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 because 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.

In my view, the essential element in ending a drug's use is that a consensus exists that the drug is bad in any amount. That is why cocaine was essentially wiped out.

In 1914, when the first prohibition amendment started through Congress, James R. Mann, more famous for the Mann Act, shepherded the Harris or Anti-Narcotic Act through Congress. No problem, Congress was opposed to narcotics.

The next week he led the fight against the prohibition amendment in the House of Representatives. Rep. Mann, like many others had a very distinct view between the two substances, namely because alcohol had become a major element in so many lives, culturally.

Talking to the current situation, most of the drugs-heroin, cocaine-have been found by the American people to be without merit in recreational use. We are in the process of making these decisions about marijuana at the present time.

I don't see that prohibition shows that we should abandon attempts to control these substances. I would say that prohibition shows that you can have a law about a substance that even is considered quite okay by many citizens and you can still reduce enormously the consumption.

The death rate from liver cirrhosis in the 1920s was cut in half by prohibition. It would have gone up if we did not have prohibition. You have to look at what it is you are dealing with and what is the response.

I would say prohibition does not offer any support for the idea of legalizing cocaine.

Mr. RANGEL. The Chair would like to recognize Mr. Guarini, one of the senior Members of our committee.

Mr. GUARINI. Culturally, our society is changing. I think we all agree that we have single-parent families, are taking the grandparents out of the family, and are replacing them with day care cen

ters.

You say education is important. I agree with you, and we should do more for treatment rehabilitation. I also agree with you. Then the problem will eventually ameliorate.

Have you put in to your consideration the changes that are taking place, which are enormous in our society today, to base your conclusion on the fact that we don't need more penalties, we don't need more law enforcement, we don't have to go after users? What is your general opinion concerning these changes that are taking place that will effect the long-range drug problem in our country? Dr. MUSTO. I hope I have made it clear I am not opposed to law enforcement in drug control. I think it is very important. To assume you will just wait around for people to stop using drugs is not a reasonable thing and it is something I don't think the American people would stand for either.

I see, from looking over the changes of attitude in this country, that a very profound change has taken place with regard to these drugs. We have moved from seeing them okay if you don't misuse them to not okay in any amount. I think a lot of antidrug efforts are going to appear to work better than they did 15 or 25 years ago: law enforcement and education will seem more effective.

When we were on the upturn of the drug problem in the early 1970's, education seemed to be of no effect at all. I think you will now find people more receptive to antidrug education for they have already learned a lot from looking around them.

I am not saying those things are not important. I also am not saying we should just stand idly by and see if it takes 10 or 20 years for this to go away. I am saying that one has to be careful that the antagonisms that grow up around drugs may become so enormous that they sanction any action labelled antidrug.

I will give an example. Cocaine had come to be seen as the most feared drug in America in the 1920's, but it was also seen by a majority of the population to be almost a black drug. It was not. It was given as a reason for black hostility in the South, at the time of lynchings, of voter disenfranchisement. Not only did cocaine become a source of problems, but it became an explanation for resistance to actions that should have happened.

So in this atmosphere, you have an almost magnetic attraction between otherwise distinct social problems. Drugs can become an explanation for just about anything.

I am not dealing with the specific issues currently before the Senate. I am simply saying that one has to be very careful that in the antagonisms to drugs, we don't indulge in overkill and also not become unduly disappointed when the drug problem does not go away in 2 or 3 years, because that is most unlikely.

Mr. GUARINI. As a historian and someone who has studied our culture as it relates to the medical field, knowing the behavior of people in our society, which I imagine is very complex because we have such a mosaic society, would you say that we would be advised to go after the user at all? Should there be penalties against the user, such as marking his passport, taking his driver's license away, or taking away certain benefits he would get as a citizen from, say, school, loans and such? Would that help?

Dr. MUSTO. My feeling is there should be some user responsibility or some user effect; if you have decided this is a very dangerous substance, you want to discourage use, but I am not able to comment on those specific recommendations contained in the bill. I have not seen the bill, and I have not considered what all the actions might be.

Mr. GUARINI. We could go after that part of the demand equation?

Dr. MUSTO. Yes. I think that it is effective and has been shown in other areas, such as in our battle against racial discrimination, that it is important to have laws appropriately applied. Mr. GUARINI. And disincentives?

Dr. MUSTO. And disincentives. There is nothing unusual about that. I am concerned about the level to which it might go. For example, in the decline phase, as fewer and fewer people use the drugs in the 1930s, 1940s, and 1950s, the penalties got higher until in 1955 we had the death penalty. Senator Price Daniels put that ino his drug penalty bill. I remember interviewing Harry Anslinger, who was our Narcotics Commissioner for 32 years. I asked, "how did the death penalty get into Senator Daniels' bill?" Anslinger replied, he wanted to make this bill different from any other bill on this issue.