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12. The Clinics The treatment of narcotic addiction in the United States has passed through several distinct stages. Prior to the 1830s little was known about addiction and there were few reported cases; it was more a medical curiosity than an object ofsystematic inquiry and treatment. The toxicproperties ofopiates were of greater interest, since the averagepractitioner wasfar more likely to encounter an overdose case than one ofchronic use. During the last two-thirds of the nineteenth century, medical attitudes changed. Opium toxicology was still important, but there was a new andgrowing emphasis on the problem ofaddiction. The introduction and popularization of hypodermic injections, the physical and emotional trauma ofthe Civil m"r, the mass marketing ofpatent medicines, and other factors helped to bring about an epidemic ofmorphine addiction in the United States. Physicians began to specialize in treating addiction, and to develop theories about it. They debated its etiology: whether it, along with alcoholism, was symptomatic ofa more general nervous disorder; whether gradual or rapid withdrawal was to be preferred; whether withdrawal could or should be palliated with nonnarcotic drugs and, if so, which ones. A hundredyears later most ofthese issues are still unresolved. Nineteenth-century physicians interested in addiction were handicapped by the embryonic state ofmedical science-they knew nothing ofdrug receptors, or endorphins, or narcotic antagonists-but they did have at least one advantage over modern researchers: almost totalfreedom. There were nofederal regulations, no bureaucracy to deal with, and medical institutions, such as they were, largely steered clear ofthe problem. So doctors were at liberty to experiment, to prescribe purges, baths, electric therapy, dietary regimens, and various exotic concoctions for their addicted patients. Many ofthe leading authorities in the field operated private asylums, where the treatment was tailored to their particular theories of addiction. Addicts, too, had a fair amount of choice. They could stay at one of the private asylums or attempt withdrawal as an outpatient under the supervision ofa physician. Some bought "opium habit cures, "patent medicines which were often laced with narcotics, and hence no cure at all. Or they could do nothing and 280 ADDICTS WHO SURVIVED simply continue to use undisguised narcotics. Few addicts were legally committed to institutional treatment. When they made an effort to quit, it was generally motivated by a sense ofdisgust, combined with health andfinancial worries and pressurefrom family andfriends. With the legal changes of1909 to 1919, thefreedom ofboth physicians and addias began to disappear. Government officials assumed that, ifaddias were denied access to drugs, theproblem would resolve itself They therefore discouraged both ambulatory treatment and maintenance by physicians; what they envisioned was institutional detoxification followed by enforced abstinence. When the Webb case was decided in 1919, they had a legal precedent upon which to base this policy. The Webb case, however, involved individuals who had allegedly conspired to violate the Harrison Act. What would happen ifmaintenance programs were instead organized by municipal governments? This was the issue that was disputed during thefamous clinic era of1919-23. Following the Webb decision, some thirty-five municipalities in twelve different states opened up "narcotic clinics, "so named because they sold morphine cheaply to their registeredpatients. A ftw also sold cocaine or heroin. What is sometimes misunderstood about these clinics is that they were not homogeneous, that their methods ofoperation varied. Some were geared toward indefinite maintenance, others toward detoxification through gradual withdrawal. Some were run for profit, others merely to break even. Some were models of efficient administration, others were fly-by-night operations. One thing, however, they did have in common: all were eventually closed by the ftderal government, most within ayear ofopening their doors. Treasury Department officials, determined to eliminate both licit and illicit sources of narcotics for addias, viewed the clinics as dangerous precedents and potential obstacles to the rigorous enforcement ofthe Harrison Act, as recently interpreted by the Supreme Court. So they moved to abort them through a combination of critical inspections, threats, and legal pressure. The clinics obviously touched a deep nerve,for, more than thirtyyears after they closed, the Bureau ofNarcotics was still declaiming against them. WILLIS BUTLER Willis Pollard Butler was the most celebrated and controversial ofall the early clinic doaors. Born in modest circumstances in Gibsland, Louisiana, in 1888, Butler movedwith hisfamily to Shreveport in 1899, where he took asummerjob as a drugstore delivery boy. (Ironically, his chores included the delivery ofdram bottles ofmorphine to the local addias.) He eventually worked his way through Vanderbilt Medical School, graduating in 1911. Returning home, he...

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