The Epidemiology of Opiate Addiction in the United States

Compiled and Edited by
JOHN C. BALL, Ph.D. CARL D. CHAMBERS, Ph.D.
Professor, Department o f Psychiatry Research Director
Temple University Health State of New York Narcotic
Sciences Center Addiction Control Commission
Philadelphia, Pennsylvania New York, New York

With a Preface by
Griffith Edwards, D.M.
Addiction Research Unit Institute of Psychiatry?
London, England

This volume is dedicated to two outstanding physicians,
Michael J. Pescor and Harris Isbell

PREFACE

?

PART I HISTORY AND PRESENT EPIDEMIOLOGY

Chapter 1
Overview of the Problem
JOAN C. BALL AND CARL D. CHAMBERS

Chapter 2
History of Legal and Medical Roles in Narcotic Abuse in the U.S.

EARLE V. SIMRELL

Chapter 3
The Extent of Chronic Opiate Use in the United States Prior to 1921

CHARLES E. TERRY AND MILDRED PELLENS

Chapter 4
The Incidence and Prevalence of Opiate Addiction in the United States

JOHN C. BALL, DAVID M. ENGLANDER, AND CARL D. CHAMBERS

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PART II PATTERNS OF DRUG USE IN THE UNITED STATES

Chapter 5
Two Patterns of Opiate Addiction

JOHN C. BALL

Chapter 6
Nativity, Parentage, and Mobility of Opiate Addicts

JOAN C. BALL AND WILLIAM M. BATES

Chapter 7
The Association of Marihuana Smoking With Opiate Addiction

JOHN G BALL, CARL D. CHAMBERS, AND MARION J. BALL

Chapter 8
The Evolution of Concurrent Opiate and Sedative Addictions

CARL D. CHAMBERS AND MARY MOLDESTAD

Chapter 9
Diffusion of the Intravenous Technique Among Narcotic Addicts
JOHN O'DONNELL AND JUDITH JONES

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PART III OPIATE USE IN SELECTED POPULATIONS

Chapter 10
Onset of Marihuana and Heroin Use Among Puerto Rican Addicts
JOHN BALL

Chapter 11
Negro Opiate Addiction
CARL CHAMBERS and ARTHUR MOFFETT

Chapter 12
Mexican-American Opiate Addicts
CARL CHAMBERS, WALTER CUSKEY and ARTHUR MOFFETT

Chapter 13
?The Female Opiate Addict
CARL CHAMBERS, KENT HINESLEY and MARY MOLDESTAD

Chapter 14
The Chinese Opiate Addict in the United States
JOHN BALL and P.M. LAU

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PART IV MEDICAL ASPECTS OF OPIATE ADDICTION

Chapter 15
CAUSES OF DEATH AMONG INSTITUTIONALIZED NARCOTIC ADDICTS

Joseph D. Sapira, John C. Ball, and Harry Penn

Chapter 16
DEATH DUE TO WITHDRAWAL FROM NARCOTICS
Frederick B. Glaser and John C. Ball

Chapter 17
SUICIDE AMONG HOSPITALIZED OPIATE ADDICTS
Carl D. Chambers and John C. Ball

Chapter 18
ABSENCE OF MAJOR MEDICAL COMPLICATIONS AMONG CHRONIC OPIATE ADDICTS
John C. Ball and John Chapman Urbaitis

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PART V CONCLUSION

Chapter 19
CONCLUSION
John C. Ball and Carl D. Chambers

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?

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Contributors

JOHN C. BALL, Ph.D.
Department of Psychiatry
Temple University Health Sciences Center
Philadelphia, Pennsylvania
MARION J. BALL, M.A.
Medical Computer Center
Temple University Health Sciences Center
Philadelphia, Pennsylvania
WILLIAM M. BATES, Ph.D.
Department of Sociology
Loyola University
Chicago, Illinois
CARL D. CHAMBERS, Ph.D.
Narcotic Addiction Control Commission
State o
f
New York
New York, New York
WALTER R. CUSKEY, Ph.D.
Department
of Community Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
DAVID M. ENGLANDER, B.S.
School o f Medicine
Temple University Health Sciences Center
Philadelphia, Pennsylvania
FREDERICK B. GLASER, M.D.
Department of Psychiatry
Temple University Health Sciences Center
Philadelphia,
Pennsylvania

R. KENT HINESLEY, M.D.
Department of Psychiatry
Aft. Zion Hospital
San Francisco, California

JUDITH P. JONES, B.A.
Office o f Research and Planning
Metropolitan Social Services Department
Louisville, Kentucky

M. P. LAU, M.D.
Departm
ent of Psychiatry
University of British Columbia
Vancouver, British Columbia

ARTHUR D. MOFFETT, M.S.W.
Narcotic Addiction Rehabilitation Program
West Philadelphia Community Mental Health Consortium
Philadelphia, Pennsylvania

MARY MOLDESTAD, B.A.
Clinical Research Center
National Institute of Mental Health
Lexington, Kentucky

JOHN A. O'DONNELL, Ph.D.
Department of Sociology
University of Kentucky
Lexington, Kentucky

MILDRED PELLENS
Deceased.

HARRY PENN, M.D.
Department of Psychiatry
Strong Memorial Hospital
Rochester, New York

JOSEPH D. SAPIRA, M.D.
Department of Medicine
University of Pittsburgh School of Medicine
Pittsburgh,
Pennsylvania

EARLE Y. SIMRELL, J.D.
Office of Legislation
Department of Health, Education and Welfare
Rockville, Maryland

CHARLES E. TERRY, M.D.
Deceased.
JOHN CHAPMAN URBAITIS, M.D.
The Phipps Clinic
The Johns Hopkins Hospital
Baltimore, Maryland

Acknowledgments

THE National Institute of Mental Health generously supported most of the research reported in this volume. While within this organization, we had the intellectual freedom to study problems of drug use in American society as we saw fit as well as the nesessary resources to carry forward our plans.

Many of the authors were not only contributors to this work but friends and colleagues as well. We wish to thank them for their encouragement to continue our epidemiological studies.

We are indebted to Drs. Ernst Jokl, James F. Maddux, Daniel Glaser, Gerald Klee, and Harriet Aronson as well as judge Irving Lang for helpful comments concerning various portions of the manuscript. Dr. Vincent P. Dole was kind enough to provide us with comparative data pertaining to New York City addicts which were incorporated in Chapter 1.

The figures in Chapters 1, 7 and 19 were drawn by Robert T. Clough. Stanton W. Saltzman provided advice concerning these and other illustrations.

Bonnie Edington and Joan Bakove labored diligently and cheerfully in the preparation of the final manuscript.

The entire book would not have been possible without the steadfast encouragement of R. Bruce Sloan.

JOHN C. BALL
CARL. D. CHAMBERS