Chapter 4
The Costs of America's Opium Problem

America faces a pandemic of drug abuse that inflicts staggering costs on the nation. The United States constitutes just one segment of the global illicit drug market, yet according to the UNDCP, its population consumes a disproportionately large percentage of the world's estimated eight-thousand-ton opium crop.

The profile of America's opium problem takes many shapes. On the one hand, the profile includes those addicted to the drug and those who supply the addicts by smuggling, distributing, and selling the contraband. To the people involved in activities that violate the law, the costs can be devastating. Many spend much of their lives in jail, while addicts who manage to avoid arrest and sentencing pay a moral cost by neglecting themselves, their families, and their jobs in a never-ending quest to purchase their next fix. On the other hand, the profile includes legions of federal, state, and local law enforcement agencies, branches of the military, the medical community, and private citizen groups trying to stamp out opium. The costs of the opium industry to these groups and to all Americans is an estimated annual $8 billion to detect, seize, prosecute, incarcerate, and treat thousands of opium smugglers, distributors, and addicts.

Twentieth-Century Moral Condemnation

By 1900 there were an estimated four hundred thousand addicts and an additional six hundred thousand casual opium users in America. Within churches, community town halls, and the halls of Congress, a moral aversion to the expansion of opium abuse and its costs to communities had inspired a prohibition movement. For the first time ever, a movement was succeeding in pressuring Congress to enact laws that restricted what Americans could or could not put into their bodies.

In 1912, Dr. John Witherspoon, later president of the American Medical Association, noted the moral costs of opium use in terms of ruined lives and destroyed families and exhorted the medical community to eliminate the opium supply: "Save our people from the clutches of this hydra-headed monster which stalks abroad through the civilized world, wrecking lives and happy homes, filling our jails and lunatic asylums [mental hospitals], and taking from these unfortunates, the precious promise of eternal life."²⁶

In 1914 Congress passed the Harrison Act, which placed opium under federal restriction and outlawed the sale, possession, and use of opium. Legitimate opium use by the medical profession ceased with the advent of gas mixtures used as anesthetics and more sophisticated analgesics that are less addictive than opium. Therefore, all opium now brought into America is smuggled to either begin or support addiction.

When Congress outlawed the possession of opium, organized crime syndicates stepped in to provide an uninterrupted flow of opium to users and in so doing created a new multibillion-dollar industry. To enforce the new opium laws and counter organized crime, a variety of law enforcement agencies worked to suppress the crime syndicates.

The crusade of law enforcement to eliminate organized opium dealers and confiscate their contraband stiffened in the late 1950s. In 1996 Martin Booth reported in his book Opium: A History, "It has been reckoned that 50 percent of all crime committed in American cities are drug related: this figure may be considerably

higher in inner-city zones."²⁷ Although crime committed by opium addicts, dealers, and smugglers represents only about 15 percent of all drug-related crime, law enforcement agencies continue to join in the struggle to remove opium from the nation's streets.

Casual Opium Use

Clearly, high moral and financial costs are attributed to opium abuse and addiction in America. Addiction begins with casual opium use. Opium may be enjoyed once in a while as an intoxicant in metropolitan areas as well as in camps of migratory workers living in tents scattered throughout hundreds of America's agricultural areas. Initially, those who take low opium doses, especially when it is eaten rather than smoked or injected, may not become addicted until they have been taking the drug for months or even years. In some cases, casual users are able to control their intake and never become addicts. For other users, this is not true.

Some casual users depend upon opium's analgesic effects in place of proper medical attention. Among middle- and low-income families where earnings are insufficient to afford proper health care, opium is used as a means of self-medication. Temporary periods of intense pain from work-related injuries, migraine headaches, and back injuries are self-medicated with small doses of opium. For many workers, particularly those working as field hands, bending over all day picking low-lying fruits and vegetables, back pain becomes a chronic problem they treat with occasional low doses of opium.

Other casual users admit using opium for temporary psychological relief of common anxiety, sleeplessness, loneliness, and sadness. To soften the impact of short-term emotional distress, opium is used as a substitute for psychiatric counseling sessions that can cost between $100 and $150 per hour and can continue weekly for several months to a year. The most common reasons cited for opium use are to relieve depression following the death of a close family member, divorce, and job loss. Regardless of the reasons people begin to use opium, the pleasurable feelings the drug provides prompt them to continue or increase use.

Casual opium use can occur without impairing the user's health. When small amounts are taken occasionally, the body recovers and repairs any damage to the cardiovascular system. The same claims cannot be made, however, when high doses are taken regularly.

America's Opium Addicts

Most opium addicts in the United States hide their addiction, rarely speaking publicly about it. One of America's most well-known poets of the mid–twentieth century, Williams Burroughs, was a confessed opium addict willing to speak openly about his addiction on behalf of those who could not. In an interview in 1956, he discussed his problem, with startling honesty about his use and attitude toward addiction:

Over a period of twelve years I have used opium, smoked and taken orally, injected in skin, vein, muscle, and sniffed when no needle was available. In all cases, the end result will be the same: addiction. And a smoking habit is as difficult to break as an intravenous injection habit. The use of opium leads to a metabolic dependence on opium. Opium becomes a biologic need just as water.²⁸

Statistics indicate that the pool of American opium addicts is older than for any other type of drug addiction; about 45 percent are over forty, 45 percent are between twenty-five and forty, and 10 percent are younger than twenty-five. One explanation for this phenomenon was the dramatic increase of opium use and addiction following the end of the Vietnam War in the mid-1970s, when returning troops brought opium and opium addiction home with them. DEA statistics further indicate that 83 percent of addicts are male.

Interview with an Opium Smoker

A San Francisco woman was arrested for opium possession. Her interview with arresting officers about her addiction can be found in The Consumers Union Report on Licit and Illicit Drugs, on the Drug Library Web site.

Q. Why did you start to smoke opium?

A. Why do people start to drink? Trouble, I suppose, led me to smoke. I think it is better than drinking. People who smoke opium do not kick up rows; they injure no one but themselves, and I do not think they injure themselves very much.

Q. Why do you smoke now?

A. Because I must; I could not live without it. I smoke partly because of the quiet enjoyment it gives, but mainly to escape from the horrors which would ensue if I did not smoke. To go twenty-four hours without smoking is to suffer worse tortures than can be believed.

Q. Then why do you return to the use of the drug?

A. Ah! that's it; there is a time when my hands fail me; tears fall from my eyes, I am ready to sink; then I come here and have a smoke, which sets me right. There is too much nonsense talked about opium-smoking. Life without it would be unendurable. I am in excellent health; but, I suppose, every one has their own troubles, and I have mine.

Q. Are women of your class [blue collar] generally addicted to opium-smoking?

A. No; they are more addicted to alcohol, and alcohol does them far more harm. When a woman drinks she gets into more trouble pretty quick.

The National Institute of Mental Health (NIMH) divides opium addicts into two general camps, those capable of controlling their addiction well enough to find employment and those who cannot. The NIMH estimates that about 65 percent of opium addicts are capable of maintaining some sort of employment. The problem, however, is that employment is rarely long-term and rarely pays well. Most addicts do not qualify for high-paying jobs because they focus more on their next fix than on their work. Some addicts can control their needs to complete an eight-hour shift, but the last hour or two brings on depression and irritation with coworkers and management.

The other 35 percent are incapable of any sort of normal social interactions, let alone employment. This group tends to survive on some sort of criminal activity to support their addiction as well as to acquire food, clothing, and shelter. Most addicts live in large American cities, because there they can congregate and work as pushers who sell opium to addicts as well as recruit new addicts. Often, living in apartments shared by several opium users or pushers, many addicts run afoul of the law by supplementing their income with armed robbery, street muggings, and auto theft.

Neglected Lives of Opium Addicts

Many new opium users quit after a few months on the drug's roller-coaster ride of euphoria and depression, yet others continue to use it for many years or become repeat customers for life. Eventually, many addicts are arrested, sentenced, and sometimes sent to jail. One such man who experienced this, a San Franciscan who asked for anonymity, had this to say about his opium use and eventual incarceration:

Five years ago I was editor and manager of a metropolitan newspaper. Today I am a convict serving my second penitentiary sentence. Between these extremes is a single cause—opium. For five years I have been a smoker of opium. For five years there has not been a day, scarcely an hour, during which my mind and body have not been under the influence of the most subtle and insidious of drugs. And now, after weeks of agony in a prison, I am myself again, a normal-minded man, able to look back critically and impartially over the ruinous past. If I can set down here fairly and simply the story of those years, I will have done something that may save many others.²⁹

In addition to leading lives of crime and poverty, many addicts suffer severe medical problems relating to excessive opium use, which takes its toll on the body. Long-term opium use is destructive to the health of the addict. Users with medical complications often show up in emergency rooms: Cardiac arrest, stroke, and liver failure are all well-documented results of excessive opium use. In addition to these traumas to the body, the addict's appetite also suffers. Continuous use of opium reduces a person's appetite, leading to a variety of illnesses due to malnutrition. According to

Jonathan Spence of Yale University, those who manage to maintain a healthy appetite suffer less than those who do not: "Those who eat regularly and well do not suffer physiologically from their addiction, but for the poor, addiction is a serious health hazard, since shortages of cash resources are put to opium rather than food purchases."³⁰

Additional health hazards affect those who smoke opium. The heat of burning opium and a variety of carcinogens inhaled with the opium pose the potential for lung damage and in severe cases lung cancer. When opium burns, it releases dozens of hot gases that damage the lung tissue, and even the cooled-down gases carried by the blood adversely affect heart valves and blood pressure. Biopsies of lung tissue taken from long-term addicts reveal that the minute and delicate alveoli cells of the lungs are badly scarred.

Numerous conditions are linked to the other ways in which opium is consumed. Some of these illnesses are commonly found among those who take opium intravenously, a practice known as shooting or mainlining. Injecting drugs often leads to the damage or collapse of veins. Addicts who shoot opium also have the problem of finding clean needles because they are illegal without a doctor's prescription. Consequently, users often share needles with others without first properly cleaning them. Sharing dirty needles places users at high risk of contracting human immunodeficiency virus (HIV) and deadly infectious diseases such as hepatitis. Nobody knows how many addicts contract HIV and hepatitis in this manner, but according to the National Institute on Drug Abuse, shooting illicit drugs, including opium, is the leading risk factor for new cases of infectious diseases.

The problem with opium addicts became so severe in the 1950s that medical practitioners coordinated their efforts to help addicts by providing a variety of psychological therapies they hoped would cure addiction.

Opium Addiction Therapy

Nineteenth-century opium users and physicians recognized the powerfully addictive nature of opium, but it was not until the mid–twentieth century that therapeutic strategies were implemented to release addicts from its grip. Since the 1950s, three therapies have been recognized as providing some limited value for addicts: psychological, sociological, and biochemical.

A variety of psychological therapies were tried first. At the heart of all of them was the belief that addiction resided in the psyche or personality of the addict. There were many variations on this theme, including the belief that addicts acquired a predisposition toward addiction in early childhood caused by such problems as poor parental judgment, acute poverty, and domestic violence. To proponents of this theory, recovery might be found during therapy sessions, occurring as often as three times a week over a three- to four-year period, in which the addict revisited his or her childhood by remembering and sharing painful events with a therapist. In theory, the healing process occurred while discussing the painful memories with the doctor. A variation of this therapy described addiction as the result of conflicts in the addict's adult life resulting from traumatic events such as divorce, job loss, or death of a family member. Whether the therapy focused on childhood or adult traumas, the goal was a restructuring of the personality to cope with life without opium.

During the 1980s, a variety of sociologically based therapies expressed the view that societal circumstances caused addiction. Doctors subscribing to sociologically based therapies believed that factors leading to addiction could include the hopelessness of living in inner-city slums, a lack of optimism brought on by poverty, boredom triggered by low income or meaningless, repetitive jobs, and a general sense of malaise, especially in those associated with teenage street gangs. Therapists who accepted the sociological model treated opium addicts in group therapy sessions of five to twenty addicts. During group sessions, the therapist forced each addict to honestly confront and discuss the reasons for abusing opium and to identify factors that triggered the need for a fix. Once the triggering factors were identified, the healing process occurred by avoiding them. Common triggering factors included friendships with other addicts, boredom brought on by cutting school or failing to go to work, and gang membership. In all cases, the common theme was the belief that addiction could be cured by engaging in healthier social contacts.

The most recent theory of opium addiction is the biochemical theory, which says that addiction is caused by chemical reactions in the brain. In this theory, the acute withdrawal symptoms suffered after an addict is deprived of opium are biochemical in origin. The cause of these immediate withdrawal symptoms is in the structure of the chemical molecule and its effect on cells of the nervous system. Exposed regularly to opium molecules, the human nervous system adjusts to its presence and in so doing becomes dependent upon it. When the opium molecules are withdrawn, the nervous system becomes seriously affected.

Biochemical therapy involves the use of chemicals to block the cravings without adversely affecting the addict. The most commonly used chemical is methadone, a synthetic drug taken orally once a day that is capable of suppressing opium withdrawal symptoms.

Methadone

For more than thirty years the synthetic narcotic methadone has been used to treat opium addiction. Research and clinical studies show that long-term methadone treatment, taken under medical supervision, has no adverse effect on the heart, lungs, liver, kidneys, bones, blood, brain, or other vital body organs, and it produces no serious side effects.

In addition, methadone does not impair cognitive functions. It has no adverse effects on mental capability, intelligence, or employability. It is not sedating or intoxicating like opium, and it does not interfere with ordinary activities such as driving a car or operating machinery. Patients are able to feel pain and experience emotional reactions. Most important, methadone relieves the craving associated with opium addiction.

Under a physician's supervision, methadone is administered orally on a daily basis at a cost of thirteen dollars per dose. Because its effects will last all day, the cost is considerably lower than what an opium addict would spend for multiple doses. Because the dose is taken orally, addicts do not run the risk of contracting or spreading HIV/AIDS or hepatitis through the use of dirty needles.

Methadone is not a panacea, however. Many people argue that substituting one drug for another does not solve the addicts' real problems. Some ultimately remain addicted to methadone, requiring continuous treatment, sometimes over a period of years.

Methadone reduces the cravings associated with opium use, but it does not provide any pleasurable experiences. Consequently, methadone patients do not experience the extreme highs and lows that result from the waxing and waning of opium. This theory is controversial in that ultimately, the patient remains physically dependent on methadone.

America's Army of Opium Chasers

The United States has an army of governmental agencies hot on the trail of opium and opium dealers before they reach America's shores. To aggressively confront opium distribution, many federal law enforcement agencies swing into action to suppress opium before it arrives.

The first of America's lines of defense is the military, especially the Coast Guard. American warships regularly cruise international waters in search of ships that may be transporting opium and other illicit drugs. When ships suspected of carrying drugs are spotted, American warships force them to stop while sailors with opium-sniffing dogs board them and prowl the corridors, engine rooms, and cargo holds. If opium is uncovered, the ship is escorted to the nearest U.S. port and is impounded until the conclusion of legal action.

Assisting the military is the Drug Enforcement Administration another arm of the federal government. Founded in 1973, DEA is charged with coordinating all drug enforcement and confiscation activities in the United States well as foreign countries. The DEA coordinates its efforts with foreign governments, usually those of poppy-growing nations, to curtail the growth and harvest of the drug.

A third arm that assists in controlling the flow of opium is the Federal Bureau of Investigation. It inspect companies suspected of trafficking in illegal drugs and foods arrests and prosecutes anyone caught distributing large quantities of opium.

Most Americans agree that opium addicts who seek help should get it. A debate, however, centers on determining the best strategy for curing the addict. This debate prompted the General Accounting Office (GAO) of the federal government to investigate the effectiveness of various drug therapies. In 1996 the GAO published the results of a lengthy study focused on opium and other addictive drugs. The study concluded that no one was certain how much success any of the therapies had provided:

Although studies conducted over three decades consistently show that treatment reduces drug use and crime, current data collection techniques do not allow accurate measurement of the extent to which treatment reduces the use of illicit drugs. Furthermore, research literature has not yet yielded definitive evidence to identify which approaches work best for specific groups of drug abusers.³¹

The conclusion of the GAO report that the best therapeutic approaches have not yet been identified piqued the interest of many specialists working in the field of drug rehabilitation. After much research, therapists have concluded that no single therapy can be identified as being the best for all addicts and that the best strategy is for the addict and his or her therapist to explore several. Experts have also concluded that whichever therapies are applied, the addict must understand that there are no short-term solutions to the complexities of opium addiction.

The Role of American Law Enforcement

While doctors struggle to assist addicts to free themselves from their agony, law enforcement officers grapple with the task of confiscating opium before it can reach more users. Suppression of the opium trade has been one of American law enforcement's objectives since 1914, when Congress outlawed opium's general use. Today all law enforcement agencies—federal, state, and local—coordinate their efforts to discourage the use of opium with a three-pronged strategy of border seizures, arrests and prosecutions of those smuggling and selling opium, and incarceration of those convicted. The implementation of these strategies is enormously expensive. Trying to calculate the financial costs is impossible, because dozens of independent law enforcement agencies, multiple layers of the court system, attorneys, the penitentiary system, and the military commit resources to suppress opium. Nonetheless, the dollar amount is in the tens of billions annually.

The U.S. border is the primary line of defense for seizing opium. Customs officers are authorized to inspect any person, vehicle, container, or object that they suspect may conceal contraband. News reports often dramatically chronicle the arrests of smugglers and seizures of opium. Customs officials and border

patrol officers cite these seizures as evidence of America's success in the war on drugs.

Using aircraft to counter the smuggling threat, the DEA equips planes with infrared cameras and radar to detect, track, and intercept smugglers' aircraft. Military aircraft bristling with sophisticated detection devices make flights from Florida and Texas deep into Central America's airspace to search for questionable aircraft flying north. When suspicious aircraft are spotted, their positions are radioed to intercept aircraft, which follow the suspect planes to their destinations, where they are searched.

The task of interdiction within the United States is a daunting one. Once opium is inside the United States, preventing its distribution and use is difficult. As large bulk shipments are broken into small packets, they are easily concealed for distribution anywhere in the United States. Law enforcement relies upon tips from paid informers, arrested opium addicts, and sophisticated surveillance to seize street-level quantities and arrest the dealers. Agencies such as the DEA are experimenting with new tactics as well. The Mobile Enforcement Team program responds to the drug-related violent crime that plagues certain urban neighborhoods, while Operations Pipeline and Convoy target motor vehicles, stopping and inspecting suspicious vehicles on the nation's highways.

Despite the best efforts of the DEA and other government agencies at intercepting the supply and punishing traffickers with jail time, the amount of opium available on America's streets remains large. The opium problem is the result of American addicts who want the drugs and foreign suppliers who profit handsomely by growing poppies and selling opium. These two forces combine to make opium a tricky international political problem.