In a cramped little office off a catwalk in the research library at the Yale University School of Medicine here, Dr. David Musto often sits contemplatively, history books, source materials and medical texts piled around him.
It is a quintessential scholar's warren, and brief excavation is sometimes necessary to find a spot for a visitor to sit. The nature of Musto's preoccupation is unusual, though. He spends his time looking for lessons of history in American drug abuse.
He has discovered many, but there is little evidence anyone else is paying attention to them. While passing local, state and national administrations may perceive drug abuse as a horrifying and new development, Musto sees little but a series of remarkably similar cycles of history.
Since the Civil War ended in 1865, these cycles of history have even generally relied on the same drugs: opium (and its derivatives, morphine and heroin) and cocaine.
It is Musto who more than a decade ago achieved a measure of national fame for dubbing this society's cyclical experimentation with mind-altering chemicals the "American Disease." He is perhaps the nation's only historian of drug abuse, having come to this discipline by accident about 20 years ago after training as a psychiatrist.
To make his point that there is little truly new on the drug scene, Musto sketches the broad outlines of a horrible contemporary-sounding "problem":
It is a drug crisis seemingly of unprecedented proportions--one in which a literal epidemic of cocaine use threatens to tear apart the American social fabric. The national mass media have glorified not just cocaine, but all forms of drug abuse, eagerly reporting on coke's prominent role at wild parties held by movie stars and socialites.
Two Hollywood celebrities have died of drug-related causes. The drug problem of one star had been uncovered and reported in agonizing detail by the press months before. Coverage of the second drug death emphasizes that the star was linked to wild "drug and wine orgies."
So grave is the perceived threat--both from opiates and cocaine--that a presidential commission is hurriedly organized to find ways to stop the drug menace. The commission learns that, in just a single recent year, more than 1 million pounds of raw opium found its way into the country. Criminals high on cocaine are reported able to withsta1852055664in the South are switching to higher caliber guns.
Within months, the blue-ribbon panel has issued a chilling report on the penetration of drugs--especially cocaine--into American society. "The illicit sale of (cocaine) is the most difficult to cope with and . . . habitual use . . . temporarily raises the power of a criminal to a point where in resisting arrest there is no hesitation to murder," says the presidential commission. "It is more appalling in its effects than any other habit-forming drug used in the U.S."
America has demanded that the countries that originate drugs do something to stem the flow. These governments, in turn, have suggested that America, itself, pass more stringent drug laws and do something to cut demand in a drug-crazed society. In Washington, there is already talk about passing a set of statutes that, together, would constitute the most sweeping crackdown on drugs ever attempted in the the United States.
Musto Pulls String
It is at this point that David Musto will probably pull the string. This is not the American drug scene today. Rather, it is a sketch of the way things were 60 to 90 years ago.
The special presidential commission report? Filed Feb. 21, 1910. The year in which more than 1 million pounds of opium got into the country? 1897. The high visibility show business drug deaths? Actor Wallace Reid, morphine poisoning, Hollywood, January, 1923, and actress Olive Thomas, suicide related to cocaine and heroin, Paris, September, 1920. The massive new legal crackdown on drugs? The Harrison Narcotic Act, 1914.
Musto sees no nefarious conspiracy behind all this. Rather, he says, the span of human memory is the culprit. As recollections of any particular drug epidemic fade, both the initial euphoria and the final desperation that characterized it pass too. When the inevitable next cycle of drug abuse begins--with the identical same drugs or chemical variations--there is a sense of new discovery, Musto said.
"Public memory for a public problem is very important," Musto said. "When there is no clear-cut solution, you have these ups and downs and swings of the pendulum. Once you reintroduce a substance like cocaine, which causes people to feel happy, or at least not down, it really has an effect.
Stages Take a Decade
"It's like reintroducing it to a population which has forgotten. But you do know what they did the last time around. They eventually became very fearful of it. The cycle started with extreme enthusiasm, then uncertainty, then a feeling that this is an extremely dangerous substance. Each of these stages takes a decade or more."
The cycles recur, moreover, because drugs represent both an inevitable lure to the human organism and a source of fear, observed Dr. Daniel X. Freedman, a UCLA expert on national drug policy. Mind-altering drugs tempt humans because they make them feel good, but terrify them because the ecstasy can't be controlled.
"You can get a chemical glimpse of paradise," said Freedman. "But (you eventually discover) that you can lease it, but you can't seem to gain ownership of it."
Although Musto published a book on the history of drugs ("The American Disease," Yale University Press) in 1973 and served for a time on a drug policy task force under President Jimmy Carter, calls from Washington have been few since 1981, when Ronald Reagan took over the White House, organizing a drug program heavily influenced by First Lady Nancy Reagan.
First Lady's Role
In public statements since, Mrs. Reagan has suggested that today's drug problem has its roots not earlier than about 1960. Musto said her activities are characteristic of a role eventually taken by publicly prominent figures once a drug abuse cycle has matured and drugs in general--or some drug, in particular--are passing once again into disrepute.
"What she is doing," said Musto of the First Lady, "is responding to a shift in attitude toward drugs in the U.S. As long as you have something that upsets many American people, it is by definition a political issue on which you can build a power base. The drug issue in America today seems to be becoming (again) one on which it is hard (for a politician) to lose."
Like most academic historians, Musto is disinclined to raise his voice often in any public debate on political policy. And so he has stayed pretty much here at Yale, writing occasional opinion pieces for newspapers ranging from Newsday to the Wall Street Journal.
They have taken a position that may sound bizarre at first flush. Essentially, Musto believes that the drug problem of the United States that began to take root in perhaps 1965 and has evolved into today's crisis led by cocaine is strikingly similar to what occurred in the country between 1900 and 1920.
The eventual result of this growing concern over drugs of all sorts makes it possible that what happened then could recur: Prohibition.
To be sure, the abuse of alcohol is often separated from the abuse of other psychoactive drugs. But Musto believes it is quite possible that the right mix of revulsion over the toll of alcohol abuse and fear of the growing use of other drugs may combine, driven by a powerful grass-roots constituency, to bring about a reprise of a societal decision to simply do away with such dangerous substances. He notes that, between 1900 and 1915, the use of cocaine surged, playing an indirect role in creating Prohibition fervor.
He stops far short of predicting that the 1920s will repeat themselves, but he believes a new American temperence movement has already taken root--starting with Mrs. Reagan's campaign, modeled after a 1971 GOP governor's conference program, to encourage children to "Just say no" to drugs, and political pressure brought by MADD (Mothers Against Drunk Driving) and groups like it.
"Prohibition represents the sour end, in many ways, of a very positive reform movement," Musto said. "You discover it (alcohol alone or alcohol and other drugs) is a problem. You publicize it. You pass laws so people become educated about it.
'Problem Keeps Growing'
"Then you discover that the problem keeps growing and you regrettably are forced to the conclusion that you will have to take action for the people's own good."
Musto says that, just as occurred in 1914, today's drug epidemic may be at the point where a package of tough, new laws will be appropriate. Musto, Freedman and Duke University's Dr. Everett Ellinwood agreed that, historically, such crackdown actions have generally achieved their announced goal. But they also emphasized that get-tough laws generally represent a societal response to drugs that follows the point at which drugs pass from favor and the epidemic begins to lapse of its own accord.
In 1914, the Harrison Act represented the first time it was illegal to import, possess and sell opiates and cocaine. Before it was passed, there were essentially no legal restrictions on such drugs. It preceded ratification in 1919 of the 18th Amendment to the Constitution--popularly known as the Volstead Act--that brought about Prohibition.
Laws May Get Tougher
Musto contends, just as occurred in 1914, drug laws could become far more stiff. It is no accident, Musto said, that House Speaker Thomas P. (Tip) O'Neill Jr. (D-Mass.) has proposed a new legal assault on drugs--one so urgent it should be exempt from balanced budget laws. More than this, Musto speculated, if this legal initiative materializes, it may--as the Harrison Act did--unwittingly come into being when the drug crisis has begun to wane of its own accord, though this will probably not be realized until years later. President Reagan said Wednesday that he plans an anti-drug campaign of his own.
Nevertheless, as new drug laws have on at least three occasions in this century, fresh statutes may quicken the quieting of the drug crisis this time too, according not just to Musto but to other national policy experts.
And just as dead movie stars helped galvanize the public in the 1920s, the recent cocaine deaths of University of Maryland basketball star Len Bias and Cleveland Browns and former UCLA football star Don Rogers may help play a role in bringing about a change of heart about drugs that is characteristic of each drug cycle.
Titillation Becomes Horror
There is in each of these recurring cycles, agreed Musto, Freedman, and Ellinwood, what amounts to a moment in history when the public, previously fascinated and attracted by drugs, turns from titillation to terror. Things have happened like this so often, say these three experts, it's almost as if someone dredges up an old script and society plays the same scene, again and again.
To Musto and Ellinwood, cocaine and other stimulants seem to play a unique role in the recurring cycles of drug abuse history. Musto is fond of drawing a little graph that shows opium and morphine consumption starting to increase nationally in about 1890. Unlike today, when law enforcement estimates of the amount of heroin consumed in the nation each year (13,134 pounds for 1984, according to the U.S. Drug Enforcement Administration) are little more than guesses, figures from the 1800s and 1900s are fairly precise since they were based on tariffs collected in legal importation.
Musto's graph shows a line rising at a 45-degree angle until about 1905. At that point, widespread cocaine abuse began in earnest in the U.S. and the nation's morphine, heroin and opium problem was quickly upstaged by the upstart drug. It was not until cocaine dominated the scene then--and, as now, Musto and others contend--that drug abuse control efforts have been truly escalated.
Paradoxically, while there have been ebbs and flows of marijuana use throughout the period in question, that particular drug doesn't appear to be related to any of the identifiable true abuse epidemics.
Counts Five Epidemics
It is Ellinwood's belief that, since cocaine was discovered in 1860, there have been no less than five identifiable epidemics of abuse of cocaine and other stimulants. In both the 1890s and 1920s, cocaine use surged. In the early 1950s and late 1960s, the same pattern developed with amphetamine and methedrine, the two major stimulant pills of the era.
Ellinwood believes that today's fifth epidemic since the discovery of cocaine is the largest and most severe--primarily because of the advancement in chemical science that has made it possible to deliver cocaine in smokable form--the preparation called "crack" that is potent, cheap to produce, widely available and with genuinely great potential for addiction and lethal overdose, most experts now agree.
Each time, the epidemics have followed what is to Musto, Ellinwood and Freedman an easily recognized pattern. At the beginning of an epidemic of whatever drug, use surges because the new drug is discovered by a small elite of users who often are able to control their responses to the new preparation. Because initial supplies of a new drug come from either legitimate (as in the case of both cocaine and amphetamines or even LSD) or small-scale illegitimate sources, cycle-starting users represent a self-selected group who often find no reason to believe the new drug is unsafe.
Bad Reactions Spread
Inevitably, however, in each epidemic, both word of mouth and mass media accounts are widely disseminated depicting the drug in question as both safe and capable of wonderfully pleasurable effects. Predictably, consumption increases, spreading to a wider cross section of users with more disparate reactions. Both because total use increases exponentially and because there is more diversity among users, bad reactions become far more numerous.
Simultaneously, medical researchers catch up with the trend, eventually discovering problems of addictive potential and long-term biological harm never imagined when the new drug first appeared or an old drug's popularity was revived.
Historically, the record demonstrates that each abuse cycle may take from 20 to 30 years. There is no reason, Musto said, to believe the situation today is any different. There is evidence that if the current cycle was overlaid on a graph of the epic at the turn of the century, 1986 might correlate with a point between 1905 and 1910.
"This is a very important issue," said Ellinwood. "I wrote an article in 1973 that describes (in terms of developments in cocaine and stimulants of all sorts) exactly what is going on today. It also describes what was going on in 1890. To me, it is crazy that we have to keep going through this process.
"One of the things that tends to happen is that (when today's policy makers return to the musty reports and documents of the earlier eras of drug abuse), the language is relatively ancient and there is a moral indignation expressed in some form.
"The moral indignation of the 1890s doesn't fit with (the tone of) our moral indignation of the 1980s. It (the older work) has such a sanctimoniousness that we automatically reject it. We may come up with a whole new set of sanctimonious expressions, but the point is that the facts are so overwhelmingly similar it's incredible."
All three experts agreed there are differences between individual epidemics. In recent years, these have had to do largely with changing chemistry, more than anything else. LSD and PCP (a drug used today, as cocaine was in 1910, to justify increasing police fire power), for instance, didn't exist in the 1900s, nor did the host of so-called designer drugs that have come into vogue lately. Similarly, the legal situation has changed. The Harrison Act was passed largely because of pressure from other countries, which pointed out that the U.S. essentially had no drug laws.
But, said Musto, most of the time, the parallels are far more striking than the dissimilarities. Examples: As today, in the early 1900s, for instance, the nation's doctors had taken so widely to prescribing huge doses of narcotics for patients that they were said to have created thousands of addicts--as many as 250,000 morphine or heroin junkies at the time nationwide.
Treatment Clinics Abound
At the same time, like today, for-profit treatment clinics--many of them franchise businesses that advertised widely in the lay press with claims of astonishing success rates at "curing" addiction--were numerous and their operations controversial. Increasingly, then as now, the public demanded that doctors stop creating and maintaining drug addicts and the outlandish claims of the franchise clinics finally came into serious question.
As striking as he has found all the parallels and cycles of drug abuse and the response to it by American society, however, Musto said he has come to see that there is almost a certain inevitability to what happens. Freedman agrees, noting that drugs have always had the ability to draw and fascinate human beings because they offer a promise that tends to be forgotten in the latter stages of each of these cycles of history:
The cycles begin because people enjoy what drugs do for them. Heroin may stand accused of having "enslaved" hundreds of thousands of addicts, but they were drawn to it, said Freedman, because the heroin high has long been recognized as the "Cadillac" of drug sensations.
Each cycle is allowed to begin because, since there have been few--if any--reliable ways of treating drug abuse or blunting the natural human urge to get high, the passage of a decade or two after the waning of one drug cycle means its unpleasant memories are gladly forgotten. Old drugs may be rediscovered or newer ones introduced to a population attracted by the high, but personally ignorant of the risks.
Finds No Progress
Inevitably, agreed Musto, Freedman and Ellinwood, history repeats itself.
"As long as we're human and there is no other cure except hard experience or religious conversion, or something like this, then you're not going to have steady progress," said Musto. "There are certain areas of life in which there is perhaps no progress over hundreds of years. We'd like to believe there is progress, and we're frustrated that there isn't."
And so it is that deja vu is the rule in the history of drug abuse:
--Vietnam was not the first war that prompted fears that American servicemen would return from combat hooked on opium and morphine (Heroin was not not synthesized until 1898.). Addicted Civil War veterans roused the same fears, and by 1900, there may have been as many as 250,000 morphine addicts nationwide, Musto said. The same panic developed during and after World War I and World War II. Years after the conclusion of World War II, drug experts identified clear war-related epidemics that had come and waned in New York City and Chicago.
--While police seizure figures may make it seem that there is no precedent for today's level of use of drugs, the era around 1900 was one of enormous drug use. In 1897, nearly 1.1 million pounds of crude opium was imported. In 1907, 151,916 pounds of smoking opium was legally brought into the country. In 1901, 50,609 ounces of morphine was produced--a quantity massively greater than what was needed for the population at the time--about 76 million people. --Today's crack problem represents far from the first time in history that blacks have been deliberately fingered as a root cause of cocaine abuse. In fact, in the 1910 report of the national panel popularly known as the Shanghai Opium Commission, it was observed that "the use of cocaine by the Negroes of the South is one of the most elusive and troublesome questions that confront the enforcement of law. This class of Negro is not willing, as a rule, to go to much trouble or send to any distance for anything and, for this reason, where he is known to have become debauched by cocaine, it is certain that the drug has been brought directly to him from New York and other Northern states."
Freedman believes that the history of drug abuse epidemics begins even before the Civil War, stretching, in fact, to London in 1750, when an epidemic of gin drinking inflicted moral devastation on that city apparently on a par with the worst drug problems of the 20th Century.
Foreigners (the Dutch) were blamed for sending the poison. Gin consumption rocketed from 1 million gallons a year to 12 million to 14 million. New laws were demanded and eventually passed, bringing the birth of the licensed, regulated tavern. Finally, a religious revolution swept the city, John Wesley founded what became Methodism and the gin epidemic died out.
Preference for Flat 'No'
As for whether the U.S. may be on the same track, Freedman is reluctant to predict Prohibition flat out, but he would not be surprised if that is what happens as a response not just to alcohol abuse but to all forms of drug abuse lumped together.
"I can see a much wider feeling of the wisdom of society saying 'no' to all intoxicants," Freedman said. "I can see some state finally saying, 'We've got more than we can handle.' "