State Control: The Tennessee Narcotic Act Of 1913

2015

Tennessee’s revised narcotic law came into effect more than a year before the Harrison Act. Its most distinctive feature was the registration of addicts to enable them to have opiate prescriptions refilled “to minimize suffering among this unfortunate class” and to keep “the traffic in the drug from getting into underground and hidden channels.” ”

Like Dr. Terry, Tennessee’s State Food and Drug Commissioner Lucius P. Brown believed that physicians were the leading culprits in causing addiction. He warned that “a very large proportion of the medical profession has either lost sight of the fact that the habitual use of an opiate produces a true disease, or never knew it.” The withdrawal symptoms, he said, were a specific disease, possibly fatal if not forestalled by the readministration of opiates. In this conviction he was following information, readily obtained from journals and textbooks, that was the chief argument for the medical approach toward addiction — it was a true disease, not a mere habit conquerable by exertion of the will.

Brown outlined the state’s options: either provide opiates to indigent addicts to prevent suffering and perhaps death, or provide “state curative treatment for all indigent addicts, with permanent commitment of those incorrigible to institutions for the feebleminded.” After registering addicts and gathering statistics in Tennessee, the option of cure or commitment proved “to be out of the question … because of the enormous number of persons involved.” The reasoning is simply stated: if addiction is a disease, the victim can hardly be made to suffer for what he cannot help and, if the state cannot build gigantic sanitaria, the necessary drug must be provided. Issues of degeneracy, criminal behavior possibly induced by drugs, and moral turpitude leading to addiction were ignored by the Commissioner. The physician or druggist was seen as the chief wrongdoer and the state as the inevitable and reluctant caretaker.

In meeting the problem of addiction the state must prevent abuse of prescriptions. Numerous regulations were intended to assure that certified addicts received drugs at only one store and that the amount was recorded. When the permit was renewed an attempt was supposed to be made to lessen the amount of the drug allowed.

In the first twelve months of operation 2,370 persons were registered, of whom 86 percent used morphine. Only 1.3 percent used heroin, although it was thought that more heroin addicts remained unregistered, “inasmuch as this drug is used almost altogether for dissipation.” Females outnumbered males two to one; the average age of addicts was 49 for both sexes and they had been addicts an average of eleven years. Although a fourth of the Tennessee population was black only a tenth of the addicts registered was black. Commissioner Brown suggested that this might be due to the fact that “the average Negro avoids as far as possible any contact with an official and to the fact that the Negro appears to use relatively less morphine, and more cocaine, than the white man.” Cocaine was not included in registration because it was felt that no disease or “toxemia” was produced by it; one could stop cocaine without any dire physiological consequences. Commissioner Brown confidently placed the blame for the addict population: “Other investigations by me, as well as the experience of all other writers on this subject, would appear to indicate that well over 50 percent of existing cases of narcotic addiction are due to the indiscreet administration of drugs by physicians.”

The Tennessee experience gives excellent information on heroin addiction. The suspicion that fewer than the actual number of heroin addicts were registered, and that heroin was used simply for dissipation, reflects attitudes toward the age group which used heroin: “youngsters from 15 to 25 years of age.” Heroin was described as having “a very pronounced stimulant effect, and for that reason is largely used by boys and young men as a means of dissipation.” The association between young men and boys and heroin was to be a repeated phenomenon in the decade 1910-20. Heroin’s appeal for the adolescent seems to set it off from opium-smoking, morphine, laudanum, gum opium, etc. The age of heroin users was much lower than the average age of Tennessee’s other registered addicts. Brown thought the habit, “as might be expected from the character of its devotees,” would be difficult to cure and advised: “The sale of this drug ought to be hedged about with just as rigid and drastic restrictions as are possible to enact into law.”

Neither Terry nor Brown was optimistic about cures in private sanitaria or by private physicians. Brown saw institutionalization as an impracticable ideal. For both, in fact, medical treatment did not mean cure, but prevention of suffering. But addiction maintenance would be associated in the public’s mind with moral turpitude, the spread of vice and crime, indulgence in sensual delights, and the destruction of the human soul. In New York State, from 1913 to 1920, the full expression of these conflicting attitudes, as well as the interplay of mercenary and political influences, provides an instructive record.