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I have had the opportunity to see what drugs have done to the minority community, especially the legalization of methadone. It doesn't seem to be introducing, in my community, rehabilitation, job skills, and it hasn't weaned

people off of heroin. I look at the thousands of people in my district and other districts, and I get the clear impression that the same way people were talking in my district in 1970, they are talking in 1988 and saying that if that is what those people want and by legalizing it it's going to cut down on crime, then give it to them and give it to them without any sense of any obligation to them as human beings. And worse than that, without any sense of obligation to the thousands of babies that are being born addicted not to just cocaine, not to just heroin, but addicted to a legal drug which U.S. taxpayers are paying for.

Do you have any observation as to the impact of the legalization of drugs, some or all to the poorer segment of the United States?

Dr. Musto. This is an extremely crucial issue. I believe in the next 30 or 40 years, much of the furture of the United States will rest on how we deal with the problems and issues of the inner city. This could not be a more crucial issue, in my opinion.

What history has to say about this is that you can overcome drug use. In my testimony, I quote the experience of Jane Adams, the first American woman to win the Nobel Prize. She fought cocaine in Chicago in 1907 to try to get a control over the problem. Of course, the cocaine problem did decline.

One of the saddest things in the argument for legalization is the argument that these are harmless drugs and if people had them, they would be okay. I don't think there is anywhere where the damage is greater than in the inner cities, with the blacks and Hispanics. They wreck family life.

It seems to me that we are talking here about the actual, physical effects of drugs. It is true that 15 years ago people said cocaine was a harmless drug. It doesn't seem that way now.

My argument is that it is a gradual process; it does not take place in 1 or 2 years. The message of the history of this problem is that this problem can decline. We essentially wiped out cocaine as a problem in the country in the 1930's and 1940's. It had been a big problem at the turn of the century.

If we allow drugs to be distributed in the inner city that ruin community cohesion, it is not only disaster for those communities but for the United States as well.

Mr. RANGEL. Are you satisfied that the Congress and the administration has done all that it can to provide rehabilitation for those people?

Dr. Musto. No, I am not at all satisfied. I think it is absolutely astounding that with the AIDS problem we have, that rather than providing treatment for people and getting them off the use of needles, it appears one of the suggestions for a solution is to hand out needles. I don't know what is going through people's minds who will not provide treatment for people who want to get off drugs. To me it is an abandonment of the inner city.

This is one of the things I want to warn about, in this declining phase. We can get so angry at drugs and drug users we are liable to write off the cities. In the cities really you find the most staunch opponents to drug use. If we rely too much on law enforcement, if we simply have draconian penalties, we are going to write off the inner cities. This would be a very, very sad thing.

I do believe if someone needs treatment and wants treatment it is inexplicable to me that we don't provide it at that moment.

Mr. RANGEL. I would like to work with you, Doctor, because as a historian, I could use the expertise you have developed.

In my opinion, the great threat to the United States is drug abuse, especially as it relates to inner-city problems. No communist came to my community and snatched a child from a mother. No communists are causing the degree of hold-ups or muggings. It seems to me if this country is vulnerable, it will be ignoring what is happening to the homeless, the jobless and the homeless who find drugs the only way of life.

Mr. Smith.

Mr. SMITH. Doctor, I am curious about your very significant statement with reference to the long way we have come in determining that these drugs are in fact very debilitating, toxic and very much a threat to the personal health of the public at large.

I have been told the largest single cause of birth-defect children today is in fact the drug addiction of either one or both parents. Is that something you could discuss for just a moment?

Dr. Musto. Well, that is a very serious problem. I would include alcohol in that if you are going to talk about birth defects, because you should not ignore the role of alcohol in this area. I don't know whether you include that when you say drug addiction, but, yes, this is a common cause of birth defects.

Then not only do you have a defective child, but the parents are in no condition or position to take care of the child so it is a tragedy for the whole trio.

Mr. SMITH. Who pays the bill?
Dr. Musto. The public pays.

Mr. SMITH. So these people who are involved in drugs wind up forcing the bill for the impact of those drugs onto society?

Dr. Musto. Yes. And you have to keep in mind that the shifting of this burden to society would not change if you legalized the drug and provided it to them as they wanted it.

Mr. SMITH. If I am not mistaken, there is another member of the panel who will be coming to testify as a witness, from a group in favor of legalizing marijuana. From his testimony, we get the same tired, old refrain: Marijuana is not toxic; it doesn't have side effects; it doesn't cause problems. If you use it, you can mellow out and be a wonderful human being.

Can you give us information about the side effects, the birth de fects from that use?

Dr. Musto. I don't think there is any substance you can study that you would not find that there are not some serious problems. I see the greatest issue on marijuana the effect on adolescents, the family, in driving and other hazardous activity.

Mr. SMITH. What does marijuana do to your frame of reference in terms of things like visual, manual capability, the ability to drive an automobile, motor and sensory?

Dr. Musto. True, it interferes with that. I remember 15 years ago when we first started talking about this, it was thought that marijuana improved driving. There was some study that indicated that. Now we no longer believe that is the case.

One of the problems with marijuana is that the purity of marijuana or percentage of THC in it keeps going up because of effective botanical manipulations. So it is becoming more powerful all the time.

The one thing I would say about marijuana this generation is making up its mind about marijuana now for the first time. We never had marijuana at this level at any time in our history. When we passed the laws in the 1930's we had very little around. It was not based on an enormous problem at that time.

Our society is deciding now whether or not we think marijuana is a suitable substance for legalization. It appears to me by looking at public opinion polls and the University of Michigan study, that our attitude since 1978 or 1979 had been becoming much more negative toward marijuana. I am fascinated by this. It has paralleled attitudes toward cocaine and its substances.

So with marijuana, we are making our minds up now about what we are going to do about it. Every indication is that as we become more familiar with it, people become more alarmed by its effects.

Mr. SMITH. Doctor, you are a professor of history of medicine and recently you wrote a book called "The American Disease," dealing with the history of drug use in the United States, right?

Dr. MUSTO. Yes.

Mr. SMITH. As a medical professional, would you in any way, shape or form recommend to any person who sought your advice as a medical doctor, other than the possibility of using some form of marijuana to treat the side effects of chemo or radiation therapy of people who have certain cancers, to reduce the symptoms of the cure?

Mr. Smith. It reduces the side effects on a person with a possibly terminal disease. But beyond that, as a medical doctor, would you recommend the use of any of these drugs in any way, shape or form other than compounded into legal prescription drugs, to any patients?

If we legalized marijuana or cocaine to allow your children to use it, would you say, "Sure, go ahead; as long as it is legal, no problem"'?

Dr. MUSTO. No.

Mr. SMITH. I am not asking you on a moral basis. I am asking you as a medical professional who has been trained.

Dr. Musto. You have to step back for a moment. When you say cocaine, cocaine is still used to some extent for anesthetic for nose and eye operations. Morphine is used as a pain medication. But other than strictly medical uses, I would not recommend it and I would do what I could to stop it.

Mr. SMITH. Why, Doctor?

Dr. MUSTO. Because of the effects of these drugs on family cohesion and social cohesion.

One of the effects is that it isolates the person from society. They are quite stimulated by these substances, and it decreases the likelihood of social interaction. That is one of the reasons why I feel this is a serious matter with regard to people in the inner city who are trying to work together to accomplish very important goals. They have great problems facing them.

I feel one of the sad effects of these drugs is that it makes social cohesion more difficult to attain.

Mr. SMITH. Doctor, my time is about to expire, but le me ask, aside from the damage you see socially as well as physically to the individual using the drugs, what is the potential for damage for other people from that person using drugs? What is the effect of cocaine or Crack?

I don't know how anybody who wants to legalize cocaine could say, "No, we will not legalize Crack.” What is the possibility of a person being hurt or challenged, be driven into when they are driving a car? I want to know the effect of that on the persons standing next to them.

Dr. Musto. Those kind of effects are the reason for the cocaine laws. The substance was completely legal and we turned against it bed of the effects on individuals, and essentially wiped out cocaine from the society.

At some point I would be happy to discuss why I think this has returned and some of the errors we made in the decline phase.

Mr. SMITH. Thank you.
Mr. RANGEL. Mr. Scheuer.

Mr. SCHEUER. Thank you very much, Mr. Chairman, and I want to congratulate you once more on this superb set of hearings that I hope will constitute the beginning of our thoughtful analysis and possible alternative to the present failed system.

I enjoyed the witness's testimony very much. I want to ask a couple of historical questions.

First, what do we have to learn from the Dutch and British experience?

Dr. Musto. I will be very happy to discuss that.
Mr. SMITH. I will then give you the second question.

What do we have to learn from our prohibition experience? And there, of course, that involved trade-off. We ended prohibition. It came very, very rapidly after the beginning of the discourse. We did it on a cost-benefit basis. We knew there would be some increase or we supposed there would be some increase in alcohol addiction but we wanted to get rid of the criminogenic characteristics of prohibition such as the Friday night massacre.

Looking back on prohibition, were we right historically to end it and what was the payoff and what was the cost of ending it? How would you apply that same philosophy to possible alternatives to our present penal approach to drugs?

You heard Mayor Schmoke and others talking about some tightly restricted availability of some drugs to some addicts. Can you see that manipulated and organized and structured in such a way that the benefits of changing the system, eliminating the profits, eliminating the awful explosion of urban crime, would, outweigh the costs if we can restrain and perhaps eliminate the costs of making some drugs available to some addicts sometime under very controlled and carefully thought-out restrictions?

Dr. MUSTO. All right. Let me deal with those questions.

Mayor Schmoke and I are going to be debating one another at Western Maryland College on November 2. I will be looking forward to dealing with some of the suggestions he made at that time.

Now, with regard to the British system. It has been said that the British had a heroin problem and they passed a law, the Dangerous Drugs Act of 1920, that allowed them to give out heroin, and by the 1930's, they had almost no heroin problem. What is the answer to this? Well, it is absolutely false.

They did pass a Dangerous Drugs Act of 1920, but why? Because the United States and other nations put the Hague Apium Convention into the Versailles Treaty. If you retified the treaty you had 12 months to pass a Dangerous Drugs Act and the British did so. Members of Parliament said, "Why are we passing an anti-drug law? It is the Americans that have the problem.” The governments reply was the requirement of the Versailles Treaty. They had no major drug problem.

Some extravagant claims-in Ambics—for the "British system” are based on an error that the most elementary historical review of it would reveal.

Mr. SCHEUER. How about the last decade?

Dr. Musto. Their problem has become more similar to ours. We had heroin maintenance in New York State. We had about 30,000 registered heroin addicts in New York State in 1920. We had more experience with registered legal heroin than the British ever had. We decided this did not work for us.

Much of this is a matter of scale. If you have 100 people with a heroin problem, and you give them heroin, the public impact is small, but if you have hundreds of thousands of addicts, you are dealing with a different kind of problem. The issue of scale is very important.

The British experience has been more like the American one in the last 15 years. They have practically ceased the use of heroin. When I was last over to Britain and I talked to the home office person responsible for legal heroin distribution, he said there were only dozens of people on it. Everyone else had gone to methadone.

I remember in the 1970's when they gave out heroin and the disillusion felt about this program. I do not see the “British system” as a helpful model for our country.

Next I will take up prohibition. Prohibition did not happen just once in our country. 1920-33 was the second major prohibition in this country. The first widespread one was in the 1850's. The next was the 1920's. In the prohibition in the 1920's, we reached the lowest per capita alcohol consumption in American history. Historians and public health people are agreed upon this. But we repealed prohibition.

This is the way I look at it: We were able to reduce alcohol to about 1 gallon per person per year, maybe slightly less. We are now around 2.6 or 2.7. We hit a peak around 1980.

Alcohol had become a cultural element in many American lives especially immigrants from Eastern and Southern Europe. It was a cultural element, and although we were able to reduce alcohol to a very low level, we were never able to persuade the overwhelming majority of people that there was something fundamentally wrong with alcohol.

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