policy came to be. A constructive way to do so is to look historically at the evolution of drug policy and the language that has been used to discuss it.

Law Enforcement and Medical Approaches

Current drug policy has its roots in the adoption of the Harrison Narcotics Act in 1914.2 Although framed as a tax measure, the goal of the statute was to suppress the nonmedical use of what are called narcotic drugs (a classification that encompassed morphine, heroin, and other opiates, as well as cocaine). The effect was to criminalize the manufacture, sale, and possession of these drugs outside medical channels. An aggressive campaign of enforcement by federal authorities was deployed in the 1920s to terminate the practice of opiate maintenance by physicians and clinics. Eventually, the prohibitory approach was extended by Congress to marijuana in 1937, and during the 1930s and 1940s all state legislatures enacted a parallel set of laws. Penalties for narcotics offenses were increased in the 1950s, and new psychoactive pharmaceutical products were brought under federal control in the 1960s in an effort to suppress nonmedical use of these drugs. This accumulation of federal and state antidrug statutes was replaced in 1970 by the federal Controlled Substances Act and by parallel acts at the state level.

Until the 1970s, enforcement of this comprehensive array of drug prohibitions was the predominant instrument of the nation’s antidrug policy. What was called the law enforcement approach was generally understood as a relatively complete policy: drugs are dangerous to the social order. Therefore, it is both just and useful to prosecute those who supply drugs and those who use them. By setting out laws against these activities and enforcing them, individuals would be dissuaded and deterred from supplying and using drugs. If some persisted despite the prohibition, it would be both just and effective to incapacitate them as threats to society.

In the late 1950s and 1960s, however, the dominance of this law enforcement model was challenged by some influential lawyers and physicians who wanted to respond to drug addiction with medical methods (including civil commitment) rather than prosecution and punishment. In their view, chronic drug use was not a wholly voluntary choice but rather a disease to which some helplessly succumbed. The disease may have had its roots in biology, in the social conditions in which people lived, or in the dependence-producing power of the drugs themselves. But whatever


For a historical summary of drug policy predating the Harrison Act, see Institute of Medicine (1990: Volume 1, Chapter 2).

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