Trebach's Solution
Trebach’s Solution
William Walter Kay BA JD
Intro
Harm Reduction godfather, Arnold Trebach, got his JD in 1951. After a few months practicing law he did a stint with the Army before heading to Princeton to grab a PhD (1958). Pre-1971 Trebach worked for federal agencies. Post-1971 he taught at American University School of Justice whilst launching non-profits dedicated to narcotics liberalization – outfits later merged into the Soros network. (1)
Trebach founded London’s Institute on Drugs, Crime and Justice in 1973. Summer schools allowed American students to research British drug policy. Trebach’s seminal The Heroin Solution (Yale, 1982) draws on this research. Heroin Solution credits British doctors and clinicians, plus 40 academics.
Heroin Solution wraps its heroin-pushing agenda in “compassionate humane treatment.” Blending keen insights with sinister disinformation the book counsels treating the terminally ill, and heroin addicts, with heroin. Below is a critical synopsis.
Heroin
C. R. Alder Wright invented diacetylmorphine in 1874 by boiling morphine in acetic anhydride (a liquid akin to vinegar). Diacetylmorphine – one morphine molecule escorted by two acetyl molecules – is 4 times stronger than morphine.
In 1898 Bayer branded diacetylmorphine “Heroisch” (heroic) to sell as cough syrup. Bayer advertized heroin as non-addictive and overdose-safe. (2) Doctors loved heroin because:
“Heroin produces an analgesic (painkilling) effect by a two-fold action on the central nervous system; the pain threshold is elevated and psychological response to pain is altered. Pain may still be recognized as present, but the individual reacts less emotionally to it.” (3)
Heroin is painkiller and euphoriant. Stoned on heroin, patients stop whining.
Heroin displaced morphine among recreational users. Due to heroin’s deployment as WWI’s battlefield painkiller, heroin addiction became the “soldiers’ disease.” Morphine produced similar results following the US Civil War. By 1898 America hosted 250,000 morphine addicts.
Suppression
America’s 1909 anti-opium law targeted smokable opium. The law was an anti-Chinese initiative and a nod to rising international discomfort over opiate abuse. Similar laws appeared elsewhere after delegates returned from the Shanghai Opium Commission (1909) and the Hague Opium Convention (1912). In 1924 the League of Nations published: The Case Against Heroin.
The 1914 Harrison Narcotics Act shifted narcotics retailing from grocers and mail-order houses to pharmacists and doctors’ offices. Doctors then built lucrative practices peddling recreational heroin. Between 1914 and 1938 the Bureau of Internal Revenue investigated 25,000 doctors of whom 5,000 received fines or imprisonment. The last holdout, Seattle’s Dr. Ratigan, charged his 14,000 patients $1 per ‘treatment.’ Rattigan deemed his racket virtuous, arguing:
“…if drug addicts could get their supply of drugs at cost there would be no illegal peddlers, and since there would be no significant amount of recruiting of new addicts the problem would tend to disappear in a single generation as the existing addict population would die off.”
In 1934 Rattigan received a 7 year sentence and $10,000 fine. He left prison a pauper.
The 1956 Boggs Act mandated 5-year minimum sentences for first-time heroin traffickers; 10-years for repeat offenders. Amendments added a death penalty option for trafficking to minors.
Clinics
In 1919 Dr. Willis Butler set up a morphine clinic in Shreveport, Louisiana. Butler pitched his clinic as crime prevention. Patients were “morphine vein shooters” to whom Butler supplied huge doses. Butler tolerated no “bums or loafers.”
“If a patient did not have a job, Butler considered it his responsibility to get him one. The same was true of a decent place to live….”
Shreveport police helped patients find housing and employment. (4)
The Feds closed Butler’s clinic in 1923.
Meanwhile in Britain, a committee chaired by Sir Humphrey Rolleston issued a report in 1926 recommending treating opiate addicts with opiates. Medics heeded Rolleston’s advice until the late-1960s, when the establishment revisited the topic:
“The descendants of the Rolleston committee could tolerate the idea of a general practitioner providing regular supplies of narcotics to somebody’s old, gentle mother, who had become used to her morphine when in the hospital twenty years ago for a cancer operation, but they positively gagged at applying Rolleston rules to that mother’s mod son, with his long hair and hippie clothes, who lived on the state, never worked a day in his life and did not intend to, and now wanted his heroin free...” (5)
G.P.s’ subsequent loss of authority to prescribe heroin spawned specialized heroin clinics. To seduce clients out of hiding clinicians opposed forcing addicts to endure abrupt withdrawal. In the mid-1970s clinics switched from injectables to orals. Why?
“…injecting is an unnatural manner of taking something into the body. Each injection causes a minute physical trauma; three or four injections a day over a period of years can cause the collapse of veins and harm to other tissue. Unsanitary injections can cause infections and the spread of disease. Second, there is some evidence that much of junky culture and the very habit itself are centered around the injecting ceremony – that the drug may hold less importance to some addicts than the needle itself. Injecting in psychiatric terms may be symbolic of compulsive masturbation or even self-destruction. (6)
Dr. Philip Connell ran Maudsley Hospital’s outpatient clinic and Bethlem Hospital’s inpatient ward. Connell criticized outpatient clinics thusly:
· Distinguishing occasional users from addicts is almost impossible. No lab test helps, and drug-users are notorious liars.
· There is no telling what dosage constitutes proper maintenance.
· Addicts deceive and coerce doctors into prescribing extra drugs.
· Horrible, infantile antics of addicts drive away staff.
On Connell’s last point:
“Many of the clinic psychiatrists, nurse and social workers had simply been worn down to the point of annoyance by addicts who came back year after year seeking not improvement, not a better life, not rehabilitation, but drugs to stick in their veins.” (7)
Seventies USA
In 1971 Nixon blared:
“Public enemy number one is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive.”
During the 1970s federal expenditures on drug programs spiked from $86 million to $902 million. By 1978 the DEA (established 1973) employed 4,000. Another 150,000 Americans worked in drug abuse prevention, treatment and research. (8)
President Carter pushed methadone and toyed with liberalization. As for prescribing heroin to outpatients Carter’s Drug Czar, Dr. Dupont, fumed:
“Take-home heroin… is a completely crazy idea. Try to picture addicts… walking out of a clinic every day with $100 to $200 worth of heroin. How much would be sold? How many overdoses would result from diverted heroin?” (9)
In 1979 Carter boasted of reducing the number of heroin addicts from 500,000 to 380,000.
Trebach’s 1980 estimates: 500,000 addicts and up to 3.5 million occasional users. Ninety percent were recreational users lacking any medical rationale for doing heroin. 170,000 were in treatment; of those 75,000 received methadone. (10)
Addiction ain’t a disease
Trebach explodes the “addiction disease” myth; albeit out of animosity toward heroin’s synthetic rival, methadone. Authorities chose methadone (over heroin) for heroin addiction treatment because methadone dulled cravings without providing euphoriant release.
Trebach decries “methadone pushers” for conflating addiction with metabolic disorders like diabetes. Methadone pushers contend that just as diabetics need insulin shots, heroin addicts need methadone doses. Diabetes, however, is a demonstrable organic condition. Without insulin diabetics die. Conversely:
“There are numerous instances in which addicts took heroin for years and then matured to the point where they became fed up with the whole addiction game and simply stopped taking the drug. Such cases of the maturing-out of an addiction have been well documented for all narcotics.” (11)
Many addicts pass through a youthful delinquent phase then mature out. Quitting isn’t an option for sufferers of real diseases like osteoarthritis, tuberculosis etc.
Dr. Connell considered addiction a “condition” which some like to call a “disease,” however it isn’t a metabolic disorder, nor a “disease” for which there exists medicinal remedy. (12)
Tolerance Denial
On Harm Reduction’s fatal flaw, drug tolerance, Trebach spares 9 lines. Worse, Trebach was a tolerance denier. Conveniently for us, he destroys his own argument.
Dredging Rolleston-era lore about patients not craving increased doses, Trebach extrapolates:
“The idea (of a stable addict) also runs counter to much high-level drug experience, for it virtually destroys the venerable concept of “tolerance,” which holds that with some drugs, such as heroin and other powerful narcotics, addicts develop a virtual numbness to the relief obtained by a given dosage and are constantly asking for more…. The fact that some addicts can live fairly normal lives on level dosages of narcotics is an extremely important philosophical and clinical underpinning for the British approach….” (13)
Back in 1926, British heroin addicts numbered in the mere hundreds. They were often cancer-ridden octogenarians. Rolleston’s sample is too small; his data too sketchy. Timeframes were often too short for tolerance to manifest. His cohort differs incomparably from modern addicts.
Trebach then summons Butler’s Shreveport Clinic:
“…the Shreveport experience cast doubt on some accepted principles of the modern drug-abuse field. Dr. Butler stated that he had no difficulty in stabilizing dosages. In other words, the process of tolerance did not seem to come into play.” (14)
Shreveport didn’t last long enough for proper tolerance analysis. Shreveport’s huge dosage limits likely staved-off displays of tolerance. Butler kept lousy records.
Neither Rolleston nor Shreveport cast shade upon conventional wisdom regarding tolerance.
Finally, Trebach’s basic pharmacological theory runs as follows: opiates lock onto receptors on neuron membranes, then: “if the nerve, to compensate, grows more receptors, or if it varies its utilization of the normal chemicals received from its neighbors, that explains why narcotic doses must be increased to achieve the same pain relief or pleasure.” (15)
Doses must increase!
Addiction and tolerance reflect the same physiological process.
Prostitution Denial
Trebach fills 50 pages on heroin-related crime (theft, robbery and burglary) yet he types not a word on sex-work. In the real underworld sex-workers form heroin’s core market. Most sex-workers are addicts. Human trafficking and drug trafficking fused long ago. Opiates enslave. Harm Reductionists hide this.
Oppression
Trebach broaches heroin realpolitik only to showcase his fatalistic libertarian Iron Law of Opium; i.e., suppressing opium cultivation somewhere incentivises opium cultivation elsewhere. Thus, he notes how the early-1970s saw Turkey’s opium harvest wilt while Mexico’s bloomed. (16)
Circa 1965-75, competition between French and American intelligence services multiplied heroin supply. Trebach acknowledges supplies ballooned but avoids discussing causes. Consequences were unavoidable:
Circa 1970-78, Western Europe’s heroin addict population grew from 10,000 to 200,000. In US-occupied West Berlin numbers swelled from 2,000 to 20,000. British heroin addicts surged from 2,000 to 15,000. Scotland Yard expressed alarm, as did British journalists who blamed supply-side forces. (17)
Trebach relays this much from McCoy:
“…heroin addicts are victims of the most profitable criminal enterprise known to man – an enterprise that involves millions of peasant farmers in the mountains of Asia, thousands of corrupt government officials, disciplined criminal syndicates, and agencies of the United States government.” (18)
Trebach then teases radical analyses of the heroin industry with quotes from Lamour et al:
“…sooner than promote a policy of full employment, the American government… prefers to hand out the dole to unemployed ghetto-dwellers knowing full well that these underprivileged people will squander the better part of it on drugs.” (19)
“…the cause of the evil is indigenous… the inevitable by-product of a decadent capitalist system… Capitalists are racists who keep non-whites subjugated and so miserable that even the pittance they are given will be squandered on drugs to help them endure their oppression.” (20)
Britain’s Institute for the Study of Drug Dependence endorsed China’s social revolutionary opiate suppression methods. Acknowledging that “addicts are antisocial and unhealthy,” the Institute reiterated Mao’s dictum: “the enemy in the anti-opium campaign is a class enemy.” Recognizing “the political basis of addiction” they concluded: “medical solutions do not get at essential causes of what is a permanent problem in society.” (21)
Radicals, favouring prevention over cure, contended:
“…the creation of new addicts depends on the number of vulnerable people and the number of existing addicts – if potential addicts have less contact with addicts and less ease in access to opiates then fewer new addicts.”
Trebach rejects these truths as quickly as he flashes them; albeit with one whopper red herring argument.
Trebach dismisses: “theories of causality which blithely assume that the mere availability of the drug is the most powerful force in producing virtual epidemic use of it.”
Such “mechanistic” thinking doesn’t explain: “choices made by the new heroin users in the experimental stage which go on for years without actual addiction.” (22)
This utter irrelevancy hardly rebuts the contention:
No opioid users – no opioid addicts!
Footnotes
2. Trebach, Arnold S. The Heroin Solution; Yale University Press, New Haven and London, 1982, p. 40
3. Ibid, p. 61
4. Ibid, p.152-3
5. Ibid, p. 174
6. Ibid, p. 192-3
7. Ibid, p. 186-91
8. Ibid, p. 241
9. Ibid, p. 275
10. Ibid, p. 3-4 & 205 & 243-9
11. Ibid, p. 282-3
12. Ibid, p. 186-9
13. Ibid, p. 104
14. Ibid, p. 152
15. Ibid, p. 61
16. Ibid, p. 236
17. Ibid, p. 12-19 & 190
18. Ibid, p. 288 & 320
19. Ibid, p. 320
20. Ibid, p. 288
21. Ibid, p. 288
22. Ibid, p. 276