by Bruce Dunlavy
(My blog home page and index of other posts may be found here.)
The War on Drugs was declared by President Richard Nixon in 1971. It has been fought for nearly half a century, and its failures have been well documented. When the War began, heroin deaths across the United States in a typical year numbered in the low four figures. In 2017, deaths from heroin were over 13,200, and opioid (prescription drugs as well as heroin) overdoses topped 60,000 nationwide. There were over 600 on Long Island alone.
The problem of opioid abuse has been laid squarely at the foot of those who created, promoted, and allowed the explosion of over-prescribed opioid pharmaceuticals, from money-hungry manufacturers to careless or crooked prescribers to politicians who put corporations above communities. This blog has published two previous posts on the heroin/opioid crisis, here and here.
No one disputes the terrible damage visited on America by opium, its derivatives, and its synthetic siblings. But opioids are not the only horrific side effect of the War on Drugs. There is a subtler, slyer companion calamity causing damage and loss of life that is not so well-documented. Its roots are not in medicine, but in politics.
The first great political attack on drugs occurred a century ago, when the United States enacted Prohibition. On January 16, 1919, the Eighteenth Amendment was ratified, giving one year for adjustment to a ban on “the manufacture, sale, or transportation of intoxicating liquors within, the importation thereof into, or the exportation thereof from the United States … for beverage purposes.” “Intoxicating liquors” meant anything that included ethanol (ethyl alcohol), such as beer, wine, or whiskey. Today, only a very few hard-liners suggest that such a program would be anything but a disaster, but at the time it was a genuine political issue.
At the same time that Prohibition was beginning its 14-year reign, there was another public health idea on the rise. On January 1, 1918, Dr. Charles Norris was appointed the first Chief Medical Examiner of New York City. Norris’s new office replaced that of the Coroner, and he used it as a platform for attacking public health problems that could lead to morbidity and mortality – notably the acute and chronic effects of industrial and household chemicals on human health.
Charles Norris, M.D. Image credit: wptschedule.org
Among the matters the far-seeing Norris was the first to bring to attention were lead in gasoline, carbon monoxide from home use of natural gas, and the dangers of “impure liquor” consumed while manufactured alcoholic drink was illegal. As Prohibition progressed, Norris noticed in his work an increase in deaths from the consumption of bootlegged liquor that had been tampered with to increase profits, liquor substitutes such as rubbing alcohol or fuel alcohol, and homemade “bathtub gin.”
Norris warned that Prohibition would have the deleterious side effect of driving alcohol addicts and abusers to these unsafe options, and he prophesied an increasing death toll from accidental poisoning. But his admonition was disregarded. Indeed, the government’s response to the use of substitute chemical intoxicants was to make them even more dangerous. Industrial alcohols were commonly stolen by bootleggers and used to create, through re-distillation, drinkable alcohol. So industrial alcohol products were ordered to be “denatured,” which meant adding poisonous chemicals to render them unpalatable or unsafe to drink. Among the additives were lead, formaldehyde, chloroform, and carbolic acid, usually in such small amounts that the primary effect was to make the alcohol taste so terrible that no one would drink it. An easier and more insidious practice was to add methanol (wood alcohol), which causes blindness, dementia, and death. The Federal government allowed up to ten percent methanol to be added to industrial alcohols.
The idea was apparently to scare people away from drinking. It didn’t work very well, as Norris had predicted. In 1926 he openly accused government agencies of complicity in thousands of deaths: “the United States Government must be charged with the moral responsibility for the deaths that poisoned liquor causes.”
He attempted to make the problem as widely known as possible, releasing statements about every death from adulterated alcohol and warning in 1928 that “practically all the liquor sold in New York today is toxic.” The story of Norris’s battle against Prohibition’s excesses is part of Deborah Blum’s excellent book The Poisoner’s Handbook, which was the basis for an episode of American Experience on PBS.
What can we learn today from the life and work of Dr. Norris and his team at the Medical Examiner’s office? We can learn the following:
- Once people find a drug they like or become addicted to, they are not going to give it up if there is any possible way to keep getting it
- No amount of scare tactics or poisonings will stop them from using
- Political fights are a poor justification for enacting laws that are detrimental to public health
Since the 1960s, there has been a very political – and very public – battle about the use of marijuana. Marijuana was the poster child for the Culture Wars of the 1960s and 1970s. It was associated with the anti-war, pro-civil rights, free-love hippies who seemed to be hell-bent on destroying “American values.” Although marijuana had long been known to be less harmful than tobacco, it was placed in the pantheon of dangerous drugs alongside heroin.
Anti-drug politicians were so incensed about the perceived evils of marijuana that they even revisited the same poisoning tactics that had been such a disaster during Prohibition. In the 1970s, the Federal government sprayed the herbicide Paraquat on marijuana fields in Mexico. Although maintaining that it was being used for plant-killing purposes, spokespersons took pains to stress the toxicity of Paraquat in hopes of frightening users into giving up the Evil Weed.
Of course, it is common knowledge that prohibitions on marijuana are not scientific; they are political. It is a last-ditch, rear-guard holding action by the Culture War losers to win a battle after the war has ended.
Today, marijuana is classified as a Schedule I drug – the highest grouping, reserved for the most dangerous illegal drugs. Schedule II, one step down on the danger scale, includes OxyContin, methamphetamine,cocaine, and fentanyl, among others. There is no record of anyone ever dying from an overdose of marijuana, yet it is classified as more dangerous than cocaine, fentanyl, or codeine (a Schedule III drug.) The explanation is that marijuana is dangerous because it is a “gateway drug” which leads its users to other illegal substances. Presumably, those other substances include Schedule II’s fentanyl, methamphetamine, etc., meaning marijuana is so dangerous because it might lead its users to less dangerous drugs!
Charles Norris was prescient in his warning that the shutoff of supplies of regulated, dependably produced ethanol would cause users to seek out more dangerous (but legal) substitutes, no matter how toxic they might be. Battery acid, lamp fuel, paint thinner, industrial solvents – anything that might produce the desired intoxicating effect was a possibility.
Yet today, we are seeing this fruitless prohibition causing serious public health problems. Marijuana may be illegal at the Federal level and in most States, but there is a constant influx of bizarre and dangerous substitutes – “bath salts” were among the first, but many more have followed: K2, “Black Mamba,” and dozens of chemically-enhanced herbs. None of them are quality-controlled, nor are they subject to regulation until governmental entities playing catch-up rewrite their laws to include each new substance that comes along.
Charles Norris was right a century ago. Public health is not a political football. Science is the proper venue for establishing the danger of intoxicants, and science should take the lead. Politics should follow, with the public interest foremost in lawmaking.