Narcotics Policy

William O. Walker III

Efforts to control the production of and traffic in illicit drugs, commonly referred to as "the war on drugs," seem like a relatively recent phenomenon. The visibility of struggles since the late 1970s against drug organizations, or "cartels," based in the prosperous Colombian cities of Cali and Medellín did much to shape that perception. Narcotraffickers, as major figures in the South American drug business are called, were responsible for the influx of powdered cocaine, crack cocaine, and, increasingly since the late 1980s, heroin into the United States.

Public awareness of drug control as an aspect of U.S. foreign policy likely began with Operation Intercept in August 1969. U.S. officials designed Intercept as an intensive effort to curb the flow of marijuana and other drugs from Mexico into California. Within two years, as narcotics like heroin began entering the United States in unprecedented amounts from various points of origin, President Richard M. Nixon had declared a war on drugs, calling them a serious threat to the security of the nation.

The Colombian, Mexican, and other examples illustrate the fact that campaigns to control drugs have a history of their own, unknown though they may be. The impetus for international drug control, commencing at the beginning of the twentieth century, arose from concern among industrialized nations, most notably the United States, about the havoc that drugs could potentially wreak upon society. Alarmed at the incidence of opium smoking in their new colony in the Philippines, U.S. authorities acted to stamp out the practice among the overseas Chinese population. They discontinued Spain's contract system under which Chinese smokers had purchased opium from licensed dens. Surprisingly elimination of the Spanish system actually increased the availability of smoking opium in the islands and led as well to a greater incidence of usage by the Filipinos themselves.

The motivation behind opium prohibition was simultaneously moralistic and economic. In the eyes of reformers and U.S. officials, good Christians only consumed intoxicants like tobacco and alcohol if they consumed any such substances at all. The smoking of opium betokened spiritual degradation if not personal depravity. Moreover, colonials habituated to opium and opiates were deemed unproductive subjects who potentially could weaken a market economy. Drug usage therefore had no place in the American empire or, for that matter, in any colonial setting.

For nearly a century the United States clung to the idea of control at the source as the only possible path to effective drug control. Whether at international parleys or through bilateral and regional diplomatic efforts, U.S. officials steadfastly pursued this goal. At the same time, as this essay demonstrates, drug control did not, indeed could not, exist in a vacuum isolated from other foreign policy concerns. Ultimately this state of affairs meant that control at the source had to give way to competing, often more important, priorities. During World War II, for instance, drug policy reflected the exigencies of global war by encouraging the production of raw narcotic material should it be necessary for the medical needs of the Allies. Throughout the Cold War, U.S. drug control officials frequently subordinated their traditional objectives to larger security considerations. This practice all too often entailed countenancing involvement with illicit drugs by so-called security assets. In the 1990s, as the Cold War ended, efforts by the United States to promote comprehensive drug control abroad became indistinguishable from the very issues of governance and state stability. This was particularly true in the Andes, most notably in Colombia, and to a lesser extent in Mexico.

THE ORIGINS OF DRUG CONTROL

The United States was not the first imperial power to try to halt the consumption of proscribed substances. Spanish authorities in colonial Peru, for instance, reversed their early tolerance of coca chewing, known as el coqueo, as they sought to transform indigenous Inca culture and develop a productive workforce to serve Spain's material and spiritual interests. In the process there arose a debate, which continued well into the twentieth century, over whether to prohibit native cultivation and use of coca. Like coca, opium has a complex past that is intermingled with issues of culture and power. The grafting of opium onto the culture of China roughly coincides with the history of the Qing dynasty. Opium smoking, likely enjoyed first by Chinese in Jakarta, Indonesia, evolved out of the habit of tobacco smoking. By the time of the mid-nineteenth century Opium Wars, when the dynasty showed unmistakable signs of instability, opium addiction permeated Chinese society.

The persistence of el coqueo among the indigenous people of Peru and the prevalence of opium cultivation and smoking among the very poor in China coincided around 1900 with a wave of reform, or prohibitionist, sentiments in both countries. The War of the Pacific, in which Chile defeated both Peru and Bolivia, lasted from 1879 to 1883 and briefly devastated Peru. Andean Indians endured especially oppressive conditions in the war's aftermath. The prospect of political change and with it, a wide spectrum of social reforms, revitalized Peru after a revolution in 1895. Inevitably some reformers asked whether traditional Indian reliance on coca had a place in modern Peru. Around the same time in Asia, the Qing dynasty came under intense pressure from Confucian scholars and others to implement broad reforms as foreign powers vied with one another to obtain concessions and create spheres of influence. Destroying the opium business became a basic part of the reform agenda in China. Chang Chih-tung, a powerful scholar-official and advocate of reform, wrote, "The development of education is the best medicine to use for the suppression of opium."

DRUGS IN THE UNITED STATES

The emergence of a drug culture, usually called a subculture, also occurred during an age of reform in the United States. The Progressive Era, as scholars have characterized the U.S. political scene, began around 1890 and persisted until just after 1920. The reform spirit of the time arose out of a felt need for order and stability amid waves of immigration, the promises and challenges of industrial consolidation, and recurring threats of recession. The historian Richard Hofstadter found that the reformers were responding to real conditions that needed to be addressed in a nation undergoing rapid urbanization. Perhaps more important, he also believed that they were engaged in a quest for meaning in their lives and, hence, were desirous of finding something akin to the sense of mission that had earlier inspired the Civil War generation. Social reform naturally became one of the causes they championed.

To be sure, Americans had inveighed against drink throughout their history, especially since the Jacksonian era. The influx of immigrants, many of whom drank as a matter of course, gave the temperance movement a new urgency in the late nineteenth century. Assimilation through acculturation became the standard by which reformers measured the success of their endeavors to transform immigrants into good Americans.

Moral and social reformers did not limit their evangelism to newcomers. They sought to curb, if not stop, excessive drinking among the male citizenry of the republic and tried to restrict, if not eliminate, the practice of prostitution. Ultimately they turned their attention to the use and abuse of opiates. In their striving to make the United States what is now inaccurately termed a "drug-free" nation, reformers created a deviant class within society. Before reformers singled out and stereotyped casual users and addicts as deviants, though, the educated and the well respected were more likely to use narcotics than members of the working class, who typically drank alcohol because of its comparatively low cost. The medical community, for instance, especially seemed to fall prey to opiate abuse. By the early 1900s researchers feared that middle-class women, young people with time on their hands, and hard-working, progressive professionals would succumb to the temptation of drugs.

The concern that educated whites would find drug use an exhilarating experience had some basis in fact. No less a social reformer than Jane Addams wrote in her account of life at Hull House that she and four classmates had experimented with opium while attending Rockford College. The data are not available to establish the extent of drug abuse or addiction during the Progressive Era; estimates range widely between one hundred thousand and one million persons. Usage, of course, often remained a secret known only to the user's doctor or druggist. Despite public impressions that addiction was rapidly increasing, consumption may actually have been in decline in the early 1900s. Consequently the reality of a serious drug problem at that time remains open to question.

Even before the inception of progressivism, some reformers in the United States, baffled by the intractability of addiction, associated the prevalence of drugs in America with a foreign presence. These reformers did not directly charge foreigners with causing America's problem with drugs. What they were alleging was rather more sinister. They contended that foreigners, often Asians, and other purveyors of drugs had managed to unlock the worst instincts of the American populace. That is, many Americans were predisposed to surrender themselves to the drug habit "based as it is," in the words of a Massachusetts physician, "upon a [human] craving no laws can eradicate."

It seems evident, therefore, that reformers in several drug producing or consuming countries around the world had a common objective in the early twentieth century: to save from themselves those people living in a culture of drugs. Drug reformers rarely asked whether their basic assumptions about the drug cultures within their societies were accurate. By failing to so inquire, they consigned those subcultures to the margins of society. The ready identification of involvement with drugs as characteristic of a dangerous culture enabled Washington to promote its style of drug control as a desperately needed international goal. In 1903 the governing Philippine Commission failed in its attempt to return to the Spanish contract system in the Philippines. Charles H. Brent, Episcopal bishop of the Philippines and a leading antidrug crusader, declared the entire opium enterprise from import to sale to consumption an unacceptable "social vice …a crime."

A report by the Philippine Opium Committee, set up in 1903 to study opium throughout East Asia, had recommended the creation of a government monopoly in the islands. Deriving revenue from opium, critics charged, would make the United States no different from Great Britain, which was still selling chests of Indian opium to the Chinese. Thus the U.S. Congress passed a law in 1905 mandating for the Philippines the total prohibition by 1 March 1908 of all commerce in opium except for governmental and medical purposes. As the law went into effect the opium business went underground, thereby creating not only an illegal drug subculture but also a chronic law enforcement problem.

The inability of law enforcement personnel in the Philippines to curtail the illicit trade in opium allowed the United States to propose a deceptively simple solution to the emerging global drug problem: control at the source. First at Shanghai in 1909 and thereafter at three meetings held at The Hague beginning in 1911, U.S. officials, notably with the help of Chinese reformers, called upon other major powers to control the production and manufacturing of narcotics. How such controls would come about could not easily be agreed upon. The British, for example, were reluctant to put a premature end to the declining Indian trade, and commercial interests in China did not want to surrender a lucrative source of revenue. Asian opium smokers living outside of China understandably feared the loss of accustomed access to their drug.

The Shanghai meeting constituted the opening skirmish in what some analysts have called a new Hundred Years' War: the campaigns to control drugs in the twentieth century. The U.S. delegation, led by Brent and Dr. Hamilton Wright, who was well known for his work in Asia on communicable diseases, knew that mobilizing an antiopium alliance would be no easy task. The meeting accomplished little more, therefore, than the introduction of the issue of opium control. Great Britain, for its part, continued not unreasonably to doubt China's willingness and ability to prevent the spread of poppy production and opium smoking.

Shanghai did, however, set the stage for additional international meetings and gave Wright and other reformers a basis for insisting that the U.S. Congress pass domestic drug control legislation. Armed with the moral high ground for having put in place a program of strict prohibition in its Asian colony, the United States was determined to accept nothing less than the same from other regional imperial powers, namely the British, the French, and the Dutch. The realities of the economic importance of opium in East and Southeast Asia and the inception of the Great War impeded American plans. Other major nations in attendance at the Hague Opium Conference of 1911–1912 agreed only to take preliminary steps to bring the illicit trade in opium under control.

Meanwhile the United States moved toward passage of its first comprehensive drug control law, the Harrison Act of 1914. During the first week of the Shanghai meeting the U.S. Congress had prohibited the importation of smoking opium. The limited and, for Wright, disappointing outcome of the meeting at Shanghai convinced him to intensify his efforts on behalf of federal regulation. Only when the United States had in place adequate federal antidrug legislation, he reasoned, could America legitimately ask other nations to follow its lead.

Fears based on race and class clinched the case for federal drug control. America's cultural majority perceived heroin, which was usually taken through subcutaneous injection, and cocaine, a drug reportedly favored by African Americans in the South, as substances that decent people shied away from. By definition those who consumed these drugs were exhibiting antisocial, deviant behavior. Since the American public feared the spread of addiction and its attendant dangerous and often criminal behavior, the advocates of federal control had virtually no trouble making their case.

With scant debate Congress passed the Harrison Narcotics Act in December 1914. President Woodrow Wilson soon signed it into law, and it took effect on 1 March 1915. This law, typical of the regulatory legislation of its time, promised to promote cultural homogeneity and social stability through the unlikely though quintessentially progressive device of revenue collection. Despite widespread popular support for prohibition, the Harrison law did not cut off access to narcotics any more than imperial edicts in Qing China had eliminated the practice of opium smoking.

THE TROUBLED 1920S AND 1930S

Ironically the domestic successes of drug reformers adversely affected U.S. efforts to promote a global antidrug strategy of control at the source. Expectations in America about how long it would take to put comprehensive controls into effect did not accord with the reality of the situation abroad. Any delay was unconscionable, in the view of some American observers, because the international drug problem had evidently become a grave one. "[S]muggling of narcotics in the United States," lamented Secretary of the Treasury Andrew W. Mellon in 1921, "is on the increase to such an extent that the customs officers are unable to suppress the traffic to any appreciable extent." The secretary's assertion gave anecdotal credence to unfounded public perceptions about the severity of the drug situation.

The newly created Advisory Committee on Traffic in Opium and Other Dangerous Drugs (OAC) of the League of Nations took charge of supervising the obligations incurred by the states signatory to the Hague conventions. Private individuals and those government officials who favored strict drug control doubted whether member states as well as the league itself possessed the political will to enact strict drug control measures. An impasse between Washington and Geneva developed during the early 1920s and kept the United States from influencing the work of the OAC until early in the 1930s. The Department of State's Division of Far Eastern Affairs, the bureau responsible for implementing drug policy, had initially hoped to find some way of cooperating with the OAC. In that spirit Dr. Rupert Blue, formerly the U.S. assistant surgeon general, attended the fourth session of the OAC in January 1923. He made it clear in his remarks to the OAC that the United States held both producing and manufacturing states responsible for escalating international drug problems. In Blue's estimation the only recourse was to call for strict controls on production and manufacture. Representative Stephen G. Porter, chairman of the powerful House Foreign Affairs Committee, who was as adamant as Blue about what U.S. foreign drug policy should be, wrote Secretary of State Charles Evans Hughes that "an effective remedy [to drug problems] cannot be secured by compromise."

Porter quickly transformed Blue's skepticism about the OAC into outright hostility. In May 1923 at the fifth session of the OAC, Porter refused even to engage in debate about U.S. proposals for immediate, comprehensive controls on manufacturing. In defense of his position, which had caused much consternation at Geneva, he belligerently remarked: "If when I get back to America anybody says 'League of Nations' to me, he ought to say it conveniently near a hospital." Porter's bellicosity was in line with Department of State thinking. Secretary Hughes had made it clear that the nonmedical or nonscientific use of drugs was unacceptable and that global production of narcotics had to be controlled. In so doing, Hughes captured the essence of the dogmatic approach to drug control—control at the source— that the United States has pursued throughout the twentieth century. Hughes once observed: "Unrestricted production leads to uncontrollable consumption, especially when the product enters international channels." This assessment of the roots of the drug problem in America resulted in February 1924 in a walkout, led by Porter, of the U.S. delegation from the second Geneva Opium Conference, which had been convened to discuss the manufacturing of narcotics. Other states in attendance would not accept without reservations an American-initiated proposal to bring a rapid cessation to the drug business.

Compounding matters, and making multilateral action against drugs difficult to achieve, was the willingness to hold foreigners responsible, if not accountable, for whatever problems impaired U.S. antidrug efforts. The substances that most captured the attention of U.S. officials in the 1920s were opiates and, to a much lesser extent, cocaine and marijuana. Opiate traffic, increasingly in the form of heroin instead of smoking opium, primarily originated in East Asia. Heroin, once believed by some in the medical community to be a cure for morphine addiction, had initially reached a wide audience as a medicine for coughs courtesy of the Bayer chemical company of Germany. A manufactured drug, heroin could be synthesized from morphine fairly easily; as a result, officials could not readily pinpoint the precise origin of the heroin found in the illicit trade.

In the early 1920s drug manufacturing was concentrated among European nations, the United States, and Japan. The U.S. Congress had tried to control the export of manufactured drugs in a section of the Narcotic Drugs Import and Export Act of 1922 by requiring exporters of such drugs to possess a proper certificate from the importing country. Congress amended the act in 1924 to prohibit opium importation for the manufacture of heroin. This legislation was meant to serve as a model for other countries but did not prevent the diversion of heroin manufactured outside the United States into illegal international channels.

The reluctance of manufacturing states to accede to controls that would mean a loss of market share turned the attention of the U.S. government to the less economically advanced drug-producing nations. Perhaps surprisingly Washington did not redouble prior efforts to curb opium poppy growth in China. Nor did diplomats serving in the Andes pressure leaders in Peru or Bolivia, where el coqueo was an integral part of national culture, to force peasants to stop farming coca. The fall of China after 1915 into a decade of internal strife dominated by regional warlords made efforts to halt poppy growing impossible. Not surprisingly, opium played a vital role in China's economy during the warlord era. As for cocaine, many urban users switched to heroin as a cheaper drug of choice after scarcity and strict enforcement of state laws combined to drive up black-market prices for cocaine. Accordingly U.S. officials encouraged Andean nations to move toward gradual compliance with international agreements relating to coca production. More serious problems lay elsewhere.

It was almost by process of elimination, therefore, that Mexico emerged as the country where U.S. officials hoped to demonstrate that control at the source was possible. Turkey and Persia, as producers of vast quantities of raw opium for both the licit and illicit trade, would also have been suitable candidates for such an effort. Turkey, though, refused to comply with anti-opium agreements until 1932, which rendered diplomatic overtures from Washington useless. Persia, which by 1920 had replaced India in the opium trade with East Asia, depended heavily on opium-based revenue and had a deeply entrenched opium culture of its own, one that transcended class lines. As a result, implementation of international accords by either country was not feasible in the 1920s and early 1930s. Diplomatic efforts to force compliance would almost certainly have failed. Mexico therefore became the proving ground for control at the source.

Mexico's proximity to the United States had rarely served it well. Not only had Mexico lost in war territory that became the states of New Mexico, Arizona, and California, it had also experienced U.S. involvement and intervention in its revolution during the 1910s. On economic and political matters the United States had frequently treated Mexican sovereignty as subordinate to Washington's own national interests. So it would be, commencing in the 1920s, with the issue of drug control.

The United States disdained Mexican sovereignty for several reasons. In the first place many government authorities and private citizens looked upon Mexico's Indian heritage as evidence of an inferior race. To make matters worse in the eyes of their detractors, the people of Mexico were not just inferior; they were unpredictable, an unpardonable trait in the age of progressive reform. In other words, cultural cohesion and political order in Mexico seemed unimaginable to many North Americans. Critics had to look no farther than Pancho Villa's raid on Columbus, New Mexico, in March 1916 for incontrovertible proof of this societal failing. Villa's men, rumor had it, steeled themselves for the raid by smoking marijuana; Villa himself reputedly neither smoked marijuana nor drank intoxicating beverages.

Marijuana seemed to be in plentiful supply along the vast open border between the two countries. U.S. officials concluded, not for the last time, that Mexican authorities lacked the political will to fight domestically produced drugs. With the creation of a black market for opiates in the United States following the enactment of the Harrison law, Mexico became an important transit country for illicit substances. Citizens of Yuma, Arizona, appealed in 1924 to the Department of State for help in dealing with the "unbridled vice and debauchery" they contended was plaguing the border region.

Moreover, corruption served to undermine Mexico's drug control efforts into the 1920s. In fact the matter was as much a question of the limits of federal authority as one of corruption, but U.S. critics of Mexico emphasized corruption wherever they seemed to find it. The State Department, predisposed to see corruption by Mexican officials who were believed to harbor Bolshevist sympathies, allowed a 1926 treaty with Mexico for the exchange of information about drugs to lapse after only one year of operation. U.S. consular officials in Ciudad Juárez had long doubted Mexico's good faith about drug control. When authorities in Mexico City dispatched a special agent to the Juárez–El Paso region in 1931, U.S. Consul William P. Blocker commented disdainfully, "The Mexican Government has at last decided to clean up the drug traffic on this section of the border."

That attitude and the coercive diplomacy to which it gave rise would often characterize U.S. antidrug diplomacy, particularly in the Americas, from the 1930s through the 1980s; it tended to ignore not only the historical but also the practical reasons limiting the prospects for control at the source. The blinders that U.S. bureaucrats wore as they endeavored to contend with illegal drug trafficking for more than fifty years made it hard for them to understand why their presumably unobjectionable goals were unattainable.

In contrast to their attitude toward Mexico, U.S. officials did not judge Bolivia, Persia, or China to be models worthy of emulation in the pursuit of control at the source. In the case of Bolivia, folk wisdom had maintained long before the modern era that without coca there would be no Bolivia. The movement toward coca prohibition that surfaced from time to time before 1900 in Peru had made few discernible inroads into Bolivia. For U.S. authorities to presume that they could alter the real economic and symbolic value of Bolivian coca was akin to cultural arrogance. Try they did, however, to influence public policy in Bolivia, although not as overtly as in Mexico. Conferees at the first Opium Conference at The Hague had agreed that drug control could never become a reality unless coca and cocaine were included among the substances being controlled. That determination meant that effective coca control must come to Bolivia. U.S. representatives in La Paz suggested to government officials there that cuts in coca production would indicate Bolivia's willingness to work with the international drug control movement. The effort got nowhere.

At Geneva in 1924 the Bolivian delegate, Arturo Pinto Escalier, said that his government found coca chewing to be "a perfectly innocuous activity." More to the point he identified how vital coca was to maintaining the integrity of Bolivian culture. It would, he had previously told the OAC, "be impossible for the Bolivian Government to contemplate restricting the production of coca leaves without seriously interfering with the needs and economic life of the working population, particularly in mining districts, as coca leaves constitute for them a source of energy which cannot be replaced." The United States would have to look elsewhere for control at the source.

The situation in Persia was also instructive for U.S. policy goals. Prior to the second Geneva Opium Conference, Moshar-ol-Molk, Persian minister for foreign affairs, declared that it would be difficult to establish an international antiopium movement. The foremost obstacle was economic, even for those states fundamentally in agreement with the strict U.S. objectives. It was "impracticable suddenly to place a prohibition on [the opium business] without …the substitution of other products for the production of opium, and the adoption of an appropriate decision whereby the domestic consumption of opium could be gradually stopped."

Persia's request for a program of crop substitution did not catch U.S. officials off guard. Elizabeth Washburn Wright, the widow of Dr. Hamilton Wright, had examined firsthand the opium situation there and became an advocate of increased silk production as a replacement for opium. She made the case for economic diversification in informal conversations with the Department of State and in her capacity as an assessor to the Opium Advisory Committee.

A former State Department economic adviser, Arthur C. Millspaugh, who headed the American Financial Mission to Persia from 1922 to 1927, also made the connection between Persia's economic stability and the status of the opium trade. In the course of reorganizing Persia's finances the American mission assumed the task of collecting opium revenues. Millspaugh soon realized that any precipitous change in the opium situation would probably result in economic chaos and political instability. At the urging of the mission Persia indicated its willingness as early as 1923 gradually to reduce dependence on opium, particularly if foreign assistance were forthcoming. No one should underestimate opium's importance, Millspaugh noted, because "irrespective of the revenue which is derived by the Government from it, opium-cultivation in Persia constitutes one of the important agricultural industries, and the only one which makes any substantial contribution to the export trade."

By mid-1926, however, the Persian government, on Millspaugh's advice, had withdrawn an official request for a U.S. loan to help finance the difficult transition from opium to other commodities. U.S. officials had let it be known that they did not want to set a precedent by underwriting such a momentous change. If American banks bailed out Persia's drug-reliant economy, would they do the same for Bolivia or China? What would be the limits of such a potentially openended commitment? Also, why would banks invest heavily in an agriculturally based economy like Persia's? Short-term profits were unlikely to flow from the agricultural sectors of the world economy in the 1920s. Nor did the United States, after its withdrawal from the Geneva Opium Conference in 1925, want to be even remotely associated with the work of the league. A league-sponsored commission of inquiry to Persia after the Geneva conference recommended consideration of a crop substitution program. Persia itself, having worked within the confines of Millspaugh's mission since 1922, was increasingly unwilling further to surrender its financial autonomy to foreign control. For the foreseeable future the substitution of other crops for opium remained out of the question in Persia.

As for China, well into the 1920s conditions there were so chaotic that there existed no realistic hope for implementation of controls on opium growing. Even before the death of Yuan Shikai in mid-1916 and the subsequent onset of the warlord period, opium production and consumption was spreading throughout China, as had been the case in the late nineteenth century. British Minister Sir John Jordan, believing that the situation would lead to a desperate quest by the government for a reliable source of revenue, termed a proposal to establish an opium monopoly "a retrograde step." Opium's hold on China precluded the chance for significant reform. To American officials, plans to create a government opium monopoly, which meant adopting and enforcing over time a program of gradual suppression, flew in the face of reason. By the mid-1920s U.S. authorities concluded that gradualism was merely a cover for continuation of the twin vices of opium production and consumption. Making matters worse for proponents of opium control was an apparently successful effort by Japanese nationals to dominate a burgeoning market in North China for illegal morphine.

U.S. appeals to Chinese authorities to control the situation where practicable fell on deaf ears. Having reasserted nominal Republican control of China with the success of the Northern Expedition in 1928, the government of Chiang Kai-shek (Jiang Jieshi) thereafter strove to appease Washington while continuing to profit from the trade. Headquartered in Nanking, Kuomintang leaders managed, simply by announcing a policy of suppression, largely to place the blame on Japan for China's opium troubles, many of which were of its own making. This accomplishment was all the more remarkable because of the Kuomintang's intimate ties to the notorious Green Gang of Shanghai, a secret society that dominated the Chinese underworld and by 1930 controlled a great percentage of the illicit trade in smoking opium in South China. Its most notorious figure, Du Yuesheng, headed the local opium suppression bureau at various times. Few knowledgeable foreigners believed that opium suppression would come anytime soon to Shanghai and, hence, to South China.

Japanese adventurism rendered largely irrelevant the actual steps taken against opium by Nationalist China. Herbert L. May of the New York–based Foreign Policy Association remarked in 1926 that the Japanese "were manufacturing drugs on a large scale and the government [in Tokyo] was closing its eyes to what was going on." Like the regional militarists, or tuchuns, of China's warlord era, Japanese civilian and military officials in North China and Manchuria were seeking to profit from the opium and morphine trade. The assassination in June 1928 of Zhang Zuolin helped to expose both Japan's expansionist ambitions in North China and beyond, as well as the role of its Kwantung Army in the opiate business there.

The League of Nations dispatched a Commission of Enquiry to East and Southeast Asia in September 1929 to investigate both opium traffic originating in China and the incidence of opium smoking among resident Chinese outside of China. The commissioners found that local opium cultures created more than a social problem; they created alternative, underground economies that helped to destabilize the political economy of the region. The commission, linking the opium business to the security of nations beyond Asia, predicted further trouble with opium unless China brought production under control. This concern was echoed by delegates and observers attending the Conference for the Suppression of Opium Smoking held at Bangkok in November 1931. The American observer, John Kenneth Caldwell of the Department of State, condemned the smuggling of opiates from East Asia, which he declared was a growing problem for the United States. Nanking's refusal to attend the Bangkok conference underlined the near stranglehold of opium on China.

China's unwillingness to participate at the Bangkok meeting derived in part, though, from the threat to its security posed by the seizure in September of Manchuria by Japan's Kwantung Army. Kuomintang leaders were persuaded that they would need all the resources they could muster, including those purchased by revenues from the opium trade, in order to contain Japan's advance into North China. In that sense the Mukden Incident, which precipitated the taking of Manchuria by Japan, allowed Chiang Kai-shek to continue to use opium revenues for his own political and economic purposes while at the same time blaming Japanese military forces for poisoning China with narcotics.

The United States, though suspicious of the Kuomintang's motives where opium suppression was concerned, increasingly supported China in its dispute with Japan over opium. The adoption of a tougher stand against Japan came with the appointment of Stuart J. Fuller to the position of narcotics chief in the State Department's Division of Far Eastern Affairs. Fuller had served in the 1920s as a consular official in Tanjin where he observed the growth of Japanese involvement with the narcotics trade in North China. Fuller's antinarcotic zeal was matched by that of Harry J. Anslinger, a onetime State Department official who had become commissioner of the Federal Bureau of Narcotics (FBN) with the creation of the bureau in 1930. Importantly, unlike their predecessors they were able to put aside tactical differences with the OAC and turn the League of Nation's efforts against drugs toward the larger American policy goals of drug control at the source and improved interdiction of the illicit narcotics traffic.

Under the obvious fiction of a suppression movement, opium production, consumption, and addiction worsened in Nationalist China. U.S. military attaché Colonel Joseph W. Stillwell succinctly summed up the situation when he observed, "Opium is the chief prop of all power in China, civil and military." U.S. reaction to conditions in China was remarkably muted. Fuller, U.S. ambassador Nelson T. Johnson, and Anslinger evidently believed that Chiang would turn against the traffic as soon as it was in his interest to do so. They therefore began to hold Japan to a stricter measure of accountability than China. Johnson wrote Fuller in March 1934 that the Japanese "have no moral scruples when it comes to opium or the use of the gun or the sword."

Even though Fuller actually did criticize China before the OAC in May 1936, he saved his strongest language for Japan. "Let us face facts," he intoned, "where Japanese influence advances in the Far East, what goes with it? Drug traffic." One year later, as tensions were mounting between China and Japan, he told the OAC that conditions in Japanese-occupied areas of North China were "appalling and beyond description." Yet neither in North China nor in Manchukuo were conditions quite what Fuller and other critics of Japan claimed them to be, either before or immediately after the inception of the Sino-Japanese War in July 1937. The reality of the situation scarcely mattered, however, to critics of Japanese expansion. To some observers the battle against drugs in North China was bigger than a mere defense of security. "Humanity," stated the South China Morning Post, "has come to rely heavily upon American aid in the war on drugs."

The characterization of American drug policy as a war on drugs precisely captured the spirit of what Fuller and Anslinger were trying to achieve in the 1930s through participation at OAC meetings and by means of bilateral diplomacy. In assessing the threat posed by drugs the two Americans viewed traffickers and producers of drugs as criminals who, in their most heinous incarnation, were also mortal enemies of the state.

Anslinger later wrote about the use of opium as a weapon of war in occupied China: "The Japanese had coldly calculated its devastating value as forerunner to an advancing army; long before the steel missiles began to fly, opium pellets were sent as a vanguard of the military attack." The inception of general war in Europe in September 1939 served to intensify American efforts to expose Japanese dependence on opiates as a way of maintaining order in their budding empire on the mainland. When the Pacific War spread to include the United States after the bombing of Pearl Harbor, the Federal Bureau of Narcotics chief declared in January 1942: "We in the Treasury Department have been in a war against Japanese narcotics policy for more than ten years…. We have experienced Pearl Harbors many times in the past in the nature of dangerous drugs from Japan which were meant to poison the blood of the American people."

In slightly more than a decade narcotics had become inseparable from the security of Washington's closest ally in Asia, China, and were playing a significant role in the development of Japan's foreign policy. It scarcely mattered whether high-level Japanese officials in Tokyo actually countenanced a policy of using drugs as a weapon of war in China at any time in the 1930s; what was important was the perception, especially in Washington, that they were doing so. In sum the drug scene in East Asia in the 1930s announced the opening of an era in which antidrug policy would become an important, if not well known, aspect of the foreign policy of many nations.

Developments in Latin America during the 1930s also offered an indication of how drugs could undermine political stability and civic order and thereby have a deleterious effect upon a nation's security. Shipments of illicit narcotics from Europe to Central America, which presumably were destined for the United States, nearly destabilized the Honduran government in the mid-1930s. While urging Honduras to deal more forcefully with the situation, Fuller and Anslinger were unable to determine the accuracy of reports alleging the involvement of North Americans in the trade.

That U.S. officials endeavored to influence the drug control policies of other countries partly resulted from a decision made by the League of Nations and reflected a tactical departure by Washington from its former hostility toward league-sponsored antinarcotic activities. The 1931 Manufacturing Limitation Convention had urged all countries, at the behest of the United States, to create an independent drug control office. In fact, the league singled out the Federal Bureau of Narcotics as a bureaucratic model that others might profitably adopt. Honduras, however, had neither the will nor the resources to follow the U.S. example.

More than any other country in the 1930s and early 1940s, with the possible exception of China, Mexico tested the limits of U.S. drug foreign policy. Would the United States be able to replicate abroad, whether through persuasion or coercion, its own restrictive approach to drug control? One prominent official in Mexico, Leopoldo Salazar Viniegra, did not believe that U.S. policy was worth emulating, a view essentially shared by domestic critics of Anslinger and the FBN. As a result of his dissent from Washington's supply-side philosophy, Salazar found himself the object of intense public and diplomatic pressures that proved impossible to resist. In August 1939 he was forced from office as head of the Federal Narcotics Service and was immediately replaced by an individual more inclined to follow the lead of the Department of State and the FBN. The change in personnel did not soon lead, however, to a noticeable improvement in the drug situation at the U.S.–Mexican border. That did not occur until World War II, when the two nations experienced limited success in controlling drugs. Even then progress seems to have reflected as much the decline in wartime demand for illicit drugs as a victory for control at the source.

ORIGINS OF THE DRUG-SECURITY NEXUS

The advent of global conflict in the late 1930s presented U.S. policymakers with an opportunity and a challenge. In the first place war in Europe and Asia slowed the world's illicit narcotics traffic, thus allowing Anslinger, Fuller, and George A. Morlock, who succeeded Fuller at the Department of State in 1941 upon Fuller's death, to strengthen U.S. influence over the global drug control movement by moving the operations of the Permanent Central Opium Board and the Drug Supervisory Body to the United States. By the end of the Second World War, U.S. officials were virtually setting the agenda of the Commission on Narcotic Drugs (CND) in the newly created United Nations. The commission essentially accepted U.S. antinarcotics objectives as its own well into the 1970s.

Anslinger and his colleagues did not easily meet the challenge posed by global war, which brought into question his conviction that he and other antidrug officials should be seen as prominent policymakers in Washington. Yet during both the immediate prewar years and the war itself, the Federal Bureau of Narcotics and the narcotics office in the Department of State helped to maintain the security of the West against the Axis powers. On the most basic level, the FBN commissioner was responsible for meeting Allied demands for medicinal drugs. He did so under a directive issued through the War Production Board by working with the Defense Supplies Corporation and the Board of Economic Warfare. So long as the primary opium-producing nations outside of China neither fell to Germany or Japan nor adopted a neutral position in the war, Anslinger's task was fairly straightforward.

In the Americas the FBN learned, however, that Argentina and Chile might be producing opiates for Germany. There existed some fear too that opium from Peru and Mexico could find its way to the Axis. In the case of Argentina, Anslinger threatened unspecified reprisals against one major firm, Hoffmann-LaRoche Inc., if the allegations were proven. In the case of Peru, its role in the Allied war effort was secured by the sale of cocaine for medicinal needs through the lend-lease program. And in what can be interpreted as an important foray into the world of intelligence, the U.S. government may have paid informants as much as $10,000 per year during the war for information about drug production in Mexico.

Moreover, the inexorable spread of Japanese influence into the fertile poppy-growing regions of Burma gave the Japanese government a major source of opium for its medical needs. Anslinger and other U.S. officials did manage to prevent a similar accretion of Japanese power and influence in the Near East in Iran and Turkey by engaging in a preemptive purchase of large quantities of opium from those two willing suppliers. Anslinger would subsequently have the occasion in the early Cold War to reward the Iranian government for its wartime loyalty, if that is an apt description, to the Allied cause by not pressing the young shah on Iran's vast production of illicit opium, much of which found its way onto the black market in Indochina. Such diplomatic largess was repaid following the shah's ascension to the peacock throne in the wake of the coup of 1953 against Mohammad Mossaddeq's regime, when Iran became a reliable ally at the UN's Commission on Narcotic Drugs in the global struggle against drugs.

Providing the Allies with reliable sources of narcotics during the war and overseeing the maintenance of the global antiopium apparatus were not, however, the most important actions Anslinger undertook to guarantee the relevance of his bureau to U.S. global security interests. He avidly interpreted President Franklin D. Roosevelt's vague anticolonial sentiments regarding Southeast Asia as a clarion call to eliminate opium smoking from the former colonial possessions of France, Great Britain, and the Netherlands. Anslinger and officials in the State Department warned that continued opium smoking would render former colonies more susceptible to internal decay and, as a result, to either revolution or foreign subversion.

In the immediate aftermath of the war Anslinger was not so preoccupied with the FBN's role in the national security state that he ignored the opportunity to advance his country's supply-side agenda at the United Nations. Two examples demonstrate his remarkable attention to virtually all drug-related matters and at the same time reveal his apparent inability to learn from past experience about the limits of policies based upon the elusive goal of control at the source.

The end of the war witnessed both a gradual rise in drug use and addiction in the United States and the revival of an active, illicit drug trade from Mexico. Not satisfied with the dilatory response of the Mexican government to diplomatic overtures, Anslinger took Mexico to task in 1947 at the second meeting of the CND for what he saw as unacceptable laxity in its antidrug activity. The public rebuke evidently had the desired effect because officials in Mexico City soon promised to strengthen their antidrug efforts at home and became more actively involved in the work of the CND.

U.S. drug control authorities also feared that prosperity after the war might stimulate the international cocaine trade, which had substantially declined in volume even before the onset of the Great Depression. Hoping to prevent a recurrence they supported sending a mission to Bolivia and Peru, the purpose of which was to evaluate the place of coca in modern Andean society. Wartime developments led U.S. officials to believe that Peru might be willing to consider strictly controlling coca leaf production, but that hope proved premature. The Commission of Inquiry on the Coca Leaf recalled the integral place of coca in the Andes and concluded that only either improved socioeconomic conditions in producing regions or stronger government action, meaning political will, could bring about the desired results. Important for present purposes is that nothing about the commission's findings, however negative in tone, persuaded U.S. officials to question their belief that Andean authorities were more or less favorably disposed toward a U.S.-style coca control program. The basic assumption that control at the source was a matter of time in the Andes would not be seriously challenged until the 1960s and after.

Instances like those involving Mexico and Bolivia and Peru were not unimportant to U.S. officials in the early Cold War, but they do not adequately show the intersection of security policy and drug control activities. It was in Asia that such a nexus was most readily discernible. FBN and State Department officials alleged that communists in China, like the Japanese before them, were prepared to ply their enemies with opium in order to suit their ideological ends. With the coming to power of the Chinese Communist Party in October 1949 and its subsequent exclusion of Western influence from China, Anslinger's allegations about drug-related subversion of the West and Japan from Beijing could not be disproved. But having an adversary that was presumably willing to use narcotics as a weapon of war appeared to support the FBN chief's traditional supply-side strategy. The Chinese communists had learned a vital lesson, however, by observing the actions of imperial Japan as it sought to subjugate China in the late 1930s: a people drugged with opium do not make good subjects.

Communist China's centrality to the issue of drugs and security policy in the early Cold War merits elaboration. Traffic in heroin destined for Western markets resumed as World War II came to an end. Despite indications that the source of opium came partially from those areas of China controlled by the Kuomintang, Anslinger and the State Department were reluctant to blame their Chinese friends for the reappearance of the trade. For some months before the communists seized power and for some years thereafter, policymakers in Washington blamed Mao Zedong's forces for orchestrating the world heroin business. The less Western observers had access to China and its remote opium-growing regions, the stronger the allegations were against the communists. Occasional doubters, whether in London or Washington, were drowned out by the mass of unverifiable information emanating from the FBN and Foggy Bottom. The CND became an important vehicle for disseminating Anslinger's anti-China message.

It is hard not to conclude that a campaign of intentional disinformation was taking place. Available evidence indicates that to an extremely limited extent some communists did seek to exchange opiates for hard currency. There is no reliable indication, however, of a plan on the part of the Chinese Communist Party to demoralize the West with heroin. Instead it seems more likely that the head of the FBN, in making his allegations against the communists, actually was collaborating in the effort to hide covert operations against the Beijing government by Kuomintang forces operating out of the Golden Triangle, the heart of opium production and traffic in Asia. The objectives of U.S. security policy toward China, although in theory separate from drug control policy, had taken precedence over the pursuit of control at the source, which in the early 1950s was seen by some officials in Washington as an obstacle to the containment of communism.

In Thailand the logic of Cold War policy fashioned dubious linkages with unscrupulous leaders like General Phao Sriyanon, whose personal and political fortunes derived from and depended upon the trade in opium. Throughout Indochina numerous participants in the opium trade, whether in the hills or the cities, offered their allegiance to the United States and its allies in Saigon. In return their reliance upon opium as a source of income remained undisturbed and probably increased. The export trade in heroin from Southeast Asia grew rapidly. And in Indochina the appearance of U.S. advisers in the 1950s and combat forces a decade later sparked a resurgence of the regional drug trade. Thus the 1953 UN Opium Conference, which on paper adopted a spectrum of controls on opium, was an exercise in futility where Southeast Asia was concerned. Rising levels of drug usage and addiction in the West by 1960 and after resulted to some extent from a countenancing of the drug trade in the name of national security.

The convergence of narcotics policy and security interests in the early Cold War made drugs available to untold numbers of Americans. Another important long-term legacy of the drug and security policy nexus from the 1950s onward was the willingness of authorities to ignore the drug-related activities of Central Intelligence Agency assets such as the contras in Nicaragua, General Manuel Noriega in Panama, spymaster Vladimiro Montesinos in Peru, and others, until those assets became expendable. A drug policy bureaucracy that set aside its own primary goals in the name of security was virtually abandoning the right to define its own mission. Objectively, illicit drug trafficking constituted a serious foreign policy problem for the United States, not a dire threat to the nation. Yet the historical efforts of Anslinger and others to propagate a supply-side strategy as the only acceptable road to drug control rendered drug policy hostage to other, more important foreign and security policy interests. In this way the linkage between drugs and security was cemented. To perpetuate the influence of the FBN, drug control authorities accepted a subordinate place at the policymaking table.

In the 1960s several important developments marked U.S. drug control policy. As if in testimony to Harry Anslinger's tenure as narcotics commissioner, which came to a close in 1962, nations from around the world signed and ultimately ratified the 1961 Single Convention on Narcotic Drugs, thereby placing under one instrument nearly all international antidrug accords. A consensus, more symbolic than real, had been reached favoring a supply-side approach to drug control. The practical effect for Washington of the convention was to place increasing emphasis upon bilateral relations. In that process frustration became the order of the day: drugs from Southeast Asia continued to reach consumers in the West. Latin America became an even greater source for cocaine, marijuana, and heroin. Demand for drugs by recreational consumers and chronic users seemed to rise exponentially. Organizational changes did little to reduce demand; without Anslinger the FBN, mired in scandal, became in 1968 the Bureau of Narcotics and Dangerous Drugs (BNDD). But the BNDD had no leader with Anslinger's stature to dominate the policymaking process.

Chaos, however, did not necessarily come to characterize U.S. drug policy. The 1960s had begun with an appeal from Mexico to the Eisenhower administration for antidrug help. By 1964 the Agency for International Development (AID) in the State Department had devised a program that previewed the future direction of U.S. antidrug assistance programs. Included in the aid package were funds for both crop eradication and weapons to combat the illicit traffic out of Mexico. Throughout Lyndon Johnson's presidency U.S. authorities tried but were unable to formalize trans-border antidrug operations with Mexico.

In the Andes an Inter-American Consultative Group on Coca Leaf Problems met at Lima in 1964 but achieved little. Bolivia refused even to sign the Single Convention on Narcotic Drugs until 1975, and Peru, although a signatory power, declared that reducing its coca crop could not be considered for perhaps twenty-five years. Complicating the already sensitive relations between Washington and Lima was the creation of a national coca monopoly in 1969.

Notwithstanding these several setbacks in the cause of drug control, the earlier linkage of drugs and security offered a new way to promote drug control. A variant of supply-side tactics, the road to drug control would increasingly emphasize law enforcement as part of a general foreign aid package. U.S. policymakers in the 1960s worried that the "revolution of rising expectations" in the Third World, which encompassed important drug-producing countries, could not easily be controlled. They nevertheless sought to do so by tying together development and security assistance as provided to local law enforcement programs by AID, part of which was intended to be used for narcotics control. It is not clear from available evidence whether the drug control performance of producer states improved, but that outcome is doubtful given the frequent additional funding that Washington made available for drug control in the 1970s and after. Drug control, therefore, had all but disappeared by the late 1960s as an autonomous foreign policy issue. Starting in 1969 the association between drugs and security would grow closer still.

THE LIMITS OF DRUG CONTROL

The more U.S. drug officials equated their activities with security policy, the more diversified became policy objectives. The event that brought about this diversification was Operation Intercept at the Mexican border. In subjecting all traffic at the border to great delays in order to restrict the flow of drugs north from Mexico, the administration of President Richard M. Nixon did two things. First, it made drug interdiction as important as control at the source. Second, and more significant, it served notice that drug production and trafficking threatened U.S. security and was evidence of a lack of political will by the country of origin in the fight against drugs. Since Intercept, U.S. policymakers in the executive branch and Congress have assumed the existence of an adversarial relationship with most producer and trafficking states.

In a major exception to this general rule, Turkey and the United States worked out an arrangement in 1972 that persuaded the Turkish government briefly to halt state-regulated production of opium poppies. Large amounts of Turkish opium had found its way into the heroin trade destined for western Europe and the United States. In severing what was termed the "French Connection," the Nixon administration temporarily muted congressional and public criticism of federal drug policy without disturbing the linkage between drug control and security policy.

Despite the administration's success with Turkey, congressional committees took an increasing interest in the course of U.S. drug policy and strategy. As early as 1971 the House Foreign Affairs Committee expressed concerns about the extent of abuse of Southeast Asian heroin by servicemen returning from Indochina. One committee report, in line with traditional U.S. policy, held that "the problem must be attacked at the source." What differed was the manner of attack that Congress had under consideration: a preemptive buy of the Southeast Asian heroin supply. Officials in the executive branch summarily rejected such a proposal at least twice by mid-decade. Even without knowing the costs of annual preemptive buys, the idea found scant favor in the White House or among drug control officials because it threatened to raise drug control as an issue on its own merits, which might undermine the favored drug-security relationship.

As the assault on executive policymaking prerogatives was being defeated on one front, the drug-security nexus was being reinforced on another. The patience of the United States for the apparent inability of Latin American states to control production and trafficking was wearing thin. In the process, the pre-1969 diplomacy of persuasion inexorably gave way to the politics of pressure and coercion. Following Operation Intercept both the United States and Mexico had endeavored to put the best possible face on a contentious situation by hastily devising what they termed "Operation Cooperation." Soon thereafter authorities in Mexico City initiated La Campaña Permanente, in which Mexican resources and assistance from the Drug Enforcement Administration (DEA), one of the successor agencies to the FBN, were used to curtail opium poppy growth and heroin production.

So far as can be ascertained, Mexico's drug control record in the late 1970s was a relatively good one. But as the United States and Mexico tried to find common ground against drugs, political developments in Washington made that task more difficult. The House Select Committee on Narcotics Abuse and Control came into existence in 1976. Headed by activist congressmen who were dedicated to crop eradication and wanted to militarize the antidrug fight, the committee looked beyond recurring promises and began to assess performance in Latin America's drug control record. Mexico naturally caught the eye of drug control proponents in the United States. It is clear that President Jose López Portillo had in his government officials who were profiting from drug production and trafficking. What López Portillo knew about that situation remains unclear; in any event, by the time Ronald Reagan's presidency began in January 1981 members of Congress and some administration officials, although few then in DEA headquarters, were doubting Mexico's good faith regarding drug control. Ironically Mexicans had their own doubts about the U.S. antidrug commitment because of strict legal prohibitions against the spraying of paraquat on domestic marijuana. The inequality of power in U.S.–Mexican relations made that concern irrelevant in the bilateral relationship.

Mexico, of course, was not the only country subjected to close scrutiny by the United States. Colombia called attention to itself when it considered a plan to legalize and tax the marijuana trade and also after the boom in the cocaine industry became apparent. Peru and Bolivia were heavily criticized in Washington for failure to enforce the coca controls envisioned by the 1961 Single Convention on Narcotic Drugs. Bolivia especially fell out of favor with Washington during and after the year-long hold on power by General Luis García Meza as a result of what has been accurately termed a "cocaine coup." To U.S. authorities Bolivia seemed little more than a nation in thrall to the coca leaf and hence cocaine. Throughout the Andes the so-called kings of cocaine were in the process of constructing a powerful, albeit decentralized narco-empire.

Viewed from the perspective of official Washington it is not surprising that pressure instead of persuasion increasingly characterized U.S. drug policy by the 1980s. The United States consciously set out to transform drug control policies and operations in Latin America at that time. The House Select Committee on Narcotics Abuse and Control, more than any other congressional committee, resolved to hold to account Latin Americans, and the Reagan administration as well, for the integrity of antidrug activities. With no specific mandate except for the presumed interests and fears of an ill-defined public constituency, the committee held hearings, conducted study missions, and released reports about the status of drug control in the Western Hemisphere.

Not only did the committee rally support in Congress during the 1980s for a foreign policy calling for a comprehensive eradication of crops in the Andes and in Mexico, it also demanded a dramatic improvement in the rate of drug interdiction, thereby criticizing the antidrug efforts of the Reagan administration. Committee leaders encouraged militarization of the war on drugs over the vocal opposition of Secretary Caspar Weinberger and the Department of Defense. By the end of the decade, though, it seemed as if selective low-intensity warfare had taken its place, next to control at the source and interdiction, as another basic component of U.S. antidrug strategy. Low-intensity conflict as a fundamental aspect of U.S. strategy would come to the fore after the drug summit held at Cartagena, Colombia, in February 1990, with U.S. assistance to Peru and Colombia increasingly emphasizing law enforcement assistance and military aid against drug production and trafficking. It would continue throughout the 1990s and ultimately metamorphose into Plan Colombia at the turn of the twenty-first century.

Also desirous of pressuring Latin American leaders to do more to control drugs were the three agencies most responsible for drug law enforcement: the DEA, Customs, and the Coast Guard. DEA agents had operated abroad at the invitation of host governments since the agency's creation in 1973. In the strictest sense their mission was to gather information and assist in the training of local antidrug forces, such as the mobile units created in the early 1980s in Bolivia and Peru. Nowhere was the DEA presence more controversial than in Mexico, where in early 1985 the agent Enrique Camarena Salazar and his Mexican pilot were abducted, tortured, and killed. The case remained unsettled to the satisfaction of the DEA for some time, despite the arrest and successful prosecution of many of those allegedly responsible for the crime.

Demonstrating how negatively the Camarena case affected U.S.–Mexican relations was the national-interest certification accorded Mexico in 1988. Several years earlier Congress had passed a law requiring the White House to "certify" whether drug producing and trafficking nations were complying fully with U.S. drug policy objectives. Failure to do so could result in the suspension, and possibly termination, of various kinds of foreign assistance. In 1988, in order to lessen congressional pressure on the administration to name Mexico as a country lacking the political will to attack drugs and to express displeasure with Mexico about the Camarena incident, the White House accorded Mexico less than full certification.

Whether or not that was the case, narcotics foreign policy became highly politicized under Ronald Reagan. Fidel Castro's Cuba and the Sandinista leadership in Nicaragua were charged with sponsoring the transport of drugs, especially cocaine, to the United States. At the same time, the Reagan administration largely ignored drug trafficking by anti-Castro Cubans and the Nicaraguan contras. The administration's readiness to portray the situation so greatly at odds with reality had historical precedent, as we have seen, in Anslinger's allegations about Communist China's involvement with the opiate trade.

Pressure for Latin America to adopt U.S.-style drug control programs can also be seen in the handling of economic development programs funded by the Agency for International Development. So limited was U.S. and international help for crop substitution and alternative development strategies that few farmers in Bolivia or Peru, the countries where this assistance was needed most, could have been expected to turn away from coca for another crop no matter how volatile the market price of coca leaves. The point is not that Bolivians or Peruvians were demanding absolute dollar-for-dollar income replacement; they were not. Rather, coca farmers, as well as processors and small-time traffickers, sought a reliable source of income if they were going to ignore the market forces that made coca an attractive economic choice. As structured in the 1980s and early 1990s, though, the development strategies devised in the United States failed to address the basic concerns of thousands of South Americans participating in the coca-cocaine business.

Indeed, aid programs were closely linked to effective crop destruction and hence were tied as well to presidential certification. The Agency for International Development never had the financial means, let alone the disposition, to address any but the most visible symptoms of this vicious cycle. When viewed in that light President George H. W. Bush's promises at Cartagena about development assistance for the Andes, as one component of the Andean Strategy announced in September 1989, seems somewhat disingenuous. U.S. drug policy toward Latin America was relying on pressure rather than diplomacy and persuasion in two other important respects. On 8 April 1986 President Reagan issued a national security decision directive to the effect that drug production and trafficking constituted a grave threat to the security of the hemisphere. Hence those nations under attack by the drug lords, especially in the Andes, ought to defend themselves individually or in concert. In practice this meant a greater emphasis on control at the source and a relentless effort in source countries to interdict illegal drugs. The United States would provide advice, training, and equipment, although the drug war would be waged first in South America and second in its surrounding international waters.

This strategy largely ignored competing security objectives that tended to compromise antidrug objectives. Panama's Noriega, for example, was arguably the Reagan administration's most vital security asset in Central America despite his well-deserved reputation for double-dealing. Noriega was deemed indispensable to the administration and remained so as long as William Casey headed the CIA. Also, the administration chose to overlook the involvement of several Honduran military officials in the drug trade because Honduras served as a sanctuary for the contras. Such contradictions in security priorities were not lost on those nations, notably Colombia, that were on the front line of the drug war.

U.S. pressure against producer, processing, and transit countries accompanied the militarization of drug strategy. Going far beyond an upgrading of the mission of the Coast Guard, the United States virtually insisted that the battle be taken to source countries. To be sure, aid for military operations came after being requested by Latin American governments. Yet it is worth asking how much of a choice Bolivia had in March of 1986 when Operation Blast Furnace was being proposed. So long as Colombia sought U.S. assistance, it had few viable options other than armed confrontation with the Medellín cartel after the assassination of presidential candidate Luis Carlos Galán in August 1989. The Bush White House viewed the response to the killing as a test of the will of the government of Virgilio Barco Vargas. (Indeed, when Barco's successor, César Gaviria, sought to craft a Colombian response to the violence of the Medellín and Cali cartels, Bob Martinez, head of the Office of National Drug Control Policy, proclaimed that Colombia was on trial before the world.)

Unwillingness abroad to strike directly at illicit production and trafficking would have jeopardized U.S. aid programs. With this implicit threat at the ready, the United States—in early 1987, more than two years before the Galán murder—had fashioned a more extensive antidrug strategy for the Andes, Operation Snowcap. But Snowcap, slow in getting underway, soon ran into difficulty, especially in Peru where the Maoist Sendero Luminoso (Shining Path) controlled coca-growing areas in the Upper Huallaga Valley. Proposals to dispatch U.S. special forces into the Andes were too controversial for Lima to accept openly, but by mid-1991 President Alberto K. Fujimori had agreed to their limited use.

The evolution of a more coercive antidrug strategy in the 1990s inevitably led to greater expectations about Latin American performance in Washington. Controlling drugs moved into the highest rank of foreign policy priorities, at least rhetorically, as the Cold War ended. Yet neither crop eradication nor drug interdiction, despite several spectacular, singular achievements, significantly reduced the flow of drugs in the Americas until after mid-decade.

Policymakers had long argued that an activist drug control strategy abroad would help to control consumption at home. Not until Congress passed the 1988 Anti-Drug Abuse Act would they seriously begin to address the issue of demand, and they did so thereafter largely as an aspect of law enforcement. Demand reduction strategies primarily existed as a by-product of other goals. In effect authorities were betting that widespread craving for popular drugs, notably cocaine, would eventually decline. What they assumed, however, to be a cyclical theory of demand in reality resembled a spiral model, that is, one with absolute usage steadily increasing.

Drug control strategy was also intended to deter newcomers from entering the business at all stages, from production to sale on the street. A tougher approach in the Chapare of Bolivia, in the Upper Huallaga Valley of Peru, or even in the cays of the Caribbean would produce the desired result of lowering drug availability and consumption on the streets of New York, for example. Likewise a strategy that emphasized strict and certain law enforcement might compel lesser players to get out of the game. Had policymakers paid closer attention to what they read in the analyses of Peter Reuter and his colleagues at the Rand Corporation, they would not have been so sanguine about the prospects for success of such a strategy. The risk factor for entrepreneurs entering the drug business was statistically insignificant, whereas the rewards were sufficient to sustain the promise of unaccustomed wealth.

Also anticipated as a result of drug strategy in the 1980s, particularly after Reagan issued his national security directive, was the apprehension of major traffickers. A number of seizures of important figures did take place, especially in Mexico and Gaviria's Colombia, but they did not appreciably affect the structure or functioning of the drug trade out of South America or Mexico, let alone within the United States. (Likewise, the heroin trade out of Southeast Asia scarcely depended upon the continued participation of its two most notorious leaders of the late twentieth century, Lo Hsing-han and Khun Sa, each of whom at one time or another swore off further involvement with opium.)

One outcome of the focus on major traffickers in Latin America would be a reduction in money laundering. The seizure of Noriega and the arrest of top officials of several major banks by the mid-1990s held out the promise of greater success over time, yet that hope was leavened by the realization that the laundering of money remained a serious problem in Panama, a nation whose government owed its very existence to the United States.

Another expected result of the battle against drugs was an increase in the price of drugs so that the economic incentive to consume them would decline. Again, U.S. strategists would do well to heed the analyses prepared at the Rand Corporation. For street prices appreciably to rise, the rate of interdiction would have to be far greater than it has ever been. Even if as much as 30 percent of illegal cocaine is seized, and few experts claim that seizures come close to that figure, the available supply would probably keep prices down and profits for traffickers acceptably high. Not even the vigorous pursuit of the longtime strategy of interdiction presents a serious threat to the major trafficking networks.

As the Cold War waned, policymakers looked to the war on drugs to provide U.S. forces with a contemporary military mission, however limited. After the Department of Defense under Secretary Dick Cheney overcame its reluctance to get involved in the drug war in Latin America and the Caribbean, commitments in the form of advice, training, and limited operations proliferated on a unilateral and bilateral basis. Yet the war remained a low-intensity conflict for both practical political and diplomatic reasons. As a result the drug war was deemed a losing budgetary and doctrinal proposition for the U.S. military and evoked demands for little more than a minimal expenditure of resources. Until the late 1990s it remained unclear what the mission for U.S. forces would be.

The unanticipated consequences of the Reagan-Bush drug war in Latin America were no more salutary. Inter-American relations were strained by the politics of pressure, which would decisively turn to coercion particularly toward Colombia after Ernesto Samper took office as president in 1994. Earlier, palpable tension at the San Antonio drug summit in February 1992, dubbed Cartagena 2, challenged the facade of a common front against drugs. The militarization of antidrug strategy and the process of certification, both of which arguably constituted an implicit denial of the sovereignty of producer, processing, and trafficking nations, placed the United States in the position of dictating a major aspect of regional relations. At the least, certification was demeaning to producer nations in that it assumed a lack of willingness to take action against drugs. The process of certification was something of a throwback to the 1920s and early 1930s in assuming that the drug issue existed apart from other vital issues such as the suppression of radical insurgencies.

It seemed too that defining the drug business as a threat to national security contributed to the realization of that very condition in the Andes. The institutional integrity of Bolivia, Colombia, and Peru was weaker in the early 1990s than before. Perhaps the economic troubles confronting those countries would have undermined national political and social institutions even without the compounding factor of the illicit drug business. Yet pressure from Washington to wage war against drugs in the name of national security made the governing process more difficult.

The Clinton administration continued to prod the three Andean nations as well as Mexico to act more vigorously to attack drug production and trafficking. Nevertheless, during President Bill Clinton's first term in office, the fiery rhetoric of the recent pas was missing. This approach to drug diplomacy reflected the reduced priority the White House was giving to drug control as a foreign policy objective.

CONTINUING CHALLENGES

Beginning in the mid-1990s there were a number of positive developments in the war on drugs. DEA agents were advising their counterparts around the world; even China and Vietnam turned to the United States for assistance. The defeat of Sendero Luminoso in Peru, combined with a disease that severely damaged the nation's coca crop, drove the drug business out of the Upper Huallaga Valley until late in 2000. The Bolivian government of Hugo Banzer adopted a policy of "zero tolerance" toward coca growing outside of government-approved areas. An uneasy peace existed between growers' unions and the government as alternative development projects failed to provide sufficient income for former coca farmers. Also at the turn of the new century, Iran was cracking down on the opium business; and aid in the form of $43 million in spring 2001 persuaded the Taliban in Afghanistan to go after the heroin trade. Following the terrorist attacks on the United States on 11 September, however, the price for heroin from Afghanistan plummeted. U.S. and international drug control officials believed that the Taliban was dumping large stockpiles of heroin to pay for weapons in the event of conflict as the United States sought to capture or kill the reputed leader of the terrorist network, Osama bin Laden, whose headquarters were located in Afghanistan.

Serious challenges nevertheless remained for U.S. drug control officials, especially in the Caribbean and Mexico. Mexican authorities at all levels remained susceptible to bribery and threats from that nation's major drug organizations even as cartel leaders were arrested and faced the prospect of extradition to the United States to face trial for their activities. During a visit to Washington in late summer 2001 President Vicente Fox pledged to cooperate closely with the administration of George W. Bush on common problems related to drugs. Whether that effort would be enough to lessen the expanding role of the drug business in Mexican politics, particularly at the state level, remained to be seen.

Illicit drugs from Latin America that were not transported to the United States from Mexico often came through Caribbean nations where authorities were unable, and in some instances unwilling, to handle a problem as complex as the one posed by drugs. The result was a greater presence of U.S. law enforcement personnel as advisers. Even Cuba began to share information with Washington about drug trafficking. Nothing happened in either Mexico or the Caribbean to suggest that drug control would soon disappear as a major foreign policy issue in the region.

However serious a challenge drugs posed to governance elsewhere, that threat paled in comparison to drug-related problems in Colombia. By 2002 foreign assistance to Colombia as part of Plan Colombia, a multiyear effort by the government of President Andres Pastrana to wipe out the drug business and defeat his nation's guerrilla insurgencies, made Colombia the third-largest recipient of U.S. foreign aid behind Israel and Egypt. Indications of progress by Bogotá against drugs in the early and mid-1990s proved illusory. Neither the destruction of the Medellín and Cali cartels nor the death or incarceration or extradition to the United States of cartel leaders slowed the traffic in cocaine and crack, heroin, and (to a lesser extent) marijuana out of Colombia. Indeed, antidrug assistance served to embroil the United States more deeply than anticipated in the Colombian crisis. The government in Bogotá controlled barely 60 percent of the national territory. How U.S. aid could affect that perilous situation remained anyone's guess. The leftist insurgency had begun in the mid-1960s and showed little sign of abating, all the more so because rebel forces increasingly relied upon income from drugs to fund their activities. Negotiations between the government and rebels had created a safe zone, dubbed "Narcolandia." Should a settlement eventuate, there was no way of predicting its durability.

What had begun a hundred years earlier as an effort by the United States to promote social reform abroad was closely linked in the twenty-first century with matters of governance and national identity. Foreign lands continued to supply the United States with illicit substances; in so doing they met rather than created a demand for drugs, though U.S. leaders did not publicly admit that reality until the early 1990s. The more that supplier and transit nations accepted U.S. antidrug strategy, and declared drugs to constitute a security threat, the more difficult for them became the process of governing. Attention to demand alone, long advocated by some producer states, could not overcome the multifaceted problems posed by drugs. For better or worse drug control had become an important, sometimes crucial, facet of American foreign policy.

BIBLIOGRAPHY

Bertram, Eva, et al. Drug War Politics: The Price of Denial. Berkeley, Calif., 1996. Critical overview of the proscriptive, punitive nature of U.S. domestic and foreign drug policies.

Courtwright, David T. Forces of Habit: Drugs and the Making of the Modern World. Cambridge, Mass., 2001. Outstanding assessment of the role of licit and illicit drugs in modern history.

Griffith, Ivelaw Lloyd. Drugs and Security in the Caribbean: Sovereignty Under Siege. University Park, Pa., 1997. Survey of the implications of the war on drugs in the Caribbean region.

Kwitny, Jonathan. The Crimes of Patriots: A True Tale of Dope, Dirty Money, and the CIA. New York, 1987. A skilled reporter's investigation of the links between illegal drugs and U.S. security interests in the 1970s and 1980s.

Lamour, Catherine, and Michel R. Lamberti. The International Connection: Opium from Growers to Pushers. Translated by Peter and Betty Ross. New York, 1974. Important book about the international dimensions of the modern commerce in illegal drugs.

McAllister, William B. Drug Diplomacy in the Twentieth Century: An International History. London and New York, 2000. The finest scholarly survey on the subject.

McCoy, Alfred W. The Politics of Heroin: CIA Complicity in the Global Drug Trade. Brooklyn, N.Y., 1991. Updated, classic account of the post-1945 nexus of drugs and security policy throughout Asia.

Meyer, Kathryn, and Terry Parssinen. Webs of Smoke: Smugglers, Warlords, Spies, and the History of the International Drug Trade. Lanham, Md., 1998.

Morgan, H. Wayne. Drugs in America: A Social History, 1800–1980. Syracuse, N.Y., 1981.

Musto, David F. The American Disease: Origins of Narcotic Control. Expanded ed. New York, 1987. Best account of the origins and history of illegal drugs in the United States.

Powis, Robert E. The Money Launderers: Lessons from the Drug Wars, How Billions of Illegal Dollars Are Washed Through Banks and Businesses. Chicago, 1992.

Riley, Kevin Jack. Snow Job?: The War Against International Cocaine Trafficking. New Brunswick, N.J., 1996. Skeptical look at recent U.S. and international efforts to combat cocaine.

Scott, Peter Dale, and Jonathan Marshall. Cocaine Politics: Drugs, Armies, and the CIA in Central America. Updated ed. Berkeley, Calif., 1998. Riveting account of the convergence of drugs and U.S. foreign policy in the 1980s.

Stares, Paul B. Global Habit: The Drug Problem in a Borderless World. Washington, D.C., 1996. Cautionary account about the limits of drug control.

Taylor, Arnold. American Diplomacy and the Narcotics Traffic, 1900–1939: A Study in International Humanitarian Reform. Durham, N.C., 1969. A pathbreaking study of international drug control.

Tokatlian, Juan. Globalización, Narcotráfico y Violencia: Siete Ensayos sobre Colombia. Buenos Aires, 2000. An impassioned inquiry into the effect of drugs on Colombia late in the twentieth century.

Walker, William O., III. Drug Control in the Americas. Rev. ed. Albuquerque, N.Mex., 1989. Leading account of drug control as an issue in the Western Hemisphere.

——. Opium and Foreign Policy: The Anglo-American Search for Order in Asia, 1912–1954. Chapel Hill, N.C., 1991. International history of the drug problem in East Asia.

See also Intervention and Nonintervention; The National Interest; Pan-Americanism .

Narcotic drugs

Definition

Narcotics are addictive drugs that reduce the user's perception of pain and induce euphoria (a feeling of exaggerated and unrealistic well-being). The English word narcotic is derived from the Greek narkotikos, which means "numbing" or "deadening." Although the term can refer to any drug that deadens sensation or produces stupor, it is commonly applied to the opioids—that is, to all natural or synthetic drugs that act like morphine.

Description

Historical background

Narcotics are the oldest as well as the strongest analgesics , or pain-relieving drugs, known to humans. Ancient Sumerian and Egyptian medical texts dated as early as 4000 B.C. mention the opium poppy (Papaver somniferum ) as the source of a milky fluid (opium latex) that could be given to relieve coughs and insomnia as well as ease pain. Traditional Chinese medicine recommended the opium poppy, known to Chinese physicians as ying su ke, for the treatment of asthma , severe diarrhea , and dysentery as well as chronic pain and insomnia. Opium latex contains between 10 and 20 percent morphine, which in its purified form is a white crystalline powder with a bitter taste.

Narcotics are central nervous system depressants that produce a stuporous state in the person who takes them. These drugs often induce a state of euphoria or feeling of extreme well-being, and they are powerfully addictive. The body quickly builds a tolerance to narcotics in as little as two to three days, so that greater doses are required to achieve the same effect. Because of the addictive qualities of these drugs, most countries in the twenty-first century have strict laws regarding the production and distribution of narcotics. These laws became necessary when opium addiction in the nineteenth century became a widespread social problem in the developed countries. Opium, which was the first of the opioids to be widely used, had been a common folk remedy for centuries that often led to addiction for the user; in fact, many popular Victorian patent medicines for "female complaints" actually contained opium. The invention of the hypodermic needle in the mid-nineteenth century, however, increased the number of addicts because it allowed opioids to be delivered directly into the bloodstream, thereby dramatically increasing their effect.

Classification of narcotics

As of the early 2000s, narcotics are commonly classified into three groups according to their origin:

• Natural derivatives of opium: Narcotics in this group include morphine itself and codeine.
• Partially synthetic drugs derived from morphine: These drugs include heroin, oxycodone (OxyContin), hydromorphone (Dilaudid), and oxymorphone (Numorphan).
• Synthetic compounds that resemble morphine in their chemical structure: Narcotics in this group include fentanyl (Duragesic), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone, and propoxyphene (Darvon).

Narcotics are available in many different forms, ranging from oral, intramuscular, and intravenous preparations to patches that can be applied to the skin (fentanyl). Illegal street heroin can be taken by inhalation as well as by injection.

How narcotics work

The central nervous system in humans and other mammals contains five different types of opioid receptor proteins, located primarily in the brain, spinal cord, and digestive tract. When a person takes an opioid medication, the drug attaches to these opioid receptors in the brain and spinal cord and decreases the person's perception of pain. Narcotics do not, however, reduce or eliminate the cause of the pain.

Some of the opioid receptors (known as mu and sigma receptors) influence a person's perception of pleasure. When a narcotic medication stimulates these receptor proteins, the person typically experiences intense sensations of euphoria or well-being. The speed with which these drugs take effect depends on the method of administration; IV narcotics reach their peak effectiveness within ten minutes, while oral narcotics take about an hour and a half, and skin patches take between two and four hours.

Overdoses of narcotics can cause drowsiness, unconsciousness, and even death because these drugs suppress respiration.

General use

Narcotics have several legitimate uses:

• Analgesic: Doctors frequently prescribe oral codeine and propoxyphene (alone or in combination with aspirin) for pain control after oral surgery, for severe menstrual cramps, and for temporary pain relief after other outpatient surgical procedures. Intravenous narcotics may be given for several days after major surgery to relieve the patient's discomfort. Subsequent methods of administering opioids following surgery include a sustained-release injected form of morphine sulfate (DepoMorphine) and a patient-controlled transdermal system (E-TRANS) that releases doses of fentanyl when the patient pushes a button attached to the arm or upper chest. Intravenous narcotics may also be used for palliative care, to relieve the pain of patients diagnosed with terminal cancer .
• Antitussive: Antitussives are medications given to control coughing. Codeine is often effective in relieving severe coughs and is a common ingredient in prescription cough mixtures. Antidiarrheal: Paregoric, a liquid preparation containing powdered opium, anise oil, and glycerin, is sometimes prescribed for severe diarrhea. The opium in paregoric works to control diarrhea because it slows down the rhythmic contractions of the intestines that ordinarily move food through the digestive tract. Lomotil, another antidiarrheal medication, contains a synthetic opioid known as diphenoxylate; it is often recommended for treating cancer patients with diarrhea caused by radiation therapy.

Precautions

In the United States, opioids are as of 2004 classified as Schedule II drugs under the Controlled Substances Act of 1970. Drugs in this category are described by the government as having a high potential for abuse and a liability for dependence and yet an approved medical use in pain management . The corresponding Canadian legislation, the Controlled Drugs and Substances Act of 1997, classifies medications containing any narcotic under the heading (N) but specifies varying levels of regulation ranging from strict controls for highly addictive single-drug products to lesser controls on drugs combining a narcotic with non-narcotic substances. As both countries' legal controls indicate, narcotics should be used cautiously, for as short a period of time as possible, and only under a doctor's supervision. In particular, they should never be used together with certain other categories of prescription drugs or herbal preparations.

Side effects

In addition to the risk of dependency or addiction, narcotics have a number of physical side effects, including the following:

• constipation
• drowsiness
• withdrawal symptoms after extended use (tearing, sweating, diarrhea, vomiting , gooseflesh, muscle twitching, runny nose, loss of appetite, and hot or cold flashes)

Interactions

Narcotics can be dangerous because of their potential for deadly interactions with other medications as well as their potential for dependence and addiction. Narcotics should never be combined with other types of drugs that depress the central nervous system. These categories of drugs include the following:

• alcohol
• benzodiazepine tranquilizers, including such drugs as diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium)
• barbiturates, used to treat insomnia and anxiety , including such medications as pentobarbital (Nembutal) and mephobarbital (Mebaral)
• antihistamines, even over-the-counter cold or allergy medications, which can interact with narcotics to intensify drowsiness and repress breathing

Narcotics can also interact with certain herbal preparations to cause central nervous system depression. Anyone taking narcotics for pain relief should avoid using herbal preparations containing kava kava (Piper methysticum ), valerian (Valeriana officinalis ), chamomile (Matricaria recutita ), or lemon balm (Melissa officinalis ), as these herbs intensify the tendency of opioids to cause drowsiness and slow down breathing. Ginseng (Panax ginseng ) should also be avoided because it interferes with the pain-relieving qualities of opioid medications.

Prevention

Scientists have attempted to develop ways to use the pain-killing properties of narcotics while counteracting their addictive qualities. Substances known as narcotic or opioid antagonists are drugs that block the actions of narcotics and are used to reverse the side effects of narcotic abuse or an overdose. A class of drugs, a mixture of opioids and opioid antagonists, has been developed so that patients can be relieved of pain without the addictive or other unpleasant side effects associated with narcotics.

Parental concerns

One minor concern that parents may have if the doctor prescribes narcotic medications for their child is that such side effects as constipation or sleepiness are more common and more severe in children younger than 18 years of age.

Far more seriously, narcotic drugs are among those substances used illegally or abused by adolescents. Some researchers estimate that as many as 90 percent of adult drug addicts began a pattern of substance abuse during adolescence . Teenagers are particularly likely to begin experimenting with narcotics in the form of prescription cough syrup and such pain relievers as Darvon or Oxy-Contin and to combine narcotics with alcohol or other drugs of abuse. Moreover, although opioid medications account for fewer cases of drug abuse than cocaine, alcohol, or several other drugs, they still account for 4 to 5 percent of emergency room visits. In addition, the death rate of opioid abusers is proportionately significantly higher than the mortality of people who abuse PCP or cocaine.

The American Academy of Child and Adolescent Psychiatry (AACAP) lists opiates as common drugs of abuse among teenagers and notes that children as young as 12 may be using narcotics. In many cases, children can obtain these drugs at home in the form of medications prescribed for other family members. Children who are abusing opioid medications may show the following signs:

• euphoria or "feeling no pain"
• constipation
• slurred speech
• shallow breathing
• itching or flushing of the skin
• mental confusion and poor judgment
• bloodshot eyes with small pupils
• nausea and vomiting
• unusual drowsiness

Parents who suspect that their children are abusing opioids, either alone or in combination with other drugs, should get help as soon as possible.

KEY TERMS

Analgesics —A class of pain-relieving medicines, including aspirin and Tylenol.

Antitussive —A drug used to suppress coughing.

Euphoria —A feeling or state of well-being or elation.

Morphine —The principal alkaloid derived from the opium poppy for use as a pain reliever and sedative. In its purified form, it is a white, bitter-tasting crystalline powder.

Narcotic —A drug derived from opium or compounds similar to opium. Such drugs are potent pain relievers and can affect mood and behavior. Long-term use of narcotics can lead to dependence and tolerance. Also known as a narcotic analgesic.

Opium latex —The milky juice or sap of the opium poppy, used to produce morphine.

Palliative —Referring to a drug or a form of care that relieves pain without providing a cure. Persons in severe pain from terminal cancer are often prescribed narcotics as palliative care.

Stupor —A trance-like state that causes a person to appear numb to their environment.

Resources

BOOKS

"Opioid Dependence." Section 15, Chapter 195 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, and Robert Berkow. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Pelletier, Kenneth R. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Pain." New York: Simon & Schuster, 2002.

PERIODICALS

Abebe, W. "Herbal Medication: Potential for Adverse Interactions with Analgesic Drugs." Journal of Clinical Pharmacy and Therapeutics 27 (December 2002): 391–401.

Cone, E. J., et al. "Oxycodone Involvement in Drug Abuse Deaths. II: Evidence for Toxic Multiple Drug-Drug Interactions." Journal of Analytical Toxicology 28 (May-June 2004): 217–25.

Elwood, W. N. "Sticky Business: Patterns of Procurement and Misuse of Prescription Cough Syrup in Houston." Journal of Psychoactive Drugs 33 (April-June 2001): 121–33.

Nevin, J. "Drug Update: Fentanyl Patch Abuse." Emergency Medical Services 33 (July 2004): 24–5.

Stern, J., and C. Ippoliti. "Management of Acute Cancer Treatment-Induced Diarrhea." Seminars in Oncology Nursing 19 (November 2003): 11–6.

Viscusi, E. R. "Emerging Techniques for Postoperative Analgesia in Orthopedic Surgery." American Journal of Orthopedics 33 (May 2004): 13–16.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016–3007. Web site: <www.aacap.org.>.

National Institute on Drug Abuse (NIDA). 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892–9561. Web site: <www.drugabuse.gov>.

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857–0001. Web site: <www.fda.gov>.

WEB SITES

Rehman, Ziaur, Suzan Khoromi, and James E. Douglas. "Opioid Abuse." eMedicine, August 15, 2004. Available online at <www.emedicine.com/med/topic1673.htm> (accessed November 30, 2004).

Stephens, Everett. "Toxicity, Narcotics." eMedicine, September 20, 2004. Available online at <www.emedicine.com/emerg/topic330.htm> (accessed November 30, 2004).

OTHER

American Academy of Child and Adolescent Psychiatry (AACAP). Teens: Alcohol and Other Drugs. AACAP Facts for Families #3. Washington, DC: AACAP, 2004.

National Institute on Drug Abuse (NIDA). NIDA InfoFacts: Prescription Pain and Other Medications. Bethesda, MD: NIAMS, 2004.

Rebecca Frey, PhD

Narcotics

Definition

Narcotics are natural opioid drugs derived from the Asian poppy Palaver somniferous or semi-synthetic or synthetic substitutes for these drugs.

Purpose

Narcotics are drugs that dull the sense of pain and cause drowsiness or sleep. They are the most effective tool a physician has to relieve severe pain. Narcotics are also given pre-operatively to relieve anxiety and induce anesthesia. Other common uses are to suppress cough and to control very severe diarrhea. In large doses, they can suppress the ability to breathe and cause coma and death. Narcotics are also taken illegally for recreational use.

Precautions

Narcotics should only be taken under the direction of a physician. These drugs depress the central nervous system and should not be taken with other drugs, such as alcohol, barbiturates, antihistamines, and benzodiazepines that also depress the central nervous system.

Opioids are broken down by the liver. Individuals with liver damage may not detoxify these substances as rapidly as healthy individuals, leading to potential accidental overdose. Street narcotics are of uncertain strength and may be contaminated with toxic chemicals or contain a mixture of drugs that can cause life-threatening reactions.

Description

Natural narcotics are derived directly from the sap of the unripe seed pods of the opium poppy. Morphine and codeine are the most familiar natural narcotics and are the narcotics most frequently used in medical settings. Often they are prescribed in combination with other non-narcotic drugs. Heroin is a semi-synthetic narcotic. It has no medical or legal uses. Other completely synthetic narcotics are made in the laboratory. These include drugs with medical uses such as fentanyl and oxycodone and illegal "designer drugs" synthesized for recreational use. Some man-made narcotics are hundreds of times more potent than natural narcotics.

Narcotics depress the central nervous system. They work by binding chemically with receptors in a way that blocks the transmission of nerve impulses. These drugs do not cure the source of the pain; they simply block the individual's perception of pain. When used to treat cough or diarrhea, they slow or block muscle contractions.

Morphine (Roxanol, Dura morphine, morphine sulfate, morphine hydrochloride) is the most commonly used medical narcotic for managing moderate to severe pain. It can be also be used to control extreme diarrhea caused by cholera or similar diseases. Morphine sulfate is a white powder that dissolves in water. It is usually given by injection into a muscle or intravenously by injection into a vein. When given intravenously, its effect occurs almost immediately. Individuals given morphine regularly have a high potential for developing dependence on the drug. Morphine can cause withdrawal symptoms if stopped abruptly. It is not a common street drug.

More codeine is prescribed medically than any other narcotic. Concentrations of codeine in the sap of the opium poppy are low, so most codeine is manufactured by chemical alteration of morphine. For pain control, codeine is combined with other non-narcotic painkillers such as aspirin (Empirin with Codeine,) acetaminophen (Tylenol with Codeine) or non-steroid anti-inflammatory drugs. These combination painkillers are manufactured as tablets (most common) or liquids and come in a variety of strengths based on the amount of codeine they contain. Codeine is also found in some cough syrups (Robitussin A-C, for example) and is used to control dry cough. Occasionally codeine is used to control severe diarrhea, although diphenoxylate (Lomotil) is used more often.

In Canada, certain low-dose codeine pain relievers are sold without prescription. In the United States pain medication with codeine requires a prescription. The likelihood of physical or psychological dependence on codeine is much lower than with morphine.

Hydromorphone (Dilaudid) is a narcotic synthetically produced from morphine. It is available in tablets or as an injectable solution and used for pain relief. It is one of the most common pain relievers prescribed for patients who are terminally ill, because it combines high effectiveness with low side effects.

Mederidine (Demerol) was originally developed to treat muscle spasms but is as of 2005 used mainly for pain relief. It is manufactured as tablets of varying strengths. Another synthetic pain relief narcotic whose use parallels mederidine is propoxyphene. When combined with aspirin this narcotic is known under the brand name Darvon.

Oxycodone (Oxycontin), a synthetic narcotic used for pain relief, is manufactured both alone and with aspirin (Percodan) or acetaminophen (Percoset) in tablets of various strengths. OxyContin is a controlled release formula of oxycodone that controls pain continuously for 12 hours at a time. Oxycodone has a high potential for prescription drug and street abuse. Hydrocodone with acetaminophen (Vicodin) is another synthetic narcotic whose use and potential abuse parallels oxycodone.

Fentanyl (Sublimaze, Actiq, Duragesic) is used as a surgical anesthetic. It is available as an injectable solution and as a skin patch.

Methadone is a synthetic narcotic used mainly as a substitute for heroin in heroin withdrawal treatment, although it does have pain-killing properties. Methadone, when taken by mouth (liquid, wafers, tablets) provides little of the euphoria of heroin, but it blocks heroin cravings and withdrawal symptoms.

The first international attempts to control narcotic drugs were made in 1909 with the formation of the Opium Commission Forum, which developed the first international drug control treaty in 1912. In the early 2000s narcotics are regulated internationally by the International Narcotics Control Board (INCB), established in 1961. The INCB regulates the cultivation of raw materials to make narcotics and natural and man-made drugs. Cocaine and marijuana also fall under the board's control, although they are not technically narcotics. Narcotic drugs are also regulated by federal and state governments. In law enforcement, the term narcotics is extended to include other, mainly illicit drugs such as cocaine that have little medical use.

Preparation

No special preparation is required before being treated with narcotics, although, as with all medications, individuals should tell their physician about all prescription and non-prescription drugs, supplements, and herbal remedies that they are taking, as certain medications may enhance the effects of narcotics.

Aftercare

When an individual is prescribed narcotics regularly for an extended period, tolerance may develop. With tolerance, the individual must take higher and higher doses to achieve the same level of pain control. In some cases, when narcotics are stopped abruptly, withdrawal symptoms may develop. These include:

• anxiety
• irritability
• rapid breathing
• runny nose
• sweating
• vomiting and diarrhea
• confusion
• shaking
• lack of appetite

In order to prevent withdrawal symptoms, the dose of narcotics can be gradually diminished, a process known as tapering, until they can be discontinued completely without unpleasant effects. Individuals may also be treated with the drug cloindine (Catapres) to relieve some withdrawal symptoms.

Risks

All narcotics have the potential to become physically and psychologically addictive. When used regularly, tolerance can develop. Abuse and dependence on narcotic prescription drugs in an increasing problem among the elderly particularly and among members of the middle class generally.

Overdose and withdrawal symptoms and reactions caused by contamination with other drugs or toxic chemicals are common reasons for drug-related visits to the emergency room by individuals using street narcotics recreationally. Overdose is treated with the drug naloxone (ReVia). Naloxone blocks and reverses the effects of narcotics. When given intravenously it is effective within one to two minutes.

KEY TERMS

Tapering— Gradually reducing the amount of a drug when stopping it abruptly would cause unpleasant withdrawal symptoms.

Normal results

When used as prescribed, narcotics are a generally safe and effective way to relieve pain and control cough and severe diarrhea. Individuals should not be afraid they will develop an addiction after a short-term course of narcotics following a dental or medical procedure, provided that they follow their physician's instructions for taking the drugs.

Resources

ORGANIZATION

National Institute on Drug Abuse/National Institutes of Health. 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561. (301) 443-1124. 〈http://www.nida.nih.gov〉.

United States Drug Enforcement Administration. Dr Mailstop: AXS, 2401 Jefferson Davis Highway, Alexandria, VA 22301. (202) 307-1000. 〈http://www.dea.gov〉.

OTHER

"Narcotics." United States Drug Enforcement Administration (undated) [cited March 25, 2005] 〈http://www.usdoj.gov/dea/concern/narcotics.html〉.

National Institute on Drug Abuse. February 4, 2005 [cited March 25, 2005]. 〈http://www.nida.nih.giv/ResearchReport/Prescription/Prescription.html〉

Stephens, Everett. Toxicity, Narcotics January 7, 2005 [cited March 25, 2005]. 〈http://www.emedicine.com/emerg/topic330.htm〉.

Narcotics Act (1914)

Jennifer Rebecca Levison

The Narcotics Act of 1914 (38 Stat. 785), also known as the Harrison Act, was one of the first attempts by the federal government to regulate drug consumption. However, it was not mainly concern about drug use at home that spurred passage of the act but rather the United States' desire to improve its relations and trade with China.

Relations between the two countries had deteriorated because of the Chinese Exclusion Acts, which kept Chinese laborers out of the United States, and because of the brutal treatment of Chinese travelers and immigrants in the United States. In response to U.S. policies concerning the Chinese, Chinese merchants organized a voluntary embargo (a stoppage of trade) against American goods in 1905. American traders, who wanted to gain entry into the lucrative China trade, then dominated by the British and other Europeans, were upset about the embargo. Thus, in addition to strained relations with China, the government was also concerned about the grumblings of its own business and trade community.

THE INTERNATIONAL OPIUM PROBLEM

Despite their strained relations, both China (at home) and the United States (in the Philippines) struggled to confront opium use, providing some common ground between the countries. Opium and other opiates are highly addictive drugs derived from the poppy plant. The opium problem had worsened when the United States took control of the Philippines from Spain following the U.S. victory in the Spanish-American War of 1898. For more than half a century, the Spanish had kept strict control over the flow of opium. Following the war, opium began to flow more readily into and out of the Philippines. By 1906 China had made clear their desire to end opium imports and the rampant addiction among China's people.

Charles Henry Brent, an Episcopal bishop, made efforts to help the United States address the opium problem in the Philippines and thus to improve relations with China. In 1906, after the Chinese embargo against trade with the United States had taken effect, Bishop Brent asked President Theodore Roosevelt to convene an international meeting of the United States, Japan, and others with interests in the Far East. Brent argued that such an international effort could stop the flood of opium into China and production of opium in the Philippines. Roosevelt favored Brent's plan because it would ease tensions between the United States and China. The State Department chose Dr. Hamilton Wright, Dr. Charles C. Tenney, and Bishop Brent to act as the United States' delegates to the opium conference in Shanghai in 1909.

At the time, the United States had no federal law limiting or prohibiting the importation, use, sale, or manufacture of opium or coca (the plant from which cocaine is derived) or any other drugs made from these substances. Secretary of State Elihu Root believed it was imperative that Congress pass an antidrug measure before the Shanghai meeting. The Smoking Opium Exclusion Act was passed in 1909.

DRUG USE AT HOME

When Wright came home from the Shanghai Opium Commission, he formulated a domestic bill concerning the control and use of drugs. Wright's bill, introduced in 1910 by Representative David Foster of Vermont, chairperson of the House Committee on Foreign Affairs, sought to control drug traffic through federal powers of taxation. The Foster bill required those who handled opiates, cocaine, chloral hydrate (a hypnotic drug), and cannabis (marijuana and hashish) to register, pay a small tax, and record all transactions. Wright told the House Committee on Ways and Means that while the Chinese community had the largest number of opium smokers, use of the narcotic was spreading to other ethic groups. He also warned of cocaine use among the African American population in the South as a way to gain the support of the Southern Democrats. However, the medical and pharmaceutical communities were not strong supporters of the Foster bill, and the bill failed to pass.

In 1911 Wright helped organize the first International Conference on Opium, convened at The Hague. The main topic was finding ways to regulate international narcotic traffic. The conference emphasized that the means to control use and trafficking of narcotics was domestic legislation within individual countries. Wright returned from the conference with a renewed determination to enact domestic drug legislation.

THE HARRISON BILL

Representative Francis Burton Harrison, a Democrat, agreed to sponsor Wright's antinarcotic legislation. The wholesale drug trade, patent medicine makers, pharmacists, and physicians met as part of the National Drug Trade Conference (NDTC) to express their opposition to the Harrison bill. To ensure that the bill would pass in the House, several of the NDTC suggestions were incorporated into the bill. However, the Harrison bill stalled in the Senate.

The Harrison bill gained renewed momentum when President Woodrow Wilson took office in 1913. The new administration directed the State and Treasury Departments to work with the drug trades and medical profession to create an acceptable bill. The NDTC finally signed a draft of the bill, and on December 14, 1914, Congress passed the Narcotics Act. The act imposed registration and record-keeping requirements on the production and sale of opiates and cocaine.

The Harrison Act did not explicitly state how to deal with drug addicts. According to the act, anyone who obtained specified drugs with "a prescription given in good faith" was allowed to possess them. Some doctors prescribed drugs in gradually diminishing amounts as a way to "maintain" addicts. Maintenance was seen as a way to cure addicts of their drug problem. The Treasury Department, which enforced the law, was against this practice and pursued druggists and physicians who maintained addicted patients.

JUDICIAL REVIEW AND LEGISLATIVE REPEAL

In 1916 the U.S. Supreme Court heard a case, United States v. Jin Fuey Moy, concerning a doctor whom Treasury agents had arrested for prescribing one-sixteenth of an ounce of morphine sulfate to an addict. The Court ruled in favor of the doctor, finding that it was unlawful for the government to interfere with the practice of medicine.

In 1919 the Court made two important decisions with respect to the Narcotics Act. First, in United States v. Doremus, the Court found that the act did not exceed the constitutional powers of the federal government. Then, the Court reversed its earlier position in Jin Fuey Moy, ruling in Webb v. United States that physicians did not have the right to maintain addicts. In 1922 the Court ruled, in United States v. Behreman, that prescribing diminishing amounts of an addictive drug with the intention of curing the addict was an illegitimate medical practice. By this time, opium and cocaine prohibition were firmly in place.

In 1970 Congress enacted the Comprehensive Drug Abuse Prevention and Control Act and repealed the existing drug laws, including the Harrison Act. For more than fifty years, the Harrison Act had served as a central feature of the entire federal legislative scheme of drug control.

See also: Anti-Drug Abuse Act; Chinese Exclusion Acts; Drug Abuse Prevention, Treatment, and Rehabilitation Act; Omnibus Crime Control and Safe Streets Act of 1968; Sentencing Reform Act.

BIBLIOGRAPHY

Epstein, Edward Jay. Agency of Fear: Opiates and Political Power in America, rev. ed. London: Verso, 1990.

Inciardi, James A., ed. Handbook of Drug Control in the United States. New York: Greenwood Press, 1990.

Jonnes, Jill. Hep-Cats, Narcs, and Pipe Dreams: A History of America's Romance with Illegal Drugs. New York: Scribner, 1996.

Krauss, Melvyn B., and Edward P. Lazear, eds. Searching for Alternatives: Drug-Control Policy in the United States. Stanford, CA: Hoover Institution Press, 1991.

McLaughlin, Gerald T. "Cocaine: The History and Regulation of a Dangerous Drug." 58 Cornell Law Review 537 (1973).

Musto, David F. The American Disease: Origins of Narcotic Control, 3d ed. New York: Oxford University Press, 1999.

NARCOTICS ACTS

Background

Control over, and prevention of, the distribution and usage of narcotic drugs has been a major priority of the federal government and the various state governments since the early part of the twentieth century. Notwithstanding these efforts, statistics on the use of narcotics in the United States remain startling. According to statistics from the U.S. drug enforcement administration, between 10,000 and 24,000 metric tons of marijuana were available on American streets. This is in addition to large quantities of other forms of narcotics, including: 260–270 metric tons of cocaine, 110–140 metric tons of methamphetamine, and 13–18 metric tons of heroin.

According to the National Household Drug Survey on Drug Abuse, conducted by the sub-stance abuse and mental health services administration, 55.6 percent of respondents between the ages of 18 and 25 said that they had used illicit drugs. This compares to 53.3 percent of respondents between the ages of 26 and 34, and 28.4 percent of respondents between the ages of 12 and 17. The National Institute on Drug Abuse's 2002 Monitoring the Future Study found that 53 percent of high-school seniors claimed to have used narcotics, including 41 percent who said that they had used drugs in the past year, and 25.4 percent who said that they had used drugs in the past month.

The efforts of law enforcement officers have had some effect on the use and transfer of narcotics in the past, although these efforts have been costly. In 2001, federal agents seized approximately 1,215 metric tons of marijuana, 106 metric tons of cocaine, 3.6 metric tons of methamphetamine, and 2.5 metric tons of heroin. The costs to society in enforcing narcotics laws have continued to increase. In 1992, the total estimated costs to society of narcotics use was $102 billion. By 2000, this number had grown to $160 billion, including almost $15 billion in health care costs.

Development of Federal Narcotics Laws

During the Civil War, forms of opiates were considered "miracle" drugs that could be used as anesthetics when a doctor performed surgery. Without opiates, surgeries during that period, which often consisted of amputations, involved a group of men holding down a patient while a doctor sawed off the limb of a patient. By the 1870s, opiates, cocaine and other drugs were used in a variety of medical concoctions, leading to increases in addictions.

The use of opium, cocaine, and other drugs continued through most of the nineteenth century. The type of addiction during that time that caused the most concern was alcoholism, and because the causes of addiction and the dangers of narcotics were both unknown, doctors recommended morphine and heroin as remedies for addiction to alcohol. Cocaine was also used in tonics, such as the mixture that became known as Coca-Cola. Moreover, patients, including those of Sigmund Freud, were treated for depression with cocaine.

Congress enacted the pure food and drug act of 1906, ch. 3915, 34 Stat. 768, which formed the food and drug administration (FDA) and gave it the power to regulate food and drugs. Drug addiction began to drop as a result of early FDA regulations. Eight years later, Congress enacted the Harrison Tax Act, ch. 1, 38 Stat. 789, which prohibited the dispensation and distribution of narcotic drugs. In 1922, Congress enacted the Narcotics Drug Import and Export Act, ch. 202, 42 Stat. 596, which prohibited importation and use of opium and other narcotics except for medical purposes.

Between 1922 and 1970, Congress enacted several additional laws that were designed to curb narcotics importation, trade, and use. Drugs such as marijuana and heroin were prohibited, as was the cultivation of opium poppies. The Narcotic Control Act of 1956, ch. 629, 70 Stat. 567 criminalized the transport of narcotics, including marijuana. Some legislation began to focus upon rehabilitation of narcotics addicts. For example, the Narcotic Addict Rehabilitation Act of 1966, Pub. L. No. 89-793, 80 Stat. 1438, provided for treatment of addicts as an alternative to incarceration.

Comprehensive Drug Abuse and Control Act

By the late 1960s, illicit drug use in the United States had become widespread. Moreover, use of narcotics became more open, causing concerns among many communities, law enforcement personnel, and legislators. Existing narcotics laws were failing to curb the usage of narcotics drugs. For example, about half of the amphetamines and barbiturates produced legally in the United States were being distributed through illegal means.

In response to these problems, Congress in 1970 enacted the Controlled Substances Act (CSA) as Title II of the Comprehensive Drug Abuse Prevention and Control Act, Pub. L. No. 91-513, 84 Stat. 1242. The CSA developed a complex regulatory system designed to control the distribution of drugs. It established five schedules of drugs, with each schedule representing the degree with which the drug is likely to be abused and the level of accepted medical use. Most narcotics, such as marijuana, cocaine, and heroin, fall within Schedule I, which includes drugs with high potential for abuse and with no accepted medical use.

The CSA has been amended dozens of times since is original enactment. In 1974, Congress enacted the Narcotic Addict Treatment Act of 1974, Pub. L. No. 93-281, 88 Stat. 124, which allows practitioners to dispense narcotics for detoxification and similar purposes. Other amendments to the CSA have established federally funded prevention and treatment programs, including drug-awareness education programs.

Anti-Drug Acts and National Drug Control Policy

Despite Congress' efforts to strengthen narcotics laws through the CSA, use and abuse of narcotics remained a major national problem in the 1980s. By 1984, narcotics were a part of an $80 million industry in the United States, and use of illicit drugs had reached epidemic proportions according to findings by Congress. Law enforcement officers were able to interdict only five to 15 percent of the drugs entering into the country. Moreover, statistics showed a high correlation between drug use and criminal activities. For example, about 90 percent of heroin users relied upon crime to fund their habit.

The National Narcotics Act of 1984, Pub. L. No. 98-473, 98 Stat. 2168 established the National Drug Enforcement Policy Board to coordinate efforts among federal agencies to combat narcotics trade and for other programs. Four years later, Congress enacted the National Narcotics Leadership Act of 1988 as Subtitle A of the Anti-Drug Abuse Act of 1988, Pub. L. No. 100-690, 102 Stat. 4181, which replaced the board with the office of national drug control policy. This office continues to implement the country's policies regarding education about the dangers of drug abuse as well as efforts to stifle the drug trade. The Office of National Drug Control Policy and the U.S. Drug Enforcement Administration are the two main federal agencies that are responsible for addressing narcotics issues in the United States.

State Narcotics Acts

Many states have enacted statutes to address narcotics trade and usage within their borders. The vast majority of states adopted the Uniform Narcotics Drug Act, which was first approved by the commissioners on uniform laws and other organizations in 1930. That act and other state laws limited the production of marijuana and generally prohibited more dangerous drugs, including cocaine and heroin. In 1970, the same year that Congress approved the federal Controlled Substances Act, the Commissioners approved the Uniform Controlled Substances Act. This uniform law was eventually approved by 46 states. Although it was updated in 1990 and 1994, few states adopted the amended version.

further readings

Jonas, Stephen. 1990. "Solving the Drug Problem: A Public Health Approach to the Reduction of the Use and Abuse of Both Legal and Illegal Recreational Drugs." Hofstra Law Review 751.

U.S. Department of Justice, Drug Enforcement Administration. 2003. Drugs of Abuse. Washington, D.C.: U.S. Government Printing Office.

cross-references

Drugs and Narcotics; Office of National Drug Control Policy.