Dr. Berger is President of Richmond Memorial Hospital; Chairman of the Committee on Alcoholism and Narcotics of the New York State Medical Society; president. Medical Society of the City of New York.
Upon pressure from the World Health Organization and other branches of the United Nations, the government of the United Kingdom had announced that after December 31, 1955, the manufacture of heroin would be prohibited. Subsequently, at the insistence of many competent medical men in Britain, that decision was reconsidered and postponed at least through 1956.
This article was presented in the bulletin of the British Fellowship for Freedom in Medicine, May 1956, as an open letter to the physicians of the United Kingdom.
The arguments for and against the proposed ban on heroin were closely followed in the United States. To the physicians of America who have entered into their professional careers since 1925 the drug is known only as a material used by addicts for self-gratification. Its medicinal virtues in uterine inertia, cough, and for the relief of terminal pain in malignancy are dimly remembered classroom phrases uttered by those of our teachers whose practices antedated our own ban on heroin. Federal law has prohibited its importation, manufacture, and even its medicinal use in this country for the past thirty-one years.
You who have, for the time being at any rate, escaped from embarking on a similar adventure with this drug may be interested in learning of our experience as we have traveled down this long and sordid path. In 1925 there were a few heroin addicts in the United States. The number is unknown, but hospitals and penal institutions of that period report that most of our addict population was using crude opium for smoking, tincture of opium, and morphine. The same institutions report heroin to be the material of choice in about 86 per cent of those apprehended today. Yet, and this needs the greatest emphasis, the material cannot be procured from any legal source anywhere in the United States. As we explore our experience, the means of obtaining this material will become apparent.
Addicts May Number 200,000!
We in the United States of America have counted 60,000 heroin addicts. An addict known to our officials is one who has run foul of the law. Countless others can either afford their habits or have never been arrested. Therefore, the actual number of addicts is a multiple of 60,000. No one, in or out of government, knows the exact figure. The Mayors Committee on Narcotics, investigating addiction in New York City, estimated that there were 90,000 in the city alone. A figure of 200,000 for the entire country is probably not an exaggeration.
Each of these thousands of people obtains enough heroin for several injections each day despite the best efforts of the Narcotics Bureau to prevent smuggling. In fact Federal Commissioner of Narcotics, Harry Anslinger, recently testified before a Congressional Committee, If we had the Army, the Navy, the Coast Guard, and the Federal Bureau of Investigation all working together we could not prevent heroin smuggling through the Port of New York.
At this point we may begin to perceive one of the cardinal effects of a ban on heroin. Lawlessness! There are, as the story unfolds, others.
Perhaps an investigation into the nature of narcotic addiction is in order. The following paragraphs are, of course, elementary. They are inserted in the interests of completeness and because there is so little addiction in the United Kingdom that some of those who read these lines may have had little opportunity to study this symptom-complex at first hand.
A point of departure might be a short review of narcotic drugs. These materials are sedatives. They induce sleep, allay anxiety, relieve pain. This is their action in addict and in non-addict alike. It is just as important to state what they are not. They are not stimulants. They do not induce violence. Crimes are never committed under their influence.
From this necessarily short summary, let us proceed to investigate the target for this substance, the addict himself. He is, as a general rule, a shy, retiring person who is incapable of facing the vicissitudes of life. He must, like so many of the rest of us, escape from every unpleasant situation. But while others recover from periods of remorse or depression with patience, insight, a new interest, or hard work, he tries to solve all of lifes problems chemically. As the years go on, he retreats ever further from the complexities of the world. He becomes the procrastinator of all procrastinators. He has now found the answer to every pain, every difficulty, every unpleasant sensation, every trial. His dread of withdrawal symptoms further enslaves him to the drug so that he believes implicitly that he cannot live without it.
Strangely enough, the addict is a rather normal person under the influence of drugs, a highly abnormal one without them. This is the reverse of the situation observed in alcoholism. These addicts can, while they have narcotics, work in responsible positions and are not likely to be a charge on the public. Without them they are one or another variety of psychopath.
This short study of the drugs and of the addicts makes one wonder why crime and drug addiction are so closely allied in the United States. The term criminal addict, on the other hand, had to be defined every time I used it during my recent visit to the United Kingdom. Since the material cannot be obtained legally here, and furthermore, as the addict believes he cannot live without it, he must obtain it, perforce, from the underworld. These materials costing only a few cents for a days supply in Red China or in the Middle East where it is produced, are sold here for at least 1,000 times the purchase price. Such profits were sure to attract our worst criminal element. An ounce of heroin purchased for $5.00 in Syria sold for $8,000 after it was cut and diluted on the New York market.
Many of our addicts must spend $100 per day to satisfy their needs. Few of our people can hope to earn such sums legitimately, particularly since they must of necessity conceal their habit and hide from the police. In addition, the somnolence produced by the heroin makes them less capable employees, further reducing their opportunity for income. As a consequence, most of them enter into a life of crime.
How They Pay For Their Drug
The most dastardly of all their activities is the initiation of neophytes into addiction. By this means they guarantee their own source of supply, for they are paid 25 per cent commission on all the heroin they can sell. We have instances where addicts desperate for drugs have induced their wives, sisters, parents, and even their children into the habit.
Unequivocally then, I would prophesy for the people of Great Britain, if a ban on heroin were ever to be imposed, that you, a nation historically and ethnically allied to our own, would repeat our unhappy experiences. In a few years your now noncriminal 279 drug addicts (figures from Mr. A. L. Dyke, Chief Inspector, Department of Dangerous Drugs, Home Office) would have expanded to many many thousands. Many of your youth, the easiest prey for the addict peddlers, would become enslaved. Your young girls who became addicted would have sold themselves in order to support the ever-increasing costs of their addiction. You too will begin to spend sums approximating to the colossal sum that heroin costs the United States.
There are other difficulties. The peddlers of narcotics dilute the material repeatedly so that by the time the consumer receives it, it may be only 3 per cent purethe average figure in New York City. What happens when the addict by some mischance gets 20 per cent pure heroin? He receives seven times his usual dose and his life is forfeited. Many of them are sickened by the diluents which are usually non-sterile. The customer may never dare complain. He is threatened with either an interruption in his supply or a Hot Spot (one containing poison, usually cyanide). The latter is responsible for many lost lives each year.
Since Britain no longer exports heroin, even under conditions of strict control, the presence of the meager quantities of this material legitimately stocked in your country in no way influences our narcotic problem. I suppose it would be true to say that none of your heroin finds its way into the United States. Therefore, the argument that the ban is necessary in order to protect other nations is untenable.
Were the proposed ban on heroin to be revived, your presently addicted patients would be deprived of the counsel and advice of their physicians. These people will obtain heroin, come what may. Prohibition would cause them to substitute an underworld character for the one person who could have helped them, their own personal physician. I am sure that this is not the intention of your well-meaning Legislature. Make no mistake, the narcotic racketeers of the world eagerly awaited the enactment of your prohibitive law. It would have opened an illegitimate income of millions to them. May I ask your indulgence if I repeat: Heroin addicts will obtain heroin, ban or no ban.
Those of us who have interested ourselves in narcotic addiction have always admired the British management of the problem. Representatives of Medical and Bar Associations have joined forces before our Congressional Committees requesting repeal of our ban and our punitive legislation. Your heartening experiences to date have been the strongest proof that this medical problem is best managed by physicians. A complicated psychological illness cannot be cured by legislative decrees or by a policemans truncheon.
You, in the United Kingdom, have 279 registered narcotic addicts; we number ours by the hundred thousand. You have no criminal problem with addiction; ours is enormous. You know little of the social ravages of drug use; to us it is relatively commonplace.
May I then, in conclusion, urge you to bend every effort to ensure that the withdrawal of the ban is made permanent to prevent this legislative mishap. We, your American colleagues, wish you every success in this effort which demonstrates the traditional altruism of the medical profession. 
Freedom To Choose Foolishly
It must be obvious that liberty necessarily means freedom to choose foolishly as well as wisely; freedom to choose evil as well as good; freedom to enjoy the rewards of good judgment, and freedom to suffer the penalties of bad judgment. If this is not true, the word freedom has no meaning. Yet there are persons in America who wish to pass laws to force people to do only good, or at least their concept of what is good. These would-be dictators are not content with a preventive law which punishes a person who deliberately chooses to injure his neighbor; a law which prevents any person from forcing his viewpoint upon any other person; a law which penalizes the person who interferes with the liberty of others. On the contrary, these persons who arrogate to themselves the functions of God demand a positive law to compel others to do as they wish them to do.
Ben Morreel, Survival of the Species