History of Medicine
In these times of relative intolerance towards ‘recreational’ drugs, it is easy to lose sight of historical perspective. Education and health awareness programs have influenced the attitudes of Canadians to the extent that most people would not question the fact that drugs, both licit and illicit, can be physically and socially destructive. It is quite apparent however, that a double standard exists for the acceptance, or at least tolerance, of certain drugs in society. Our moral framework of drug use is such that the use of alcohol, caffeine, and nicotine is generally not a moral crime, and certainly not a legal crime for adults. On the other hand, outside of a select group of medical uses, the consumption of morphine, cocaine, and marijuana is generally viewed as morally reprehensible, and is subject to criminal punishment under the Narcotic Control Act.
To answer the question of how this incongruent state of affairs was born, one has to examine centuries of history and follow a chain of events stretching from tea in China, to the Industrial Revolution in Europe, to North America at the end of the 19th century. The story is a fascinating example of how moral reform movements, racism, and the pursuit of political power can combine in an ‘unholy’ alliance to change society in ways that the original participants could never have imagined.
This essay will review the forces that led to the creation of Canada’s Opium Act (1908), and the United States’ Harrison Narcotics Act (1914). Rather than serve as a detailed historical treatise, the paper is an attempt to provoke readers to question why we have narcotics laws and to ask themselves: "What purpose do these laws serve?" Particular consideration will be given to how social and legislative pressure forced the use of certain drugs to the fringes of society, and then labeled the group involved in their use and distribution as criminals.
By the late 18th century, tea-drinking had already become an integral part of British society. In order to meet this insatiable British demand, the East India Company imported vast quantities of tea from China for an enormous profit. However, largely because of this one-sided trade in tea, between 1760 and 1830, Britain accumulated a trade deficit with China of roughly 100 million dollars. In order to combat this imbalance, British merchants tried to increase trade between their colonies in India and China. Trade between Britain and China included various products including cotton and Indian opium (1).
Although there has been much scholarly debate about how cultural, racial, and political motivation all contributed to the war between Britain and China, there is no doubt that the trade of opium was at the centre of the conflict (1). Importing opium into China was prohibited by Manchu Emperor Yung-Cheng in 1729 as a measure to decrease ‘immoral’ opium smoking (1). This immorality stemmed from Confucian views that "using the drug [opium] habitually led to [a] gross offence against filial piety" (11). Not all the Emperor’s subjects followed this belief and the opium trade flourished. Chinese officials could do little to stop the smugglers; officials were bribed and the Imperial Chinese navy was no match for the smugglers’ warships and fast clippers. Officially, the British controlled East India Company forbade their ships to even carry opium, however, in reality they had built up the opium trade to the point where it was "probably the largest commerce of its time in any single commodity, anywhere in the world" (11).
By 1840, the opium trade was causing serious economic problems for China, as a large portion of its silver reserve was being drained to buy Indian opium. When Emperor Tao-Kuang came to power in 1821, he led a ‘patriotic’ movement to ‘save’ China from opium. An essay written in 1833 entitled, "Essay on Eradicating the Disaster," describes the disaster not as the use of opium, but rather the loss of silver (1). It seems that economic reform, which hid behind the guise of moral reform, was the driving force behind China’s unsuccessful campaign to enforce opium prohibition. This essay stressed that opium prohibition would probably never succeed and could only lead to corruption. This view was never presented to the Emperor, as his moral stance would in no way allow for the legalization of opium (1).
Mid-way through 1839, the Chinese introduced a determined new program to eliminate the use of opium. The subsequent destruction of a large amount of Indian opium by the Chinese lead directly to the conflict known as the Opium War (1840-1842). The British Royal Navy easily defeated the Chinese, and the end of the war was marked by the signing of The Treaty of Nanking in 1842. This treaty opened Chinese trading ports, including Hong Kong, and ended the Chinese anti-opium crusade. A second Opium War (1856-58) lead to the legalization of opium trafficking in China (1). This second war was an effort by the ‘Great Powers’ of the time – Britain, France, Russia, and the United States to win concessions from China. The political and military maneuvering of this conflict is beyond the scope of this essay; a comprehensive review by Beeching (1975) details the politics of the era (11). It was not until 1906 that China embarked on another anti-opium program (2).
At the height of the opium trade (1830-1840), it has been estimated that 0.7% of the Chinese population (3 million people) were ‘addicted’ to opium. However, since no records exist detailing the number of addicts in China during this time, historians have made the simple calculation of dividing imports of opium by the theoretical daily amount each opium user would consume (1). The figure of 0.7% is a gross overestimation because it assumes that every user was an ‘addict’ and that no opium was for medicinal purposes. Before Britain started exporting opium, the Chinese had used opium for over a thousand years for various illnesses, including pain relief and dysentery. It is improbable that there were 3 million addicts in China, and the government campaign of ‘opium mania’ was probably an attempt to win support for opium prohibition to improve China’s economic situation.
"For most of human history, drug use has been informally controlled by cultural norms, and the criminal law had no role in determining what people ingested" (3). This quote, from Steven Duke and Albert Gross serves as a reminder that drug control is a modern phenomenon. As these authors suggest, every culture has its own drug that may be used in association with particular social or religious events, to provide release and "achieve pleasure" (3).
The introduction of new drugs from foreign lands came at a time when Western society was going through the social changes of the Industrial Revolution. As people moved from the closely-knit social structures of small communities to large cities, they were presented with "a varied menu of imported drugs and the weakening of cultural controls". As the 19th century came to a close, society’s views on the use of drugs began to change from one of tolerance - viewing their use merely as ‘bad habits’- to one of moral evil (3). These changing attitudes added momentum to a campaign for drug prohibition. How did this happen? The answer lies in a closer examination of the medical profession, racism, and international relations.
When the 19th century began, "‘heroic therapy’ that killed as often as it cured" was mainstream medicine (4). To cure pain the physician relied heavily on opium; and the combination of physician over-prescription, the introduction of the hypodermic needle, and accessibility to new potent opiates, such as morphine and heroin, led to a rapid increase in the consumption of opiates. At the height of opiate use there were an estimated 250,000 ‘addicts’ in America (4).
In 1901 the American Medical Association began lobbying to transform the availability of drugs. One of their goals was to increase the medical control of drugs by increasing the physician’s prescribing authority. This campaign was a direct effort to curb the non-medical use of opiates. To encourage patients to seek advice from physicians, the AMA worked vigorously to expose the fraud of ‘quack’ medicine, and lobbied politically to gain control over drug distribution via physician-regulated prescription. This effort of the AMA was partly responsible for the introduction of the Harrison Narcotic Act in 1914, which legislated that opiates and cocaine could only be used when prescribed by a physician and dispensed by a pharmacist (5).
Before the Harrison Narcotic Act was passed, the "typical addict appeared to be a respectable woman, whether in city or county, whose dependence began in prescription from a physician for real or fancied ailments" (4). After the Harrison Narcotic Act was passed, the demographics changed such that the predominant users were young males of lower socioeconomic class. This group of users did not obtain the drugs from a physician but rather from a black market, which sprang up in part because physicians refused to challenge the idea that addiction was a crime rather than a disease (5). Reasons for the change in demographics are explained in a paper by Neil Boyd: economics and a socially constructed criminal pathology (14). To quote Boyd:
|"The law would serve to socially construct a criminal pathology. The greater severity of punishment naturally led to increased business risks, risks that were passed on to the consumer in the form of high prices. The…addict became quite literally an individual who had to steal to support a craving. The legal creation of false scarcity was socially responsible for the self-fulfilling assertion – the …addict as lowly predator" (14).|
Historical research tabulated by Brecher (1972) concurs with this hypothesis and demonstrates that the demographic profile of addicts changes with the channels of distribution (12). When narcotics were prohibited law-abiding citizens quit or found a new vice, and those that were addicted were left to fall through the cracks of society.
When the Harrison Narcotic Act was passed the intent of the law was to ‘clean-up’ the patent-medicine industry and regulate physician-controlled prescription. Brecher (1972) went as far to say that, "It is unlikely that a single legislator realized in 1914 that the law Congress was passing would later be deemed a prohibition law" (12). The criminal justice system of the United States interpreted the Harrison Act to mean that since "addiction is not a disease, the addict who seeks a maintenance dose is therefore not a patient and maintenance doses are therefore not supplied in the course of…professional practice" (3). Outrage in the medical community over the interpretation of the Harrison Narcotic Act simmered into the editorial pages of the day:
|"Narcotic drug addiction is one of the gravest and most important questions confronting the medical profession today. Instead of improving conditions the laws recently passed have made the problem more complex…One has only to think of the stress under which the addict lives, and to recall his lack of funds, to realize the extent to which these…afflicted individuals are under the control of the worst elements of society."|
If the medical community had such insight, why did it allow the addict to become a criminal? One reason was that the AMA was still in its relative infancy and it was not prepared for a political campaign. As detailed by David Musto (1973), before World War I, the AMA was a relatively small group of physicians that enlisted the legislators to increase their professional status (13). By the 1920’s the AMA had grown substantially in prominence and mounted considerable, yet unsuccessful, opposition to the Harrison Act (13). Therefore, in order to escape the shadow of iatrogenic drug addiction, and increase their professional power and public respect, the AMA abandoned the drug addict and "allowed the Supreme Court…to define appropriate and inappropriate treatment for opiate addiction" (5).
American sociologist Howard Becker first used the term ‘moral entrepreneurism’ to describe, "those highly committed individuals who take it upon themselves to disseminate their views to the public and to make sure that their own version of right and wrong becomes law for all" (6). The story of how Canada came to pass the Opium Act in 1908, reviewed in detail by both Green (1979) and Cook (1969), is one that revolves around a moral entrepreneur named William Lyon Mackenzie King.
The opening of the Canadian west by railroad relied heavily on Chinese labour. By the late 19th century the job opportunities of the railway had disappeared, and now the Chinese were competing for employment opportunities with the white population . Increasing resentment towards Asians boiled over in 1907, when a riot broke out in Vancouver during an anti-Asian demonstration (6). The federal government sent Mackenzie King (Deputy Minister of Labour) to Vancouver to investigate the riot and reimburse business owners who suffered damages (6, 7).
The discovery that two opium merchants wanted reimbursement for their losses lead King to embark on an investigation of the opium ‘evil’. It seems that the evil was particularly intolerable because "the habits of opium smoking was making headway, not only among white men and boys, but also among women and girls" (6). King’s support for legislation to restrict the sale of opium stemmed from his moral stance that "to be indifferent to the growth of such an evil in Canada would be inconsistent with those principles of morality which ought to govern the conduct of a Christian nation" (6). Mackenzie King delivered his report on opiate use to the Minister of Labour in 1908, and within three weeks narcotics legislation was drafted and passed in the form of the Opium Act (6). This Act stated that the sale of opium for non-medicinal uses was punishable with a maximum 3 year prison term and a $1000 fine (10).
In the United States and Canada during the beginning of the 20th century, the temperance movement was enjoying widespread support and indulgences such as alcohol, opium, cocaine, and sexual promiscuity were commonly blamed as the root of moral degeneration (3, 4). In order to promote their views and gain support for legislative change, these moral reformers used racism and fear-mongering as publicity tools (3, 4, 6, 7). The following are some of the common portrayals of drug users and their habits indicative of the views being propagated:
|"The colored people seem to have a weakness for it [cocaine]. They have no regard for right or wrong. They would just as leave rape a woman as anything else and a great many of the southern rape cases have been traced to cocaine"|
"It is claimed also, but with what truth we cannot say, that there is a well-defined propaganda among the aliens of color to bring about the degeneration of the white race. It is hardly credible that the average Chinese peddler has any definite idea in his mind of bringing about the downfall of the white race, his swaying motive being probably that of greed, but in the hands of his superiors, he may become a powerful instrument to this end."
|"Persons using this narcotic, smoke the dried leaves of the plant, which has the effect of driving them completely insane. The addict loses all sense of moral responsibility. Addicts to this drug, while under its influence, are immune to pain, and could be severely injured without having any realization of their condition. While in this condition, they become raving maniacs and are liable to kill or indulge in any form of violence to other persons, using the most savage methods of cruelty without, as said before, any sense of moral responsibility."|
Propaganda such as this served to isolate addicts from mainstream society and label them as a dangerous group. Alcohol, which was also labeled morally unacceptable, probably escaped legislated restriction in Canada because the reformers could not persuade the middle class to give it up. For the majority of Canadians, banning opiates was not a contentious issue; it would appease the reformers thirst to battle ‘moral evil’, while leaving unrestricted access to their drug of choice, alcohol (3).
At the end of the Spanish-American War in 1898, the United States found itself in control of the Philippines (2). The former Spanish rulers operated a system where opiate addicts were licensed and provided with narcotics (8). This policy did not agree with Reverend Charles H. Brent, first Episcopal bishop of the Philippines, who lead a campaign supported by American missionaries in China to eliminate drug trafficking (8). It is unclear if this moral effort alone would have succeeded in persuading the U.S president, Theodore Roosevelt, to lobby for an international opium conference. Regardless, the U.S had much more at stake than morals for wanting a ban on international opium production (9). As explained by David Musto (1994), many reasons led to the movement for drug control in the United States:
In 1906, China started yet another effort to eliminate opium smoking (2). The United States, which in 1905 saw China start a boycott against American consumer goods in response to U.S racism directed at Chinese immigrants, saw agreement with Chinese opium policy as an opportunity to establish better relations (9). Furthermore, the U.S wanted to gain access to the vast Chinese marketplace:
|"If we continue and press steadily for the Conference, China will recognize that we are sincere in her behalf, and the whole business may be used as oil to smooth the troubled waters of our aggressive commercial policy there."|
In 1909 and 1912 international commissions were convened, and the participating nations signed a treaty requiring the control of morphine and cocaine. These commissions were instrumental in the introduction of the Harrison Narcotics Act in the U.S in 1914, and subsequent changes to Canada’s Opium Act of 1908. In order to get global support for the conferences, the Hague Convention was attached to the Versailles Treaty, which ended the First World War (6).
Canada’s Opium Act and the United States’ Harrison Narcotics Act were the direct result of:
None of these groups (except perhaps the moral reformers) wanted or would have conceived of an environment where the drug user is imprisoned. Yet that is what faces the current drug user in North American society. They are outcasts, and viewed as unproductive members of society. It is to the shame of the medical and legal professions, which both profess to protect the interests of the weak, that the problem of criminalization of addiction is not addressed politically.
1. Chung, T., China and the Brave New World, Allied Publishers Private Limited, Bombay, 1978, pg 71-221.
2. Musto DF., Opium, Cocaine, and Marijuana in American History, Scientific American, July, 1991, pg 40-47.
3. Duke SB, Gross AC., America’s Longest War, GP Putnam’s Sons, New York, 1994, pg 78-86.
4. Morgan HW., Drugs in America, Syracuse University Press, Syracuse, 1981, pg 10-43, 88-117.
5. Porter R., Teich M., Drugs and Narcotics in History, Cambridge University Press, New York, 1995, pg 114-128.
6. Green M., A History of Canadian Narcotics Control: The Formative Years, University of Toronto Faculty of Law Review, 1979; 37:42-79.
7. Cook S., Canadian Narcotics Legislation, 1908-1923: A Conflict Model Interpretation, Review of Canadian Sociology and Anthropology, 1969; 6(1):36-46.
8. Bertram E., et al., Drug War Politics: The Price of Denial, University of California Press, Los Angeles, 1996, pg 61-77.
9. Musto DF., The Global Drug Phenomenon: Lessons from History and Future Challenges, in: Perl RF., Drugs and Foreign Policy, Westview Press, San Francisco, 1994, pg 1-6.
10. Erickson PG., Cannabis Criminals, Addiction Research Foundation, Toronto, 1980, pg 14-17.
11. Beeching Jack, The Chinese Opium Wars, Hutchinson and Co., London, 1975, pg 11-39, 295-331.
12. Brecher Edward, Licit and Illicit Drugs, Little, Brown and Company, Boston, 1972, pg 3-63.
13. Musto DF, The American Disease, Yale University Press, New Haven, 1973, pg 56-63.
14. Boyd Neil, The Origins of Canadian Narcotics Legislation: The Process of Criminalization in Historical Context, Dalhousie Law Journal, 1984; 8:102-136.