Curing Addiction, Voices From the War on Evil and Corruption

In the year 1918, the U.S. Treasury Department took a census of drug addicts and calculated there to be in “excess of a million” (Williams, 1938, pg 15). Three-fourths of these were considered to be engaged in gainful employment as laborers, physicians, . . .salesmen, actors, in business, as professionals, . . . pharmacists, journalists, merchants, and the most frequent addicts in the 1918 census were housewives (Williams, 1938). Once drugs were withheld, “made inaccessible at a reasonable cost,” thousands of addicts began to commit petty thefts to support their habit (Williams, 1938). Before we began warring on drugs, most narcotics users did not understand they were addicted, “any more than the average tobacco smoker [in the early 1900’s] realizes that he is a nicotine addict” (Williams, 1938, pg 17). Narcotics were not illegal or stigmatized, using the medicines “wasn’t even morally significant” (Williams, 1938, pg 17). To understand what addiction is, one must understand what creates addiction. Foremost, the disease of addiction is the product of a corrupt society, it’s not simply transmitted to a person from using a drug or in combination with some psychological shortcoming. Anything could become an agent like drug addiction when prohibition is enacted based on prejudice, greed, fear, and ignorance. The past sheds light on the present to help illustrate how the policies of drug prohibition manifested drug addiction, creates proxy wars, results in mass incarceration and in genocide. America’s opiate epidemic is the product of the drug war and stifled progress into the implementation of new treatment drugs and strategies. There can never be a cure for addiction until the societal constructs that initiate it have been abolished.

Many believe that the Harrison Narcotics Tax Act of 1914 or Richard Nixon in the 1970’s marks the beginning of the war on drugs but it really began behind the scenes. The first arrest wave of the drug war targeted physicians who were charged and convicted for supplying narcotics under the 1914 Tax Act (Williams, 1938). However, The Harrison Narcotics Tax Act “makes no estimate of any kind as to the use of narcotics; makes no mention of addiction or any other malady; does not in the slightest degree seek to hamper the physician in the exercise of his professional functions,” it was just a tax (Williams, 1938, pg 59). That changed in 1921 when a leaflet was drafted by the Deputy Commissioner at the head of the Narcotics Division of the Prohibition Unit of the Treasury Department, Mr. Harry J. Anslinger. This served as a code which stated,“The revenue officer does not approve of the medical treatment with narcotics of patients who are addicted to the habitual use of these drugs, unless these patients are forcibly confined-hospitals, sanitariums, or jails” (Williams, 1938, pg 5). This notion of needing to restrain a patient suffering from addiction in order to cure them was based off a recommendation from the president of the American Medical Association (Williams, 1938). Addiction was not well understood, even by most physicians of that time. Henry Williams explained in his book written in 1938 that, “any changes in operation of the [Harrison Narcotic Tax Act] have not been due to legislative action, but to judicial or bureaucratic interpretation” (Williams, 1938, pg xviii).

Harry Anslinger is the mastermind behind today’s global war on drugs. Johann Hari illustrates in his book, “Chasing the Scream,” how Harry was motivated by personal prejudices and paranoia. Harry said of drug users that they are “criminals first and addicts afterwards” (Redmond, 2012). Anslinger’s racism was not unaccompanied. As Johann puts it, “the reason obsessing the men who launched this war-was that the blacks, Mexicans, and Chinese were using these chemicals, forgetting their place, and menacing white people” (Hari, 2018, pg 26). Harry was responding to a “race panic” in American culture, “he told the public that the increase in [drug addiction] is practically 100 percent among negro people [and] while they make up 10% of the population they account for 60% of the addicts” (Hari, 2018, pg 26). There seemed to apply a preferred substance to each racial group, the blacks weren’t angry about slavery, they were high on cocaine (Hari, 2015). The Chinese were immigrating to undermine democracy with opium and eventually Mexicans were raping women loco on marijuana (Hari, 2015). These racialized trends are best described in Michelle Alexander’s book on the drug war entitled, “The New Jim Crow.”

A doctor named Henry Smith Williams, “shared all of Harry Anslinger’s hatreds,” especially for drug addicts (Hari, 2018, pg 25). Johann characterizes him as a social darwinist and quotes him as having said, “the idea that all human life has genuine value . . . is a banality. The world would be far better off if forty percent of its inhabitants had never been born” (Hari, 2018, pg 34). Eventually, Henry Smith Williams would publish the most comprehensible anti-drug prohibition book ever written to this day, “Drug Addicts Are Human Beings,” became buried with the origins of drug prohibition (Hari, 2015).

Henry Smith’s brother, Edward, was one of the most accomplished addiction experts of his time (Hari, 2015). Edward was running a clinic to help addicts until he was set up in a sting operation (Hari, 2015). An addict was paid by Anslinger’s bureau to get him to write a prescription for opium before the police burst in to arrest Edward for violating the Harrison Tax Act (Hari, 2015). Henry Smith Williams had to watch as his brothers career was being destroyed, this gave Henry a change of heart and he began to look at the problem of addiction differently (Hari, 2015). Edwards wasn’t alone, following Anslinger’s leaflet, there were over 110,000 arrests under the Harrison Act for 1921–1923 (Williams, 1938, pg 9). In 1938, when Henry wrote the book, over 25,000 doctors had been charged with violating the Tax Act and over 5,000 were convicted with either a major fine or a prison sentence of as high as 5 years per written prescription (Williams, 1938, pg xix).

The drug war began to gain momentum with the investment of organized crime (Hari, 2015). In Williams’s book he details how Chris Hanson, Anslinger’s bureau chief in California waged a drug crackdown sponsored by the drug dealers themselves (Hari, 2015). Once the clinics were shut down, the black market had a monopoly on illicit drugs (Williams, 1938). Williams reasoned that similar things must have been happening nationally, in fact, corruption seems to be a necessity for the drug war to “succeed” (Williams, 1938). In a modern study, the DEA surveyed its top fifty informants to inquire what’s most important in a drug business, they overwhelmingly answered, “corruption” (Redmond, 2012). Corruption in the literal sense at the level of government yet, another definition of corruption also fits, the state of something being morally depraved. Corruption, and not individual moral failing created the drug law violator, a new class of criminal (Redmond, 2012).

Rodrigo Duterte, president of the Philippines is a figure borne out of Anslinger’s vision and the continued failure of the drug war. He has exclaimed that “you cannot wage a war without killing,” adding that many drug users were beyond rehabilitation (“Drug users aren’t human…,” 2016). Rodrigo compared himself to hitler, “Hitler massacred three million Jews …. There’s three million drug addicts. There are. I’d be happy to slaughter them” (President Rodrigo Duterte, 30 September 2016) (Johnson, 2018). While statistics vary on the number of extrajudicial killings, Duterte operates with impunity, “Crime against humanity? In the first place, I’d like to be frank with you: are they humans? What is your definition of a human being?” he told soldiers (“Drug users aren’t human…,” 2016).

A very successful online news company called Rappler started in 2011 and is based out of the philippines, the founder and CEO is Maria Ressa. Rappler and other journalists have been targeted by duterte through various government action and by Duterte’s own words, “Just because you’re a journalist, you’re not exempted from assassination, if you’re a son of a B*TCH” (Simon, 2016). This was stated June 1st, 2016, at the start of his presidency but he didn’t just target journalists. When he was elected, Duterte created a watch list of drug suspects, “anywhere from 600,000 to 1 million names on it, including at least 6,000 police officers, 5,000 local village leaders, and 23 mayors” (Johnson, 2018). President Trump has since invited Duterte to visit the white house, praising his drug war, “When president Trump called CNN fake news, a week later Duterte called Rappler fake news” (Resa, CEO of Rappler). In an interview, Amy Goodman of ‘DemocracyNow’ asked Maria Ressa what the implications of Trump supporting Duterte are for Policy in the Philippines, Maria answered, “I think it’s a bad time for the world when the former beacon of democracy, the fighter for press freedom and human rights, is notably absent, and I think you’re feeling that all across the world” (M. Resa CEO of Rappler, personal communication, 2019). President Trump has spoken numerous times, including February 15, 2019, about the novelty of executing drug dealers, a sentiment shared by many of his supporters (Rosenberg, 2019). The president of Sri Lanka also praised Duterte in Jan 18, 2019, exclaiming that Duterte’s drug war is “an example to the whole world” (Lema, 2019). From july 1, 2016 until early 2019, the most recent U.N. estimates put the number of extrajudicial killings in the philippines at more than 27,000 (M. Resa, personal communication, 2019).

“These are not the drug dealers that are being killed, these are the poor people, these are in the poorest of the poor areas . . . The people who cannot defend themselves, the people who are on a list, a random list they’re not backed, there’s no trial, there’s not any proof that the people being killed are drug dealers” (M. Resa, personal communication, 2019).

All prejudice has as a single unifying tenet, the dogmatic dehumanization of someone. Recorded history documents numerous accounts of genocide based off this creed. Evil has long been discussed as a philosophic and religious concept. St. Augustine of Hippo in A.D. 388 said in “On The Morals of the Manicheans,” Chapter 8: Evil is Not a Substance, But a Disagreement Hostile to Substance, “Moral evil, in particular, arises from error, and is to be gradually eliminated, or at least minimized, by improved knowledge of the conditions of human welfare” (St. Augustine, A.D. 388). Ending the war on drugs is not as simple as demonstrating all of the problems inherent in drug prohibition both historically and as a political policy. The war on drugs did not begin with practical political policy but was motivated by racism, prejudice, and ignorance. It’s not enough to revisit the political realities of the time through court transcripts and other historical records to prove this actuality. Countless papers, books, and studies have demonstrated these facts going back to Dr. Williams’s book, written in 1938. In order to end the war on drugs we must consider other aspects of our society that through their archaic origin still exist today as tools of greed and regression. We must imagine a utopia and then consider what aspects of our civilization are tragically incomplete.

It wasn’t until the controlled substance act of 1970 was amended in 1974, that narcotic treatment clinics were legal again, namely methadone clinics. In addition a legal framework for “detoxification” and “maintenance treatment” was established (“A History of Opiate Laws,” 2016). David Courtright seamlessly discusses the history of U.S. narcotic treatments in his 1992 paper entitled, “A Century of American Narcotic Policy:”

“In two cases decided March 3, 1919, the Court sustained the constitutionality of the Harrison Act and ruled that a physician might not write prescriptions for an addict “to keep him comfortable by maintaining his customary use. Following the [1919] rulings, a number of cities and towns set up facilities to dispense narcotics to addicts. If private maintenance were disallowed, then organized, public maintenance might yet take its place. There were altogether 35 of these municipal “narcotic clinics,” so named because they sold morphine cheaply to their registered patients. A few also sold cocaine or heroin. What is sometimes misunderstood about these clinics is that they were not homogeneous, that their methods of operation varied. Some were geared toward indefinite maintenance, others toward detoxification through gradual withdrawal. Some were run for profit, others merely to break even. Some were models of efficient administration, others fly-by-night operations. One thing, however, they did have in common: all were eventually closed by the federal government, most within a year of opening their doors. . . If the narcotic clinics had not been closed back in 1919–1920, if medical discretion and supervision had been permitted within the context of detoxification-or-maintenance programs, and if this approach had been widely emulated, then incalculable suffering, crime, and death could have been averted” (Courtright, 1992).

Evidence has accumulated showing there are more effective alternatives than methadone for substitution therapy. However, in countries that have abandoned prohibition such as Uruguay, MMT still remains the primary source of treatment. Drug prohibition has given addicts few options in overcoming their affliction and it has stifled progress into truly remarkable treatment drugs that could change our understanding of the disease. In addition, there are breakthroughs in addiction research and novel non-opiate drugs with various properties that could be utilized alongside interdisciplinary treatment to cure most cases of addiction. We are no longer in an age of powerlessness over addiction.

Before imagining a perfect world where the only war fought is the war on evil and corruption, begin to conceptualize a cure for addiction. Envisioning begins by tearing down the structures built by war. No facet of narcotics prohibition exists more plainly as a tool of biopower than methadone maintenance therapy (MMT). The perpetuity of MMT as a treatment for opiate addiction necessitates a Foucauldian critique. Given the nature of capitalism and the financial profitability of MMT to stakeholders, it’s reasonable to assume that MMT will only be phased out through these same measures. It should not be necessary to put MMT out of business as you would in a capital marketplace, the quality of the product has fallen far behind the science of the disease. The origin of methadone is Nazi Germany. The drug was not invented for what it is used for, it was simply the first synthesized opiate and a U.S. pharmaceutical company acquired the patent after WWII. The continuity of MMT treatment clinics which use substandard care practices, a repurposed obsolete medication (the first synthetic opiate), the lack of investment in the efficiency of these sites, and the globalized cloning of this model further speaks to a stark Foucauldian permanence.

The ineffectiveness of MMT as a treatment drug was noted by the Healthcare Effectiveness Data and Information Set (NCQA) through their removal of methadone from the initiation and engagement measure medication list for 2019 (NCQA, 2019). Studies dating back to 1997 have demonstrated medical grade heroin to be more effective as a substitute opiate when administered in treatment settings (Bourgois, 2000). Recent studies have explored this relationship through testing slow-release oral morphine against methadone with similar results (Falcato, Beck, Reimer, Verthein, 2015; Hämmig et al, 2014). The continuity of MMT has been explored through Foucauldian critique where methadone as an opiate substitute is considered, “inauthentic and dangerous” (Keane, 2009, p 3). The inability to distinguish between, “attributes of MMT that belong to clients and those that belong to the process of program delivery,” suggests an inadequate delivery system and inadequate treatment strategies that create undue burden on clients (Keane, 2009, p 3). There’s no doubt, as a substitution therapy weighed against a placebo, MMT is more effective than a placebo but this standard of care has resulted in the U.S. opiate epidemic. If drug treatment culture was up to date with addiction research science then red flags would have gone up much sooner. Another misconception that contributed to overprescription of opioids and high rates of addiction among patients with chronic pain occurred around the turn of the millennium, diagnosing “pain as the fifth vital sign” (Council, 2001). Foucauld is most useful in understanding the interplay between social acceptance of prohibition, the unchanging nature of MMT, and the difficulty of replacing these clinics with a modern model that serves all forms of addiction.

The treatment potential of ibogaine for all substance use disorders (SUDs) has been studied since the mid 1980’s. SUDs contribute “nearly 5% of all disability-adjusted life years and 4% of overall mortality” to the total global burden of disease (Nielsen, C., 2018, p 5). For opioid dependence, 5-year relapse rates are “as high as 97%” (Nielsen, C., 2018, p 5). Among prescription opioid use for chronic pain, misuse has been reported at between 21% and 29% (Sutherland et al, 2018, page 4). Recent studies into ibogaine have shown that it triggers “remodeling of the housekeeping metabolism and an energy economizing effect” (Paškulin et al, 2012, p 324). Ibogaine operates under the same principles of a healthy organism, profiting from improved fitness, mental performance, and stress levels as they relate to disease development (Paškulin et al, 2012). This same benefit of ibogaine provides support after a disease is acquired, such as addiction syndrome (Paškulin et al, 2012).

Ibogaine is unregulated in most of the world, due to its hallucinogenic properties it has been illegal since 1967 in the U.S. as well as 9 of the 28 countries in the European union (Brown, Alper, 2018). Given a classification of schedule-1 in the drug war, ibogaine is said to have no medicinal value, a similar situation has occurred with the herb formerly known as cannabis (Herer, 1985). However, derivatives of ibogaine have just begun to be studied with grants from organizations such as the National Institute on Drug Abuse. Their goal was to isolate the anti-addictive properties and separate them from the undesirable hallucinatory counterparts. Noribogaine is one of these derivatives and it has been found to “prevent the development of tolerance to the analgesic effects of morphine” (Maillet et al, 2018, p 2). The lack of pharmaceutical and governmental interest in ibogaine, furthermore, the prohibition of this drug and classification of it as having no medical value highlights the Foucauldian interplay of biopower and government.

Recent research into ibudilast suggests its high potentiality as an addiction treatment drug (Sutherland, Nicholls, Bao, Clarke, 2018; Cooper et al, 2016; Cooper et al, 2017). When used in conjunction with opiates, ibudilast has been shown to increase the analgesic effect (Cooper et al, 2016; Cooper et al, 2017). Experiments with rodents that administered morphine using a tail-flick test have shown an “antinociceptive effect and even reversed allodynia in rats with central nervous system damage” (Cooper et al, 2017, p 7). Since women have a greater analgesic response than men (30–40%) they may have a more significant response to lower dosages of ibudilast but further research is needed (Cooper et al, 2017). The implications of ibudilast and other non-opioids as treatment drugs are profound.

In addition to new treatment drugs that will reshape therapy, studies are ongoing into a variety of strategies for addiction that are less invasive than current practices. Computer Assisted Therapies (CATs) specially tailored for SUDs are a cost effective way to offer a new perspective (Elisona et al., 2017; Carroll, Kiluk, 2017). CATs are not limited to computers but can be built into smart phone apps and other trends of technology, utilizing social media (Elisona et al., 2017; Carroll, Kiluk, 2017). Recovery lines to offer live support when used in a methadone maintenance therapy, increased the period of abstinence (Moore et al., 2019). Alternative medicine is constantly breaking new ground when it comes to addiction therapies, another example is the use of sound to reduce recidivism following detoxification (Sewak, Spielholz, 2018). Out of 22.7 million individuals ages 12 and older who needed treatment for a substance addiction in 2013, only 11% or 2.5 million received specialty care (Dayer et al., 2018). The harm reduction movement has had some success as an alternative to punitive practices (see https://harmreduction.org/). Secondary harm reduction takes the principles of harm reduction further and calls for a more compassionate, humanitarian approach (Blaustein, McLay, McCullouch, 2017).

In Mexico, real war ensues and the number of dead as a result of the violence borne out of prohibition numbers the hundreds of thousands. Mexico tried to change directions in 1938 when the head of the Federal Narcotics Service, Doctor Leopoldo Salazar Viniegra, attempted to implement a new drug policy “based on public health and harm reduction principles . . . he’d worked for years with drug users in a psychiatric hospital and was a researcher and writer who studied the effects of drugs” (Redmond, 2012). His efforts fell victim to the international pressure that Harry J. Anslinger put on them and indeed the world to propagate drug prohibition (Hari, 2018; Redmond, 2012). There’s no way to measure the toll on human civilization that the war on drugs has cost; the amount of death, suffering, corruption, waste, confusion and ignorance generated by going to “war on drugs.” When slavery was abolished, the prejudicial sentiment was not extinguished and it became something else, something evident through the mass incarceration of minorities for drug offenses. The privatization of prisons and treatment for profit provides further evidence of the direction that prohibition is moving (“Recovering from Rehab: Work-based Therapy in the US,” 2019).

There are two sides to the war on drugs, two absolute positions, you are either for or against the personal and recreational use of drugs. Those in favor of drug prohibition have bought into Anslinger’s prejudice, whether they know it or not. On the other side, there are those who openly violate drug laws or who are against it, these drug law violators represent a new class of criminal (Redmond, 2012). Drug law violators are resisting not merely unjust laws but the prejudicial sentiment to judge, fear, and choose ignorance over acceptance of another based on their creed or lifestyle. While the world was going to war, not once but twice, another global civil war was taking root. It’s easy to imagine the escalation of killings in the Philippines, the adoption of Duterte’s drug war model by other nations, and the subsequent widespread genocide of drug users in the name of a better world. What’s not easy to imagine, what may be even harder to accept, is that slavery, the civil war, the holocaust, the world wars, these calamities never ended, they became something else. They became the war on drugs, all are borne of the same prejudicial sentiment. We’re left with a predicament, drug prohibition has one eventuality, corruption and warfare (Mexico) or genocide (Duterte’s war).

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