[13] (*) THE MILBANK QUARTERLY, Vol 69, No 3, 1991 pp 437-459 “Social Behaviour, Public Policy, and Non-harmful Drug Use” by Charles Winick


One conclusion of the literature on mood-modifying drugs like heroin and cocaine is that their regular non medical use will almost inevitably lead to bleak personal and social outcomes. My article suggests that the conventional picture of uniformly negative consequences of regular drug use is not supported by the data.

... in a state-wide study of all the narcotics addicts who could be located in Kentucky ... more than nine-tenths of the males receiving drugs legally were working effectively at established occupations. An improvement in work pattern typically followed an addict's securing a stable drug source, suggesting that this facilitated or caused improved work situation.


One ophthalmic surgeon noted: ``With Demerol, I can do three or four perfect operations a day. It builds up my resistance and makes it easier for me to concentrate when I am working double shifts and just couldn't keep up with it. The drug helps a lot.'' A trumpeter said: ``With the heroin, I could feel and look cool and reach and hold the sound I wanted.'' A warehouse worker stated: ``It's a very slow and long day, taking plumbing parts out of bins. Without the drugs, I couldn't make it.'' A television cameraman observed: ``I can't make a mistake on the job. I work a lot of overtime and the drugs make it easier for me to concentrate.'' No doubt other factors in the lives of these study subjects contributed to the relatively prosaic character of their drug habit and enhanced their ability to work: licit occupations, structured schedules, and participation in conventional family and community activities.


William S. Halstead, the father of modern surgery and a founder of Johns Hopkins Medical School, was cocaine dependent until the age of 34, when he turned to morphine, on which he probably remained continually dependent until his death at age 70. He was professionally active and medically creative during his whole life.

There are no reports demonstrating that addicted physicians are more likely to commit malpractice than others. Indeed, the country's largest program for addicted medical professionals reports that a physician's professional activities represent the last aspect of his or her life to be affected by drug dependence. Drug-using physicians typically have successful and active primary care practices ... some addicted physicians were described as ``the best doctor in town''


A 46-year-old practical nurse was observed driving his fairly new car to a Harlem crack house while parking his other car near his co-op apartment. ... Among the other regular users at the crack house were social workers, a maintenance man, and other healthy looking people with conventional jobs.

Upper-income users may find it easier to get drugs from OB physicians and powerful people could have access that is not possible for others. Narcotics Commissioner Harry J. Anslinger, the leading foe of narcotics maintenance, secretly authorized the use of maintenance for specific persons on a number of occasions. Thus, in the 1950's he maintained influential United States Senator Joseph R. McCarthy, who was a political ally, on morphine for years.


Studies in different societies, both economically advanced and underdeveloped, and involving a range of substances, have documented the use of habituating drugs by persons who are effective workers.

An investigation in Thailand found that some hill tribes reported that opium enabled them to function and it was not unusual to see a villager who had been addicted for 30 to 40 years and was still working actively.

In Jamaica, where ganja plays a significant role in social and economic life, the drug often facilitates the accomplishment of work by individuals and groups. ... users generally feel that ganja enhances their ability to work by promoting strength and stamina. Supervisors agreed that the ganja helps workers in the arduous job of reaping sugar cane.


Dutch cocaine users not only used it while functioning effectively on the job, but typically worked while under the influence. American observers at national meetings of the Dutch ``junkie union'' have been surprised at seeing members injecting heroin and then chairing the meetings with facility and skill.


A report by a British investigator concluded that a substantial proportion of the addicts receiving heroin at English clinics in the late 1960's could be characterized as stable, with high employment, legitimate income, and no hustling.


Other cultures provide clues that, without repressive laws, adult users may be able to regulate their own behaviour and decide for themselves what constitutes appropriate use. The Dutch study of cocaine users, for example, demonstrated that a significant proportion of the samples experienced periods of increasing use. For others, cocaine use became so problematic that they abstained, either for long periods of time or entirely. So long as our government policy is based upon the assumption that non medical drug use is destructive, we cannot develop substantial knowledge of the factors that enhance such effective self-regulation of use.