Appendix A: Regulation of Addictive Substances

The United States has made various social and legislative attempts to deal with addiction, especially in the twentieth century. But history reflects our society's ambivalence about whether to outlaw addictive substances or to allow and regulate the consumption of them. Efforts to ban the use and sale of alcohol during Prohibition led to the growth of an underground black market and organized crime. When it was believed that heroin addiction was the cause of increasing inner-city crime in the 1940s and 1950s, heroin addicts were listed on federal registers and sent to federal treatment centers. The advent of methadone maintenance treatment, controversial as it was, allowed heroin addicts to reenter society but made little impact on the course of the addiction itself in the individual addict.

In the 1960s the use of hallucinogens for their "mind expanding" powers was promoted by some, and legislation was passed to decriminalize the possession and use of marijuana.

The subsequent epidemic of crack cocaine use, however, increased public concern about the destructive aspects of drug addiction, and vast amounts of tax dollars have been spent on the "war on drugs." When AIDS became epidemic among intravenous drug users, proponents of clean needle programs came forward, but so did people who strongly opposed those programs. We have seen increasing social concern about drunk driving, but attempts to lower the legal alcohol blood limit nationally have engendered controversy.

And while some debate the regulation of nicotine products, including cigarettes, others promote the easing of restrictions on casino gambling.

Before the early 1900s, unregulated sale of patent medicines led to widespread opiate addiction. In the 1800s most pharmacies sold preparations such as Dover's Powder and McMunn's Elixir of Opium, which contained morphine. Derivatives of the coca plant including extracts and pure cocaine were widely used for their stimulant properties and were not considered harmful. Coca-Cola is an example of a popular tonic that contained active cocaine when it was first produced.

Some acknowledgment of the addicting nature of these patent medicines was made in the medical and religious literature, but social disapproval of their use was minimal.

In the early 1900s the federal government instituted control over the sale and use of opiates. The Pure Food and Drug Act of 1906 required that all patent medicines have an accurate list of ingredients, conform to standards of purity, and truthfully describe their intended effects. Public awareness of the extent of the availability of opiates increased, and educational efforts were made to reduce the prevalence of addiction to these tonics.

The Shanghai Opium Commission was convened under the leadership of Theodore Roosevelt and led to the adoption of the Smoking Opium Exclusion Act of 1909. The Hague Treaty of 1911 called for national and international efforts to curb the use and distribution of opium and coca products.