联邦权力对成瘾治疗的介入小结

早在美国禁毒外交政策启动之时,联邦政府就将麻醉品的非医学使用视为禁止的对象,只是在《哈里森法》通过之前,因缺乏必要的法律依据而无法对此动用具体的措施。从1915年联邦麻醉品法实施以来,美国基本上就是沿着禁止成瘾以及反对成瘾维持疗法的方向执行着联邦麻醉品法。但是,在麻醉品法执行之初,由于美国社会各界对于成瘾认识的不同,对于成瘾者的同情态度依然存在于社会的各个层面,这种现象即使在1916年联邦最高法院的有关案例中也有充分的显示。在各种社会力量掣肘的时代背景下,初期的联邦执法机构对麻醉品的使用以及维持成瘾的治疗方式,只能采取默认但又时而威胁的手段。伴随着第一次世界大战的结束与第一次赤色恐惧所带来的对成瘾者危害的偏激认识,成瘾等同于罪恶的思维形式也在美国社会上日益得到普及,其直接后果则表现在联邦最高法院于1919年3月的判决上,而联邦最高法院的判例则直接为联邦麻醉品法的严厉执行提供了指南,禁止成瘾因而也在法理上得以确认。

但是,在考察美国毒品控制模式的过程中,其禁毒政策实施的每一步并非无懈可击。对《哈里森法》的认识不同,使得早期麻醉品法的实施过程充满了反复多变且松紧不同的状态,而且不论在联邦与地方,即使是联邦政府内部甚至是同一部门之间,由于时间及环境的不同,其执法的力度与着重点都存在着明显不同。所以,虽然联邦最高法院于1919年3月已经明确表达了禁止成瘾以及反对维持成瘾的态度,但是,作为麻醉品法执法机构的国税局,却在各地大力兴建为成瘾者提供麻醉品以便实施维持成瘾的诊所,这显然是一种非常“矛盾”的现象。当然,这种看似矛盾的现象固然是出于预防成瘾者因突然断瘾而带来社会问题,更为重要的是,无论是有意的还是无意的,麻醉品诊所的建立都应该成为联邦麻醉品法执法机构在1919年之后开始强行介入成瘾治疗的一项标志性指标。

麻醉品诊所时代是美国联邦执法与治疗的一个集中交替的时代。在此之前,任何联邦权力对于医疗领域的介入都会引起一场联邦权限合宪与否的争论,更何况,《哈里森法》在其形成过程中,尤其是在实施过程中就已经充满了如何有效运用联邦权力的论争。因此,早期联邦政府对于成瘾医疗的介入总是抱着审慎的态度。但是,伴随着毒品控制之“古典时期”的到来,在很大程度上,联邦权力在成瘾治疗领域的积极介入,更多地反映了医学界在成瘾治疗上的迷失与无奈。可以说,联邦权力在医疗领域的介入固然是联邦执法机构积极运作的结果,但在相当层面上,它更是医学界在经历了19世纪末特别是20世纪初的乐观治疗时期之后,因其逐渐陷入针对成瘾治疗之束手无策的境地后而不得不求助于联邦政府的一种心态或现象的反映。

从“麻醉品诊所”到“联邦麻醉品农场”,这是美国联邦政府从积极介入到完全控制成瘾治疗主导权的两个大步骤。在这期间,联邦执法机构严厉打击私人医生治疗成瘾,尤其是维持成瘾的行为,实质上也是它在成瘾治疗上立足以法律威慑力来阻止人们接触毒品,以强制性的关闭治疗设施来力求成瘾者脱离困境的努力过程。事实上,医生与联邦执法机构之间的纠葛,恰恰也是这类行医权争夺的一种表现而已。毕竟在主导成瘾治疗的权力之争中,医学界在联邦麻醉品面前显然处于一种弱势地位。因此,作为联邦毒品控制模式内容的两个方面——法律惩戒模式与医疗模式相互纠缠的关系中,医疗模式最终只能沦为一种附属物而归附于当时强势无比的联邦麻醉品司法体系。事实上,在早期美国毒品控制时期,美国医学界人士在成瘾治疗地位问题上所面临的前后不同的两种境遇,恰恰就是当时美国联邦毒品控制模式之法律惩戒模式与医疗模式之间关系的如实反映。

注释


[1]Philippine Commission Eighth Annual Report, 1907, Bureau of Insular Affairs, War Dept. GPO, 1907, Part 2, p.18.

[2]Philippine Commission Eighth Annual Report, 1909, Bureau of Insular Affairs, War Dept. GPO, 1909, p.102.

[3]Arnold H. Taylor. American Diplomacy and the Narcotics Traffic, 1900—1939[M]. Durham, N. C.: Duke University Press, 1969, pp.43-45.

[4]详细内容可见本书的第八章内容。——笔者按

[5]Hamilton Wright, 9 January, 1908, WP, entry 51.

[6]Letter from C. B. Towns to H. Wright, 13 June 1911, WP, entry 36.

[7]Samuel Merwin. “Fighting the Deadly Habits: The Story of Charles B. Towns”[J]. American Magazine, Oct., 1912, pp.707-717.

[8]Ernest Drucker, From Morphine to Methadone[EB/OL].[30 Dec.2011]http://www.drugtext.org/Opiates-heroin-methadone/from-morphine-to-methadone.html.

[9]Ernest Drucker, From Morphine to Methadone[EB/OL].[30 Dec.2011]http://www.drugtext.org/Opiates-heroin-methadone/from-morphine-to-methadone.html.

[10]New York Times, 23 March, 1919, cited in David F. Musto. The American Disease[M]. New York: Oxford University Press, 1999, p.140.

[11]Exportation of Opium, Hearings before a Subcommittee of the Committee on Ways and Means on HR 14,500, House, 67th Cong., 3rd. Sess., 8 and 11 Dec., 1920 and 3 and Jan., 1921[GPO, 1921], p.47.

[12]Laws of Massachusetts, Ch. 694, Sect. 2, Acts of 1914.

[13]Laws of Pennsylvania, Act No. 282, Sect. 8, approved 11 July, 1917.

[14]J. A. Cutter. Medical Economics of the Boylan Law[J]. Medical Economist 2, 1914, p.296.

[15]Special Committee of Investigation, Appointed March 25, 1918, by the Secretary of the Treasury: Traffic in Narcotic Drugs, GPO, 1919, p.3, pp.9-15.

[16]David R. Bewley-Taylor. The United States and International Drug Control[M]. New York: Continuum, 1999, p.139.

[17]Special Committee of Investigation, Appointed March 25, 1918, by the Secretary of the Treasury: Traffic in Narcotic Drugs, GPO, 1919, pp.19-22.

[18] David F. Musto. The American Disease[M]. New York: Oxford University Press, 1999, p.139.

[19]President's Home Commission, Senate Doc., No. 644, 60th Cong., 2nd Sess., 8 Jan., 1909, p.258.

[20]France Bill, 66th Cong., 1st Sess., S 2785 on 15 Aug., 1919.

[21]Letter from D. C. Roper to Sectary of Treasury, 15 July, 1919. PHSR.

[22]Charles E. Terry and Mildred Pellens. The Opium Problem[M]. New York: Bureau of Social Hygiene, 1928, p.887.

[23]A. G. DuMez. “Some Facts Concerning Drug Addiction”, Memorandum dated 9 Dec. 1918, sent to the Surgeon General from the Hygienic Laboratory, 16 Dec., 1918. PHSR.

[24]罗波的个人简历参见Daniel C. Roper[EB/OL].[31Dec.2010]http://en.wikipedia.org/wiki/Daniel_C._Roper.

[25]Daniel C. Roper. Fifty Years of Public Life[M]. Durham, N. C.: Duke University Press, 1941, p.186, pp.189-193.

[26]这是国税局在1921年4月30日时的统计数字。参见Letter from O. G. Forrer, Assistant Director, Narcotic Field Force, to L. g. Nutt, Director, 30 April 1921, RPU。如果计算到1925年为止以及算上国税局无法把握的诊所,其数量则可能更多。

[27]格令(grain)为衡量中的最小单位,可略写为gr.,每格令相当于0.0648克。——笔者按

[28]New York Times, 12 & 13 April, 1919.

[29]Letter from R. S. Copeland to Thomas Cooper, Treasury Department, BIR, 16 Oct. 1919.

[30]S. D. Hubbard. “New York City Narcotic Clinic and Differing Points of View on Narcotic Addiction”[J]. Depart of Health N. Y. City 10, Monthly Bull, 1920, pp.46-47, p.40.

[31]T. F. Joyce. “Denarcotizing the Addict”[J]. Department Health N. Y. City, Monthly Bull, June, 1921, pp.132-136.

[32]S. D. Hubbard. “New York City Narcotic Clinic and Differing Points of View on Narcotic Addiction”[J]. Depart of Health N. Y. City 10, Monthly Bull, 1920, pp.46-47.

[33]罗波于1917年9月26日—1920年3月31日任职国税局专员。其后任为威廉·威廉姆斯(William M. Williams, 1920年4月1日—1921年4月11日)。[EB/OL].[2 Jan. 2011]http://en.wikipedia.org/wiki/Commissioner_of_Internal_Revenue.

[34]Alexander Lambert. “The Underlying Causes of the Narcotic Habit”[J]. Modern Med. 1, 1920, p.8.

[35]S. D. Hubbard. “New York City Narcotic Clinic and Differing Points of View on Narcotic Addiction”[J]. Depart of Health N. Y. City 10, Monthly Bull, 1920, p.34, p.42, p.44.

[36]S. D. Hubbard. “Some Fallacies Regarding Narcotic Drug Addiction”[J].JAMA 74, 1920, pp.1440-1441.

[37]S. D. Hubbard. “Some Fallacies Regarding Narcotic Drug Addiction”[J]. JAMA 74, 1920, pp.1439-1441; “Municipal Narcotic Dispensaries”[J]. Public Health Reports 35, 26 March, 1920, pp.771-773.

[38]A. R. Braulich. “Treatment of Drug Addiction at Riverside Hospital”[J]. Monthly Bull. Dept. Health N. Y. City, Feb., 1920, pp.47-49; T. F. Joyce. “The Treatment of Drug Addictions”[J]. Dept. Health N. Y. City, Weekly Bull, 9 Oct., 1920, pp.322-324.

[39]Department of Health, City of New York, Annual Report, 1920, p.257.

[40]T. F. Joyce. “Denarcotizing the Addict”[J]. Dept. Health N. Y. City, Monthly Bull, June 1921, p.136.

[41]A. G. DuMez. “Treatment of Drug Addiction”, Memorandum to the Surgeon General, 28 Feb., 1919, PHSR.

[42]Letter from Dr. J. C. Perry to Dr. Oscar Dowling, 29 Nov., 1920. PHSR.

[43]David F. Musto. The American Disease[M]. New York: Oxford University Press, 1999, p.179.

[44]Letter from L. V. Nutt to Prohibition Commissioner John F. Kramer, 5 May, 1920, RPU.

[45]Special Committee of Investigation, Appointed March 25, 1918, by the Secretary of the Treasury:Traffic in Narcotic Drugs, GPO, 1919, p.3.

[46]Pearce Bailey. “The Drug Habit in the United States”[J]. New Republic, 16 March, 1921, pp.67-69.

[47]T. F. Joyce. “Denarcotizing the Addict”[J]. Department Health N. Y. City. Monthly Bull, June, 1921, p.133.

[48]Letter from Levi G. Nutt to John F. Kramer, 5 May, 1920, RPU.

[49]U. S. Treasury Dept., Bureau of Internal Revenue. Amending M-Mim 2212 dated 31 July 1919 and Outlining Treatment of Narcotic Drug Addiction Permissible under the Harrison Narcotic Law, Pro-Mimeograph, pro., No. 217, 19 Oct., 1921, GPO, 1921.

[50]Hearings before House Appropriation Committee, Treasury Dept. Appropriation Bill 1930, 23 Nov., 1928, 70th Cong., 2nd Sess., p.475.

[51]Hearings before House Appropriation committee, Treasury Dept. Appropriation Bill 1930, 23 Nov., 1928, 70th Cong., 2nd Sess., p.475.

[52]Albert S. Gregg. “United Stated narcotic Farms”[J]. Narcotic Education 2, 1928, pp.9-10.

[53]Cong., Rec., Home, 69, pt. 9, 70th Cong., 1st Sess., 21 May, 1928, pp.9412-9413.

[54]“Federal Narcotic Farm”[J]. California and Western Medicine, Vol. 42, No. 3, March, 1935, pp.228-229.

[55]Federal Medical Center, Lexington[EB/OL].[4 Jan. 2011]http://en.wikipedia.org/wiki/Federal_Medical_Center,_Lexington;此外,有关“列克星敦麻醉品农场”相关的历史、相片以及杂志等内容可参见Nancy D. Campbell & JP Olsen & Luke Walden. The Narcotic Farm[M]. New York: Abrams, 2008。

[56]G. H. Hunt and M. E. Odoroff. “Follow-up Study of Narcotic Drug Addicts after Hospitalization”[J]. Public Health Repots 77, 1962, pp.41-54.

[57]Nancy D. Campbell & JP Olsen & Luke Walden. The Narcotic Farm[M]. New York: Abrams, 2008, Cover page.

[58]Exportation of Opium, Hearings before a Subcommittee of the Committee on Ways and Means on HR 14,500, House, 66th Cong., 3rd Sess., 8 and 11 Dec., 1920 and 3 and 4 Jan., 1921, GPO, 1921, p.105, p.108, p.133.

[59]Lawrence Kolb. “Pleasure and Deterioration from Narcotic Addiction”[J]. Mental Hygiene 9, 1925, pp.699-724.

[60]Editorial, JAMA 60, 1913, p.1364.

[61]American Pharmaceutical Association Archives, Box 31, Washington D. C., pp.86-87.

[62]U. S. v. Behrman, 258 U. S. 280, 27 March, 1922[EB/OL].[5 Jan. 2011]http://www.druglibrary.org/schaffer/legal/l1920/united_states_v_behrman.htm.

[63]David F. Musto. The American Disease[M]. New York: Oxford University Press, 1999, p.186.

[64]“House Investigation of Narcotics”, House Res. No. 258, 67th Cong., 2nd Sess., 4 Jan., 1922, Cong., Rec., Vol. 62, Pt. 1, p.808.

[65]“Proceedings of the St. Louis Session, 23 May, 1922”[J]. JAMA 78, 1922, p.1715.

[66]“United State Supreme Court Distrusts the Harrison Narcotic Act”[J]. Editorial, JAMA 86, 1926, pp.627-638.

[67]Interim and Final Reports of the Joint Committee on Narcotic Drugs. Drug Addiction: Crime or Disease[M]. Bloomington & London: Indiana University Press, 1961, p.5.

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