Heroin Maintenance Policy Seminar: Summary of Proceedings

Foreward

The National League of Cities encourages the formulation of creative solutions to our urban problems through an open and participatory process of policymaking. It was this process that brought NLC to its present advocacy of heroin maintenance research. Drug abuse, especially in the form of heroin addiction, represents a major obstacle to restoring the health and vitality of our inner cities. NLC is not afraid of taking some risks in the search for solutions to the debilitating problem of heroin addiction.

We were pleased to sponsor the Heroin Maintenance Seminar under a grant from the Drug Abuse Council of Washington, D.C. These proceedings capture the flavor of the open debate and dialogue that characterized this meeting. The seminar was only a first step in examining the feasibility of heroin maintenance experiments, but it provided a useful summary of the potential benefits of such a program. The National League of Cities will continue to encourage exploration of policy alternatives in the drug abuse field.

Many persons shared responsibility for the Heroin Maintenance Seminar. First, our thanks to Thomas E. Bryant and Peter Goldberg of the Drug Abuse Council. The Council not only funded the seminar and the publication of these proceedings, it also offered assistance and encouragement to NLC's Human Resources Committee as it struggled with the development of an urban drug abuse policy. Most of the credit for organizing and designing the seminar goes to Carol Moody Becker, who served as Director of NLC's Drug Abuse Project until October 1, 1977. Cathleen Schurr provided a summation of the verbatim transcript of the seminar.

Alan Beals Executive Director National League of Cities

Seminar Agenda

PLACE: National League of Cities (NLC) 1620 Eye Street, N. W. Washington, D.C. 20006

DATE: June 2, 1977

SEMINAR CHAIRMAN: The Honorable Richard G. Hatcher Mayor of Gary, Indiana Former Chairman of the NLC Human Resources Committee

WELCOMING REMARKS

Fred Jordan, Director of Communications National League of Cities

Thomas E. Bryant, President Drug Abuse Council

PANEL DISCUSSION ON THE HEROIN ADDICTION PHENOMENON

Mayor Hatcher "Impact of Heroin Addiction on the Inner City"

Judge Charles Halleck, Superior Court of the District of Columbia "Impact of Heroin Addiction on the Criminal Justice System"

Norman E. Zinberg, M.D. Harvard Medical School "Factors Relating to the Continuing Increase in Heroin Use and Addiction"

COMMENTS AND QUESTIONS FROM SEMINAR PARTICIPANTS

PANEL DISCUSSION ON HEROIN MAINTENANCE RESEARCH

David Lewis, M.D. Washingtonian Center for Addictions

Chairman, Mayor's Coordinating Council on Drug Abuse, Boston "Pros and Cons of Heroin Maintenance".

George Gaines, Deputy Director Detroit Health Department "Heroin Maintenance Research in Microcosm-Detroit"

COMMENTS AND QUESTIONS FROM SEMINAR PARTICIPANTS

SPEAKER: Robert L. DuPont, M.D., Director National Institute on Drug Abuse "The Federal Perspective on the NLC Drug and Alcohol Abuse Policy"

PANEL DISCUSSION ON VICTIMLESS CRIME

Charles Morgan, Jr. Charles Morgan, Jr., & Associates, Chartered Member, National Board of Directors American Civil Liberties Union "The Civil Rights Perspective" Sterling Tucker, Chairman District of Columbia City Council "'Me Political Perspective"

Chief James York Orlando, Florida Member, Police Executive Research Forum "The Police Perspective" SUMMARY, CONCLUSIONS AND FUTURE DIRECTIONS

Mayor Hatcher

Development of NLC Drug Abuse Policy and the Heroin Maintenance Seminar.

The National League of Cities' heroin maintenance policy evolved from its concern about the overall impact of heroin addiction and trafficking on the urban environment. In addition to alarm over the debilitating effects of addiction on urban youth, an equal concern was felt about the impact of heroin-related crime on the general community. Particular attention was given to inner-city residents for whom the day-to-day task of living is inherently difficult because of the burden of poverty. Property crimes committed against the poor, including those committed to obtain money for illegal drugs, strain life to the boiling point. Such crimes further reduce the circumstances of the poor, and make community and economic development a theory instead of a reality.

The NLC Human Resources Committee began to consider heroin maintenance research because it seemed to address the committee's concern with both the addicted and the community at large. It was felt that this research should be conducted in order: (1) to determine if heroin maintenance could undermine the high cost of street heroin and thereby reduce heroin-related crime; and (2) to assess the medical and social effects of heroin maintenance on the addicted.

It should be noted that while the NLC Human Resources Committee was developing its heroin maintenance policy, the committee was also focusing on drug abuse prevention. Heroin maintenance was seen as a means of coping with the problem after the fact. The greater concern was with those factors in the urban environment which lead youth, in particular, to seek drugs as an escape from reality.

The committee recognized that many of the urban factors which lead youth to drug use and abuse relate to national concerns such as distribution of income, family structure, and quality and availability of education and housing. Addressing these broad concerns requires long-range planning and implementation at the federal level, with extensive program coordination at all levels of government. However, the committee believed that meaningful unilateral as well as cooperative attempts could be made by government to develop some broad prevention approaches in the schools, through the development of meaningful job training and employment opportunities for youth, and the provision of adequate recreational activities.

The membership of the NLC approved this policy unanimously. Inherent in their approval was the fact that local elected officials have considerations beyond drug abuse which extend to the protection and quality of life of the whole community.

Following its passage at the Congress of Cities in December 1976, the NLC Drug Abuse Policy received wide press coverage which resulted in the NLC receiving numerous inquiries and comments from associations and individuals about how the policy should be implemented. The League found itself in the position of being the only national political organization to have taken such a position on heroin maintenance.

The League envisioned pursuing its policy in two ways. First, it would seek support for an in-depth study of policy alternatives relating to heroin maintenance in pilot cities. If this study indicated that pilot heroin maintenance research programs were feasible in those cities, then additional support would be sought for implementation.

Second, it would promote serious public discussion of the issue, particularly among policymakers. The seminar described in this publication was such a discussion. The seminar participants included policymakers from the executive and legislative branches at the federal, state, and local levels of government and from the private sector. The panelists were comprised of League members and representatives from the legal and medical professions and the criminal justice system.

Seminar Discussions

a. Opening Remarks
b. The Heroin Addiction Phenomenon
c. Heroin Maintenance Research
d. The Federal Perspective on the NLC Drug and Alcohol Abuse Policy
e. Victimless Crime

The seminar was chaired by Mayor Richard G. Hatcher of Gary, Indiana. Mayor Hatcher, as Chairman of the NLC Human Resources Committee, had taken the lead in developing heroin maintenance as an issue for the committee's consideration. He then served as spokesman for the policy at the NLC Congress of Cities. The delegates to that body ultimately accepted the committee's recommendations on a heroin maintenance policy and included them in the 1977 NLC National Municipal Policy.

a. Opening Remarks

Fred Jordan, NLC's Director of Communications, put this policy in perspective. He pointed out that the local elected officials who were delegates to the Congress of Cities were hard-headed pragmatists. They can hardly be categorized as radical by any stretch of the imagination. Their approval of the policy, in Mr. Jordan's opinion, is tantamount to "telling us... the epidemic... rages in the cities of the country" and "is a matter of such high priority with them that they feel it's time for the country to begin looking at any and all feasible means of help."

Dr. Thomas E. Bryant, President of the Drug Abuse Council, underscored the Council's serious assessment of the NLC policy. The policy is of major importance since it reflects the collective concerns of the country's local elected officials with responsibility for the general welfare of America's cities. While referring to the policy statement as appropriately cautious and modest, Dr. Bryant also called the NLC initiative courageous, responsible, and remarkably effective in promoting open discussion of alternatives to current drug programs and policies.

Dr. Bryant pointed out that the NLC policy did not call for a national heroin maintenance system, but rather for exploration of the feasibility of conducting research on such a program. Dr. Bryant explained his personal as well as Drug Abuse Council reservations about a heroin maintenance system. He felt, however, that one could not ignore the escalating social costs of drug abuse, despite the $3 billion spent for federal drug abuse efforts in the past four years.

Dr. Bryant stated his conviction that the pursuit of total elimination of heroin abuse seemed to have increased prices of heroin and the attendant black market activities which are detrimental to the addicted and to the community at large. He concluded by saying:

We can no longer dismiss out of hand any alternative proposals for dealing with drug problems. They all deserve to be discussed... distinguishing more carefully between what we would like to see happen and what we can practically and realistically predict will happen.

He further recommended that:

... we relinquish our moralistic demands for total abstinence of non-approved drugs, and turn instead to the consideration and adoption of policies designed to reduce some of the social costs of drug abuse.... To those who would say how can we avoid making matters worse, I would provide a simple answer, how can we afford not to take the risk?

b. The Heroin Addiction Phenomenon

Mayor Hatcher's concern over the effects of heroin abuse on Gary, Indiana, caused him, as Mayor of that city, to undertake an assessment of drug abuse prevention and treatment efforts in his community and in the nation. The continuing growth of drug and drug-related problems led him to the conclusion that our present approaches are ineffectual at best and may even contribute to the problems. He concluded that the situation demanded new approaches, even consideration of such "unthinkable" experiments as heroin maintenance. Mayor Hatcher described the political risks he took in raising heroin maintenance as a topic for discussion:

I also run more danger of risk, not only as an elected official, but as a black elected official, because as many of you know... many members of minority groups feel very strongly that heroin addiction is just one more form of genocide, one more conspiratorial plot to eliminate or at best neutralize millions of people across this country who happen to be members of minority groups.

The Mayor went on to describe heroin addiction in his city as "marked by dimensions of enormous personal tragedy." Young people waste their lives in the heroin subculture, and sometimes turn to crime to support their habits. Families and neighborhoods are torn apart by hatred, despair, and fear. Central cities are perceived as hazardous, and this discourages businesses which could provide desperately needed jobs to inner-city residents.

Mayor Hatcher concluded:

... I have become convinced that central city crime rates and addiction rates are inextricably intertwined.... As an administrator of a city, my judgment is that heroin addiction, along with other forms of drug abuse, tends to make cities most dysfunctional.

Judge Charles Halleck of the Superior Court of the District of Columbia discussed escalating court costs, the lack of correlation between drug abuse and unemployment, the perpetuation of what he considered unnecessary drug abuse programs, and possible parallels between decriminalization of alcohol abuse and decriminalization of drug abuse.

Judge Halleck pointed out that public inebriation was decriminalized several years ago in the District of Columbia. As a result, he said, millions of dollars in court time have been saved and freed to deal with other more pressing matters. And there seems to have been no appreciable increase in the number of alcoholics on the street. Considering that in 1975, 18 percent of all male arrests and 17 percent of all Superior Court cases involved drugs, it is clear that the impact of drug abuse on the criminal justice system is significant and costly. Judge Halleck emphasized the need to consider these financial factors. In Fiscal Year 1976, despite increased costs and inflation, the District of Columbia court funds and staff were cut. As Judge Halleck put it, ". . . public officials are responding to taxpayers' revolts, and they simply are not appropriating more monies to run the court systems." In view of this trend toward austerity, he suggested that the focus should be on the crimes which the public fears most-violent crimes against persons and property.

Judge Halleck said that the impact of drugs on the criminal justice system results from the laws that make drug abuse a crime. He suggested that the decriminalization of alcohol abuse should be analyzed with a view to the possible decriminalization of drug abuse, and he emphasized his belief that drug abuse is a medical problem which is not appropriately handled through the court system.

Judge Halleck then went on to question other assumptions about drug abusers. One such assumption is that drug abusers are generally unemployed and need to commit crimes to support their habits. A computerized analysis of court records indicated that 55 percent of those charged with simple drug offenses in the District of Columbia were employed. Other studies have indicated that the frequency with which addicted individuals commit crimes does not materially change between the pre- and post-addiction stages of their lives. Judge Halleck urged that ". . . substantial research be done to explode... the myth that all of us have engaged in, that... drug addiction causes people to commit all this crime. "

Judge Halleck also asserted that drug abuse treatment and rehabilitation programs were expensive and were perpetuated only because of their association with the court systems.

Dr. Norman Zinberg, a well-known researcher in the drug field and a Professor of Psychiatry at the Harvard Medical School, addressed three topics: psychological and social characteristics of users and addicts, the differences between users and addicts and how those differences affect public policy, and why some heroin addicts and users never come into contact with the criminal justice system.

Dr. Zinberg described a Drug Abuse Council-funded study of controlled (or non-addicted) heroin users which is now continuing with funds from the National Institute on Drug Abuse. The research focuses on moderate, occasional users of heroin, or "weekend warriors" as Dr. Zinberg calls them. In his research, Dr. Zinberg has found significant differences between these moderate heroin users and heroin users who are in treatment.

We find users who become addicted for short periods of time.... We found people, the so-called working addicts, who are employed and maintain themselves. The treatment sample [on the other hand] looks very different from any other sample of heroin users you can find. They are usually the people who have been involved with the criminal justice system... who are much sadder people... having a great deal of trouble emotionally.

This study, though admittedly a small and limited one, may, nevertheless, have significant consequences for public policy because much of our public policy has been based on the characteristics of the treatment sample. The treatment group. according to Dr. Zinberg, does not represent the range of heroin users. Yet if one talks about two million heroin users and then discusses heroin maintenance policies, one thinks of vast numbers of people receiving heroin. To extrapolate exclusively from the treatment group is an error which keeps us from developing policy and treatment options.

A natural result of focusing on the treatment sample has been our policy of prohibition. Dr. Zinberg believes that this policy has not been successful, i.e., it has not reduced heroin use. Cutting off the heroin supply is not necessarily a good thing. It may, in fact, result in people moving toward more damaging drugs such as alcohol.

Why do some users run afoul of the criminal justice system while others do not? Dr. Zinberg mentioned a study conducted by Dr. Peter Bourne which showed that most controlled users are involved only with a small number of other controlled users and are secretive about their use. They do not flaunt it as compulsive heroin users tend to do. In Dr. Zinberg's sample there has not been a single arrest in the several years of the program. In other words, controlled heroin users are less dysfunctional and are thereby less identifiable as heroin users.

During the question and answer session following the panel presentations, Judge Halleck was asked how addicts supported their habits if they were not involved in crime. He replied that they were to a large extent involved in the importation, distribution, and sale of heroin. A question on the physiological effects of heroin use brought from Dr. Zinberg the response that except for chronic constipation, heroin is a really benign drug in a physiological sense. Judge Halleck was requested to set research priorities on heroin use from the perspective of the courts and the criminal justice system. He answered that the relationship of drug use and abuse to crime should be studied further; e.g., does abuse cause criminal behavior or are these people criminal by nature? Another area for research would be the effect of decriminalization of drug possession and other vice offenses upon police investigations of other crimes. Police often say that these laws must remain on the books to be used as leverage on offenders whose help is needed to solve more serious crimes.

c. Heroin Maintenance Research

Dr. David Lewis of the Washingtonian Center for Addictions explained that heroin maintenance has a number of different meanings and implications. We already have opiate maintenance programs such as those which use orally administered methadone and long-acting methadone. And Dr. Avram Goldstein of the Addiction Research Foundation in California has recently proposed using morphine instead of heroin in an experimental program. In the past, proposals for heroin maintenance have occurred within the context of medical treatment and focused on the individual addict. Recently, however, says Dr. Lewis, "discussions about heroin maintenance... have been broader, and have come about as a result of a public health concern and a criminal justice concern."

It is assumed, according to Dr. Lewis, that if we could design an experiment to tell us how to provide heroin in a treatment context, we would end up with something similar to our current forms of addiction treatment. Limited research with heroin maintenance could clarify the question of whether more addicts will enter treatment voluntarily if an injectable opiate is part of the treatment program. However, limited heroin maintenance experiments will not provide answers to questions about the relationship of heroin addiction and crime. Such programs would be too small from which to draw any conclusions about large-scale effects. Pilot research projects would be tiny in comparison to the existing street market and would have no effect on it. Therefore, limited experimentation will not have the kind of impact on major urban problems that has been discussed.

It is possible to design a heroin maintenance research program within the context of medical treatment. The difficulty is that the more specialized the experiment, the less one can generalize from its results. However, pilot programs can help to demythologize heroin — to show that it is a drug with potential for both good and bad.

An additional difficulty is that any medical heroin maintenance effort will probably set abstinence as the ultimate goal. Will addicts, in large numbers, voluntarily enter heroin maintenance programs that aim at abstinence? Dr. Lewis believes this is a major problem in our present thinking about heroin maintenance experiments:

There's not a high interest in the addict population voluntarily to enter the treatment system.... The issues have to do with voluntary versus involuntary. They have to do with some kind of an institution that we don't have in this country, which is something between the criminal justice system and the public health system, some other place where this could be done.

Heroin maintenance is closer to the issue of heroin decriminalization than it is to medical treatment. Both the medical and criminal justice systems have limitations. Physicians, for example, do not generally believe in involuntary treatment, and there is no great willingness on their part to do something simply because it is an alternative to jail. The solution to the urban problem of heroin addiction does not lie within a quasi-voluntary treatment system such as we have now. The mechanical model of heroin maintenance is not likely to work in the absence of heroin decriminalization.

George Gaines, Deputy Director of the Detroit Health Department, spoke about: (1) the circumstances surrounding emergence of the heroin maintenance issue in Detroit; (2) policymakers' reactions to heroin maintenance in Detroit; (3) various means of resolving the issue; and (4) the feasibility of the proposed heroin maintenance experiments.

The heroin maintenance issue emerged in Detroit as a result of the NLC policy statement and of the introduction of a bill in the state legislature to establish an experimental heroin maintenance program in Michigan. What the legislator who introduced the bill and others do not realize is that heroin maintenance will not eliminate the black market, said Mr. Gaines.

Response to the proposed heroin maintenance program was by no means uniformly favorable in Detroit. New Detroit, Inc. (the local counterpart to the Urban Coalition) considers heroin addiction to be the number one economic and social problem in the city. New Detroit has developed a comprehensive plan to combat heroin addiction, which includes a massive infusion of employment funds, new directions in treatment programs, and changes in American policy toward poppy-growing nations; but it does not include heroin maintenance. The Wayne County Substance Advisory Committee has also taken a position against heroin maintenance.

Instead of heroin maintenance, Mr. Gaines proposed "habilitation and rehabilitation." Criminal activity will continue unless the addict population is rehabilitated. Gaines feels that heroin maintenance would only result in addicts shifting from impulsive street crimes to crimes involving more planning:

For the government to provide heroin to addicts only changes the source of the heroin and does not alter the basic needs and lifestyles of the individuals. A person in poverty on heroin maintenance must still have money for food, clothing, shelter, etc.

The spread of new heroin use has not been brought under control, and the public health system seems to play a relatively small role in controlling heroin addiction. Mr. Gaines illustrated this by pointing out, "In Detroit, only about 5 percent of the $13 million we spend to control drugs is in primary prevention," a traditional public health responsibility.

Mr. Gaines sees heroin maintenance as having two basic objectives: "to offer addicts a legal option to street heroin and to compete with the illegal market." But if heroin maintenance were adopted, illegal operators might increase availability and attempt to open new markets. And because of high illegal profits, dealers could also respond by reducing the price. This would probably increase the number of addicts. If heroin use was made completely legal in order to compete with the illegal market, public health problems would result. Controlling heroin use is an extremely difficult and complex problem.

A more promising method of controlling the spread of addiction, Mr. Gaines said, is "secondary prevention." The public health system should make efforts as early as possible to reach people who are experimenting with drugs. Such efforts would be preferable to heroin maintenance since the costs of heroin maintenance would be high, and it would probably be financed at the expense of prevention efforts.

Mr. Gaines concluded with his own recommendations for the control of heroin and the treatment of the addict population. These recommendations included rejecting the idea of legal heroin, placing emphasis on primary and secondary prevention, and requiring more public health and law enforcement cooperation. In addition, Mr. Gaines recommended that public health agencies try to limit the demand for heroin by detoxifying and re-educating arrested addicts in rehabilitation centers, using a quarantine concept. He also urged that international and national law enforcement efforts be stepped up in an attempt to cut off the heroin supply.

Asked about Mr. Gaines' presentation, Dr. Lewis replied:

Primary prevention... cutting down the supply... from a theoretical point of view, we all love it. The fact of the matter is... these things aren't very workable.

Judge Halleck went further and said that these approaches (increasing enforcement and preventive education) had not worked at all. It seemed foolish to him to keep pouring money into the criminal justice system to fight drug abuse.

Dr. Lewis was asked about the value of heroin maintenance experiments. He answered that, first, it must be determined whether they could legally and practically be done anywhere in the United States and, second, whether more addicts would voluntarily enter such a program than enter more conventional programs now. Dr. Lewis reiterated his belief that pilot heroin maintenance programs would help to demythologize heroin use. Medical research on the effects of heroin could also be carried out as part of a heroin maintenance program.

NLC Human Resources Committee member Sue Hone asked if doctors were ready to lobby for experimental heroin maintenance. Dr. Lewis said that he saw no grass-roots movement within the medical system advocating heroin maintenance. Mr. Gaines added that a new stereotype of a physician has emerged as a result of methadone maintenance: the entrepreneurial methadone maintenance doctor who makes several million dollars a year. Mr. Gaines said he would be suspicious of physicians wanting to start heroin maintenance programs.

d. The Federal Perspective on the NLC Drug and Alcohol Abuse Policy

Dr. Robert DuPont, Director of the National Institute on Drug Abuse, began by thanking NLC for its contributions to the drug abuse field. He then made clear his opposition to heroin maintenance:

I think that the use of short-acting intravenous drugs as part of treatment programs is an undesirable development; and for the same reason that methadone is a better drug from a rehabilitative point of view, long-acting methadone is a better drug than methadone.... The issue lies in longer acting drugs rather than shorter acting drugs.

Dr. DuPont discussed three possible models of heroin maintenance. The drugstore model implies that heroin would be available for those who want to consume it. There is no serious support in the U.S. for such an approach, declared Dr. DuPont. The second is the clinic model, which would "add heroin to the menu at drug abuse treatment clinics." This is essentially the British model. The third type is the heroin lure model, or the induction model, in which heroin is used for a short period of time to attract into treatment addicts who are subsequently transferred to other forms of treatment.

Experimental heroin maintenance has limited potential benefits. One possible gain is the demythologization of heroin that Dr. Lewis referred to. However, Dr. DuPont thinks that such experimentation would have no impact on crime, the black market, or the number of addicts in the community. No one is really in favor of heroin maintenance-only of examining its feasibility; yet, the subject keeps cropping up. One reason that it remains a topic of discussion is the supposed failure of existing policies, which leads people to think in terms of alternatives that are either "give the addicts the dope" or "lock them up."

According to Dr. DuPont, our heroin policy has not failed. Rather, he argues, it has succeeded dramatically. Americans often compare our policies to those of Great Britain, praising their success and lamenting our failure. Yet the British system of prescribing heroin has been all but abandoned because doctors are switching to oral methadone for pharmacological reasons. Within the next few years, heroin prescriptions may totally vanish in Britain, predicted Dr. DuPont.

Dr. DuPont does not believe that it is useful to look to the British system for a solution to our problems. Unlike the United States, Britain never had a "street addict" problem until the late 1950s. From a U.S. perspective, the British are liberal in allowing access to heroin. They believe their clinics have succeeded, since clinic distribution limits access to heroin. But it is a myth that the British use the medical method to control heroin while the American approach is criminal justice. The British also use law enforcement and believe in it strongly. Another myth is that there is no heroin black market in Britain. "'The price of heroin in Piccadilly is the same as it is in Harlem," declared DuPont. And every year for the last ten years there have been more addicts reported to the British Home Office than there were the year before.

Current American policy on drug use is a balance between supply reduction and demand reduction, explained Dr. DuPont. "It is easy to find the failures on both sides of this, but the hallmark of our current policy is one of reducing our level of expectations, of setting priorities ... respecting the balance between these various approaches and trying to reduce the rhetoric and the hysteria."

Heroin maintenance would not reduce either treatment or law enforcement costs in this country, claimed Dr. DuPont. There would be no reduction in the black market. It would have no effect on addict-related crime or on the number of addicts.

Dr. DuPont maintained that present law enforcement efforts are having a positive effect on total heroin supply. He cited the example of Washington, D.C., where heroin deaths went from 70 in 1971 to 4 in 1973, due to a reduction in the supply of heroin. Because of President Carter's and that of Dr. Peter Bourne, Director of the Office of Drug Abuse Policy, Dr. DuPont said he had real hopes that for the first time some muscle will be put behind international efforts to reduce the supply of heroin.

When asked about the impact of heroin users on non-users, Dr. DuPont said that this negative influence creates a bad climate in a community and causes drug use to spread. To combat this we must get more addicts into treatment.

When questioned about the feasibility of block grants to cities with large populations of drug abusers, Dr. DuPont said he thought the idea merited further study. Cities could be prime sponsors for the development of comprehensive programs, he added.

In closing, Dr. DuPont remarked that "a lot of people do get better.... in some ways, we have been our own worst enemies in terms of talking to the public about the horrors of the problems."

e. Victimless Crime

"A primary political concern with respect to heroin is whether or not voters want to get rid of its prohibition, as they did with alcohol," declared opening speaker Charles Morgan, a Washington attorney. Our heroin policy evolved during the era of Prohibition.

Crime and its connection to heroin is a major problem in our cities. Whether people were criminals before or after they became heroin addicts, they need an enormous amount of money to support their habits. Often the money can only be obtained through crime. One of the problems, though, in enforcing laws against heroin (and other laws proscribing various types of personal conduct) is that these laws reflect the middle-class morality of the lawmakers. Their standards of morality are applied to put poor people in prison. This is a dilemma we may never be able to resolve satisfactorily. As Mr. Morgan put the question: "Does the government have any right to tell citizens what they can do with their lives as long as they are not affecting and hurting other people?"

District of Columbia Councilman Sterling Tucker began by stating that he had never found a satisfactory operating definition of "victimless crime." We ought to work toward a definition that tells us at what point one's life activity or lifestyle affects society adversely, he suggested.

Since most people do not use heroin, or will not admit to it, it is difficult to find a constituency to address these questions. When the D.C. City Council first tried to decriminalize possession of small amounts of marijuana, a group of ministers put great pressure on the Council not to enact the legislation, said Mr. Tucker. Politically, they told Tucker, they had to oppose marijuana decriminalization. "It is difficult," Mr. Tucker explained, "to sell this issue (drug decriminalization) because some people don't understand the arguments." A political figure often is then placed in a position where he or she cannot do what's right. Most people do not even distinguish one drug from the other; marijuana and heroin are synonymous to many people.

Councilman Tucker went on to suggest that studies and research results on victimless crime have not been distributed effectively to groups who could help to create public opinion and promote change. Mr. Tucker suggested that arguments should not be made upon the basis of morality or immorality, but on questions of resource allocation. For example, how should law enforcement priorities be set, given a finite number of dollars? Uncertainty as to what would happen if police were to cease enforcement of laws relating to victimless crime prevents politicians and police from making such allocation decisions. Decriminalization, heroin maintenance — these are political problems, said Mr. Tucker, and we must put the research results and the politics together if we are going to headway.

James York, Chief of Police of Orlando, Florida, explained that his problem with defining "victimless crime" is that the term is too simplistic, too shopworn, to use in discussing such very complex issues. Under the heading "victimless crime" fall activities that raise questions of urban aesthetics, economics, and equal treatment under the law. They involve foreign policy and domestic issues. "Gambling, for instance," said Chief York, "is more an economic issue involving public funding than it is a crime and punishment issue." He went on to say that the question is not whether we should legalize gambling — 32 states already have some form of legalized gambling — but rather how much should be legalized.

Prostitution, said Chief York, is both an economic and an urban aesthetics issue. Nobody wants streetwalkers in their neighborhood, so why should they be allowed in minority communities when they are not allowed in upper-middle-class neighborhoods? This also involves zoning. We can legalize prostitution, but that will not make it socially acceptable.

Drug abuse is not a law enforcement-created problem, and law enforcement is not particularly well-equipped to deal with it, stated Chief York. Local law enforcement, particularly, is at the mercy of the ability of federal law enforcement to prevent the importation of drugs; and federal law enforcement is at the mercy of foreign policy. Declared Chief York, "We are a little tired of being society's whipping boys with respect to crime generally, and the so-called victimless crimes specifically."

Each panelist was then asked to express his opinion of heroin maintenance. Mr. Morgan said that serious consideration ought to be given to decriminalization of heroin. Chief York stated that based on the experiences the British are having with heroin maintenance, he is not now in favor of it. (Mr. Tucker was absent.)

Conclusions: Mayor Richard Hatcher

Mayor Hatcher thanked the participants for the opinions and attitudes they had expressed, and said that they would help to define the issues which must be dealt with. It was clear that opinions differed widely with respect to heroin maintenance; but, declared the Mayor, the session brought into focus certain areas that deserve further exploration. For example:

1. The relationship between criminal behavior and heroin addiction may not be as strong as we think.
2. It may not be true that most drug users are unemployed.
3. There may be more people using heroin than the official estimates suggest, but they may not be abusers or addicts.
4. Heroin is a physiologically benign drug.
5. It remains unresolved whether experimental heroin maintenance programs will reduce crime or decrease reliance on the street market.
6. Heroin maintenance programs may be symbolically valuable by serving to demythologize the drug.
7. There is little federal government support through the National Institute on Drug Abuse for heroin maintenance programs.

The mixed opinions offered little clear direction as to where NLC should go from here, said the Mayor; but it is vitally important that the League continue to examine the feasibility of heroin maintenance research. The Human Resources Committee of NLC will certainly continue to debate this issue and to present new policy directions for consideration by the membership at the annual Congress of Cities. We must, and will, Mayor Hatcher said, continue to explore heroin maintenance and other means of meeting the drug crisis in our cities.

Afterward

On December 7, 1977, the National League of Cities reaffirmed its support for exploring heroin maintenance programs. The following are the sections of the National Municipal Policy on Human Resources that concern heroin maintenance.

Goals for Drug and Alcohol Abuse Treatment and Prevention

Drug and alcohol abuse represent a serious health and social problem to the cities of this country. The current policies related to prevention of abuse have failed and the cities bear the adverse social consequences of this failure. The National League of Cities is convinced that many of the conventional assumptions about drugs, drug abuse and drug abusers are inaccurate and fallacious. The League believes there should be a complete reevaluation of alcohol and drug abuse policies which examines this social problem in the broadest context in order to focus more directly on such goals as:

E. Starting to examine the consequences of establishing heroin maintenance programs with appropriate medical controls for addicted persons, in order to reduce the social costs resulting from the highly profitable illicit drug trade, as well as from the commission of property crimes to support costly illicit drug habits;

Policies for Action

The national policies for prevention and treatment of alcohol and drug abuse should include:

D. Reduction of the crime, corruption, and other social costs which result from the immense profitability of trafficking in heroin. The concept of a heroin maintenance system warrants examination. including the possibility of administering a small number of carefully controlled research programs on heroin maintenance. This would better enable public policies on drugs to be related to factual and sound data;

E. Controlled heroin maintenance experiments which are designed to provide data on the effects on individuals of controlled use, as compared with similar persons not included in the experiment. The difficulties of such an experiment must be identified and overcome in order to provide information on this approach as one option for reducing the problems of addiction;

F. An exploration by the federal government of alternatives of heroin maintenance such as a long-term test of a concentrated drug education program.

National League of Citiies

Alan Beals Executive Director

Jacques Avent Director Membership Services

Criminal Justice and Public Safety Program

William R. Drake Director

John W. McKay Deputy Director

Lynn Olson Assistant Director

Jan Frohman Tara McCallum Judy Little Cecilia Rankin Rici Rutkoff

This publication was prepared under a grant from the Drug Abuse Council, Inc.