(Fay USE OF NARCOTICS IN THE UNITED STATES HEARING BEFORE | THE COMMITTEE ON PRINTIN a UNITED STATES SENATE e SIXTY-EIGHTH CONGRESS .. | FIRST SESSION | . ON .: | | S. Con. Res. 10 : A RESOLUTION, TO,PRINT, FIFTY MILLION ADDITIONAL _ COPIES OF AN ARTICLE ENTITLED ‘“‘THE PERIL OF NARCOTICS—A. WARNING TO THE PEOPLE... ) OF (AMERICA, BY THE‘INTERNATIONAL: 1/57: ‘NARCOTICS EDUCATION. ASSOCLATION © JUNE 3, 1924 : | | Printed for the use of the Committee on Printing ee WASHINGTON GOVERNMENT PRINTING OFFICE 170% ; 1924 ‘COMMITTEE ON PRINTING GHORGE H. MOSES, New Hampshire, Chairman ARTHUR CAPPER, Kansas. DUNCAN U, FLETCHER, Florida. GEORGE WHARTON PEPPER, Pennsylvania. JOSEPH E. RANSDELL, Louisiana. — SIMEON D, FESS, Ohio. WILLIAM CABELL BRUCE, Maryland. HENRIK SHIPSTEAD, Minnesota. Marrua R, GOL, Clerk CONTENTS Statement of— Hon. Richmond Pearson Hobson (Page Hon. John J. Kindred be 6 Hon. John W. Summers Hon. Henry Rainey 14 21 Dr. Lawrence Kolb. Mr. Edwin L. Neville te Ae 538 USE OF NARCOTICS IN THE UNITED STATES - TUESDAY, JUNE 3, 1924 eee Sratms SENATE, CoMMITTEE ON PRINTING, Washington, D.C. ‘The committee met, | pursuant to call of \the. chairman, at. 2.30 o'clock p. m. in the committee room, Capitol, Senator George H, Moses, chairman. Present: Senators, Moses (presiding), Capper, Pepper, Fess, Fletcher, Ransdell, Bruce, and) Shipstead. The Cuamrman. Senator Bruce has asked me.to count him for, a quorum and to vote for him.. A quorum of the committee being present, the committee, will come to order. This is a, special meeting of ‘the committee called for the consideration, of, Senate Concurrent Resolution 10, intro- duced by the Senator from Kansas, Senator Capper. ; Resolved by the Senate (the House of Representatives concurring), That there shall be printed as a Senate document an eight-page article entitled ‘‘ The peril of narcotics—a warning to the people of America,” by the International Narcotics Education Association, and that 50,000,000 additional copies shall be printed, of which one-half shall be for the use of the Senate and one-half for the use of the House of Representatives. Following the practice of the committee, the clerk Be the com- mittee sent the manuscript as originally submitted to the committee to the Public Printer for an estimate. In the meantime a revised copy of the article has been submitted, but I understand that the revision made no change in the length of it. The chairman also submitted the transcript to the Federal Narcotics, Control, Board for an opinion, which has been rendered in: writing, signed by the rep- resentatives on behalf of the Treasury Department, the Department of Commerce, and the State Department. The estimate as sent from the Government Printing Office is as follows: JUNE 8, 1924. My Dear SenAtTor: In response to telephone request from your office, I am pleased to submit the following statement in regard to the proposed printing of 50,000,000 copies of the document, entitled ‘‘ Habit Forming Narcotics”: 50,000,000 copies on newsprint papers: -uu4 8 Leu, -yoed abopel $161, 001. 24 50,000,000: copies on machine-finish papers. i—-- 2 188, T71. 24 In addition to the above cost of printing the document, 50,000,000 envelopes for mailing the same will cost $147,539.95. It. is estimated that the printing of 50,000,000 copies of the document will require the operation of one web press for 250 days running eight hours per day. With the vast amount of other important work ahead of us, this office could not place more than one press on the job, except at the delay of, other printing urgently required for the transaction of the public business. 1 a 2 USE OF NARCOTICS IN THE UNITED STATES The printing of 50,000,000 naples of the document will require approximately 885,500 pounds of paper, equaling about 20 carloads. Respectfully, ‘ GrorcE H. Carter, Public Printer. Hon. Grorce H. Mosszs, Chairman Senate Committee on Printing, United States Senate, Washington, D. C. And the committee is here this afternoon to hear Captain Hobson in behalf of the adoption of the resolution, Captain Hobson being the author, as the Chair understands it, of the article in question. We will hear you, Captain Hobson. Senator Pepper. May I inquire, Mr. Chairman, whether that esti- mate includes. the cost of handling that number of documents through the mails? The Cuarrman. No; we never get that sort of an estimate. ~ Senator RansDELL.. May I ask what was the substance of the re- port from the Federal Narcotics Control Board; not the whole of it, but the substance of it? The Coarrman. It was not favorable. The representatives of the board are here to be heard on it. peoeeeceit® if you wish it, I can read it into the record. Senator Suresteap. What board is that? The Cuarrman. The Federal Narcotics Control Board, made up of the Secretary of the Treasury, the Secretary of Commerce, and the Secretary of State, and they are represented on the board by ai ae sentatives from those departments. The letter or report from them is as follows: FEDERAL NARCOTICS ContRor BOARD, (SECRETARY OF STATE, SECRETARY OF THE TREASURY, SECRETARY OF Commerce), Washington, D. C., May 27, 1924. Hon. Grorce H. Mosss, #4 Chairman Committee on Printing, United States Senate, Washington, D. C. My Drar SENATOR: Receipt is acknowledged of your letter of May 24, 1924, inclosing a copy of Senate Concurrent Resolution 10 introduced by Senator Capper, providing for the printing of 50,000,000 copies of an article entitled “The Peril of Narcotics,” by the International Narcotics Education Associa- tion; also inclosing copy of the article referred to in the resolution, and re- questing a memorandum regarding the correctness of the statements contained in the article, also regarding the organization known as the International Nar- cotics Education Association. In view of the fact this matter comes up at once in your committee, time — will not permit going into the matter in detail. The article is based on an entirely erroneous premise that “The growth of narcotic addiction in the United States and the world over is the most alarming symptom of the new century,” and ‘‘ Our youth, both sexes, by the thousands are being hooked and brought into this living death.” These statements as to the United States can not be backed up by facts or figures. On the contrary, those who are enforcing the laws with regard to narcotics and who are, without doubt, in ' the best position to know actual conditions, deny these statements. A recent survey made by narcotic officers throughout the United States shows the number of addicts as well within the half-million mark, whereas the article makes an estimate of 1,750,000. This estimate, it will be noted, is based upon figures published from various parts of the country through various unoflicial sources as far back as 1913, prior to the passage of the Harrison Narcotic Act, and the latest date, 1918, which it is noted: was prior to the amendment to the Harrison Act which tightened up that law and made enforcement much more effective. The statements made with regard to the annual per capita consumption in | the United States, as compared with that in foreign countries, is based upon USE OF NARCOTICS IN THE UNITED STATES 3 tigures published seven. years ago, and do. not in any way show. the correct conditions at this time, as the latest official. figures, show . the annual per capita consumption of opium at the present time as about 7 grains; in morphine equivalent seven-eights of a grain, and cocaine less than one-quarter of a grain) per capita. The statements with regard to the alarming addiction of school ‘children — -are tended to create hysteria, and are not true. The statement with regard to the potentiality for addiction of 1 grain of heroin and 1 ounce of heroin is in the same category with that regarding school children. The assertion that one-fourth of a grain of heroin will cause addiction of ‘a child, and therefore 1 ounce will make 2,000 addicts is beyond comprehension, and. leads the layman to believe that addiction is growing at that rate. The _ article, based on an erroneous premise, naturally draws wrong conclusions; and, if placed in the hands of the young people of this country would stir up in many of them a desire to know something of this, to them, new thrill giver. It is recognized that proper publicity based upon facts is beneficial; but such articles as the one presented places a wrong light upon the subject and causes undue and unwarranted excitement, in view of the fact that the dope evil is now practically centered in the underworld, where it can best be coped with. To refer again to the matter of the school children being made addicts, at- tention is called to the fact that the present street price of narcotics ranges around a dollar to two dollars per grain, and in this article it is stated that the average consumption of an addict is 10 grains per day. It, therefore, can not be seen how school children could ever be able to cater to their addiction ence of this office that confirmed addicts have no end of trouble identifying at the price of ten to twenty dollars per day. Furthermore, it is the experi- | themselves with peddlers sufficiently to be trusted with a purchase of. dope, and they are continually violating the law in the presence of officers in order that they might be sent to a penal institution for a cure due to their difficulty _/ to procure the needed drug. The effect upon legitimate manufacturers of face powders with regard to the admonition “In using any brand of face powder regularly, it is a wise. - precaution to have a sample analyzed for heroin,” can readily be imagined, as the only inference is that such manufacturers are surreptitiously spread- ing the drug evil through the medium of their products. It is understood that the Public Health Service is transmitting to you a memorandum upon this article. That service has recently been employed upon a survey of narcotic conditions in the United States, and it might be stated | that their findings with regard thereto are confirmed by the recent survey made through narcotic officers. It is. certainly felt that the publication of such an article in its present form would be most ill-advised and would, in a.measure, place the stamp of governmental approval upon a statement which this office can not in any way approve, With regard to the organization known as the International Narcotic Educa- tion Association, you are informed that this office has no information. other ‘than that gained through newspaper articles which have been published, pur- porting to be from that organization, and the article now presented to you for publication, The records of the Narcotic Division fail to show that this organ- ization has advised of the alarming conditions pointed out in the article in order that proper investigation might be made. - Respectfully, L. G. Nutt, Secretary, Federal Narcotics Control Board. Epwin L. NEVILLE, Representative, Department of State, Federal Narcotics Control Board Advisory Committee. F. R. ELpRInGE, Representative, Department of Commerce, Federal Narcotics Control Board Advisory Committee. Senator Carrer. Have you some report from the Public Health Service ? The Cuarrman. The Public Health Service has sent a representa- tive to speak for it at the hearing. We will now hear Captain Hobson. J 4 USE OF NARCOTICS IN’ THE UNITED STATES STATEMENT OF HON. RICHMOND PEARSON HOBSON, FORMERLY CAPTAIN, UNITED STATES NAVY, FORMERLY MEMBER OF CON- GRESS FROM THE STATE OF ALABAMA, AND PRESIDENT OF THE INTERNATIONAL NARCOTICS EDUCATION ASSOCIATION, WITH HEADQUARTERS IN LOS ANGELES, CALIF. Mr. Hogson..Mr.. Chairman, before I proceed I wish to challenge the ae, of those who signed that’ report. The CuarMan. Well, this committee is not going to try the com- petency of the Federal Narcotics. Control Board. Mr. Horson.. My statement. opens with. this: The representative of the Public Health Service is present here; Doctor Kolb, and in his presence and in the presence of the representative of the State Department, Mr. Neville, and in the presence of Mr. Eldridge— I do.not see him here—in. the office of Colonel Nutt, in a conference at which I was present, in a discussion largely amongst themselves, ended with the premise that not only this matter is not’ of primary importance’ but that the addict is inherently a good citizen and does not have the psychology or. criminology, and the trouble with him, is he is not,able to get his drug; if you let him have his drug eis all right; and the climax was reached in these. words in a state- ment by Doctor Kolb, who is here present, to wit, “'There is more rime,in a gallon of liquor than.in a ton of narcotics.” : I am ready now to proceed, Mr. Chairman: ‘And I mention this at the outset, Mr. Chairman, for the reason that I tried very dil- gently to know what kind of a report came, so that I couid meet. it in an Open way... _ We propose, Mr. Chairman, to: show the: fiaklomtiniae First, that narcotic addiction in America is ‘very serious and that its srowth, with the addition of heroin, is alarming. Furthermore, that it. is not.fair for the narcotic bureau and the other agencies to demand proof that involves the great field of smuggling. The burden of proof’is on their side when they admit that 90 per cent of all the narcotics used by this army of addiction which we are concerned with is smuggled and when they have not made any effort. themselves to find out how many addicts have been registered by physicians, or treated by physicians, or in sanitariums, . or who are in prisons, or anywhere else. The half has never been told. ; Furthermore, itis against public policy to. minimize this terror. It is the most secretive activity known and the most difficult of all activities in which to establish the truth. And with the public at large there is not enough.intelligent interest to bring about the cooperation of State governments and municipal governments with the Federal Government.» ‘There is actually not enough knowledge abroad in society at large to bring about the enactment of intelli- gent laws and regulations in States. and cities, and the crying need is for information and education; and at. the present moment the only way to get that and the action that will flow from it is to reach andvawaken' the motive of ‘self-preservatiom in these young people who are being beset and menaced daily by this terror, and in society, the institutions‘of which are being’ undermined and ‘whose life is . being threatened. _ USE OF NARCOTICS IN THE UNITED STATES 5 The whole struggle—and it is a biological'struggle for the life of our people and the species—the whole biological struggle is a fight to reach and arouse the motives of self- preservation in society, in groups in the species at large. This motive aroused will insure every form of action to bring safety. If dormant, then in ignorance this disease will run its course. It arose’ in Asia ‘in a slowly advancing form in the body social of humanity. Alarming symptoms have appeared at various times, indicating’ a more rapid march, notably in the dis- covery of morphine, and then cocaine, Now the recent discovery of heroin; nearly four times as powerful as morphine, whose addicts become’ recruiting agents, where the increase is not by addition but by multiplication. The disease has taken on a galloping form. © - We propose to show, Mr. Chairman, first that the situation is seri- ous and that its expansion is alarming. We propose then’ to prove’ that education isa necessity; that a simple warning at this time will save thousands of our young people from this fate that is worse than death. Some pamphlet ought to be issued, some notice in some form; and we submit this little pamphlet, the best we have been able ‘to bring forth as having the elements; the vital and fundamental elements of carrying the truth. : ‘We suggest a revision'committee to go over the document before! it is sent to the printer.’ If the chairman will permit, I will suggest suitable names, most of whom I have contacted, and they will gladly serve. -On'the part of the’ Senate, Senator Copeland, Senator Spen- cer, and Senator Ball, all M. D.’s; on the part of the House, Doctor Kindred, Mr. Rainey, Doctor Summers, and Doctor’ Temple. I would suggest that this committee secure the assistance and the ad- vice of the narcotic division of the Public Health Service and of Assistant United States Attorney General Crim, who actually con- tacts the real products of this addiction. The gentlemen mentioned being, most of thémn, M: D.’s, and Mr. Rainey ‘having been chairman of a committee which made the most thorough investigation ever made of this subject and the best pode manon’this subject now. | And Doctor Temple, who is an eminent eden HK and I am sure that Senator Fess, who is also‘an eminent educator, will cooperate with us in getting this matter in form for education purposes. » Now, as to the numbers that are required, we are recommending that two-fifths only be prepared now, and three-fifths in the winter. The reason for this is that. the Members of the House, in particular, are not in position to handle now the full amount, and the Printing Office, Mr. Kiess informed me, is very congested. In this proposition the Senators would have enough to reach the colleges, schools, and the secondary institutions, and. down to and including the sixth grade. We expect valuable educational. aid in solving the problems of pedagogy now. difficult in the. lower rades. 5 The State Board of Education of the State of California is study- ing the problem through special committees... The State, boards of education of 44 States are ready to study it now. I find that Members of the House could not handle more than 50 per cent. This two-fifths proposed makes about. 40 per cent. 6 USE OF NARCOTICS IN THE, UNITED STATES I am authorized to assure Senators and Members of the House of the cooperation of 500,000 women who are ready to aid in the distribution; women that are organized and efficient and trained, and who would gladly cooperate in the counties and cities to see that the best distribution of documents is made. They will gladly give their help when called,for. I refer to the Women’s Christian Tem- perance Union. : ; Senator Fiercusr. Captain, may I ask you a question? Mr. Hosson, Certainly. Senator Fiercurr. Whether or not there is any danger of this spreading, or any possibility of its spreading in: the country; that is, in the rural districts? Mr. Hozson, I will be very glad to read to the Senator a report of the Whitney committee, of the State of New York. That is the best evidence we know and the best investigation of that kind. I can give you the substance of it in a sentence. Senator Fiercumr. The idea was that there was.no use of going into that field unless there is danger or trouble there... Mr. Hoxzson. This report shows. that, it.is spreading in the rural districts more than it is in the bigger cities. The report is that it is spreading in the towns, and in the country, in the rural districts, far more rapidly than it was thought possible. The youth in the country are more unsuspecting, and more easily “hooked.” This disease goes through the whole body social—rural, suburban, urban. I propose to produce witnesses, then documents, then make a state- ment. ; The Cuamman. What, do you mean? That you want a further hearing for the introduction of witnesses? Mr. Hogson. No; I will reserve any time that you might accord me after our witnesses have appeared, and then I will produce my documents and sum up. B45; : The CHatrman. The: ordinary practice in a Senate committee, Captain Hobson, is for those who are proposing a resolution to go ahead and make their case. Mr. Hogson. That is what I propose to do. Doctor Kindred. is here, and with your permission he will make a statement at this time. And in asking Doctor Kindred to come I think it is proper to say that he has been connected with the treatment of narcotic addicts for a generation, and is one of the best practitioners—an expert in active work. STATEMENT OF HON. JOHN J, KINDRED, A REPRESENTATIVE FROM THE STATE OF NEW YORK The Cuarrman. Doctor Kindred, will you state your name and address to the reporter ? Mr. Kinprep. John J. Kindred, River Crest Sanitarium, Queens Borough, New York City. ; Senator Fxss. And I think you ought to state to the reporter that you are also a Member of Congress; a Member of the House. Mr. Krnprep. I shall accept that suggestion. I am speaking pri marily, however, as a physician, Senator Fess,and gentlemen. I suppose the committee, like all our committees, is exceedingly busy at this time, and I presume it would be well for me to shorten my statement. USE OF NARCOTICS IN THE UNITED STATES % The Cuarrman. The committee will appreciate it, Doctor, if you will. . Mr. Krnprep. Then I will hurry on and discuss very briefly, in a few headlines, what I would like to present in regard to this subject, which is of national importance. I will first make a statement as to the estimated number of those who are addicted to habit-forming drugs in the United States. In the nature of things it is difficult to secure accurate and real reliable information as to the number who are thus addicted, but from re- liable reports through Dr. Carlton Simon, who has been made a com- — missioner by the mayor of the city of New York—so important does he regard this question he has made him a commissioner with full power to look into this entire matter and to handle this important mat- ter, and with no other duties; and it is his opinion that including those of the underworld, who are the most numerous class of addicts to habit-forming drugs, and another class who are not at all of the underworld and which includes some of the most cultured people in the city—he estimates all of those classes to run up, in the city of New York and the State of New York, to around-200,000. The estimate which I have arrived at in some remarks which I haye made on the subject on the floor of the House of Representa- tives—my estimate of the number in the United States, which is based on various sources, is around—and I do not intend to make extrava- gant statements or sensational statements, but to be conservative in everything I say—my estimate is that the number is around 1,000,000, and that is as near an approximation as can be made, I think. The addiction has become of late years an addiction to heroin and cocaine more than to the alkaloids of opium. The alkaloids of opium were formerly the chief drugs of addiction, but not so during the last 15 years; not so now, because during the last 15 years there has been a very rapidly increasing number who have become ad- dicted to heroin, which, as has probably been stated before, its strength—as it is made from the alkaloid of morphine by synthetic and laboratory methods—its strength is four times as great as opium. There has also been a large increase in the cocaine addiction. But the addiction to heroin is much more rapid and has increased much more rapidly than the addiction to any other drug. And in connection with the heroin and cocaine addiction itself— and that will be borne out by the unbiased scientific evidence of jail physicians, and prison physicians who see these criminals after they are brought to our prisons, the statement is that nine-tenths—per- haps that is extravagant, but 75 per cent of all the crimes of ex- treme violence which are committed in this country, and which have been so rapidly increasing since the war—and I am not saying that all the increase is due to increased drug addiction, because other fac- tors enter into it—but 75 per cent of those who commit those crimes, seemingly motiveless, are committed by these addicts. I might cite as an instance of what I mean, that striking case that we have recently been reading about, by the two apparently in- tellectual boys of about 19 years of age, in the city of Chicago, who, seemingly without much forethought, took an innocent little boy on the street and took him in an automobile and through the in- fluence, we will assume for the sake of this argument, because that 8 . USE OF NARCOTICS IN THE UNITED STATES fits into the case of those who commit crime—through the influence and a morbid influence that possessed them, they killed him, whether with or without motive. I will not say that the drugs in question were the sole cause of the crime, but I am taking it to illustrate what I mean. It will be found, and the prison physician might be able to tell us to-day from those two boys, from his obser- vation, of their withdrawal symptoms, whether they were addicts, and whether the drugs were the cause, fundamentally, of that crime. The withdrawal symptoms is a medical matter that I will not take the time for now. Senator Fiercumr. What do we. understand by: withdrawal symptoms? I notice in the papers, it speaks of one of those boys who is calling for sweet. spirits of ammonia all the time. I do ..not know whether that has any connection with the drug habit, . or not. ... Mr. Kanprep. It-has. The drug habit has to be spoken of in a . generic: sense, because if one can: not get his heroin or morphine, _he will gladly take some other substitute. As a matter of fact, it . has been a common practice with physicians, who keep sanitariums, like one of the two I keep, to treat. drug fiends—morphine fiends, and cocaine and heroin—those who take even two or three hundred grains of morphine, which I have seen now and then—not that quantity is taken as a rule—but I have seen one patient who took over 800 grains of morphine, bearing in mind that one grain would kill the normal person. And here is a matter in regard to the demand. for another: drug. by those who have been addicted—and this answers your question—that man who took this enormous quantity of drugs ; Senator Perrrr (interposing). Does that mean per diem? Mr. Kinprep. Yes; he-could have those drugs withdrawn by a substitution of sublimate of heroin; he could be experimented with for 72 hours, and in 72 hours he could be withdrawn entirely. Now, the victim of a drug, therefore, who goes to jail and who can not: get his drug of addiction will gladly take anything. And I was interested to hear you'say that you had seen that statement that one of those boys had asked for a stimulant like sweet spirits of ammonia, because I have not seen it, and I did not know that those boys were addicts, but this.case fits in with the idea, and fits in with the holdup crimes, which are increasing so alarmingly in the city of: New York and throughout the country districts, that I mentioned those boys as an example. Now, there is one other phase that I would like to call the at- tention of the gentlemen of the committee to with the view to se- curing their interest in some needed changes in our exising laws for the benefit of the drug addict in the future; and this is a matter which has been referred to here by Captain Hobson, the matter of 90 per cent of drugs which is being taken in this country, the proof is that 90 per cent is being smuggled in. That is probably quite true, and in the nature of things must be true, — because the law undertakes to regulate and does regulate as strin- gently as any law could, the dispensing of narcotic drugs. But this is what. I want to call your attention to: ‘That law does not allow physicians to treat with narcotics any patients who are suffering with the narcotic disease itself. To give an example: A USE OF NARCOTICS IN THE UNITED STATES 9 physician can, within the provisions ofthat law, give any amount of morphine to a patient, if he accounts for it 'to the proper au- thorities.' But if he gives it to an addict, or a substitute to taper off, he can not, under the law, give that’ patient any drug at all. And right there I want you to observe, and I am stire that Senator Ransdell will be ‘interested in this condition I'am going to’ cite, _ because it is in his State. In the little city of Baton Rouge, a very honest and very self-sacrificing physician, whose name I have forgotten—lI believe that is an industrial city: Senator Ranspreru. Yes; they have the second largest chemical refinery there for refining oil in the world. Y | Mr. Kinprep. Then this case will illustrate two things: That addicts in the industrial towns—that it is not only in the larger cities, New York and Chicago, that are the hotbeds of crime; but in the smaller towns, Senator Fletcher, to which you referred, with- out intending to exaggerate the facts at all, because the facts are that there is an increasing tendency, and an increasing number of drug addictions. Now, to illustrate the’ néed for’ a change in the Harrison law with reference to’ narcotic drugs, by ‘the situation in your State, Senator, it was undertaken ‘there by this honest physician—there was no question about his’ reputation—to estab- lish a clinic, because ‘there grew up rapidy, as there’ grew up in certain other centers; a large number of addicts, and who wanted to keep them comfortable so that a man who ‘had gotten into the drug ‘habit, and who wanted to quit, and’ who had’ to’ quit: on ae:+ count of the law, a man who had got to the point where he took 3 or 4 grains a day, or maybe 5 grains a’ day—that is the most common in the beginning—and they increase if they ‘can get it, and it is wonderful how addicts can balance it’ and keep it up. And this’ physician wrote a most interesting article m a leading publication, and I was very much impressed by it, in which he showed that he was trying to enable the heads of families; who took 5 grains of morphine, we will say, or lesser quantities of cocaine, or the same quantity, to keep comfortable and to go on with his work and to support his family, rather than to go into the hands of the bootlegger who would encourage him to double his quantity, and at a price which would cause starvation to his family. Now, that is the point. I am going to introduce an amendment to the Harrison law in the next short session of Congress—and I'am glad to have this opportunity to speak to you gentlemen as to the reason wny we should have an amendment to it, to allow physicians who are reputable—to allow them to use it not alone in the treatment of their patients for other diseases’ but in the treatment of narcotic reduction itself—if I make that point clear. © a7, OYE ' Senator FrercHer. Doctor, may I'ask a question there? Mr. Kinprep. Yes, Senator Fletcher. 3 Senator Fiercuer. To give ‘your expert opinion as to whether the distribution and circulation of such an article as this, or almost any article outlining the nature of the drugs, and reciting the fact’ that they are being obtained and used—-whether that would have the effect of restraining or checking the spread of this thing, cr whether it might act in the contrary direction, as is the point made in the report which was read here? JI would like to get your opinion of that phase of it. , 10 USE. OF NARCOTICS IN THE UNITED STATES Mr. Kinprep: Well, Senator Fletcher, Iam not trying to answer your question too broadly, but I am trying to answer it funda- mentally... 1 think we are faced with the necessity of education in everything. Of course, your question suggests, “Shall we suggest evil to people when they know not of the evil?” eit | Now, my opinion is based on some hard and practical experience with human beings in New York City, where 1 have worked with the poor people for many years before I had enough success to get a good shirt. That is, we must educate them and tell them the truth, if in. the end you are going to get better results. To illus- trate the point, more particularly on sexual questions, I think you have got to open the book and educate them. And as to the kind of education along this line, I think I can give you a pretty good idea—as I said, I do not want to be extravagant or sensational in any view I may try to impress, but I know that schoolboys and schoolgirls—and I know it personally—are for the first time in history becoming more or less addicted to the drugs. Now, that depends on the community, as to whether they are very much ad- dicted to heroin, and they are addicted to heroin more than to cocaine, because the peddlers are on the job. I do not think it is an international syndicate. You know Mr. Porter, over in the House committee, has been doing some work to repress opium. But I do not think it is organized into the shape of an international traffic, but there are peddlers and tempters upon the streets and around the public schools of our cities to try to find a market. for their poisons and. for their poisonous stuff. Senator Fiurcurr. Are those peddlers themselves addicts? | Mr. Kinprep. Yes; they are in most. cases addicts. And that is very strikingly true of heroin, Morphine, we will say, there are not so Many cases. They, like the fellows who take too much liquor, they will say it is a bad thing. But the heroin addict seems to be inspired with a spirit of devilment to make the others do it, also. That is a physiological condition of.this drug, and, if you gentlemen are interested enough in this, I think you will find it confirmed if you will study it. | Senator Ranspexu. It appears in statements in the press that drugs are prescribed at times. Do the doctors now prescribe heroin? — Mr. Kinprep. No, sir; Senator Ransdell, they do not prescribe it now. When heroin was first introduced, in the form of a drug it now is, in the United States Pharmacopoia it was indorsed by the medical profession, and it appeared then as a sedative in cough medicine. And it. was a good sedative in cough medicine, not as good a sedative as some others, but it was a good sedative, but four or five years ago it was taken out of the list of drugs in the United States Pharmacopeeia. And now we are considering a law—and I think maybe it did go through in my absence in New York—a law in relation to health, which would do away with it. If it did not go through, such a law should be passed. “tt oe Senator Ranspett.. It is still prescribed ? Seder ost Pein Mr. Krnprep. No, sir; the United States Pharmacopoia leaves. it out as no longer an official drug; no druggist has the right to dis- pense it. at an. ib slotar + Senator Ranspetu. How long since has that been so? Mr. Krnprep. I should say four or five years. USE OF NARCOTICS IN THE UNITED STA'TES 11 . Senator Ranspetz. I know a man'who has given a good deal of it within the past 12 months, in my ‘little town. Mr. Kinprep. Isay that most physicians understand the danger of heroin, and have long since stopped giving it, because covein, which is a comparatively’ less dangerous substitute as a sedative, and it is good enough to go into’ cough medicine, is used. — | Senator Prprrr. Doctor, along the line of Senator Fletcher’s in- quiry, and taking it for granted that education is one of the means of fighting this evil, the question always recurs, does it not, in a particular case, whether the educational instrument that’ you are using is adapted to its end? - Mr; Kinprep.' Yes; I would say so unqualifiedly. Senator Prrrzr. And that means, 'in the first place, in a’ case of es you first want to be sure that the fpets hs as stated are aceu- rate? . Mr. Krnprep. Yes, sir. Senator Prprer. And in the second place that the form of pres- entation is educational and not exciting? Mr. Kinprep. Yes, sir. Senator Puprzr. I have seen, in dealing with young péabla, a lot of well-meant experiments in relation to the giving of the facts of life, sexual relationships, and so on, more harm than good ‘done by having it done by the wrong’ people in the wrong way at the wrong time; and I, for one, feel that we are asked to take a tremendous responsibility here ‘in disseminating any particular document to get into the hands of thousands and perhaps’ millions of people when the possibility is not only that itis not accurate, but that the form of it tends to excitation rather than prevention. Now, that is ‘the thing that worries me about this proposition. Mr. ‘Kinprep. I understand the Senator’s point of view, and I agree ‘with ‘the general principle of the point of view absolutely. Now, with relation to'the proposed document, if there is a proposed document—of course, I am addressing myself, gentlemen, you might say, to the abstract, to the general proposition. Now, I have already answered-—— The CHAIRMAN’ (interposing). The question here, Doctor, before this committee 1s whether we are going to report a resolution to print a document which is here. Senator Carrer. May I ask the doetor if you have read the docu- ment which it is suggested we print? © Mr. Kinprep. I was coming to that: Tam ney glad you asked the question. Senator Fretcuer. I understand the suggestion of Captain’ Hob- son'was that that was to be referred to some joint committee for con- sideration. Mr: Kinprep. J have read, let me say—I spent with Captain Hob- son an evening, and a ‘good deal of the night, in going over the docu- ment ‘which he had, and while we did hot finish it completely, I have gone over what’ I consider the most of it, and while I would want to read it again very carefully to answer ‘conscientiously and literally all that you have suggested, I think the general principles of thé document would be educational and prove useful. Senator Prpprr. In whose hands? The hands’ of’ teachers ‘or parents ? Eee . £2 USE OF NARCOTICS IN THE UNITED STATES _. Mr. Kryprup. I think the same limitation might. be placed upon the method of use as is placed upon any other publication. Senator Prrrrr. But if we turn this, loose we can not control the distribution of it. And my observation has been, in teaching real- ism, you handle the problem very differently when you are trying to reach parents than you do if you are tryimg to reach teachers, and you handle both of those differently than if you are trying to reach the, very young, I can justify myself.in putting matters into the hands of parents or the professional, teacher,.and I would put a document, into the hands of either which I would not: think would be a document to ~ into the hands of the. young. Mr. Kinprep. I think, you. are quite' right, Senator, .There is a logical difference between the old and the young, But I had, sup- posed that. any document,-.as suggested by Senator, Fletcher, sub- mitted by anyone, would be submitted to a special committee. The Cuatrman. That is a very unusual.manner to deal with a matter that is presumed, to be printed, in either House of Congress. Mr. Kinprep. I suppose the Senator refers to,what,is the routine? The Cuairman. I am not referring to the routine ; Iam referring tothe rules of the Senate. _ Mr. Kinprep. Are the rules of the Senate the same as they are in the House? The CHairMan, Anything to be printed.i in the Senate, except bx unanimous consent, comes to the Committee on Printing, and it goes over. the matter, not only with reference to the matter of the cost. but with reference to the suitability of it. In our last meeting we edited three proposed, documents, one for Senator, Ransdell, and one for Senator Fletcher, and one for myself. Mr. Kinprep. What I am. very much interested.in, is the funda: mental principle of getting this before. the people, and the only two fundamental things that are going to eliminate this evil are education and knowledge.on the part of the people, And whatever you may hear to the contrary; there isa great and growing evil in this couptry in this matter. Senator RanspeE Lt. Doctor, I believe, if you aa ‘permit me. to break in there, that all, of us are intensely interested in this thing, but we want-to be sure we dre right... That is why I asked to have this report read. The Cuarrman. I do not -want to diminish your race Dector, but the Senate has voted to adjourn on Saturday, and I, at this very time, have: a most important conference on.a bill, as one of the conferees from the Senate, and I would like to get along with this hearing as fast: as we can, Mr. Krnprep. Senator, you have. been exceedingly patient aid courteous with me, and I believe you have already given me enough time. I will quit now, unless there are'any questions you care'to ask. Senator Ranspetu. I want to ask you, are you prepared to indorse this document unqualifiedly and say that we ought to publish it at this considerable expense of probably $300,000, and. put it. out, as coming from the Congress of the United States, correctly stating these facts and. this situation—and it is a horrible situation if the facts are correctly stated. But, here come three gentlemen who are represen- tatives of the Government, from the: Narcotics. Control Board, who say that these facts are not accurately stated. cf USE OF NARCOTICS IN THE UNITED STATES 13 Mr. Kinprep. Gentlemen, why do you not take a 50-50 view of it and refer it to a special committee? Senator Ranspreixi. That would be fine, if Captain Hobson would agree to it. . Mr. Hozson. You know where the session stands—to adjourn on Saturday. Senator Ranspzuu. Yes. Mr. Hoxsson. Believe me when I tell you that the postponement of doing this at this session, as compared with the doing of it will involve the welfare and safety of a great many young Americans. The Cuairman. Captain Hobson, are they going to be saved by this pamphlet ? Mr. Horson. Yes; Mr. Chairman we have seen it from the inside in Los Angeles. Parents bring children to us, after they are hooked, and when we ask them, “ How in the world did you get started 4 invariably they say, “ We never dreamed what it was.” In the case of the girls, they are often told it is headache powder, and in the case of the boys they say, “ Watch me. This is snow,” or “Come to a snow party,” and soon. It-is not guess work. The physiological elements are as I have stated them. Doctor Kindred will tell you the same or any other doctor. A knowledge of the effect on the brain, and on the organs of reproduction, will stir the deepest motives of em preservation. A warning will save our youth, a large number of them. We are proposing, Senator, that we do not pass on the merits of the document now, but that we pass on the principle and authorize it; now, then, let a committee determine its merits and revise it ‘as they may see fit. The Crairman. A committee you are naming? | Mr. Hogson, No. I simply named them because they a are mostly physicians, and ‘are. Members of Congress. The Cuarrman, ‘Those who are still remaining in Congress have some rights in the naming of committees. Mr. Hozson. Excuse me, Mr. Chairman; I am aware of the rights of the chairman to name committees—I simply made suggestions. Senator Ransprru. I. do not think he meant any harm by picking out Members of the two bodies of Congress, and: suggesting that they © be named. Mr. Hoxson. The committee was suggested to pass’ on the ques- tion of the medical and scientific suitability, and on the pedagogical suitability of the document. Senator Ranspetu. Personally I) would: like to see » the program undertaken, but I understood you wanted us to agree to-day to publish this document: Mr. Hosson. After it has been passed on. The CuHarrman. There is nothing before this committee except the Capper resolution. Mr. Kryprep. Can that not be modified ? The Cuarrman. Undoubtedly it can be amended. Senator Ransprnx. Let us try to do that. The Cuatrman. Have you anybody else to present ? Mr. Horson. eee I would like to present Doctor Summers. 14 USE OF NARCOTICS IN THE UNITED STATES STATEMENT OF HON. JOHN W. SUMMERS, A REPRESENTATIVE FROM THE STATE OF WASHINGTON Mr. Summers. Mr. Chairman, I am a physician by profession. I am not a specialist in the treatment of drug addicts or anything of that sort. I have only had time to examine a few pages of the docu- ment that is before you. I believe there is a real menace that it would be well for the young, through parents or through teachers, to be warned of. I am not yet fully persuaded that it is the thing for general distribution. As to the document here, I found, perhaps in each half page, a few words in a line that I think should be changed. But, of course, that could be done by a revising committee that you might select if you decide to do this. In my humble judgment a very considerably abbreviated document might be authorized, which would cost much less and which would carry the same message and go to a more restricted number of people and in the main would be the most desir- able thing. Something that Captain Hobson, I believe, had in the way of a mimeographed copy of about three pages, something that came to my desk ahead of any of this other material, it seemed to me told the story about as well as the more lengthy document. I believe ‘it is well worth while and advisable that the thing be favorably con- sidered, as I say, in the more restricted form and in the more abbre- viated form, because we can go farther, if we think it seems desir- able, a little later. But.as to the importance of the matter, I believe that it is impor- ‘tant. Iam sure, as I read part of this document to some members of my family and my friends, that it served as an opportunity, and gave an opportunity to me, you understand, as a physician, to empha- size to them some warning—give them some warnings that I never would have taken occasion to do, perhaps, and so I can see how in the hands of a teacher or a parent it might serve the same good purpose. _ Senator Frercuer. You would limit the distribution, Doctor, to parents or teachers? + - Mr. Summers. Yes; that is my impression at this time of a very considerably abbreviated document; and, of course, the language as to its scientific value and the manner of presentation, those are both of very great importance, as the Senator has said. It is possible, of course, to rather excite, and so on, rather than to serve the good purpose of warning. I am not saying that that is a criticism here, but it is a point to be taken into consideration in anything that is done. Senator Prrrrr. That is the reason that I ventured to say what I . did to Doctor Kindred, because I have observed, and I have had some experience in dealing with young people, that the same fact stated to a parent or to a teacher will constitute a warning of the most selemn sort, which will call for and secure preventative action. But if stated to a young person it may stimulate curiosity and have precisely the opposite effect from the one that is intended. And I have never seen a document yet, or a picture, or any set of statistical statements which in exactly the same form are usefully prescribed for those various sets of people. It seems to me you have got to vary your instrument. USE OF NARCOTICS IN THE UNITED STATES 15 Mr. Summers. Now, again indorsing the general plan, you under- stand, I have nothing further to say, unless there is something that you wanted to ask me. Mr. Hozson. Mr., Chairman, we have other witnesses; we expect Senator Copeland and Congressman Rainey and Senator Ball, but the hour is already late. I will omit much of the evidence of documents and sum. up briefly. With regard to the evidence of the head of the narcotic division, T notice in his release of May 23, 1924, the narcotic division has a statement that was based on an extract from a report of the Com- missioner of Internal Revenue for 1923. In 1922 there was a total of 2,996,000 and some odd ounces of narcotic drugs of all kinds im- ported. During the year following there was an aggregate of over 6,000,000 ounces, an increase of over 100 per cent. I see no reference to that in this release. I have here a report of the special Treasury committee appointed in 1918, reported in 1919, a committee that undertook to get figures, which this bureau has not, or this division has not. After writing to all of the physicians in the country, and all of the health agencies in the country, they received replies upon which they have worked out the figure of 237,000 under treatment by physicians, and 420,000 in institutions, making a known total under treatment of >= a ae ee C447 about 660,000 medical addicts. This does not include nonmedical _ — addicts of both kinds; only a part are known. I wish to put in evidence extracts from the report of the Whitney committee, appointed by the Legislature of New York, as it answers the question that was asked a few moments ago about the rural communities. It says that the results of the investigations in the rural communities showed that the condition is far more serious and dangerous than was deemed possible. The Cuarrman. Do you wish to put that whole report into the record ? Mr. Hogson. No, sir; just special paragraphs. They estimated after an unusually extensive investigation that from 2 to 5 per cent of the entire population of the city of New York were drug addicts. The figure that I used for New York, merely as a matter of sugges- tion, was 1.8 per cent. The committee’s lowest estimate is 2, its highest 4. The report proceeds to say that “ reliable statistics ob- tained from physicians and others, and from the investigators in the Federal courts, indicates that the disease is more prevalent and wide- spread in the small cities and rural communities than was believed to be possible.” I will not quote further from this committee’s report, except to take their summing up, and this is not far from our motto. In speaking of drug addiction, they said, “ The cause is ignorance; the results misery; the remedy education.” Now, in the recent hearings held—— Senator Frercuer (interposing). Is heroin manufactured at all in this country, Captain ? Mr. Horson. Yes; but only a small part of the total. Doctor Richardson, a member of the board of trustees of the American Medical Association, before the Committee on Ways and Means of the House of Representatives, in the hearings on the antiheroin bill, _fpFIwiceezte ¢ 16 USE OF NARCOTICS IN THE UNITED STATES made the statement that in New York City the physicians prescribed during the last year 58 ounces of heroin; but that conservative esti- mates based the consumption at 76,000 ounces in that one city. That brings up again the testimony from the narcotic division. They will tell you that only 5,000 ounces were sold that year. That illus- trates that what is sold hardly touches, so far as heroin is concerned, this great and growing menace; that is, that is recorded as sold. « It illustrates that the whole traffic is gigantic, illicit, and under cover, and that this division does not contact it. Neither do these reputable druggists and reputable doctors. And I will again refer at that point to a statement in this same -report of that bureau that 90 per cent of all the drugs used by non- medical addicts in this great field that concerns us—that 90 per cent of it is smuggled through the bootleggers. Recent investigations have disclosed a situation with respect to the smuggling of drugs that he himself declares “is quite alarming.” Senator Frurcumr. Does that suggest, or not, Captain, that the way to reach this trouble is to stop the smuggling? Mr. Hopson. Of course it does, Senator, but if you will allow me, I will bring in at that point what I was going to bring in later, that with the best laws it is possible to place on the statute books, you. can not reach the source of supply for heroin addiction. They can take crude opium and morphine, just beyond the border, and treat it with vinegar, or acetic acid, and: make heroin. One-fifth of a grain of heroin is'a medical dose for a man. The average age of the heroin addict is 22:):They ‘become addicts in their. teens. If a minor attends a snow party a day for six days, he will become _an_addict. It would: be possible to. make four addicts, or more, < —-out.of a grain, or 2,000) addicts: out of an ounce. A carrier pigeon “can transport that ounce. Wehave authentic.advices from Europe— where we have offices—that: continental druggists have discovered how to produce heroin and cocaine by synthetic processes out of coal tar products;\and: that great; chemists are working on other synthetic drugs, some:of them expected: to: be more powerful than heroin. ra¥ tii | | You can not control 'the:source of supply or. the transportation. In saying this I do not mean that. we should not have the best. laws that can’ be devised: We’ should have the best laws for States and counties and municipalities to cooperate with the Government. But at best laws are inadequate. td : Furthermore, it will be impossible to change most of these addicts. A young man called at our office; he was 24 years old, and told us that he had taken'the cure 26 times. . You can get them off the drug, but they are in a pathological condition. The ones that were noted, that stayed off of it, were the ones that got religion. Doctor Buckter, superintendent of the tuberculosis sanitarium in southern California, and who was in charge of the clinic in Los Angeles some years ago for treating addicts—several other cities had them. He told me he treated 700 addicts, and had high hopes that 10 per cent of them had been cured. He says since that time he has had occa- sion to check up on those supposed to be cured. He told me solemnly | that he did not believe that one remained cured; that it is as incurable as leprosy. USE OF NARCOTICS IN. THE UNITED STATES 17 All addicts have an. antisocial, psychology... When their drug’ is concerned any addict will lie like a trooper, the testimony of addicts is worthless. They will steal. They will murder to! get their drug. where the question of the supply of the drug is concerned, they forget, public policy, or anything else, and everything else. We must realize that they are sick. You do not see them under the torture. That. they are subject to, withdrawal symptoms and must judge them differently. Now, in addition to this antisocial effect, it produces:a very switt\, - change in the brain—an exaltation of the ego. The addict will say, in his ego, he knows everything; he can do everything, and put it over. He is suited for, daring crimes, holdups, robberies, and such crimes as bandits of old never dared. vs But what is more alarming and. biologically supreme in im- portance is that he has a psychology, that compels him to be a re- cruiting. agent. I do not mean. simply like any. addict, that he desires to have those close to. himy become addicts; I.do not mean that he has an obsession, merely; but I mean that he has a matlia “ to see others become addicts. ae The average age of the heroin addict is 22, so he is recruited below the age of 20. They catch them, as low as'8.; I have seen addicts as low as 8 years. But, the chief recruiting, age.is-16, 17, 18, and up to 19. . Psychology, is. quickly to form, a gang. “ We are going together as comrades;. come. and ;join in the, snow gang.” . They give heroin free until the youth are hooked; and’ once hooked, they are slaves. .Then they start: corrupting, their friends... They begin to. steal and soon drop. into tthe. underworld, the girls: into —pros- titution.and the boys into crime: «9 fei: r bel 10997 I will:read: the evidence of, the.commissioner. of health, of the city of Chicago. I will not. read much of, it.. .He gives his estimate of over..a million drug addicts, in the United States. .He describes here. the psychology’ of the addict, particularly.the heroine and the cocaine addict that I spoke, about. ..He says that) there is nothing that.the addict will not. do.to obtain,the drug,,’ He igoes. on to-enu- merate: the acts. he will commit.,../ | Mes te Senator Pepper. Mr. Chairman, if I may interrupt Captain | Hobe son, I want to say that.I find myself a,good deal,embarrassed. | I am, very deeply impressed with, the, seriousness of this situation and the;importance of some, governmental action in regard. to it. I do not, like od? ph CL yom iy gS ea 44, 000, 000 77,410 19, 219 96, 629 2, 196 ASRS See orgs or Paar ce eg eee eee a 56, 000, 000 135, 221 34, 895 169, 626 |. 3, 029 dee Suds ALT ie SATA e ey 68, 000, 000 309, 023 39, 985 246, 008 3, 617 DUAL OOD FAG an leks he Beery ad oo oe oe by ee 83, 000, 000 195, 278 69, 267 254, 545 3, 066 a aN aR St al 98, 000, 000 151, 671 None. 151, 671 1, 547 RE CERE LE wee eM, te, nae ae eee eee 2 106, 000, 000 87, 856 None. 57: 856 : 546 Smuggled opium must be reckoned with after 1915, and no allowance has been made for opium exported from the United States. 36 USE OF NARCOTICS IN THE UNITED STATES Opium and opium alkaloids entered, into the United States for consumption Number of ad- Puen! herb ; whie Number Ga | opium | of opium Ne ; | Cpium | Opium | Opium | (over 9 | smokers Per per Cent i(gméking)| (total | alkaloids | per cent | which cnet: Population hine) entered | entered | entered’| mor- could a Decade of the United) ? an a for con- | for con- | for con- | phine) besup- eumdte States for e a sump- | sump- | sump- | would lid | tion es et , tion tion tion supply at 24 ohana a = annually | annually | annually with 6 pounds te annually pee er ‘ j phine sulphate daily Pounds | Pounds Ounces Grains 1860-1869... _.___- 34, 000, 000 | 110,305 al, 176 181, 481 §28 44, 143 8, 470 31z 1870-1879... _ 44, 000, 000 192, 602 48, 049 241, 807 2, 296 77, 410 19, 219 38h 1880-1889________. 56, 000, 600 328, 392 85, 988 414, 381 | - 20, 212 135, 221 34, 395 53 TsoGeis09) eee 68, 000,000 | 518,070 | 92462 | 605,533 | 20,193.) 209,023] . 36, 985 624 1900-1909_ =. 2 2. - 838, 000,000 | 480,009 | 148,168 | 688,177 17, 511 195, 278 59, 267 534 1910-1919________. 98, 000, 000 366, 054 None. | 366, 054 27, 143 | 151,671 None. 21F 1920-1923. 2... 106, 000, 000 144, 805 None. 144, 805 5, 292 57, 856 None. | $ (Additional evidence submitted by Doctor Kolb.) THE PREVALENCE AND TREND OF Due ADDICTION IN THE parE SraTEs AND Factors INFLUENCING ir By Lawrence Korg, Surgeon, and A. G. Du Muz, Pharmacologist, United States Public Health Service INTRODUCTION There have been published during the past: decade many estimates of the number of persons in the United States addicted to the use of narcotics. The numbers estimated range, in round numbers, from 100,000 to 1,000,000 (1-6. ) Some of the estimates are mere guesses, as they were based on nothing tan- gible, but most of them represent sincere attempts to. arrive at accurate figures. All, however, are open to criticism on the ground that they are based on insufficient data, or that not all of the pertinent factors. were taken into consideration. For the same reasons the published statements in which it is asserted that the present trend of addiction to narcotics in this country is upward are subject to criticism. Owing to the lively interest which has been taken in the problem of ad- diction to narcotics throughout the world since the end of the World War, and as a result of the enactment of new laws for the more rigid control of nareotics in this country, there have been made available additional staticties on the traffic in narcotics and on certain other- phases of addiction. It is believed that the proper interpretation of these statictics and their applica- tion to the problem in hand make possible a more accurate estimate of the number of narcotic addicts in this country than any heretofore published, and serve aS a means with which to determine accurately the trend of ad- diction. For these reasons, the study herein reported was undertaken. NUMBER OF ADDICTS It is realized that it is impossible at the present time to make an exact count of the persons addicted to narcotics in the United States, in an indi- vidual State, or even in one of our larger cities, because of the social and legal factors tending to make addiction a secret practice. It is believed, however, that it is possible, by utilizing all of the information now available, to delimit the number by certain maximum and minimum figures. With this object in view, a number of the more important narcotic surveys made in recent years were analyzed; also the reports made by agents of the Bureau USE OF NARCOTICS IN THE UNITED STATES 37 of Internal Revenue and other persons on the narcotic clinics conducted in different parts of the country; statistics on the dose of addiction, world production of narcotics, and the quantities imported into this country were compiled and studied; and numerous physicians in different parts of the country were interviewed in person to ascertain the number of addicts they were treating in the course of their practice. The results of these analyses and studies follow. 1. NUMBER BASED ON NARCOTIC SURVEYS AND CLINIC REPORTS Tennessee survey (4).—One of, the most complete surveys of drug addic- tion for a large community was made in Tennessee by Lucius P: Brown, State food and drugs commissioner. In 1913 Tennessee passed a law regu- lating the sale of narcotic drugs and under it regulations were made which provided for the refilling of prescriptions for persons addicted to opiates. The. purpose of these regulations was to minimize the suffering among addicts and to keep the traffic in opium from going into illegitimate channels. In order to obtain a regular supply, addicts were required to send to the pure food and drug inspector their own affidavit accompanied by one from a physi- cian certifying as to their addiction and giving certain other information. In the discretion of the board of rules and regulations a permit would then be issued authorizing the refilling of the prescription. This permit would be surrendered by the addict to a pharmacist, who was required to make a copy and return the original to the food and drug inspector. On January 1, 1915, after 12 months of operation, there were 2,370 persons of various ages, white and negro, registered under this system. Commissioner Brown was of the opinion that all of the addicts in Tennessee had not regis- tered, and he fixed 5,000 as the probable number in the State. Using this figure as a basis, he estimated 215,000 for the entire country. He then added 25 per cent to allow for conditions which he thought existed in more thickly settled communities and arrived at 269,000 as the possible number of addicts in the United States. Treasury Department survey (5).—A. special committee appointed by the Secretary of the Treasury in March, 1918, made the most comprehensive survey of drug addiction that has yet been made in the United States. One of the means used by this committee for securing information consisted of sending vut questionnaires. For the purpose of ascertaining the number of addicts under treatment questionnaires were sent to every physician registered under the Harrison Act, and replies were received from approximately 302 per cent of them. _A-total of 73,150 addicts was reported. If there had been 100 per cent replies, with the same average maintained, there would have been shown to be 287,655 addicts under treatment for the entire country. Penns ylvania survey (7T).—In 1917 there was created in Pennsylvania a bureau of drug control, operating under the State narcotic law.