Addicts Who Survived: An Oral History of Narcotic Use in America before 1965

Epilogue to the 1989 Edition: From Methadone to the Drug War

Epilogue to the 1989 Edition: From Methadone to the Drug War E p i l o g u e t o t h e 1 9 8 9 E d i t i o n 3 4 5 Anslinger faced in his time. It is not that there has been a fundamental change in philosophy; substances like heroin and marijuana are still outlawed2 and their suppression remains a law-enforcement priority. What is different is the extent and especially the complexity of drug use in the country today versus twenty-five years ago. This is true in virtually every respect. Legally, therapeutically, pharmacologically, and socially, the problem has grown more complicated. The situation has become more complex legally because methadone maintenance has been superimposed on laws aimed at prohibition and interdiction. Recall that, from the early 1920s until the middle 1960s, American narcotic policy had two key objectives: the quashing of legal maintenance and the suppression of illicit narcotic transactions through vigorous police enforcement. What has happened since then has been a qualified abandonment of the first goal, but not of the second. This was intentional: the liberal supporters of maintenance never espoused, nor could they have achieved, a libertarian resolution of the problem. The government was not about to get out of drug enforcement and proclaim caveat emptor. Most liberals were perfectly willing to see addicts, whom they regarded as victims, treated in clinics, and traffickers, whom they regarded as criminals, sent to jail. This arrangement is at best paradoxical ; some critics have described it as confused and contradictory.3 What about the addict who is also a dealer? Or the addict who is a predacious criminal, before, during, and after treatment? Or the addict who diverts methadone into the black market? Methadone programs have reduced the frequency with which their clients violated the law, but they certainly have not eliminated all of their legal or behavioral problems.4 These difficulties are not unique to narcotic policy. In virtually every area where liberals successfully challenged restrictive policies in the 1960s and 1970s, similar quandaries have arisen. Gambling is a good example. State-run lottery games and other forms of legal gambling are now freely available and widely advertised. But illegal gambling has not disappeared, as some liberals hoped or assumed; the police still have plenty of sports bookies and bolita operators with whom to contend. The public, meanwhile, gets a decidedly mixed message: some forms of gambling are acceptable, but others are not. The same is true of drug use. Classic-era narcotic policy, despite its faults, was at least consistent. Its message was unambiguous: drugs are bad for you. This is one reason why proponents of therapeutic communities remain deeply suspicious of methadone maintenance: it contradicts, both symbolically and actually, the traditional goal ofabstinence. "It's just another political expediency," charged Dr. Judianne Densen-Gerber, founder of the Odyssey House therapeutic community. "There's no reason to change a heroin user to methadone, just as there's no reason to change a scotch drinker to cheap A d d i c t s W h o S u r v i v e d 3 4 6 wine.... People should not have a dependency disease. They should be able to make decisions without being controlled by their need for a substance."5 Others have countered that the problem has nothing to do with methadone maintenance but with the regulations that have hamstrung the programs . The late Marie Nyswander, whom we interviewed in 1981, was amused to find herself "sounding like a Republican" on the issue of federal controls. "I don't think there's any question about it," she said. "If we had decent treatment, in all the ways people could be treatedclinics , hospitals, doctors-then we'd probably take in the majority of addicts. But right now methadone is operating at only 30 to 50 percent of its potential."6 Why not, she urged, permit stable, long-term patients to simply receive a several months' supply from a private physician? For Nyswander, contemporary narcotic policy was insufficiently reactionary; that is to say, the clock should have been turned all the way back to 1914, when doctors still had wide latitude in maintaining addicts, rather than to 1919-23, when a handful ofmunicipal programs struggled to treat patients in a hostile regulatory environment. Indeed, the 1970s and 1980s might be aptly described as the New Clinic...