Question 3: What is the history of U.S. regulation of heroin?

Answer: U.S. regulations governing the manufacture, distribution, or use of heroin fall into four historical time periods:

• 1860-1909: Minimal Government Involvement
• 1909-1924: Increasing Federal Government Role
• 1924-1960: Criminalization of Narcotics Use
• 1960-Present: Combined Medical-Criminal Approach

1860-1909: Minimal Government Involvement
The Institute of Medicine documents U.S. narcotics policies from the 19th century through 1992 (Courtwright, 1992). In the first years following widespread use of heroin in the United States, there were no Federal regulations about the manufacture, distribution, or use of heroin, and the few State or municipal laws that existed were enforced sporadically. Physicians, pharmacists, and opportunists were free to prescribe opioids–and treat subsequent opioid addiction–in whatever manner they chose, which contributed to widespread addiction and sometimes unscrupulous practices. Inadvertent addiction to early over-the-counter medications prompted enactment of the 1906 Pure Food and Drug Act, which first authorized Federal regulations on any medication.

1909-1924: Increasing Federal Government Role
In the United States, heroin was first placed under Federal control by the 1914 Harrison Narcotic Act, which required anyone who sold or distributed narcotics–importers, manufacturers, wholesale and retail druggists, and physicians–to register with the Federal Government and pay an excise tax. The United Nations Bulletin on Narcoticsdocuments early international efforts to address opioid addiction (United Nations Department of Social Affairs, 1953). The United States was among the organizers of the 1909 International Opium Commission in Shanghai, China, and a signatory of the 1912 Hague Opium Convention, the first international treaty to make heroin a controlled substance.

1924-1960: Criminalization of Narcotics Use
Between 1924 and 1960, the United States approved a series of progressively stiffer narcotics policies, first establishing mandatory sentences for possession and sale of opioids in 1951 (Courtwright, 1992). Internationally, the United States was a signatory to two more international treaties to limit the manufacture of narcotics: the Geneva Convention of 1925 and the Limitation Convention of 1931 (United Nations Department of Social Affairs, 1953).

1960-Present: Combined Medical-Criminal Approach
Scientific advances in the 20th century revolutionized our understanding of addiction and contributed to a medical approach to drug abuse treatment coupled with criminal sanctions for drug traffickers. The 1962 White House Conference on Narcotic Drug Abuse first recommended more flexible sentencing, wider latitude in medical treatment, and more emphasis on rehabilitation and research. By 1971, the Special Action Office of Drug Abuse Prevention (SAODAP), established within the White House, was responsible for drug treatment and rehabilitation, prevention, education, training, and research.

Currently, heroin is regulated under the Controlled Substances Act. Federal policies and regulations about heroin are coordinated by the following agencies:

• The Office of National Drug Control Policy (ONDCP) operates within the White House to establish policies, priorities, and objectives for the Nation's drug control program.
• The U.S. Department of Health and Human Services to promote and regulate addiction treatment services.
• The Drug Enforcement Administration (DEA) operates within the Department of Justice to prevent diversion and illicit use of controlled substances and administer criminal sanctions for drug traffickers.

References

Courtwright D. A century of American narcotic policy. In: Institute of Medicine. Treating Drug Problems: Volume 2. Washington, DC: IOM, 1992, pp. 1-62. Available online at: books.nap.edu/openbook.php?isbn=0309043964. [Accessed March 23, 2006.]

United Nations Department of Social Affairs. History of heroin. Bulletin on Narcotics 1953;V(2):3-16. Available online at: www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1955-01-01_1_page011.html. [Accessed March 22, 2006.]