By Edward Marsh, The New York Times, February 9, 1913
On the Eve of a Decisive Battle Against It at Albany, Charles B. Towns, One of its Arch Foes, Tells How Our Present Laws Make It “Criminally Easy” to Become a Morphine or Opium Fiend.
The battle against drugs has crystalized before the Legislature at Albany in the introduction in both houses of a bill which, it is confidently believed by its supporters, will at least approximate a solution to the troublous problem. This bill has already been indorsed by the Kings County Medical Society; the New York Medical Society, it is believed, will have indorsed it prior to the publication of this article.
The bill was drawn by Charles B. Towns, a New Yorker and an expert of international reputation, whose writings on the subject of drug-habit perils in The Century Magazine and elsewhere have attracted much attention during the past year; whose treatment for drug habits, pronounced the most effective yet devised, has been freely given to the medical profession by its discoverer; who has studied drug and liquor addictions for twelve years to the exclusion of all else, traveling as far as China in his search for facts, and whose work has won unqualified indorsement from such distinguished medical men as Drs. Cabot of Boston and Lambert of New York.
He went to China on the suggestion of the State Department in 1908, to make a demonstration of his plan for treating opium-habit victims, with a view of showing beyond question its practicability. He opened three hospitals in china, at his own expense—one in Peking, one in Tien-Tsin and one in Shanghai—and successfully treated something like 4,000 patients. It was after this extraordinary demonstration that he put the climax on his work by presenting, gratis, to the medical profession, without reservation, the formula which, up to that time, he had kept secret because he held it to be in the experimental stage. He was present at the opium conference in 1909. In all he has been eleven months in China. The ineffectiveness of existing legislation has been generally recognized, and each effort to improve upon it has been subject to like criticism. In this proposed law, known as Boylan-Kerrigan bill, it is believed that the old troubles have been done away with.
I talked with Mr. Towns upon an Albany-bound train last Wednesday, as we were going up to a committee hearing, thus supplementing a study of his plan which has extended over something close upon a year.
“Nothing could be more gratifying than the fine support the medical profession is giving to this proposed legislation,” he told me. “No honest doctor wishes things to remain as they now are, and the proportion of dishonesty in the profession is very small, indeed.”
“It has been criminally easy to acquire the drug habit and criminally easy for those who have acquired it to obtain the drug with which to feed their appetite. Ninety per cent of drug victims suffer through misfortune, not through fault. Drug taking is acquired as a form of dissipation only in the ‘underworld’ and for the ‘underworld’ I feel small concern. The greater number of drug victims is made up of those who have been led into the habit, or who have turned to it, as a means of easing pain; therefore the average drug habitué is much more to be pitied than the victim of the drink habit.”
“A large proportion of voluntary drug users started with small doses, with no thought but that of saving themselves misery arising from some physical ailment. An even larger percentage has undoubtedly been led into the habit by the administration to them of the drug by their physicians for what they though legitimate purposes and under what they though a real necessity.”
“Comparatively few physicians have recognized the fact that it is unsafe for sufferers to know what will ease pain. The conservative physician uses very little morphine. One of eminence and an enormous practice, assure me that, in his prescriptions, he does not average one-half grain a year; another, of like eminence, told me he had never gone beyond two grains a year in his whole practice.”
“Therefore a very small proportion of drug habitués begin to take the drug through its legitimate medical prescription for a necessary purpose, and among the small proportion for whom drugs are legitimately prescribed is a large number who, had the proper medical treatment been directed at the cause of the disorder, rather than at the pain, which is only a symptom, would never have been given a grain of any habit-forming drug.”
“Opiates do not remove the cause; they merely blunt the agony of the disorder’s manifestation by inhibiting the body’s functions.”
“Thus 90 percent of the opiates medically used are used without valid excuse. Among the something more than three thousand cases of drug addiction which I have studied in this country, at least three quarters received their first dose of the drug when there was no sufficient reason for its administration.”
“But the first dose taught them that drugs would ease their pain. The succeeding process was inevitable. When again pain came, again they turned to drugs, sometimes with, sometimes without, the knowledge of their doctors. Presently the habit was inevitably fastened on them—and they had joined the ranks of the unnecessarily ruined.”
“It may be at once admitted that there are cases in which continuous pain from an incurable disorder would be inevitable if drugs were not administered. In such cases it should be made easy for the sufferer to get his drug. No good purpose can be served by forcing him to suffer without the possibility of relief. To furnish opiates in such cases as promptly as is possible is only ordinary human mercy.”
“But these cases are uncommon. In almost every other instance drug administration should be surrounded by such safeguards as will make it practically impossible for it to begin.”
“My entrance into the legislative field was due to my discovery that the physician who began to protest against drug use was likely to be instantly and bitterly attacked by the manufacturer of instruments and by the wholesalers of the dangerous drugs. One of these men was drawing his income from the manufacture of the gun, the hypodermic syringe; the other was obtaining his through the manufacture of the ammunition, the drug itself. They wished no interference with their selfish war upon society. And they were very powerful. They did not find it difficult to harm doctors who opposed them seriously.”
“It occurred to me that if it could be possible to stop the sale of guns and the sale of ammunition would automatically decrease, for a large share of habit-forming drugs consumed are taken hypodermically.”
“The result of this very simple course of reasoning was the drafting of a bill making it illegal to sell a hypodermic syringe except on the prescription of a physician. That bill was passed and now stands as a law upon the statue books of New York State. Before it was enacted any one could sell hypodermic syringes. They were freely offered to the purchaser, not only in the least important and least reputable drug shops, but even in department stores, where they took their turns at price reduction, and, upon occasion, were announced for bargain sale.”
“That law has done some good, undoubtedly, but it has by no means solved the problem. It very quickly became evident that legislation must go further, and, in consequences, the bill now in debate was drafted. It will probably become a law at this session of the New York Legislature, and I have assurances that it will be accepted as a model for new legislation in several other States.”
“But wherein do existing laws fail?” I inquired.
“Existing laws which at first seemed so desirably drastic, but which in practice have proved almost valueless, hold no one responsible,” was the replay. “One man should be held responsible—the physician.”
“The reputable doctor feels no fear of suffering, through this: the man who does, declares himself unworthy by the mere acknowledgment that he feels fear. No habit-forming drugs should be administered without real need, no subterfuge should be accepted as excuse; the use of opiates to cover ignorance should be rigidly prevented.”
“I have no desire to throw the burden and expense of medical attendance upon any one; I am not favoring the doctor at the expense of the druggist; I am trying to protect all honest men—the honest doctor and the honest druggist among them—but, most of all, the honest and entirely helpless sufferer. He tragically needs protection. In safe-guarding him lies that protection for society itself, which as present lacks and which it must get, if it is not to suffer greatly.”
“In the proposed legislation the effort has been made to put the drug traffic upon an absolutely honest basis, where the public thought it long since had been placed, but where it never has been. The belief that it already had been carried to the doctor and there held rigidly, has been a popular error.”
“The almost universal theory has been that drugs could only be obtained upon prescription given by physicians, and the natural and usually correct assumption that physicians know their business, are men of a high class and will give out habit-forming-drug prescriptions only when they are completely justified, has given the public a fine sense of security. But, unfortunately, there are weaknesses in this scheme of protection, weaknesses which practically nullify it.”
“Up to a few years ago, in New York State, a patient coming into the legitimate possession of a drug prescription, signed by a physician, could use it and re-use it, until it was worn out, and then get from the druggist a fresh copy of it, as effective as the original had been. Thus, without the intent or even knowledge of the doctor who provided it, the prescription might, and a prescription often did, produce a ‘fiend.’ This is not theoretically impossible in New York State, but it is not even theoretically impossible in most other States. Although the greater number of physicians are reliable and high-class men, and although most of them are competent, so far as competence can be acquired in schools, the value of the clause was practically destroyed in spite of them.”
“And even among the doctors, blacksheep will occur, as they occur in all professions. Often those who do most harm in the promotion of drug habits are themselves drug victims. With health and character undermined by heavy doses, little can be expected of them in the way of mental stamina or moral force.”
“My attention has been called to more than one case involving druggists anxious to sell quantities of habit-forming drugs at a high profit, who have employed physicians of this kind to furnish the required prescriptions to all comers who might ask for drugs and would otherwise be refused unless the law were violated.”
“Another danger lies in this condition: druggists have no way of knowing whether or not prescriptions handed to them to be filled have really been written by physicians. Any ‘fiend’ can forge the name of a physician with very little chance of exposure, or, without incurring even that small risk, he can invent the name of a fictitious doctor and use that on a prescription blank which any printer will innocently furnish to him at a small cost per hundred. There is no length to which habitués will not go to satisfy their crave for the drug which has a hold on them, there seems to be no limit in their ingenuity.”
“But this plan requires no bravery and very little cleverness. It has become common practice. It must be remembered that the law as it now reads permits a pharmacist to dispense habit-forming drugs on the prescription of any doctor whatsoever, resident at any distance from the scene of the sale, citizen of the State or not, known or unknown to the pharmacist. No investigation by the druggist is required; that would plainly be to impose a hardship on him.”
“Nor is there any restriction now placed by law on the amount of morphine, for example, which can be purchased by the retail druggist; no report is asked of him as to the distribution which he makes of what he buys. To-day in New York City I could buy enough morphine of either wholesale or retail druggists to form the cargo of a ship of size without entailing any violation of the law upon the part of those who sold it to me. “
“If I went to the same printer who provides the ‘fiends’ with ‘fake’ prescription blanks and had him print me letterheads announcing me as a retail druggist, or setting up a man of straw as a retail druggist, I could send to the wholesalers my orders, written on the printer’s product, and receive the drug in wholesale quantities by the next day delivery. Should I send my order to a wholesale druggist in, say, Philadelphia, the chance that he would ever learn that he was shipping to a person not legitimately engaged in retail drug sale would be infinitesimal, and the wholesaler could not be punished for delivering the drug to me, even if it could be proved that he knew I was no druggist. And I could not be punished for my subterfuge. Thus the so-called restrictions which no surround the sale of drugs are found not to restrict, in fact.”
“The only way in which a penalty could be inflicted on me would arise through my being discovered to be engaged in the illicit sale of the supplies I had purchased. I could present them to my friends among drug takers without fear of punishment. I could drug myself to death, and no one, save my family, would have the power to stay my hand.”
“And if a provision prohibiting sale, except when a physician’s prescription is presented, amounts to nothing, other conditions are as lax. The importer reports only to the Customs Service on the drugs which he imports, and such reports are followed merely by the payment of the legal duty. The manufacturer reports to no one, for a while the tobacco factory is surrounded by restrictions, the drug factory is not.”
“There are fewer safeguards around morphine that there are around beer. Its production is unhindered and conducted without supervision; its manufacturer does not even pay a license fee to city, State or Nation. He is as free to make his poisons as a hatter is to make his hats. The contents of the workman’s pipe are guarded by far more effective legislation than the contents of the dope fiend’s’ hypodermic.”
“While the world has an idea that it has met and mastered this great problem it has done nothing with it. How utterly this is the case was illustrated recently in my own experience. A lady who had incurred the morphine habit through the administration of the drug to ease the pain of illness, was cured of it. While she had been taking morphine she had bought the drug in quantities of $25 worth at a time from a certain well known wholesaler. Having been relieved of the necessity for taking it, her orders to this wholesaler ceased, of course.”
“Not more than one week had elapsed after the passage of the date when, according to the old routine, her order for a new supply would have been in his hands, when she received a letter from the dealer asking her why she no longer favored him with custom.”
“This was done quite frankly, in the normal way of normal business. The firm did not wish to lose a customer. It indicated careful business management. It was as if a regular purchaser of onions or spool-thread had ceased , without an explanation, to send in orders to the previous sources of her supply. The house was looking after its legitimate trade. Nothing could more clearly illustrate the worthlessness of the restrictions now surrounding traffic in habit-forming drugs.”
“Recently a man came to me who had become a victim of the heroin habit. He was a traveling salesman and was in really bad shape. I asked him how he had been getting his supply of the drug.”
“’Nothing could be easier,’ he answered. ‘When I’ve run out I’ve simply dropped a note to the Philadelphia branch of a New York drug house, signed my own name with “M.D.” after it, giving my own address, inclosed [sic] the necessary the necessary postal order and received the drug, in 500 tablet lots, sent promptly. No one made the least objection.’”
“Nor could anyone make a legal objection!”
“I asked this man how he acquired the habit and his answer was about the same as that which I have had from hundreds. One day while he was on the road and troubled by a bad cold in the head a friend recommended certain pills which he instructed the inquirer to crush and use as snuff. He did so. The result was comforting. In a short time he was saddled with a habit which might have wrecked him.”
“Are these episodes not proof that the so-called restrictions which now theoretically surround the sale of habit forming drugs are wholly farcical? You can say, without reserve, that nothing has been really accomplished through all the opium conferences, although intense thought was devoted to the effort to make them of practical utility, and that practically nothing has been gained through all the legislation which incumbers [sic] statute books in every State.”
“In spite of all these things the sale of habit-forming drugs has steadily, alarmingly increased; it has grown until its magnitude is such that it constitutes a National threat. These are not the words of an enthusiast. Any reputable physician who has made a study of the situation will indorse them.”
“And the most pitiful detail of it all is that many drug victims remain in total ignorance of the fact that they are being chained to a deplorable habit until it has so fastened on them that to shake it off, without assistance, is impossible.’
“It is surely true that presently this Government must adopt Federal legislation which will minimize illicit importation and regulate legitimate importation. Had the international understanding, proposed at the Hague Conference, been agreed to, foreign manufacturers could have sold only to such American buyers as were authorized by our authorities to make purchases of habit-forming drugs and our Government would have been advised of all sales made. That would have stopped drug smuggling.”
“But the grand total of drugs smuggled is a minor matter when compared to the appalling total of drugs manufactured in excess of the requirements of necessity, here at home, quite legally, and as legally distributed to work their dreadful harm. No man has to smuggle smoking opium in order to secure it for his pipe or for his customers. He can manufacture it in the United States. A large part of that used here is thus created.”
“I am hopeful that the bill which I have drafted will do something very definitely important as a starter toward the necessary regulation of the startling evil. It proposes, first, that the State Board of Health, or some other especially authorized body, shall prepare and furnish to all druggists and other retail dealers in the habit-forming drugs a special form of order blank, safeguarded against forgery, upon which all orders sent to wholesalers, manufacturers, and importers must be written if the drug is to be obtained. Of these orders the sender must keep a carbon copy, open to some authorized inspection; the receivers must preserve the original blank, similarly open to inspection. By this means the wholesaler and the manufacturer will for the first time be compelled to make accounting of their wares.”
“The next provision of the proposed law calls for a special form of prescription blank, made into books and serially numbered, to be furnished upon application to physicians who are registered in the New York State by the same board which guards the wholesale traffic. The physician using this will be required to preserve carbon copies of all blanks which he fills in, and upon the special form he must affix his own name and address and the name of the patient for whom the drug is ordered.”
“Each druggist must provide a special file for blanks of this sort, which shall be open to inspection at all times. No prescription can be refilled and any prescription made out in due form but not filled within ten days becomes null, void, unsalable. No druggist can give copies of a prescription of this sort to any person bringing one to him to fill.”
“Up to this point the wholesaler has been regulated for the first time in the history of drug legislation; and the retailer is not only regulated, but protected.”
“The retail druggist, it must be remembered, is protected against thefts; his clerks’ honesty, general character and health are safeguarded, and his own pocket is protected. Hospitals and other public institutions which use large quantities of habit forming drugs are by this bill insured against financial loss through theft and against scandal due to drug degeneration in the character of their employees. Two physicians in the employ of public institutions and victims of the drug habit have been among my recent patients. Had this bill been upon the statute books they could not have become addicted. Imagine, therefore, the protection which the law would give to inmates of such institutions!”
“I have discussed the bill with many druggists. One said to me the other day:”
“’To the honest retail druggist such regulation would be a boon. It would safeguard his stock and protect him and his customers from the incompetence and possibly dangerous irresponsibility of clerks suffering from the effects of various narcotics. A drug taken clerk is as great a menace to his boss as a definitely criminal clerk would be; he is a frightful menace to his employer’s customers. He is, indeed, a public peril. His name is legion now. This bill would eliminate him if made into a law and properly enforced.’”
“The proposed legislation is merely an enforcement clause for the existing law, which, although, upon the statute books, is as I have pointed out, farcical at present. The doctor is held responsible for what prescriptions he may issue, as the druggist is for those he fills. And provision also has been made against leakage from the doctor’s private stock, hitherto, unsafeguarded; and in safeguarding that we shall safeguard himself against the use of drugs.”
“A most important feature of the bill is that it does not permit individual physicians to assume the personal responsibility of administering habit-forming drugs to patients for a period longer than three weeks, which I have found to be the average limit of safety. Longer administration means the probability of the establishment of a habit.”
“My reasons for inserting this clause were twofold, first to remind the physician of the danger point in drug administration, and, second, to better enable the physician to control a patient when he has become a drug habitué through some physical trouble which has led to the administration of narcotics to ease pain. Many a doctor has regretfully seen patients to whom he had occasionally given a ‘hypodermic’ in emergencies go, when he refused them new injections, to some less scrupulous source of supply—and to their ruin.”
“The moment a man becomes addicted to a habit-forming drug and knows it, just that moment his is ripe for plucking by all sorts of ‘home cures,’ sanitarium boarding houses and sanitarium hotels, as well as by cure-alls whose promoters’ business is not to help those who apply to them for help, but to keep them on their list as long as they possess a dollar or their friends and relatives remain willing to be deceived and robbed or to pay high prices for the sequestration of the unfortunates for unscrupulous purposes. Such cases may be listed as sanitarium assets until their obituaries have been written. “
“I have established the fact that a week, at most, offers ample time in which to determine, through definite medical treatment, whether or not a patient is a hopeless case. If he is hopeless, then he should be given his drug in some simple, inexpensive form and way, without being victimized.”
“There we have the bill as it now stands before the Legislature, and about as it will stand before many Legislatures in the various States before the present year is passed. When uniform State legislation has been secured along such lines and when regulations have been adopted by the Federal Government controlling inter-State traffic, then we shall have mastered one of the greatest evils which has existed in this country, one of the greatest threats which ever menaced civilized society, an evil so tremendous that those who are familiar with it cannot guess the final harm which it may do, an evil which at present is spreading with such speed that the whole fabric of our national life is menaced by it.”
It should, perhaps, be added that the crusade, which Mr. Towns is carrying on against drug selling and
drug taking is wholly at his personal expense. He has rejected many offers of
financial help, although his consultations with others interested in the battle
against drugs have been continuous through a period of years.
 Four Century Magazine articles written by Charles Towns appeared in 1912 and are examined in Chapter 6 of King Charles of New York City.
 The treatment has had numerous names over the years. The Towns Treatment, the Towns-Lambert treatment. Members of AA typically refer to it as the belladonna treatment, though belladonna was just one of the three major substances included.
 Some have referred to Towns as a quack. Though the methods used by Towns can seem rather bizarre by the standards of today, note how his treatment in 1913 was considered as effective as any available..
 The adventures of Charles Towns in China is discussed in detail in Chapter 4 of King Charles of New York City
 According to David F. Musto, support from the medical community was sparse. “[From] the rank and file [physician] who was then beginning to organize to better his economic and social status, [Towns] evoked hostility and resentment . . .Towns set himself up as an enemy of the average physician in New York City . . . Towns antinarcotic law was opposed more for its threat to traditional freedom of medical practice than for its goal of restricting narcotic use.” p.81 King Charles of New York City [Authorhouse], p. 58 King Charles of New York City [Westwood]
 Dissipation – overindulgence, the squandering of money, energy or resources
 Many of the first patients of Towns in the era prior to 1908 were said to have been members of the underworld.
 Today these words are hard to comprehend. Apparently the invention of the hypodermic syringe was considered to be an unknown to most outside of the medical community. Today the free distribution of syringes in some cities in the United States to avoid sharing needles makes Towns words here look incredibly naïve by the standards of today.
 Unfortunately, a substantial shortcoming of Towns begins to be revealed. The only source that he quotes turns out to be his own experiences. The claims of two doctors can hardly be an indisputable trend of the use of painkillers of these times.
 Many addicts of today might be able to make the same claim that they were first introduced to pain killers by their doctor and became addicts as a result.
 Towns had no other source for this assertion but himself. But these strong assertions are what brought him to the attention of top medical people of the times, who, unfortunately, could not dispute Towns since they had no solution to addiction or alcoholism themselves.
 Once again, no clinical study quoted. Towns was his own authority.
 Towns would believe himself to be entirely reasonable with his condemnations, but would masquerade as being entirely reasonable and restrained in such observations.
 Contrast the desire of these times to have syringes available only through a doctor’s prescription versus the availability of syringes in some cities in the United States for free to anyone, so that needles won’t be shared and communicable diseases through blood contact will be minimized.
 In Reclaiming The Drinker written eighteen years later by Towns, his demonization of beer was most pronounced. “Now, hashish contains exactly the same elements as are found in the lupulin glands of hops—bitter tasting resins, an ethereal oil, and one or more alkaloids. Therefore, hops exert the same effect on the human body as hashish-differing only in degree.”
 Heroin had been introduced to the United States through the Bayer Corporation, a German company. There was much sabre rattling of the times between European monarchies as World War I approached. German drugs were to become a threat to the American population. This “threat” was only to increase. As the era of American alcohol prohibition was in the near future, the threat that alcohol prohibition would lead to the alcoholics running to drugs became very much of a concern and was considered an additional threat.
 The Federal Harrison Act, modeled after the Towns’ legislation that resulted in the Boylan Act in New York State, was passed the following year in late 1914.
 There are 1,500 Federal lawsuits active in 2019 against pharmaceutical companies on the very issue of such companies providing far more drugs than consumers actually required. https://www.cleveland.com/court-justice/2018/12/federal-judge-wont-dismiss-key-rico-fraud-claims-in-opioid-litigation.html
 Written in an era when the sophisticated and omnipresent smuggling industry of today was all but inconceivable.
 Once again we see how Towns uses himself as an authority. The first person pronoun once against has appeared.
 Towns had an obvious contempt for the sanitarium industry, which in his opinion, because of the profit motive, would wish to keep their patients far longer than treatment actually required. Towns Hospital, on the other hand, required one payment for treatment to be paid up front. This practice was to result in a patient being “cured” within five to seven days at Towns Hospital. The hospital would make more profit the quicker the patient was treated and released.
 Consider the ethics and/or consequences of such an assertion. Should “hopeless” addicts be supplied drugs indefinitely by society and kept in such a manner that society is safe from interacting with these addicts? Might this be a desire to create “drug farms” where the addict can stay indefinitely and be supplied with his drugs?