WHEN CLINICS GAVE AWAY HEROIN

Policy: Supplying addicts in the interest of public health and safety is

not a new idea and has been tried -- in this country, in this century.

Appalled at the crime and degradation resulting from drug addiction among
the inner-city poor, public health officials take a radical step: They open
a clinic where addicts can come and get their heroin free.

The year is 1919.

"The Clinic has served a humanitarian purpose in that it has provided a
place for a careful physical examination, advice as to needed medical
treatment and careful oversight of the progress of the drug disease," wrote
New York's health commissioner, Dr. Royal S. Copeland, in January 1920.

The Worth Street Clinic, then open for just eight months, had served 7,000
addicts, cut out the "wicked profiteering" of illicit drug suppliers,
improved addicts' health and reduced crime, the doctor asserted. And it was
not alone: From 1919 to 1925, some 40 clinics across the United States
legally supplied addicts with heroin, morphine and cocaine.

History, that great recycler, may be preparing to stage an updated version
of that experiment.

Drug-policy reformers met recently in New York City to hear about the
claimed success of a three-year Swiss program of "heroin maintenance."
Baltimore's health commissioner, Dr. Peter Beilenson, and drug-abuse
experts at the Johns Hopkins University raised the possibility this month
of a research trial aimed at luring hard-core addicts into treatment by
offering them heroin.

Politicians rushed to denounce the idea. They may not have known it, but
their objections, too, were an echo of the past.

In 1920, busloads of tourists stopped to gawk at the young men standing in
New York's "dope line." Patients conned doctors out of extra doses, which
were resold on the street. Plans to wean addicts from drugs by gradually
reducing doses failed.

In March 1920, health authorities, under pressure from the federal
government, closed the New York clinic after less than a year.

"Physicians should not be permitted, under the guise of treatment, to
prescribe narcotics for such indulgence," they wrote. "The only hope is
cutting off the supply of drugs as completely as possible."

Nearly eight decades later, the old ambition to "cut off the supply of
drugs" remains the core of American narcotics policy. But the drug supply
has never been bigger, and some public health officials are again tempted
by the radical idea of providing addicts with heroin.

Most Americans assume drug abuse began with the rebellious youth culture of
the 1960s. But the problem, and the debate over solutions, are far, far older.

"People say, `Go look at the Swiss experience,' " says David N. Nurco, a
veteran Baltimore drug-abuse researcher. "I say the Swiss should look at
our experience."

Nurco remembers interviewing in the late 1970s an elderly addict -- a
safecracker by trade -- who had received narcotics from the New York clinic
in 1919.

"He said that for him, it was a good thing," Nurco recalls. "But he said
the clientele ruined it. They'd steal the typewriters and the rugs.

They'd send their girlfriends in to get extra drugs."

Given the scale of drug abuse today, it may come as a surprise that the
rate of opiate addiction in the United States at the turn of the century
was probably at least as high. Then, an estimated 250,000 Americans out of
a population of 76 million were dependent on opium, morphine and heroin,
which existed in over-the-counter medications, according to Dr. David F.
Musto, a drug historian at Yale University.

Indeed, opium and morphine addiction were so widespread that when heroin
was first put on the market by the Bayer Pharmaceutical Co. exactly a
century ago, in 1898, some doctors enthusiastically promoted it as a cure
for addiction to the older drugs.

Bayer chemists had developed diacetylmorphine chiefly as a cough
suppressant for victims of pneumonia and tuberculosis; they named it
"Heroin" from the German word for "heroic," applied to powerful drugs.

But by 1903, medical journals were questioning Bayer's claim that heroin
was not habit-forming. By 1910, police were reporting recreational use of
heroin, chiefly by young white men, mostly in New York, near Bayer's supply
houses.

In 1914, Congress banned non-medical narcotic use with the Harrison
Narcotic Act. But lawmakers failed to clarify whether doctors could legally
maintain a patient indefinitely on heroin or other

drugs. A class of unscrupulous "dope doctors" emerged, living off addicts
by writing as many as 200 prescriptions a day for heroin, morphine and
cocaine.

In 1919, at the urging of government lawyers, the U.S. Supreme Court
clarified the law by ruling that such addiction maintenance was illegal.
Police moved swiftly to shut down the prescription mills, cutting off the
drug supply for thousands of addicts.

That was when health authorities, in New York and elsewhere, opened drug
clinics to head off a crime wave. "They thought, `Oh, my gosh, we'll have a
black market, we'll have desperate addicts committing crimes,' " says David
T. Courtwright, a historian of narcotics at the University of North Florida.

Many of the clinics, says Baltimore writer Jill Jonnes, author of a 1996
history of U.S. drug culture, "were aimed at genteel, middle-class addicts
who got on drugs through medical treatment."

Such was the case, for instance, in Shreveport, La., where the chief of
police declared the clinic "a model that should be copied over the entire
United States. It has practically eliminated the bootlegger who deals in
narcotics."

In New York, far more of the addicts were recreational users with criminal
records -- gang members, gamblers and prostitutes roughly resembling heroin
addicts of today, Jonnes says.

"The neighborhood was very unhappy, because hundreds of addicts were
hanging out, waiting for their drugs," Jonnes says. Controls were lax. When
Col. Levi Nutt, the federal drug czar of his day, stood in line, he had no
trouble getting supplied with drugs.

By 1921, sometimes under pressure from Nutt's Treasury Department agents,
most clinics had shut down. The last one, in Knoxville, Tenn., closed in 1925.

On occasion since then, the maintenance option has been raised. A 1972
paper by the U.S. Bureau of Narcotics and Dangerous Drugs assessed its pros
and cons, declaring that "it might be possible to virtually eliminate the
organized black market." But whatever the medical merits, the prospect of
taxpayers paying for addicts' drugs has proved political anathema.

Courtwright, the historian, says he believes outright legalization of drugs
would be a catastrophe. But he nonetheless thinks the government took a
costly wrong turn when it closed the clinics and in effect turned the
narcotics trade over to organized crime.

"The crucial question was whether medical personnel would be allowed to
offer addicts a legal supply of drugs," he says. "After 1919, the
government said no. I think that was a serious mistake."

Checked-by: Mike Gogulski