Law and Policy: History of, in the United States

Americans have always used drugs that affect the mind, especially alcohol. And for as long as there has been drug use, there have been attempts to regulate, control, and even prohibit this use through law. Many changes have occurred in drug and alcohol regulation over time, but certain basic impulses behind control have played a continuous role in the history of drug policy in the United States.

Alcohol: The Road to Prohibition

On January 16, 1920, the Eighteenth Amendment to the United States Constitution took effect, one year after its final ratification by the states. The amendment read in part: "the manufacture, sale, or transportation of intoxicating liquors within, the importation thereof into, or the exportation thereof from the United States . . . for beverage purposes is hereby prohibited." This experiment in national alcohol prohibition lasted nearly fourteen years, until the Twenty-first Amendment repealed the eighteenth. Prohibition was not an isolated event. In fact, it was the culmination of many decades of efforts to control alcohol. These efforts were rooted in three impulses common to all efforts at drug control: medical, moral, and social.

Medical Reasons for Control. The medical aspects of alcohol control date back to the eighteen century, when physicians were among the first advocates of what came to be known as temperance. Although temperance was eventually thought of as a movement to ban alcohol altogether, in its early forms it usually emphasized the health bene- fits of moderate consumption. Drinkers were advised to avoid drunkenness, and to consume less powerful fermented beverages such as beer and wine, while avoiding hard liquors such as rum or whiskey.

As temperance grew into a mass movement in the nineteenth century, it continued to draw support from medical and scientific re- search. Physicians discovered a great deal about the action of alcohol on the human brain and its influence on memory, perception, and motor function (movement). The new field of public-health research found statistical links between heavy (and even moderate) alcohol consumption and disease. In the end, organized medicine joined the fight against alcohol: in 1918, the American Medical Association passed a resolution opposing the use of alcohol as a beverage.

Moral Reasons for Control. A second impulse, at least as old as the first, was the moral opposition to drinking and drunkenness. Religious revivals during the early 1800s turned the fight against alcohol into a popular crusade. Evangelical Protestantism spread a message of abstinence and sobriety, coupled with a belief that laws could be used to create a more moral society. In this last respect the anti-alcohol movement made a critical step: it went beyond merely redeeming, or saving, an individual drinker and instead worked to- ward larger social change through public policy.

Social Reasons for Control. Efforts to control alcohol reflected concerns about the social impact of drinking. The focus of these social fears was the saloon. The saloon was a product of the newly industrializing nation of the early nineteenth century and was the center of leisure activity for working-class males. To critics, the saloon was a breeding ground for vice (immoral behavior), crime, and disorder. The Woman's Christian Temperance Union (WCTU), formed in 1874, fought alcohol with the slogan "Protect Our Homes." The Anti- Saloon League (ASL), formed in 1895, organized itself under the slogan "The Saloon Must Go." These organizations had impressive political skills. Their efforts brought prohibition first to many local communities and several states, then finally to the entire United States in 1920.

The Origins of Narcotic Control

In 1919, as the final states prepared to ratify the Eighteenth Amendment, the federal government was also strengthening its control over narcotic drugs, especially cocaine and opiates . (At the time the term "narcotics" was used to apply to opiates and cocaine and, later, to marijuana as well.) As with alcohol, the road to control on the national level was a long one, and it reflected some of the same basic impulses.

Medical Reasons for Control. Developments in trade and technology in the nineteenth century changed the face of drug use in the United States. Standard preparation of drugs during the late- eighteenth century and early-nineteenth century made opium widely available to the American consumer. Advances in chemistry gave consumers powerful new drugs made from plants. Commercial production of morphine (from opium) began in 1827, and of cocaine (from the coca plant) in 1884. As more and more people were exposed to opiates and other drugs, use and abuse increased. This led doctors to focus on the subject of drug addiction. The American Association for the Cure of Inebriates, founded in 1870, was one of the first organizations to raise medical awareness of addiction.

Medical concerns were closely related to professional concerns about the control of the drug supply. Drug manufacturing was changing dramatically, as small operations selling plant and herbal medicines gave way to large corporations with more aggressive approaches to drug development, research, and promotion (advertising). At the same time, makers of patent medicines marketed a wide range of medicines directly to the general public. Doctors and druggists (pharmacists) feared that the drug industry's desire for profit would overwhelm concerns for public health and safety. They sought to limit the sup- ply of drugs to a quantity necessary for "legitimate" purposes. By this they meant the quantity that physicians used themselves or that they recommended to their patients. Medical and professional impulses came together in the passage of the Pure Food and Drugs Act of 1906, which set the first national rules for drug promotion (advertising), packaging, and distribution.

Social and Moral Reasons for Control. The social and moral impulses behind alcohol control were just as important to drug control. Opium smoking, a practice that originated in China and spread widely in the United States in the 1870s and 1880s, first raised these concerns. While people addicted to opium through medical use were of- ten seen as deserving of sympathy, pleasure-seeking opium smokers were seen as suspicious characters who cared only for their own satisfactions. Opium smoking was not a product of medical use at all; smokers purposely sought what they saw as opium's recreational pleasures. Smokers gathered in opium dens, places that the general public strongly disapproved of. The public's response to opium smoking was repeated in the response to cocaine in 1884 and to heroin in 1898.

The Crime Control Model

The first antidrug legislation was an 1870 San Francisco law that sought to eliminate opium dens. During the decades that followed, numerous communities and states passed their own drug laws, restricting the use of opiates and cocaine. In 1914, Congress passed the Harrison Narcotic Act, signaling the start of national drug control. The Harrison Act was a tax measure, requiring doctors and druggists who dispensed opiates and cocaine to register with the federal government and pay a special tax. The purpose of the 1914 Harrison Narcotic Act seemed to be to limit opiates and cocaine to medical practice, not to regulate that practice or to cut addicts off from medical supply. By 1919, however, it became clear that the federal government intended to use the Harrison Act as a means to prohibit all drug use related to addiction.

The year 1919 began with two Supreme Court decisions. These decisions confirmed that three aspects of the Harrison Act were constitutional: (1) the act's tax on physicians, (2) limiting distribution to legitimate medical practice, and (3) the government's view that the maintenance of addicts was not a legitimate medical practice. In the fall, Congress rejected an ambitious public-health measure that would have approved the construction of a large system of publicly funded treatment institutions. At the close of the year, federal narcotics enforcement shifted to the newly formed Prohibition Bureau. The leadership of the new narcotic division immediately determined to investigate and close the city drug maintenance clinics that had been created to assist addicts in the aftermath of the Harrison Act.

As the next decades unfolded, the government became involved in a flurry of activity aimed at crime control and law enforcement. Drug addicts were seen as diseased law breakers, social misfits, and failures. Then a doctor interested in the treatment of addicts, Dr. Lawrence Kolb, made a distinction between the "normal" addict who had been accidentally "hooked" through medical practice, and "psychopathic" addicts who took drugs for pleasure and suffered from some sort of personality flaw. Kolb was the first director of a combination federal prison/hospital for addicts in Lexington, Kentucky. The institution opened in 1935 to serve addicts from around the country. Although the creators of the prison/hospital hoped it would operate more as a hospital, Lexington in fact followed a crime-control approach, with patients kept in prisonlike cells. All patients received similar, rather than individualized, treatment, showing that the staff had little optimism that patients could be cured or reformed.

Legislation, 1920 1960

Most new legislation of this period emphasized the crime-control approach to drug policy. Three federal laws stand out in this regard: the 1937 Marijuana Tax Act, the 1951 Boggs Act, and the Narcotic Control Act of 1956. All three reflected the influence of the Federal Bureau of Narcotics (FBN) and its director, Harry J. Anslinger. Anslinger had been picked to be the first head of the FBN when it replaced the old narcotic division of the Prohibition Bureau in 1930. For the next thirty years, both the public and politicians approved of Anslinger's belief in a strict law-enforcement approach to drug policy. The 1937 Marijuana Tax Act introduced the first federal penal- ties on the cultivation, sale, and possession of marijuana, while the Acts of 1951 and 1956 increased penalties for federal drug law violations. The FBN viewed drug users and addicts as criminals whose antisocial behavior threatened public safety.

Formal regulation of the legal drug supply expanded in 1938 with passage of the Food, Drug, and Cosmetic Act, which created a large class of drugs that would from that time forward be available only with a physician's prescription. For the first time, the Food and Drug Administration began to try to limit the distribution of certain non- narcotic drugs of abuse, especially amphetamines and barbiturates. In 1951, the Durham-Humphrey Amendment created two classes of drugs—prescription and nonprescription—into which all drugs had to be placed.

New Approaches to Modern Drug Control

In the 1970s, an important period of policy development began that led to the modern drug control system. In 1969, the administration of U.S. President Richard M. Nixon saw a "triple threat" coming from the youth drug culture, ghetto heroin use, and drug use among soldiers in Vietnam. It reacted by beginning a dynamic period of policy making both at home and internationally.

Reducing Demand. Under President Nixon, the federal government made a decision to reduce the demand for drugs through the public funding of addiction treatment and prevention programs. The most important aspect of Nixon's policy was a full-scale commitment of federal money to drug treatment, especially methadone maintenance for heroin addicts. Methadone maintenance grew out of the work of doctors Vincent Dole and Marie Nyswander, who determined that regular maintenance doses of methadone reduced craving for heroin and allowed addicts to function normally in their daily lives. Federal funding for treatment increased more than tenfold between 1970 and 1973. In 1974 the creation of the National Institute on Drug Abuse expanded the focus on treatment, education, and prevention, and funded a new generation of addiction research.

Treating All Types of Addiction. Another important change in national policy was the increased recognition that drug policies could no longer focus only on opiates. For decades the drug problem had been seen as a heroin addiction problem. The growing diversity of drugs of abuse led to the Comprehensive Drug Abuse Prevention and Control Act of 1970. This act created five categories (known as schedules) of drugs, based on their potential for abuse, degree of harmfulness, and the potential for legitimate medical use.

The Continued Importance of the Crime-Control Approach

The crime-control approach has remained at the core of drug policy. Crime control in modern America concentrates on the sale and distribution of illegal drugs through four basic approaches: (1) inter- national control of drug supply, (2) interdiction (seizure of drugs at the borders), (3) disrupting drug traffickers, and (4) enforcement at the level of street sales. Since 1970, the effort to control the supply of drugs has grown to extraordinary levels. In the last year of the FBN (1968), the agency had about one dozen foreign agents in the field. By 1978, the Drug Enforcement Administration (DEA) fielded 228 agents in sixty-eight overseas offices. In the early twenty-first century, the DEA influences drug control programs in countries around the world.

According to one estimate, the United States spent a total of $28 billion in 1990 for all aspects of drug control. Drug arrests also indicate the enormous scope of control efforts, with over one million ar- rests annually for drug-law violations in the United States. On the state level, these higher numbers meant higher prison populations, placing a strain on prison systems and state budgets. In California, the number of drug offenders sent to prison increased from approximately 1,500 in 1980 to 22,600 in 1990.

Conclusion

As drug policy enters the twenty-first century, it builds on a history featuring both change and continuity. Historical changes include the end of alcohol prohibition, the rise in popularity of some drugs and the disappearance of others, and higher or lower levels of enforcement. These changes are reminders that drug policies can be altered and improved on. The continuities, especially in the basic impulses for control, are evidence that the control and regulation of drugs and alcohol are a fundamental part of U.S. public policy.