sec AEN te ext 1919 TREASURY DEPARTMENT UNITED STATES INTERNAL REVENUE TRAFFIC IN NARCOTIC DRUGS V % REPORT “SPECIAL COMMITTEE OF INVESTIGATION APPOINTED MARCH 25, 1918, BY THE SECRETARY OF THE TREASURY JUNE, 1919 WASHINGTON COVERNMENT PRINTING OFFICE 1919 - ~S>— FOREWORD. In publishing the report of the Special Narcotic Committee the department does not vouch for the accuracy of the figures given nor assume finality for the conclusions arrived at. A careful reading of the report will make clear the reasons for this statement. Complete and accurate statistics of the extent of drug addiction have never been compiled and are not now available. In view of the scattered sources of information and the fragmentary statistics secured, the report of the committee probably presents as comprehensive a survey as is possible under the circumstances of the problem from the humanitarian as well as from the administrative viewpoint. The importance of securing accurate data regarding the extent and growth of the traffic in narcotic drugs is coming to be more keenly appreciated by all.authorities and in the near future it is hoped that far more complete data will be made accessible to investigators. This report is presented to the public in the hope that it will enlist the interest and cooperation of all official and social agencies in working out the best program for effective administration of the antinarcotic laws and for the rebuilding of those unfortunate persons afflicted with the narcotic habit. To the end that our man power may be properly protected from this growing evil, all interested individuals and organizations are urged to furnish information regarding unsatisfactory conditions in their respective communities -and to submit suggestions for the better enforcement of these laws. 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Sir: The special committee appointed by your predecessor on March 25, 1918, to investigate the traffic in narcotic drugs has com- pleted its work and the findings thereof are embodied in the following report which the undersigned have the honor of submitting herewith. The committee’s investigations have been as thorough and extensive as possible with the facilities at hand and-the time allotted to the work, and it is thought that the data herein presented convey with a fair degree of accuracy the conditions of the traffic in these drugs pre- vailing at the present time. As not all narcotic drugs are habit forming or of importance in the sense understood by the committee, and as some of the habit-form- ing drugs commonly spoken of by the laity as narcotics are not nar- cotics in a medical sense, the committee has limited its investigations to the traffic in opium, its preparations and habit-forming alkaloids, and coca leaves, their preparations and habit-forming alkaloids. These are the drugs which are definitely covered by the Harrison Act and are most pernicious from the standpoint of habit formation. The nature and scope of the committee’s activities are definitely stated in the outline which was drawn up at the beginning of the committee’s labors, a copy of which was submitted to your predecessor. For the purpose of securing information relative to the different phases of this traffic, as described in the above-mentioned outline, the committee has used every means at hand. Certain data were obtained through the efforts of individual members of the committee. Other information was secured through questionnaires addressed to indi- viduals or institutions likely to be in possession of the same, and by consultation with individuals interested in the problem of drug addic- tion. Still other information was secured through the efforts of the internal-revenue agents. All information thus obtained was care- fully weighed and that portion which, in the opinion of the com- mittee, appeared to be of value has been used as the basis of this report. In further compliance with the request of your predecessor, the recommendations of the committee for changes with a view to improv- (5). 6 ing the present laws and regulations governing the sale and use of these drugs have been appended. These recommendations are based on the conditions set forth in this report and are, therefore, thought to be particularly pertinent. COMMERCE IN NARCOTIC DRUGS. ‘The extent of the commerce in narcotic. drugs in the United States can not be accurately estimated because of the fact that up until the present time the laws and regulations governing their sale and use did not make provisions for tracing these drugs from the importer to the ultimate consumer. Some idea of the magnitude and ramifi- cations of this traffic may, however, be obtained from the following table: Registrations under the Harrison Narcotic Law, year ended June 80, 1918. Physicians. outhouse 125, 905-| Hospitals, ete_....---__-_____ 8, 799 Wholesale. dealers.i_-_______ . 881 | Educational.____._._-___________ 188 TASS ane oe tne 42,240 | Retail dealers__...-_._.____- 48, 196 Manufacturers _-__-__--_____ 888 | Miscellaneous _-..----__-__ 258 Veterinarians —..-___- 10, 899 ate Importers_o20 0 bo 76 | ibe i _ slo y tit ida 3c 238, 491 ‘Neither can the value of this commerce be accurately estimated, as the crude drugs are in greater part manufactured into the more costly medicinal preparations and alkaloids. A minimum estimate can, however, be arrived at by computing their value on the basis of the retail price of the crude products. Thus, the average yearly con- sumption of opium for the period 1910 to 1918 was 491,043 pounds. At the present retail price of $40 per pound, the total Sate would be $18,841,720. The average yearly consumption of coca leaves for the same period was 1,048,250 pounds. At the present retail price of | $1 per pound the total value would be $1,048,250. ‘The grand total ‘would, therefore, represent a value of approximately $20,000,000. From the information at hand, it is concluded that the larger part of these drugs pass. directly frotit the hands of the importer to those of the manufacturer, where they become'a part of medicinal prepara- tions, or are manufactured into alkaloids. The following data com- piled by the Bureau of the Census give a fair idea of the extent of these operations in 1914, except that they do nct show the total quan- tities of alkaloids produced. Of 4,092 manufacturers making patent and proprietary medicines and compounds and druggists’ preparations, 882 reported the use of opium in their preparations, 300 reported the use of morphine or its derivatives, 188 reported the use of heroin, 142 reported the use of diacetyl morphine (heroin), and 136 reported the use of cocaine or its déerivatives—a total of 1,098. The quantities of these materials used are as follows: 7 " Narcotics used by manufacturers during 1914. Opium pounds__ 118, 282 Morphine, or derivative --..ounces__ 816, 130 Heroin_______-_-__----- ae _do___. 18,039 Diacetyl morphine___.._.---------_---------------------=--- -do__. 28, 859 Cocaine, or derivative._.._________ — i do____ 414, 255 _A very considerable quantity of these drugs, however, is secured by the wholesaler, who disposes of them to the retailer (pr incipally druggists, physicians, dentists, and veterinarians, although. they are also handled in the form of exempt preparations and proprietary remedies by grocers and department stores), and eventually they reach the consumer through these channels. The foregoing statements apply only to the legitimate traffic in these drugs. In addition, there is the so-called “ underground ” traffic, which is estimated to be equal in magnitude to that carried on through legitimate channels. This trade isin the hands of the'so-called “ dope peddlers,” who appear to have a national organization for procuring and disposing of their supplies. For the most part, it is thought that they obtain their supplies by smuggling them from Mexico or Canada, although smaller quantities of these drugs are obtained from un- scrupulous dealers in this country or by theft. Smuggling is also practiced to a considerable extent on the Atlantic and Pacific coasts, where the drugs arrive on ships hailing from Europe and the Orient. That considerable quantities of these smuggled drugs are exported from this country for the purpose of reentry through illicit channels appears to be indicated by the following data showing the increase in the exportation of opium, morphine, and cocaine to Canada in recent years: Imports of opium and morphine into Canada from all sources,.and from the United States, years ended Mar. 81, 1918-1918." Description. 1913 1914 1915 1916 1917 1918 Total imports: Crude opium..............-. spounds - 5,117 4, 436 7, 284 1, 741 15, 423 12,471 Powdered opium.. wseeee---GO.... 301 287 267 170 659 51 Morphine......-.------------- ‘ounces. .| 2, 035 4, 487 259 15, 495 52,215 27, 520 From the United States: Crude opium......-.--...... pounds. . 917 904 1, 823 1,351 2,413 [2.222.026 : Powdered opium.......-...-- do.... 116 157 14 |....------1 62 foes eee eee Morphine.....-.... wwaenched ounces. . 5 207 59 12, 393 16, 496 29,838 1 Data obtained from ‘‘Unrevised monthly statements of imports for consumption and exports of the Dominion of Canada,” compiled by the customs department, Ottawa. 2 Computed on the basis of the importation of 17,682 ounces at a preferred tariff. This illegitimate traffic has developed to enormous proportions in ‘recent years and is a serious menace at the present time. It is through these channels that the addict of the underworld now secures the bulk of his supplies. 8 OPIUM AND COCAINE CONSUMED. The consumption or narcotic drugs in this country has steadily i in- creased from the date of their introduction. brought out by the following table. This is strikingly Average annual consumption of opium, by decades, ge the period 1860 to 1915, inclusive, so vere Average Average opium (9 per amount of amount of : Font - ae opium. opium (both Decade. | Population. hine) en- (smoking) kinds) en- Sead aa: entered for tered for consumption consumption | consumption: annually. annually. annually. Pounds. Pounds. Pounds. ISA MAGE bi. wren on batennnoomasingn cider de «a «tees 31, 000, 000 110, 305 24, 705 135, 110 TRVOAISTO SSL. an om vow wee ateics Dinke ce cewbasccese 38, 000, 000 1927 002 48, 704 240, 704 1880-1869. PB ped Sucgey Hee on Bee wh: - 42 395 || North Dakota...... 153 163 913 District of Columbia |. 443 AD 1,055 |} Olio... eee. 4,151 614 6, 749 Plorida...........- 882 2531. 3,425 || Oklahoma. . 7. -.- is 2,422 53 4,500 Geongians . ci. i586 2, 242 58% 3,865 || Oregon........-..-. 369 463 790 Hawaii.-..........- 99 GQ) 99 || Pennsylvania...... 3,791 364 10, 202 Idaho. s.....2. S = ea: 4 _ $75 || Rhode Island. ..... 548 56. 980 Tllinoisges...-..2--- 2, 274 27% 8, 218 |. South Carolina..... 73 () 73 Indiana: se. 1,540 184 8,488 |) South Dakota....-. 175 16%} 1,045 TLOWEbs 2 o-oo ens = 2 PRE 1,158 462 2,496 || Temnessee........-- 5,366 652 8, 180 Heatisee ys eee 1, 477 ws 1, 918 aby FOI REEET 498 21 2, 371 entucky......0... 1, 612 422 fo Tg tee... ook os a f 35 4 4,375 Louisiana s..2.2/..- 1,110 64 17,620 |) Vermont 27.62 .eike 612 392 1, 554 Maines wv. s0cccdene 427 392 1,084 || Virginia.../........ 2, 566 654 3,931 Maryland.......... 1,062 42 2, 630 Washin eho See 1,373 584 2, 347 M: aaeanicasaag ——e 2272 16% 18, 770. ||. West. Virginia...... 1,642 718 2, 286 Michigan.:... 2.2.2, pee 47%). 5,757 || Wisconsin........¢. 422 “ay fy 422 eaeneeeia ane ee 1, ai Oe pan Wyoming. ......... 60 _ 60 100 ssissippi......... 3 , tae whet ed B83 3 i 142 a fan hptalA isis 73, 150 302 237, 655 ontana........... 3 $ , 000 1Per cent replying can not be given, as collectors summarized the data and did not furnish the num- ber of reports. NARCOTIC PRESCRIPTIONS FILLED BY DRUGGISTS. Answers to the preliminary questionnaire addressed to druggists, of whom 52 per cent replied, show that there was a total of 9,511,938 narcotic prescriptions filled within one year. On the basis of 100 per cent replies, if the same conditions prevailed in the different sections 11 of the country, there was filled during this period a total of 18,299,- 3897 prescriptions containing narcotic drugs. The following table gives in detail the information obtained upon this point by this ques- tionnaire: Number of narcotic prescriptions dispensed, as reported by druggists. - Esti- Esti- : mated mated Narcotic roe cent TS Narcotic Per cent | number ; rescrip-| of drug- | ; of pre- prescrip- | of drug- | of pre- States. ® tions gists re- | scriptions States. tions gists 7 seripfans reported.| plying. -| for 100 - . reported.| plying. | for 100. per cent per cent replies. i srr bape forse replies; Alabama....-.....- 264, 443 478, 540, 124 Montana. weeeee weeee 4,612 24 169, 000 Alaska ....2....2.. 1,427 728. L 965 || Nebraska. ...... ...| 88, 420 75 117,893 Arizona..........-- 28, 187 (4) 28) 187 |} Nevada........---- 2,997 100 2,997 Arkansas.........-- 141,903 |. 783 | ° 180,768 || New Eeiipelnee « 23,267.) ~~ 232 98,314 California. ......... 270, 334 100 270, 334 || New Jersey... .-{ 380,073 674 565, 584 Colorado. ........2. 87, 234 602 — 143, 792 || New Mexico........ 23, 007 (2) 23,007 Connecticut........ 151, 857 734 207,455 || New York......... 1,381, 646 50 2, 763, 292 Delaware........--- 23,650] 444: |. 53,446 || North Carolina..... 313, 048 672 462,632 District of Colum- North Dakota...... 38, 612 32 120, 662 bia...------...ee- 88, 676 444 200,963 || Obio..2.....2.2...- 361, 886 754 | 480,379 Florida..........--- 132, 619 622 181, 059 || Oklahoma.......... 148, 075 56 264, 419 Georgia....--.2:--.] 311, 226 644 490, 273 Oregon Ride ec acest 82, 351 732 109, 470 Hawaii........ lownes 551 @) 551 || Pennsylvania. .....{1, 012, 223 424 | 2,365, 007 Idaho.......-.....- 2, 794 24 99, 786 || Rhode Island ...... 85,019 73% 118, 877 Tilinois............. 454, 761 272 | 1,659,711 || South Carolina..... 188, 533 @) 138, 533 Indiana.......- ass.{ 188, 005 73h 256, 837 || South Dakota. . Senece 39, 285 32 122, 765 Towa.:....... seeie-} 111,909 724 153,721 || Tennessee.....:.... 322, 583 672 476, 137 Kansas...........-- 150, 297 783 191,217 || Texas............-.) 65, 429 8 817, 862 Kentucky......-... 213, 484 662 $20,151 || Utah.........-..... 433 24 15, 464 Louisiana........-- 227, 681 874i 261,102 || Vermont........:.. 26, 855 233 113, 472 Maine. ..2.........- 50, 612 232 213,853 || Virginia............| 229, 881 37 621, 300 Maryland.......... 284,809 |i = 444 643,636 || Washington........ 106, 237 72% 146, 332 _ Massachusetts...... 401, 180 815 492,246 || West Virginia...... 130, &81 764 171, 813 Michigan. .........- 201,418 |: 53,85 373,688 || Wisconsin.......-.. 169, 549 76% 221, 632 Minnesota.......... 157, 126 92 170,789 || Wyoming.......... 6, 674 60% 11, 001 Mississippi......--- 130, 447 4755 271, 593 - Missouri........---- 253, 782 674 374, 309 Total.......-./9, 511, 938 52 {18, Bites 397 1 Per cent replying can not be given, as collectors summarized the data and did not furnish the num- ber-of repor TS, NARCOTIC PREPARATIONS DISPENSED WHICH ARE EXEMPT UNDER THE LAW. In addition to the above information, the druggists were requested to furnish a statement of the quantities of the exempt preparations dis- pensed—Bateman’s Drops, Godfrey’s Cordial, paregoric, etc. The replies received showed that a total of 1,294 gallons and 175,858 bot- tles of Bateman’s Drops had been sold by 52 per cent of the drugs ists who replied. Estimated on the basis of 100 per cent replies, there was a total of 2,508 gallons and 312,934 bottles of this exempt prepara- tion sold by druggists within one year. These druggists also reported the sale of 1,274 gallons and 228,344 bottles of Godfrey’s Cordial. On the basis of 52 per cent replies, this indicates a total of 2,584 gallons and 441,056 bottles of this prep- aration sold within the same period. Sales of paregoric were reported as follows: 7 7 883 gallons and 10,012 bottles. Basing the estimate of the total upon the 52 per cent of druggists who replied, there was sold a total of 148,328 gallons and. 18,435 bottles of paregoric within one year. 12 For detailed statistics of the sales of these various preparations, see the following tables. . Bateman's Drops, Godfrey’s Cordial, and paregoric dispensed, as reported by druggists, BATEMAN’S DROPS. Reported to Number for 100 per _ ree ; collectors. cent, estimate. States . : Per cent £itot i replying. 7 Gallons. | Bottles. | Gallons. | Bottles. Alpbaine aki « enepte fiatas «peas igneaones orgie: At, 27 2B, 7 57 54,372 VRANSAS. 2.22 ee eee ee eee tenes 8s 3 6 4 1,110 YRIMEIEGTO- Si oe vse eek cp oe cameo te 44h 20) 1,089 45 2, 461 District of Pokum bia. a RARE nico oon foie ce we ne worn Sede tee © | 44e 0 lle... + (0 [al ee 883 Ss. . =-4.-- Sipe os si Sygate Sass - SPRINT ds it Be Bees oe 622 17 10, 418 20 16, 749 Georgia... 1.2... e eee cee eee cece cee eee ee ene enee 644 103 31, 254 159 48, 455 TEEAVGES., ... 3 otf ogbge oS Se ee a JOSE Bs os sa see 272 5 1,001 17 s ae fi Teno oat ees Goins eo - + tyeameh samen * Oe ‘7 1, 168 9 1,618 POUT ial nu ca wh an Din fais os 0d Ce A ew ete dn ee een een a Oe ake Reateetsie «|: epee he Se 122 WORE, loss oe ook dee ace ee RET SES i 791 i 1,066 Kentucky -..---......002- 2.0 eee oa ote bo Se A reba es 5 663 4 6, 958 6 10, 437 Lewisiana.....2.0..... Fe ae 8m y 5 39 5 |e 44. Maryland... ~dedege ‘ A bas AS . 14 5, 444 31 12, 264 ichigan..... ity: Vode «Sones <4 - 16 je... eee. 29 Minnesota........ tag Bee ser BA | oceeg 91 Mississippi......:....i....se00c0sf0e05 abies 47,5, 1 375 2 790 oe yo Ke oS tenia sappy Cotas gee et eS ecg st Ore 1 1, 545 1 2, 278 CDG AS Oia te phan See eee Set oA RE fe cob ROB ea nk ns New Jersey. ..cp 20. SL ogee 0 11a es - 672 174 |e... 259 |e... 2... ee New Yoork!. (csc...) cone bees SR 1DEI Tiga eee 50 7 2 cot ba PO 4 North Carolina. .....,...-. a WR Es 1 ce 672 267 10, 591 394 : Goes wee (Re gees io = ep. Reems fT Ey, 734 53 8, sun 70 11, 164 BL AAMONTLEY S- - Begie o's wu Bi Rta hide wa is Seed so T gee nee OUR | -h.- Sane = - =| Re ode fee vows 1,048 EGRASYLV aD aeats 0: v0} epee Gran cate til ee Ae 424 218 2,345 509 5, 460 South Carolinas... sik vec tae | AS15513 ce ee me) 12 10, 440 12 10, 440 poe npn = SEAL a0 a'e Popeye scapes be PEELS eee cate » ~ : on 36 7, ae _ 58 10, ies GROS cs t.n feat ~~ abide cpteae wks Soe Moe epee Be a atsee wh: ate eg [sabe Pan PU eave iled whe ced foe 62 Weiiginiay. . f: Ban §.. 3.8 ae ae oe bce P DSc lita pe oe 37 303 26, 719 819 72, 213 Washington .....2--. 12.2222... elit ieee eee Ne es Eee oe in ee ote} ee eee kai SODAS 4 "WiestpValbeintaais ss . 0 caghy ebjoe one cdl oss geqangde sass 764 16 21, 902 21] . 28,755 Wisconsin. ...-. 0.1... 1.2 eee 2 Ree Bltie.. TOR | ee OF HB ore ner ee -.20- Dotaleaieact se24 “nase as ehitvons baaleeicio ds ciebe 1,294) 175,858| 2,508! 312,934 GODFREY’S CORDIAL. Alabama. veciacincesigteg-lmabes faces piles eas rp e MEAS Hecke cee 272 26 9, 692 95 35, 372 pues Oe PAR An SERA. Bd eR ABO. ee 24 12, a 32 17, 466 OW Dias cepa be Por epedes Sete d- dieiicen Pah ecS- d-0-45) 1g eet LL. oo OBA da ee Kansas SAS Sa TO aa 733 2} 1,654 2, 104 Heutyeny: » 663 20 13, 549 30 20, 323 Louisiana. . 874 6 563 646 Maryland....... 444 62 8, 734 140 19, 737 Massachusetts. ..- 7 SIk f..-.-.----f BL Jee. eee. 2 Michigamneser. - fopes sj. i upape geeks «$25 psec Ss get 5335 15 10, 361 28 19, 222 Mississippi.....-- 2-22-22. 2-2 eee eee cee eee eee eens Ais 2 2,465 4 5,198 Missouri Be ifhed tas ats deen OB. LEB. fers Leeee ste 7 8, 042 10 11, 861 @braska.. 1... eee eee eee eee eee eee ee ee| LO [eae e eae eee 7. os rs 28 New Jersey... .-. 0 - eee e ee ee eee eee e cent eee nc eaeee 674 30 35 45 52 New Mexico. ....-.-. 0.00. eee ee eee eee eee eee e cece (ee eee oe 42 Newi lf ofc E32 1 i t8. wahdeck .. oSiccex iene. 22-2 22 | 5, 578 44. 11,156 N eae Caroling. vs cori 2. ot cobs SESE ee aa = a oe iE He 138 RP. Bod, bite SS SOLER, 14: 52d. SEE LO 3 IA GMb foc oe eek cai BG. -[ivavay.= 2 SOSTat. 28k ee 9,977 Pennsylvania: J) 4. ied het 2. SOL Adie. 424 83 7, 583 194 17,717 . Per gent replying can not be given, as collectors summarized the gale and did not furnish the number of reports 13 Batemans Drops, Godfrey’s Cordial, and paregoric, etc—Continued. GODFREY’S CORDIAL—Continued. Reported to Number for 100 per : collectors. cent, estimate, States Fer cent : replying. Gallons. | Bottles. | Gallons. | Bottles. Rhode Island... 2.2... cece ee cece eee cence eee neceeee TBE |[..ee--eeee 180 |...-...... 177 South Carolia. .... 2... eee eee eee eee eee eee eee eee « 14 11,781 14 11, 78 South Dakota. ....-. cee eee cee ce ee cece eee eee e eens 32 |e e eee eee 12 |........-. 37 Tennessee... - 22 - ee eee eee eee eee eee e eee cence 673 39 21, 295 57 31, 432 TOXAS. 00. ccee ewes ccces ener e eter ete ten ces scateeeere i 730 |..-------- 9,125 VARTHRON 3g. ete ew ow gc bes oa te oo alee won gate tees Blea ceeeeeee 12 |.......... 51 Virginia... 2... cee cee ee eee eee eee e teen eees 37 309 4,491 835 12, 138 Wrashittgton 25: 1. ssincjae ct3S 020 seis sp oisa eb Gee eees 722 1 40 1 "55 West Virginia. ....-.-.----- cee nce e eee e noes Rinna >= 765 12 8,308 16 10, 909 WaSCDISID 23 «ape 5 oe nk Pek ote eine «ae oe eB Ge ots 764 1 194 1 254 Total «Rie iie exe da davsiteee vice bes eae- Kelp Mee, vs 52 1,274 | 228,344 2,486 | 441,056 Arkansas.......-.2e.00- te saapngir me geaaeios shpke ae d @alifomnian. oo. A a a 100 Colorado... ac ve cin's ods eebte tee deenapaceactactesediee 602 Connecticut... 2-2 cca eee cece cece cece e ee cenenens 73% DEIAWALC 6. Aon os beinaete eda eee ncccdas wgchwetnnee ce 444 District of Columbia... ....... 2.22. e cece eee e ec eeeces 444 Bloridan oa eee coe ewe thn ein nage se acne ope cm epee’ 624 GOOPZIB. eee cece ce cece cee nen n ccc cetenesere 644 Hawaii... eee eee ween eee ae griet seat Q) CG) 0 24 Tlimois. 2. eee cc cw ce cece cece ewe eceneeen 272 Tndiand. 22. ccc cece ec cee n ccc nnncencccecennccccoeas 73h TOW . 6 ec cc cece nnn cence cc cccecenecnccsccaccccsscces 724 FKAMSAS . 0. eee cece eee cee eect ne ne ccc ennteenece 783 Kentucky ..-. 0... cece cc ec enn c cece een ceene ieee aglaw e 662 Louisiana... ec... cece cee ccc een cece tcccccsccccces 87k Maine... ..--..0s-ssccssceseseecccececcecescccecesenee 234 Maryland... 22... cece cence nce een ncn n cece eccscenee 444 Massachusetts. -.-..2...00.2 eee eee estat, + Calis Siedne ese 814 Michigan. .... 02.2... cece cece cece cece eee eee e eee enneee 53%) Minnesota... 2. eee e ec eee ce eee cee e wer eenences 92 Mississippi... 2... 2. eee eee eee e cece nce wene 47.8, Missouri... 2.2.2... cece eee eee eee 674 Montana... --..cec sce cee nseceecceaecs 24 Nebraska...... 75 Nevada... .... 2-0. cece eee cee cence eeweeecnee : 100 New Hampshire. ....... cc cee eee cee cece eee eeeccene 232 New Jersey. - 2... cece cece ewe c cc ence nnn cceceenceene . 672 New Mexico... 2... eco ewe ee eee e cece n cnc cuaneecenee Q@) 96 96 New York... 02... .. cece eesecccceee sencsecece sue cnawe 50 9,038 |.....---.- 183076 [zi eee. North Carolina... -.... cece eee cece cece eee en eens 672 3, 062 133 4,825 196 North Dakota. .......0 cece cece ener ecerecccccecceas 32 85 |. eee eee 265 |.eceeeeece C0) 0 754 3,929 |.....- eee 5,215 |... 2... Oklahoma,... 2... eee ween eee een ence nen ececennces 56 153 |... eee eee 240 :|- 2 odes ve OTOZON «0. cee eee eee ewe wee ene e nn cee neeeneeeeeae 732 342 |.....----- 466 |. ........e Pennsylvania... 2. ers cecccaesceeececcecensccnnceaes 424 8,637 84 20,179 196 Rhode Island... ,. 4.2.0... eee e ec ee cee eee e rece eencees 732. 586 |.......--- 800 |......-.-- South Carolina. . oe. ee eee eee cee e cece eee eeee @) 1,126 [.......... 1,126 |...22....- South Dakota... . eee cee cece ence nce eweecccee 32 208 |...-.----- 650 |... eee TeNNESSCE . . ee eee ce eee tcc ee eee eee e cee eee 673 2,741 236 4,046 348 TOXAS - 2 eee cece cee enc ween renee encencancees 8 52 |..-eeeeee- 650 |... eee eee GANA si eo Sa ween bane iae ecb Speevaneedencace 2¢ 4 lee eee 144 |...... ee Vermont... eee ena c cece ccc e ewe cence cern ceenecee 232 220 |...-..---- 920 |......---- Virginia... 0. e ween eee eee eneccener 37 3, 127 24 8, 451 65 Washington... eee eee cece eect ete e eee eee eee ees 723 505 10 696 14 West Virginia... cece ccc nce e cence eee net: - 76% 895 228 1,175 300 Wisconsin... cece e eee een eee n nee e ence eee e eee ewees 76% 389 |.......... 508 |...----0e- Wyoming... --. 2. ce cence eee cece ee eee eee cen eeenee 60% TAs Ss QFE ae Nee od hye) Se sD 52 77, 383 10,012 | 1438, 328 18, 435 1 Per cent replying can not be given, as collectors summarized the data and did not furnish the number of reports. 14 In- explanation of the above figures, it may be stated that they do not include the sale of other exempt preparations which were made up by druggists and of which no record was kept, nor do they show the sales of the same or similar preparations by grocers and other whole- salers and-retailers who, in certain States, are permitted to sell these cea pt preparations without restriction. « In addition to the above-mentioned aicckeaeaeS, the committee sent out five others, as follows: ; POLICE STA’ TISTICS ‘ON ADDICTION. A@hostionnais No. 1 was addressed to the chief. of Bate of each of the 1,263 cities in the United States having a population: of 5,000 or hore. Replies were received from 760, of which 388: contained cer- tain information, while 372. reported that they had no available records or data. This represents replies of approximately 60 per cent to. the que but only about 382 per « cent contaimed any in- formation. * The police officials in 34 ditties reported an increase in narcotic drug addiction, while 287 cities reported a decrease. The increases re- ported were from the larger cities, while the decreases occurred in the smaller cities. Of those reporting an increase, 8 gave as a cause- for this condition, prohibition; 8, association with other addicts; 6, because of free use of drugs by physicians; 4 reported increase due to immigration; 2 ascribed the increase to the creation of addicts by anders because of the large: profits; while 1 | reported: it due to lax laws. Of those reporting a decrease in addiction, 80 ascribed iy to the Harrison narcotic law; 62 stated it was due to the difficulty in pre- curing drugs; 26 to the laws in general; 24 gave as a reason State laws; 12 ascribed the decrease to the activity of police officials; 11 said it:was due to the high price of drugs; 11‘on account of prohibition; 11 because of death of addicts; 9 because of prosecutions for violations of laws; 9 because of restricted sales; 9 because of emigration of addicts to other parts; 5 to treatment and cure of addicts; 2 to activ- ities of the State board of pharmacy; f£ because of refusal of physi- cian to prescribe drugs, and 1 because of the selective draft. The causes for dri addiction in the order of their frequency. were given as follows: Use of physicians’ prescriptions, association with other addicts, prohibition, use of narcotic drugs for chronic diseases, curiosity to learn the effects of the drug, prostitution, use of patent or proprietary medicines, use of certain narcotic dries as a stimulant, idleness, and use by dentists. With respect to the order of frequency in which the different drugs were used they reported as follows: Morphine, cocaine, heroin, opium, laudanum and paregoric, and codeine.. 15 ‘These officials also reported the arrest of 5,534 persons addicted to. the use of drugs in 1916; 5,628 in 1917; and 5,443 in 1918. The population of the cities represented by these officials was 26,514,361, or approximately 25 per cent of the total population of the country. If the same record of arrests prevailed throughout the smaller cities and rural districts, the number of. addicts arrested, based on the: population of the entire country, would be 21,772 for 1918. The offenses for which arrests of addicts were made are given in their order of frequency as follows: Larceny, burglary, robbery other than larceny, vagrancy, prostitution, disorderly conduct, assault and battery, drunkenness, murder, and forgery. In further explanation - of these arrests it is stated by 46 officials that morphine was used by persons committing violent crimes; 46 stated that cocaine was used by persons. committing. violent crimes; 18 reported heroin, and 4 re- ported opium as the drug used by such persons. With respect to the. lesser crimes, 62 officials reported morphine as the drug used by such persons, 23 reported cocaine, 14 opium, 13 heroin, 18 PAPREOUIC, 2 laudanum, 1 codeine, and 1 yen shee. These nalice siizials also reported 1,800 drug pedillons doing busi- ness in the United States at the present time. A number of these officials stated that they knew it to be a fact that peddlers secured _ their supplies by smuggling from Canada and. Mexico. Others stated that smuggling from other countries, stealing, and through pre- scriptions written by unscrupulous physicians constituted the chief means of securing these drugs. The occupations of the peddlers were given as follows: Gamblers, taxicab drivers, domestics, solicitors, messengers, vagrants, lunch room helpers, pool room employees, porters, laundrymen, ete. STATISTICS FROM PENAL INSTITUTIONS. . Questionnaire No. 2 was sent to a total of 3,271 wardens of State, county and municipal prisons and reformatories, to which 762 re- plied.. Of these replies 126 contained certain formation, and 636 were returned with the statement that no records had been kept and, therefore, no information was available. The total number of re- plies received represents 23 per cent of the questionnaires sent out, but the number containing information represents only 3.9 per cent of the total sent out. The census report of 1910 shows the number of inmates of penal or reformatory institutions on January 1 of that year and during the year 1910 to have been 630,406. Figures showing the total number of inmates confined in such institutions during the years 1916, 1917, and 1918 were not available, but the replies to the questionnaire show that there were 1,376 addicts in 1916, 2,176 in 1917, and 1,861 con-. fined in such prisons during 1918. These figures would apparently 16 indicate thet only a small percentage of persons incarcerated in penal institutions are addicted to drugs, but this is an assumption which is partly negatived by the fact that only a very small percentage of such institutions kept any records relative to drug addiction. The following table gives information relative to the drugs used by addicts who were inmates of these institutions. Classification of addicts in above institutions according to drug of addiction. Drug. 1916 ; 1917 | 1918 | Total. Drug. 1916 | 1917 | 1918 | Total. Gum opium......... 5 53 29 87 || Paregoric... J. 00.2... 3 5 12 20 Smoking opium. .... 76 101 83 260 || Cocaine........-.. .--| 100 144 133 377 Morphine............ 431 | 648] 626] 1,705 || Cannabis or hashish. 10 19 20 49 Heroin. ............- 588} 829} 508) 1,925 : Codeine ......... tine a 7 4 15 Hotals (IASI 1,223 | 1,808 | 1,423} 4,454 . Laudanum....-...-. 6 2 8 16 The officials of these institutions reported the predisposing causes of addiction as follows: Low mentality in 198 cases, nervous diseases in 55 cases, chronic or painful illness in 49 cases, and other predispos- ing causes in 125 cases. The manner in which the habit was acquired was reported to be as follows: Through direct administration by physicians in 64 cases, through physicians’ prescriptions in 240 cases, through self-medica- tion or the use of proprietary remedies in 18 cases, through association with other addicts in 974 cases, through other ways, including the - white-slave traffic in 42 cases, and through surgical operations in 23 cases, | elles | The order of frequency of addiction according to nativity was given as follows: American, Italian, Irish, English, Russian, Jewish, French, Negroes or Chinese, Mexican or Austrian, German or Ca- nadian. ET The reports of these officials also show that there was no connection between occupation and addiction, although they reported that the occupations of addicts in the order of their frequency are: Waiters, waitresses, chemists, paper hangers, laundrymen, laundresses, paint- ers, cooks, mechanics, chauffeurs, tailors, salesmen, laborers, prosti- tutes, and vagrants. STATISTICS OBTAINED FROM ALMSHOUSES, Questionnaire No. 3 was sent to 2,464 superintendents of State, county, and municipal. almshouses; 584 to superimtendents of State hospitals; 471 to superintendents of insane asylums; 1,582 to county and municipal hospitals, making a total of 5,101 institutions. Only 1,520 replies were received, or approximately 30 per cent, of the total number mailed. Of these, only 380 contained information, or, in other words, only about 6 per cent of the institutions gave any information 17 of value to the committee. These replies showed that 1,774 addicts had been treated in these institutions during 1916, 1,535 during 1917, and 1,449 during 1918. With respect to the drug of addiction, 111 were reported as using gum opium, 157 smoking opium, 3,072 morphine, 900 heroin, 30 co- deine, 75 laudanum, 123 paregoric, and 24 cocaine. As predisposing causes for addiction, low mentality or ar rested de- velopment Was mentioned in 924 cases, nervous diseases in 266 cases, chronic or painful illness in 590 cases, surgical operations in 160 cases, and unclassified causes in 595 eases. In respect to the request for information relating to the manner in which addiction was acquired, direct administration by physicians was reported in 280 cases, through physicians’ prescriptions in 364 cases, through self-medication and the use of patent or proprietary remedies in 206 cases, through association with other addicts in 1,275 cases, and through other ways in 355 cases. The relative frequency of addiction in the above cases with ee to nationality was given as follows: American, Canadian, Irish, English, German, Scotch, Russian, French, Ttalian, Chinese, Mexi- can, Armenian, Swiss, and Swedish. The occupations of addicts in order of their frequency were given as follows: Housekeepers, laborers, clerks, physicians, salesmen, nurses, pharmacists, actors, prostitutes, waiters, cooks, sailors and soldiers, horsemen, barbers, butchers, bartenders, draftsmen, teachers, and unemployed. The institutions which replied to the question relating to deoules _ from which the addicts were suffering, reported that 40 were suffer- ing from yheumatism, 45 from cancer, 62 from asthma, 159 from heart disease and nervous troubles, 106 from tuberculosis, 148 from: venereal diseases, 71 from chronic Nishasus unclassified, and 56 from insanity. - Of the total number of institutions replying, 79 stated that they gave special treatment for narcotic drug addiction. The average length of time of treatment of an addict is reported as being 2 years 104 months. The average daily cost per capita for treatment and maintenance was stated to be $1.29. _ HEALTH OFFICERS’ REPORTS, _ Questionnaire No. 4 was addressed to 3,023 State, district, county, and municipal health officers. To this questionnaire, 983 replies were received, or 33 per cent of the total number sent out. Only 777 of these, or 26 per cent of the total, contained any information of value to the committee. Most of these officials replied to the effect that 13: they kept no teeords of the number of drug aahicte, nor had they any means of securing such information. The number of addicts reported by the ifivials replying was given as 5,271 in 1916, 3,542 in 1917, and 2,877 in 1918. The officials in 14 cities and counties reported. an increase in — addiction. The cause of the increase was given as immigration in 4 reports, prohibition in 3 reports, lax laws in 2 reports, and war conditions in 1. Officials in 627 cities and counties reported a de- crease in number of addicts during this same period. The cause for decrease was given as the Harrison narcotic law in 317 reports, ina- bility to obtain drugs in 145 reports, laws in general in 46 reports, State and Federal lnw-i in 86 reports, deaths in 23 reports, treatment. and cures in 21 reports, cooperation of physicians in 20 reports, emigration in 12 reports, prohibition in 8 reports, high cost of drugs in 7 reports, efforts to prohibit sales in 6 reports, cooperation of authorities in 5 reports, employment in war work in 8 reports, prose- cution in 3 reports, and environment in 2 reports. The predisposing causes of drug addiction in order of their fre- quency as stated in these reports are chronic diseases, prostitution, mental troubles, nervousness, and neurasthenia. The ways in which the habit was acquired, stated in the order of | their frequency, are as follows: Through physicians’ prescriptions, use of drugs for chronic diseases, prohibition, association, use of patent medicines, prostitution, as a means of producing stimulation, and through curiosity. In reply to the question relative to the nature of drug addiction, 425 health officials stated that the physicians in their communities regarded it as a disease, while 542 reported that they regarded it as a vice. , With respect to the treatment of drug addiction, 88 health officials reported that physicians in their community followed special pro- vedures in the treatment of addicts, while 351 reported that the phy- sicians followed the procedure commonly known as the reduction treatment. These health officials also stated that 192 cities and coun- ties over which they had jurisdiction make provision for the treatment of addicts in almshouses and penal institutions. PRIVATE HOSPITALS AND SANATORIA. Questionnaire No. 5 was sent to. 4,568 superintendents of private hospitals and sanatoria. Replies scant to 36 per cent of the total sent out were received. Only 227 of these questionnaires, however, con- tained any information of value to the committee. Most of them re- plied that no records were kept, or that the records of the institution were not arranged in such manner as would give the information desired. 19 The replies received showed that 506 addicts were being treated in these institutions during the year 1916, 551 during 1917, and 624 in 1918. Of the total number of patients treated by these institutions for the three-year period, 27 used gum opium, 21 smoking opium, 1,056 morphine, 297 heroin, 28 a 17 laudanum, 55 paregoric, and 28 cocaine. As predisposing causes for drug addiction, low mentality or ar- rested development was given in 102 cases, nervous diseases in 195 cases, chronic or painful illness: in 180 cases, surgical operations in 154 cases, and other predisposing causes in 200 cases. With respect to the manner in which addiction had been acquired, direct administration by physicians was given in 133 cases, the use of physicians’ prescriptions in 93 cases, self-medication in 117 cases, asso- ciation with other addicts in 205 cases, and in other ways, ineluding the white-slave traffic, in 270 cases... The. nationality of addicts, where such information was given, is reported as American in 94 instances, German in 10, Irish in 8, Eng- lish and Scotch in 6, Jewish in 5, French in 4, deinkavail in 3, Biiaiach and Grecian in 3, aia Mexican in 2. The occupations of addicts in the order of their frequency are re- ported as follows: Housewives, laborers, physicians, salesmen, actors and actresses, unemployment, business men, nurses, farmers, office workers, professional . men and women, prostitutes, pharmacists, “dope”. peddlers, mechanics, mer chants, gamblers, newspapermen, and printers. The diseases of addicts other than that of addiction are e reported as venereal in 109 cases, tuberculosis i in 14 cases, nervous troubles in 198 cases, insanity. in 66 cases, lung diseases other than jupeacm ose in 39 cases, abscess and cancer in BA cases, stomach troubles in 5 cases, and heart disease in 7 cases. These private institutions repor ted that the average length of time of treatment of opium addicts was 64 weeks, orniris” addicts 7 weeks, and cocaine addicts 6 weeks. The average cost per capita. for troafment and maintenance is given as $5.21 per day. Of the total number of addicts treated in these institutions, 74 per cent are stated to have been benefited to some degree, and 61 per cent are said to have been permanently cured of their addiction. SUMMARY. Trafic in narcotic drugs.—Statistics compiled by the Department of Commerce show that the quantities of narcotic drugs imported into this country steadily increased from the date when ‘the first entries were reported until our chief sources of supply were shut off as a result of the present war. In 1915 the quantities of these drugs con- sumed in this country amounted to approximately 490,000 pounds of epium and more than 1,000,000 pounds of coca leaves. These quan- 20. tities of opium and coca leaves, in their crude state and in the form of manufactured products, were supplied to the public through a total. of 233,491 individuals and institutions registered under the Harrison Narcotic Act. The minimum value of these drugs com- puted on the basis of retail price of the crude material would be some- thing over $20,000,000. The actual cost to the consumer, while it greatly exceeds this amount, can not be estimated at the present time. When we take into consideration the fact that various investigators have stated that only from 10 to 25 per cent of the quantities of these drugs imported is actually needed to supply the demand for legiti- mate medical purposes, we can arrive at some idea of the quantities of these drugs consumed by addicts and the amount of money ex- pended for the satisfaction of their addiction. The foregoing represents only the extent of this traffic as carried on through legitimate channels. In recent years, especially since the enactment of the Harrison law, the traffic by “ underground” chan- nels has increased enormously, and at the present time it is believed ‘to be equally as extensive as that carried on in a legitimate manner. ' This traffic is chiefly in the hands of so-called.“ dope peddlers,” who obtain their supplies by smuggling from Canada, Mexico, and along the Atlantic and Pacific coasts. _ : Extent of drug addiction.—The number of individuals addicted to the use of opium, its preparations or alkaloids, and coca leaves, their preparations and alkaloids, in the United States has, at various times, been estimated to be from 200,000 to 4,000,000. These estimates must, however, be looked upon as mere guesses in most cases because of the fact that there have been no means available for reaching an accurate estimate in the past. The following table shows the num- ber of addicts in the United States, or parts thereof, as estimated by a number of different investigators who have made a more or less extensive study of the situation. Number of addicts, as estimated by various observers. Ps Per cent Observer. Year. arnt per at Cae aes or of popu-| Kinds of addicts. lation. T. D. Crothers......-..------ 1912 1,000,000 | United States..... 1.0 50 per cent morphine, C. E, Terry.....--------+-+-- 1913 887 | Jacksonville, Fla .. 1.31 | All drugs. L. 7 Bowe bc eeregeceaiwale 1915 269,000 | United States..... 27 Do. wpeemwelecatecastasers 1915 5,000 |} Tennessee........- 22 Do. M. L Wilbert eye cone phases 1915 175,000 | United States..... .175 | Opium. WQS ee Ss 3B SE 2? 1915 80,000 }....- GOT alae ele .08 | Cocaine. Jeannette Marks........--.-- 1915 4 4,000,000 |..... So ee aeeee Sees 4.0 Opiuni-cocaine. Horatio C. Wood, jr........- 1916 100,000 |...-.do.......-...-. wl Opium. J. R. Campbell.......-22---- 1916 115,000 Now York State. . 16 All drugs. Massachusetts committee on : habit forming drugs. 1917 60,000 | Massachusetts. .... 1.6 Do. George H, Whitney... ....-.-. 1917 100,000 | New York State... 1.0 Do. . Bamest ¥, Bishop....-.....- 1918 200,000 |..-.. do......---.-. 2.0 Do. Eng PAAR VANE AY 1918 - 100,000 | New York City. . 1.8 Do. L. 8 Hinckley os pig eadinEdene 1918 2, 000; 000 | United States..... 2.0 Do. 1 Children, 21 -Qwing to the lack of laws and regulations making it compulsory: for the registration of addicts throughout the country or the keep- ing of any records as to their identity, it has been impossible for the committee to obtain information which would give*the exact number of addicts in the United States at the present time. It is believed,, however, that a fairly accurate estimate of their number canbe made from the information which the committee has obtained. At- tempts to accomplish this have been made as follows: The number of addicts reported by the health officials rinliaiogs to questionnaire No. 4 was 105,887. As this number represents the addicts reported. by only 26 per cent of the health officials from. which this information was requested, it may be assumed that had all the health officials replied: the total number would: have amounted: to approximately 420,000. This number, however, appears to be much too low, in view of the fact that the physicians of the country are estimated to have had about 237,000 addicts under treatment during this same period, and only a small portion of. the total. num- ber of addicts present themselves for treatment.’ Addicts of the “underworld,” for instance, secure most of their supply through ilicit-channels and rarely, if ever, consult a physician. It appears that a more accurate estimate of the total number of addicts may be obtained from the data secured by those investigators who have made an intensive study of drug addiction in certain re- stricted communities. Jor example, the health officer of Jackson- ville, Fla., reported 887 addicts in that city in 1913, : This number represents 1.31 per cent of the population. Upon this basis the total number of addicts in the United States; in 1918, taking the estimated population as 106,000,000, would be 1 388 5600. In reply to questionnaire No. 4 sent: to health officers of States, counties, and municipalities, the health officer of New York City reported a total of 103,000 addicts, which is equivalent to 1.8 per cent of the population. On this basis, there would be 1,908,000 addicts in the United States. : Information in the hands of the committee indicates that drug addiction is less prevalent in rural communities than in cities or in congested centers. It would, therefore, be unfair to estimate the number of addicts in the entire country on the basis of the figures obtained for New York City. Furthermore, it is the opinion of the committee that an estimate based on the number of addicts in a small city like Jacksonville, Fla., would not be representative for the entire country. Taking these facts into consideration, the com- mittee is of the opinion that the total number of addicts in this country probably exceeds 1,000,000 at-the present time. . With respect to the increase or decrease in the number of addicts within the last year, the following statements can be made: In re- 22 sponse to the question Has narcotic drug addiction increased or de- creased in the past few years? which inquiry was directed to 3,023 health officers and 1,263 chiefs of police, 962 expressed an opinion. Forty-eight stated that there had been an increase and 914 reported a decrease. Taking into consideration the population of the cities or counties reported by the officials giving these opinions, it is found that in practically every instance the increase reported was from the largest cities, and in particular in those cities where more than the usual attention is being directed to the eradication of drug addiction. Thus each of the 20 following cities, having an aggregate population of approximately 10,000,000 people, have reported: an increase: San. Francisco, Calif.; Wilmington, Del.; Macon, Ga.; Louisville, Ky.; Brockton, Mass.; Detroit, Mich.; Kansas City,-Mo.; Elmira, N. Y.; New’ York City, N. Y.;. Utica, N. Y.; Yonkers, N. Y.; Charlotte, N..C.; Muskogee, Okla.; Oklahoma, Okla.; Toledo, Ohio; Portland, Oreg.; Harrisburg, Pa.; Chattanooga, Tenn. —e Tenn. ; and Nashville, Tenn. : ‘Replies in which a decrease in the sed of addicts were re- ported were received chiefly from rural districts or smaller cities _ where little or no attention has been given this subject, so that it is quite possible that the opinions expressed by the officials resident in these places are at variance with the conditions as they actually exist. What effect, if any, nation-wide prohibition will have on the situa- tion could not be definitely determined by the committee. The con- sensus of opinion of those interested in the subject appears to be to the effect that the number of addicts will increase as soon as the pro- hibition laws are enforced. These opinions are based, for the most part, on the theory that drinkers will seek a substitute for alcohol and that the opiates and cocaine will be found to be most satisfactory for this purpose. This opinion apparently receives some support from investigations made in some of the Southern States, where pro- hibition has been in effect for some years. It has been noted that in these States the sales of narcotic drugs and cocaine, and especially the sale of preparations exempt under section 6 of the Harrison Act, such as Bateman’s Drops, Godfrey’s Cordial, and paregoric, have greatly increased during this period. . Whether or not this condition will become general when national prohibition becomes effective is a question which can not be answered at the present time. Etiology of addiction—The investigations of the committee have led to the conclusion that addiction to the use of these habit-forming drugs is not restricted to any particular race, nationality, or class of people. Anyone repeatedly taking a narcotic drug over a period of 30 days, in the case of a very susceptible individual for 10 days, is in grave danger of becoming an addict. And, when addiction has been established, it is impossible for the individual to discontinue the 23 use of the drug without outside assistance. These statements are supported. by the opinion of medical men who were consulted on the matter and by reports which have appeared in medical journals. The more important findings of the committee which have a bearing on the subject of the etiology of drug addiction are as follows: . Data assembled by the committee show that the habit of using opiates or cocaine is acquired through association with addicts, through the physician, and through self-medication with these drugs, or patent or proprietary preparations containing the same.’ The first two ways in which addiction is acquired are of about equal importance. at the present time, the last being of lesser importance in the light of the replies received to the questionnaires sent out. ; With respect to this phase of the subject, the committee finds that addicts may be divided into two classes, namely, the class composed’ principally of addicts of the underworld and the class which is made up almost entirely of addicts in good social standing. MEM, - The addict of the underworld, in a large majority of cases, ac- quires the habit of using these tacigs through his or her associates. This is probably due to the fact that addicts of this class make use of heroin and cocaine most frequently, these drugs being employed as a snuff. It is therefore an easy matter to treat a companion to a sniff of the “ ape ” Tn addition, these drugs are made use of by “ white. slavers ” in securing and holding their prey, and by peneiabaong in entertaining their callers. With. respect. tothe addict of:.good corti standing, the phiduane obtained by the committee points to the physician asthe agent through whom the habit is acquired in the majority of cases. Some, however, become addicted to the use of these drugs through self-: medication, while a few first indulge-as a social diversion. . ESE The drugs used by addicts in.order of their frequency, as shown in’ the replies-to all forms of questionnaires sent out by the committee, are as follows: Morphine, heroin, opium (all forms)~ and cocaine. Codeine, laudanum, and paregoric are reported as being used in about equal amounts, but to a lesser extent.. In recent years the use of heroin has greatly increased, and in some communities it is at present used more extensively than any of the other drugs. This is believed to be due to the ease with which it can be taken, it being usually employed as a snuff, and to the fact that the habit is acquired by association in a large majority of cases. It is at present regarded by many as the most dangerous of these drugs from the steedigolnt of habit forma- tion: and the creation of new idldiets:: The committee has obtained.no information to show that there is any relationship between the age of individuals and susceptibility to addiction. The range. of ages of addicts was reported as 12 to 75 years. The large majority of addicts of all ages was reported as 4 using morphine or opium or its preparations. Many of the older ad- dicts were reported to have acquired the habit when still in their teens. Most of the heroin addicts are comparatively young, a large portion of them being boys and girls under the age of 20. This is also true of cocaine addicts, many of them, according to reports, being mere children. — .The statistics compiled by the committee show that the greater part of the addicts in this country are American born. It is a rare occurence to find an addict among the immigrants on their arrival in this country, although some of them become addicted to the use of these drugs after taking up their abode in this country. Of course this statement does not apply to the Chinese and certain other nationalities of the Orient. In the replies received to questionnaires sent out by the committee, practically every nationality was reported. These replies, however, did not show any relationship between na- tionality and extent of addiction among the foreign born. Contrary to general opinion the committee finds that drug addic- tion is not more prevalent. among females than males. Reports obtained from some parts of the country show that the females out- numbered the males, while in other sections, officials reported a pre-. ponderance of males. Taking all factors into consideration, it appears that drug addiction is about equally prevalent in both sexes. The information collected by the committee does not show any direct relationship. between any specific occupation and drug addic- tion. Addicts are found engaged in all lines of work. It has been stated that the percentages of addicts is greatest among people engaged in the practice of medicine or closely related occupations, such as the practice of pharmacy, dentistry, and nursing. The com- mittee was, however, unable to confirm this report. From the sta- tistics collected it appears, however, that a large portion of the addicts are not engaged in occupations which call for hard labor, and that many are not employed at all or work intermittently. This is especially true of cocaine and heroin habitues. Effect of addiction on health—The committee is forced to conclude from its investigations that the habit-forming drugs herein men- tioned produce a marked physical and mental deterioration in indi- viduals addicted to their use. The constant use of narcotics, suchas opium, its preparations and alkaloids produces a condition in the human body which is beginning to be looked upon by physicians as a disease. This diseased condition requires the repeated administration of the drug of addiction to keep the body functioning normally or the institution of medical treat- ment. The mere withdrawal of the drug induces such fundamental disorganization and such painful disturbances that addicts are driven to any extreme to procure more of the drug with which to allay their 25 suffering.. For years, individuals addicted to the use of opiates may appear quite normal to the ordinary observer, but close attention will usually reveal signs of diseased conditions as evidenced by variability of moods, waxy complexion, emaciation, diseased condition of the respiratory organs, heart, and kidneys. Continued addiction brings about sexual sterility and thus reduces the birthrate among this class.’ If impregnation occurs during a period of abstinence from the drug, and the mother later begins using the drug again, the herr when born becomes addicted through the mother’s milk. _ The effect of cocaine is somewhat different... While it causes a more -rapid physical and mental deterioration than the opiates, the changes produced are not as profound, and the drug may be completely with- drawn without danger of serious results following. In addition to the systemic effects of the use of cocaine, individuals addicted to this drug often show a perforation of the nasal septum as a result of the. local action of the drug when it is used asa ‘snuff: .This condition has also been observed in heroin addicts, this drug being usually taken in the same manner. ‘The committee also finds that insanity is not in- frequently a result of the use of cocaine in the case of addicts. In cases where any of these drugs are taken hypoderimically, there is freqently noticed abscesses, scarring, and disfiguration of those parts of the body in which the needle was inserted. In general the physical deterioration which results from the continued use of any of _ these drugs brings about. a diminution in the power of resistance so that the addict falls an easy prey to some other ailment, and ei _ very seldom reaches. old age. Effect of addiction on morals —From silesrnidittaw’ i in the hadidin of the committee, itis concluded that, while drug addicts may appear to be normal to the casual observer, they are usually individuals weak in character and will, and lndiettials in moral sense. ; The opium or morphine addict is not always a hopeless thes a wibiGl wreck, or a creature sunk in vice and lost to all sense of decency and honor, but may often be an upright individual except under circum- stances which involve his affliction, or the procuring of the drug of addiction. He will usually lie as to the dose necessary to sustain a ~ moderately comfortable existence, and he will stoop to any subterfuge and even to theft to achieve relief from the bodily agonies ex- perienced as a result of the withdrawal of the drug. There are many instances of cases where victims of this disease were among the people of the highest qualities morally and intellectually, and of the greatest value to ee communities, who, when driven by sudden deprivation of their drug, have been led to commit felony or violence to relieve their misery. Addiction to the use of cocaine produces a much more rapid de- terioration of mental powers and moral sense. It is this class of 26 addicts that most frequently commit moral wnoner and crimes of violence. - Among the nddicts of the underw orld, siistioally all show a low mentality, a lack of decency and honor. This condition, however, is not entirely due to the effect of these drugs as might be inferred, but is largely the result of degeneracy due to environment and association. Relation of drug addiction to crime.—The committee finds that the drug habit has some bearing on the question of crime. Reports from officials of prisons and reformatories show that a number of the in- mates are drug addicts. In 1916, the addicts in the city prison (Tombs) at Manhattan constituted 5 per cent of the total nuniber of ‘prisoners. There is, however, a great variety of evidence on this | stepjert which has not yet been made clear. ‘ The users of opium and morphine are seldom seen in the courts: fer _ brutal crimes. The offenses: committed by them in the order of their frequency as indicated by replies to questionnaires sent out by the “committee are larceny, burglary, vagrancy, forgery, assault, and “violation of the drug laws. They are frequently aiders or abettors of crimes, but less commonly the leading actors in criminal conduct. In cases where addicts have committed violent crimes, it-is reported that they were users of cocaine or heroin. These are also the drugs which are most frequently used by prostitutes and those engaged in “the “ white-slave traffic.” These drugs appear, therefore, to be the most obnoxious. i ‘Economic aspect of drug addiction.—While the committee has been unable to secure suflicient data to enable it to formulate a statement which will convey exact knowledge of the economic phase of drug addiction, it is believed some idea of the economic loss to the country - sustained through addiction may be gained from the cost of the drugs used by addicts and the loss through unemployment of those addicted. It has been computed by the State food and drug commissioner of one of the States having stringent regulatory laws that the average annual expenditure for an addict to satisfy his addiction amounts to $61.18. Upon this basis of cost of drugs alone, the addicts of this country annually pay over $61,000,000 for the satisfaction of addiction. The figures obtained by the committee vary as to the average per- centage of addicts regularly employed, employed part of the time, and not employed at all. But it is concluded from a careful analysis of these figures, as well as those obtained by other investigators who have made a study of this problem, that at least 25 per cent of the addicts are not steadily employed in gainful occupations. This would represent at least 250,000 unemployed addicts in the United States. At a conservative estimate this would represent the loss in wages of $150,000,000 annually. These figures, however, do not in- 27 elude the cost of drug addiction to individuals as a result of loss through theft and burglary, nor the cost to the States and municipali- ties in the suppression and punishment of crime, and the care and treatment of those who eventually become a charge “ome the com- munity. CONCLUSIONS AND RECOM MENDATIONS. From the data obtained the committee is convinced that there is a nation-wide use of narcotic drugs for other than legitimate medical needs, and that such use for the satisfaction of addiction has mate- rially increased in certain sections of the country despite the vigorous efforts exerted in the past four years in the enforcement of the Fed- eral antinarcotic law, and in the enforcement of the laws of the States and municipalities which have enacted such for the contre] of habit- forming: drugs. Furthermore, it is apparent from the replies to questionnaires sent out that. there has been no. definite or concerted action on the part of the majority of the State and municipal govern- ments to suppress the illicit traffic and use of habit-forming drugs, and. that there has been but little, if any, attempt made to secure accurate information concerning the problem of drug addiction ds a basis for the enactment of proper legislation and regulation. The replies to the questionnaires sent out to State; county, and municipal officials show that.a great. majority of these officials kept no records and therefore had no information upon the subject. This condition is believed, to be due principally to a lack of knowledge of the serious- ness of. the situation.. In many cases it is no doubt partly due to the more or less general acceptance of, the old theory that drug addiction is a vice, or depraved taste, and not a disease, as held. by modern inives- tigators. ‘This attitude-has, had the. effect of holding. these unfortu- nate creatures up to public scorn, and thereby lessening. any interest in their welfare... Records having a-bearing on-any and all phases of drug addiction are of sufficient importance to warrant immediate action for the purpose of remedying these conditions, Inasmuch as the Harrison antinarcotic law has recently yaar amended by Congress in accordance.with the suggestions made. by the committee in its preliminary report, it is believed that the present Federal statute. confers the necessary power for the effective control of the manufacture, sale, distribution, and administration of nareotic drugs, and it is the opinion of the committee that no further national legislation is necessary for this purpose at this time. It is, however, the opinion of the committee that there yet remain several phases of the narcotic problem which merit the consideration of the Con- gress. One of the more important of these is the question of the responsi- bility for the care and treatment of addicts who, by reason of the 28 amended statute, will find it difficult, if not impossible, to obtain the supplies of drugs necessary to maintain their normal condition due to habituation. The enactment of legislation on the part of the National Government covering this phase of the problem, likewise the passage of similar measures by the States and rae is _ deemed urgently necessary. There also remains the intentional aspect off the opium traffic which should: receive immediate consideration. If this and the other countries represented at the international opium ‘convention are to effectually control the traffic in opium and other habit-forming drugs, some concerted action is necessary. It is, therefore, recom- mended that this country, through the State Department; take up this matter with the other powers which were signatory to the inter- national agreement entered into at The Hague in 1912 with a view to persuading such Governments to enact the necessary legislation to carry out the terms of The Hague protocol. Otherwise, the task of this country of suppresing the illicit traffic in habit- forming drugs will be rendered much more difficult. Pending the ratification of The Hague opium convention by the various powers and the enactment of necessary legislation to carry out the terms thereof, it is urgently recommended that the United States Government take up with the Governments of the Dominion of Canada and Mexico the subject of more effective control of the manufacture and exportation of narcotic drugs therefrom for the purpose of securing their cooperation with this Government in the suppression of the smuggling of such drugs from one country into the other, which now affords the principal source of supply for the illicit traffic in these drugs. It is also recommended that educational campaigns be instituted in all parts of the United States for the purpose of informing the people of this country, including the medical profession, of the seri- - ousness of drug addiction and its extent in the United States, and thereby secure their aid and cooperation in its suppression. It is also recommended that both public and private medical or- ganizations which have research facilities be requested to undertake studies to determine the nature of drug addiction with the view of improving the present forms of treatment or evolving some new and more efficient method of handling these patients. The Jatter state- ment is made in view of the fact that at the present time there are numerous forms of treatment for drug addiction, none of which appear to have been given a thorough trial by the medical profession, as a whole, or to have received the unqualified support of those members of the profession who have had no financial interest in the matter. 29 Tt is the opinion of the committee, based on the results of its inves- tigations, that the medical need for heroin, a derivative of morphine, is negligible compared with the evil effects of the use of this alkaloid, and that it can easily be replaced by one of the other alkaloids of opium with the same therapeutic results, and with less danger of creating habituation. Therefore, consideration should be given the subject of absolutely prohibiting the manufacture, sale, distribution, or administration of this most dangerous drug by: the States and municipalities. - aghares 48 Respectfully, Ei aR a ENRY AINEY, M ember of Congress, Chairman. Rien Hunt, Professor of Pian macology, Harvard Univer sity. B. C. Kerru, | Deputy Commissioner of Indernal Revenue. A. G. Du Maz, United States Public Health Service, Secretary. B. R. Ruges, M. D., Clerk to. Committee. @) -