two narcotic hospitals to house addicted federal prisoners and probationers (as well as voluntary patients ), federal prison wardens were among its supporters. The Public Health Service Narcotic Hospital at Lexington, Kentucky,3 and its companion institution at Fort Worth, Texas, were intended from the outset to function as both prisons and hospitals. An institution that doubled as a hospital and a prison was no anomaly, given the long shared history in Europe and America of these two kinds of institution of con- ⡢⡡⡢ ⡠⡣⡠ finement. The hospital and the prison show contrasting faces of societies’ sometimes blurred distinctions between dependency that merits pity and conduct that deserves incarceration. The hôpital général of early modern France, for example, was an institution of last resort where the state immersed idlers, vagrants, and the unemployed poor in work and religion to make them more productive subjects in a mercantilist monarchy.4 More immediate antecedents for the PHS narcotic hospitals included the nineteenth-century asylum for the mentally ill, discussed in Chapter 5, and the inebriate sanitarium. Inebriate sanitaria dating from the late nineteenth century provided treatment for those suffering from inebriety, that is, dependence on alcohol or opiates. By the mid 1880s, prolonged sequestration in a rural setting was the standard treatment for inebriety.5 Meeting a broad market demand, sanitaria for inebriates varied widely in quality and method in their treatment of opiate addiction. Some, like the Montefiore Sanatorium in Westchester County, New York, included farmwork in their therapy.6 The worst simply provided opiates under the guise of treatment. Some offered little more than a retreat for managing detoxification and an indefinite stay in a low-stress setting with rest and nutritious meals. Many deployed specific treatments for opiate addiction, ranging from quack remedies to management based on the latest medical modes. However variable their quality, they met a real demand for relief from opiate dependence. In the 1920s, as prohibition of both alcohol and opiates undermined the mission of these institutions, their numbers decreased substantially.7 Both insane asylums and inebriety sanitaria provided precedents for institutionalizing addicts (defined as suffering from mental illness) at a time when addicts were being imprisoned for possession (and sometimes sale) of drugs. Criminal justice management of addicts created the context for defining addiction not just as a diffuse disorder (as reflected in Chapters 4 and 5) but as a serious form of mental illness, comparable to schizophrenia or incapacitating depression, in that it warranted lengthy, forced institutionalization. When Stephen Porter brought a bill before Congress in 1928 to create a new kind of institution, to be called “narcotic farms,” its supporters included both law enforcement officials and scientific experts on addiction . Federal penitentiary wardens saw addicts as troublesome. The Justice Department wanted a better sentencing alternative for those convicted under the Harrison Act. Regular prison sentences seemed unduly harsh in some cases. By the late 1920s, those experienced in addiction treatment recognized the frequency of relapse following withdrawal, and Healing...

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