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Social events and narcotic addiction: The influence of war and law on opium use in Laos
0306-4603
~78/0501b4x35710200/0
SOCIAL EVENTS AND NARCOTIC ADDICTION: THE INFLUENCE OF WAR AND LAW ON OPIUM USE IN LAOS JOSEPH WESTERMEYER,M.D., Associate
Professor,
PH.D.
Department ‘of Psychiatry, University Minneapolis, Minnesota 55455
of Minnesota,
Abstract-War in Laos caused removal of opium farmers from their mountain poppy growing areas and contributed to difficulties in transport of opium from nearby areas. This has led to an increased cost and low availability of opium, which in turn has caused addicts (1) to reduce their narcotic dosage, and (2) to reduce their smoking of opium in favor of the less satisfying but more economic oral route of administration. Increased cost/low availability of opium, together with unemployment from refugee movements, produced economic pressure on families with addicted members and resulted in widespread theft. This in turn led to anti-opium laws, which had the effect of favoring heroin addiction. Heroin addiction further exacerbated the addict’s problems since heroin production costs considerably more than the production of smoking opium.
INTRODUCTION
Data collected 10 yr ago on opium use in Laos led to the prediction that opium smoking patterns would change only negligibly or not at all (Westermeyer, 1969). In a sense, that statement still holds true; addiction in Laos has remained stable (Westermeyer, 1974). But in other respects, narcotic addiction has changed remarkably-and unexpectedly-in the last several years. This paper records the changes that occurred in Laos and relates them to analogous changes in narcotic addiction elsewhere in the world. METHOD
Baseline data were collected in 196567; the method and results have been previously published (Westermeyer, 1969, 1971). In early 1971 during a 2 month field trip, 40 opium addicts were interviewed (Westermeyer, 1974). Late in 1971 and early in 1972 consultation to the Ministry of Health in Laos led to further studies regarding the problem of refugee opium addicts (Westermeyer, 1973, 1974). In this paper the status of opium addiction in 1971-72 (a time of refugee movements and anti-opium laws) is compared to that in 1965-67 (a relatively stable time prior to anti-opium laws). RESULTS
Social Changes Between 1965-67 and 1971-72, the intensification of armed conflict forced many opium-poppy farmers down from the mountains of northern Laos on to the flood plain of the Mekong River where opium-poppy could not be grown (Burchett, 1967; Dommen, 1960; Langer & Zasloff, 1970). One tribal people, the Hmong, had raised opium as their primary cash crop (Barney, 1967; LeBar & Suddard, 1960). Pushed out of their mountainous poppy-growing areas, they could no longer produce opium (see “a” in Fig. 1). Hmong addicts, and lowland addicts dependent on Hmong opium production, had to rely on opium produced elsewhere (see “b” in Fig. 1). This led to an increase in the cost of opium (see “c” in Fig. 1). In addition, military insecurity impeded transportation throughout the area (see “d” in Fig. 1). This exacerbated the problem of obtaining opium from distant areas still growing poppy. Consequently, addicts had to contend not only with increased cost, but also inconstant availability of opium, which further increased the cost (see “e” in Fig. 1).
JOSJ.PH WI:STLRMEYI:H
58
WAR Dlsploced op,“mpoppy farmers
Interference transportatloC
of
Dpwm Imported from Ewm and Thailand
and thetr fanllles,lncreased
theff
Increased poltce ccfruptlon ”
Introduction
of herom
I
k
HeroIn Industry chemcals.equipment,chemlsts, high risk capbtal ,securlty
Increased cost of narcottc for addict
Fig.
drugs
1
As a result of the various events, farmer-addicts-who had never previously comprised a national problem-became a major social problem in refugee camps and resettlement villages around Laos. Addicted fathers and grandfathers would deprive their families of food and clothing in order to purchase opium. Theft became a commonplace event as addicts sought to obtain money for opium (see “f’ in Fig. 1). In this context, the government of Laos passed a law proscribing the transport and sale of opium (see “g” in Fig. 1). Prior to the anti-opium law, heroin use in Laos had been virtually absent (Westermeyer, 1976). However, this changed abruptly within weeks following passage of an anti-opium law. Since opium is a bulky substance with a characteristic odor, its transport and sale could be readily detected. Consequently in areas of effective police control (i.e. mainly the area around Vientiane, the capital city), opium trade was effectively controlled (see “h” in Fig. 1). This in turn led to police corruption, since the police suddenly gained power and authority over what had previously been ordinary events (i.e. raising, transporting, selling and using opium). Some police accepted bribes in return for ignoring events against which they had no personal objections (see “i” in Fig. 1). Heroin is odorless and occupies a fraction of opium’s bulk. Unlike opium, it can be more readily transported without police detection. Consequently, heroin use appeared within weeks after the anti-opium law passed (see “j” in Fig. 1). Heroin production required industrial-grade chemicals, trained chemists, equipment, high-risk capital, and security-all elements not required for opium production (see “k” in Fig. 1). This led to further increases in the cost of sustaining addiction to narcotic drugs (see “1” in Fig. 1) and to further theft and economic burdens on family (see “m” in Fig. 1). Thus, the total effects of war and the anti-opium law were (1) increased economic burdens on addicts and their families, (2) increased theft, and (3) increased police corruption.
Social events and narcotic
addiction
59
Extended fomlly Alienotlon of deprived of d food, clothing, -*d’cted Person from fomlly etc.
Anh-opum
low
refugee areas
Fig. 2
EfSects on Addicts These military and legislative changes, followed by changes in price and availability of narcotic drugs, had major effects on addicts themselves. Perhaps most important was the economic effect. Formerly most tribal addicts grew their own supply of opium. Non-tribal peoples bartered rice or other goods for opium. Urban dwellers supported large addictions on fairly small sums of money (U.S. $8 to $15 per month). Later, even small narcotic habits were relatively expensive (U.S. $30 to $60 per month in urban Vientiane and U.S. $12 to $20 in more remote refugee areas closer to supply routes). As a consequence of these economic changes, addicted people began to use smaller amounts of narcotic drugs. Of 40 addicts interviewed in 1971, all had cut down on their opium usage (Westermeyer, 1974). Most reported daily dosages that had ‘been reduced from one-half to one-quarter of their previous amounts. No addicts among the 40 interviewed were using opium more than twice daily (though 3-times-a-day usage was commonplace in 1965-67 (Westermeyer, 1969)). A few were using only once a day in order to stretch their opium supply (see “a” in Fig. 2). Opium smoking had been the common mode of opium usage among all opium addicts, although it was a wasteful method since much drug was lost through volatilization. Addicts preferred this method because it produced a more rapid, more pleasurable effect than eating opium. On the other hand, opium eating was less wasteful of the drug. By 1971 only a minority of addicted people could afford to take opium entirely by smoking. Most of the remainder ate opium during the early part of the day and smoked it only in the evening. Impoverished addicts used only the oral route of administration. (See “b” in Fig. 2.) The effect of refugee movements and higher opium costs compounded the financial problem of opium addiction for families. Many refugee farmers were not able to obtain work. The need of refugees to purchase food and to replace abandoned cooking and farming implements depleted their scarce resources. Since most people in Laos live within an extended kin group, an addicted uncle or grandfather caused Anancial strain on a large group of people. Under these circumstances, some addicts-who had previously been accepted within the family-became alienated from the family. (See “c” and “d” in Fig. 2.)
60
JOSEPH WESTERMEYER
Theft also became a problem, especially in refugee camps. This problem was unexpected, since refugees moved as entire intact villages and theft was not a prevalent problem among villagers. During previous refugee moves, people had merely moved from one mountain to another and were able to raise opium-poppy after settling into the new area. As large-scale refugee movements took place, and as people moved onto the plains where opium-poppy could not be raised, theft became prevalent (see “e“ in Fig. 2). This in turn led to passage of the anti-opium law in late 1971, which led to the appearance of heroin. which further raised the cost of narcotic drugs (see “f,” “g” and “h” in Fig. 2). Initially the general concensus among opium addicts was that heroin was “too intoxicating.” Seasoned opium addicts often became lethargic and unable to work (or even walk) for .an hour or two after using it. Heroin addicts also had the urge to smoke again within 4-6 hr, whereas opium addicts could function for 8-12 hr without another dose of opium. The situation regarding heroin changed dramatically within 1 yr. Among 439 people voluntarily treated for opium addiction between September, 1972, and June, 1973. 17.3% were using heroin part or all of the time (Westermeyer, 1976). Opium addicts traditionally sought treatment for their condition, and a variety of “folk treatments” for addiction were known in Laos (Westermeyer, 1973). It was not unusual, then, that addicts sought treatment in facilities provided by the Laotian government after 1972. Quite unexpected, however, were the large numbers who sought treatment at considerable inconvenience and some expense to themselves: about 3000 addicts were treated in two different government-sponsored programs during 1973374. In addition, treatment approaches were accepted which would not have been popular earlier. For example, over 2000 addicts voluntarily went to a program located at a Buddhist temple that required “cold turkey” withdrawal (see “i” in Fig. 2). DISCUSSION
In 1965-67 opium addiction was a problem of the individual and his family. Addicts worked to raise or purchase their own opium supply in a culturally approved way. Impoverished addicts unable to raise or purchase their own opium resorted to begging, not to theft. War and refugee movements changed these conditions greatly. Village leaders and government officials began to report increased theft associated with narcotic addiction. In response to this, an anti-opium law was passed. This in turn led to increased cost of opium and the appearance of heroin addiction. The Laos case provides an example of the effects produced by decreased drug availability and increased cost. Under the pressure of high costs and low availability, addicts limited frequency of self-administration. They used a less satisfying, but more economic route of administration to stretch their supply (i.e. oral use of opium rather than smoking). Large numbers of addicts also voluntarily sought treatment. High cost/low availability of narcotic drugs had harmful effects for addicts, their families. and society. It led to the appearance of heroin addiction, worsening financial problems among addicts’ families, corruption, and increased theft by addicts. This association of crime with high cost/low availability of narcotic drugs has been described
Social events and narcotic
addiction
61
in the United States by Hughes et al. Similar events occurred in China during her early post-imperial days when anti-opium laws had been passed but could not be fully implemented: in 1925 an American physician, the captive of Chinese bandits for 10 weeks, noted the tendency of most bandits to be opium addicts (Howard, 1927). In sum, from the perspective of reducing or eliminating problems related to narcotic addiction, restricted availability (as opposed to no availability) is a mixed blessing. Although less drugs are consumed and addicted people seek treatment in increasing numbers, social and family problems increase. Of course, this is not to say that open availability has fewer untoward effects for severity as a whole than restricted availability. An hypothesized relationship of availability to social problems is presented in Table 1. Acknowledgements-The author would like to thank Dr Kamphay Abhay (Minister of Health. Laos) and Dr Charles Weldon (Public Health/AID/Laos). This study was supported in part by the Minnesota MedicaI Foundation, the International Programs Office at the University of Minnesota, and the National Institute of Drug Abuse (grant number 5 TO1 00040-02).
REFERENCES Barney, G. L., The Meo of Xieng Khouang Province, Laos. In P. Kunstadter (Ed). South-east Asian Tribes. Minorities. and Narions Princeton, NJ: Princeton University Press, 1967, p. 271-294. Burchett, W., Mekong Upstream, Hanoi Red River Publishing House, 1960. Dommen, A. J.. Conflict In Laos. New York: Praegar Publ. 1960. Howard, H. J.. Ten Weeks with Chinese Bandits, London John Lane, Bodley Head, 1927. Hughes. P. H., Baker. N. W., Crawford, H. A. Kc JalTe, J. H., The natural history of a heroin epidemic, American Journal of Public Health, 1972, 62, 995-1001. Langer, P. F. & Zaslog, J. J., North Vietnam and the Pathet Lao: Partners in the Strugglefor Laos, Cambridge, MA-Harvard University Press, 1970. Le Bar. F. & Suddard, A., Laos Hew Haven, CT-Human Relations Area Files, 1960. Westermeyer, J.. The use of alcohol and opium by two ethnic groups in Laos, Transcultural Psychiatric Review, 1969, 6, 148-151. Westermeyer, J., Use of alcohol and opium by the Meo of Laos, American Journal of Psychiatry, 1971. 27, 1019-1023. Westermeyer, J., Folk treatments for opium addiction in Laos, British Journal of Addictions, 1973, 68, 345-349. Westermeyer, J., Opium dens-a social resource for addicts in Laos. Archives of General Psychiatry. 1974. 31, 237-240. Westermeyer. J.. Opium smoking in Laos-a survey of forty addicts, American Journal of Psychiatry. 1974, 131, 165-l 70. Westermeyer, J.. The pro-heroin effects of anti-opium laws, Archives ofGeneral Psychiatry, 1976, 33, 1135-l 139.
~78/0501b4x35710200/0
SOCIAL EVENTS AND NARCOTIC ADDICTION: THE INFLUENCE OF WAR AND LAW ON OPIUM USE IN LAOS JOSEPH WESTERMEYER,M.D., Associate
Professor,
PH.D.
Department ‘of Psychiatry, University Minneapolis, Minnesota 55455
of Minnesota,
Abstract-War in Laos caused removal of opium farmers from their mountain poppy growing areas and contributed to difficulties in transport of opium from nearby areas. This has led to an increased cost and low availability of opium, which in turn has caused addicts (1) to reduce their narcotic dosage, and (2) to reduce their smoking of opium in favor of the less satisfying but more economic oral route of administration. Increased cost/low availability of opium, together with unemployment from refugee movements, produced economic pressure on families with addicted members and resulted in widespread theft. This in turn led to anti-opium laws, which had the effect of favoring heroin addiction. Heroin addiction further exacerbated the addict’s problems since heroin production costs considerably more than the production of smoking opium.
INTRODUCTION
Data collected 10 yr ago on opium use in Laos led to the prediction that opium smoking patterns would change only negligibly or not at all (Westermeyer, 1969). In a sense, that statement still holds true; addiction in Laos has remained stable (Westermeyer, 1974). But in other respects, narcotic addiction has changed remarkably-and unexpectedly-in the last several years. This paper records the changes that occurred in Laos and relates them to analogous changes in narcotic addiction elsewhere in the world. METHOD
Baseline data were collected in 196567; the method and results have been previously published (Westermeyer, 1969, 1971). In early 1971 during a 2 month field trip, 40 opium addicts were interviewed (Westermeyer, 1974). Late in 1971 and early in 1972 consultation to the Ministry of Health in Laos led to further studies regarding the problem of refugee opium addicts (Westermeyer, 1973, 1974). In this paper the status of opium addiction in 1971-72 (a time of refugee movements and anti-opium laws) is compared to that in 1965-67 (a relatively stable time prior to anti-opium laws). RESULTS
Social Changes Between 1965-67 and 1971-72, the intensification of armed conflict forced many opium-poppy farmers down from the mountains of northern Laos on to the flood plain of the Mekong River where opium-poppy could not be grown (Burchett, 1967; Dommen, 1960; Langer & Zasloff, 1970). One tribal people, the Hmong, had raised opium as their primary cash crop (Barney, 1967; LeBar & Suddard, 1960). Pushed out of their mountainous poppy-growing areas, they could no longer produce opium (see “a” in Fig. 1). Hmong addicts, and lowland addicts dependent on Hmong opium production, had to rely on opium produced elsewhere (see “b” in Fig. 1). This led to an increase in the cost of opium (see “c” in Fig. 1). In addition, military insecurity impeded transportation throughout the area (see “d” in Fig. 1). This exacerbated the problem of obtaining opium from distant areas still growing poppy. Consequently, addicts had to contend not only with increased cost, but also inconstant availability of opium, which further increased the cost (see “e” in Fig. 1).
JOSJ.PH WI:STLRMEYI:H
58
WAR Dlsploced op,“mpoppy farmers
Interference transportatloC
of
Dpwm Imported from Ewm and Thailand
and thetr fanllles,lncreased
theff
Increased poltce ccfruptlon ”
Introduction
of herom
I
k
HeroIn Industry chemcals.equipment,chemlsts, high risk capbtal ,securlty
Increased cost of narcottc for addict
Fig.
drugs
1
As a result of the various events, farmer-addicts-who had never previously comprised a national problem-became a major social problem in refugee camps and resettlement villages around Laos. Addicted fathers and grandfathers would deprive their families of food and clothing in order to purchase opium. Theft became a commonplace event as addicts sought to obtain money for opium (see “f’ in Fig. 1). In this context, the government of Laos passed a law proscribing the transport and sale of opium (see “g” in Fig. 1). Prior to the anti-opium law, heroin use in Laos had been virtually absent (Westermeyer, 1976). However, this changed abruptly within weeks following passage of an anti-opium law. Since opium is a bulky substance with a characteristic odor, its transport and sale could be readily detected. Consequently in areas of effective police control (i.e. mainly the area around Vientiane, the capital city), opium trade was effectively controlled (see “h” in Fig. 1). This in turn led to police corruption, since the police suddenly gained power and authority over what had previously been ordinary events (i.e. raising, transporting, selling and using opium). Some police accepted bribes in return for ignoring events against which they had no personal objections (see “i” in Fig. 1). Heroin is odorless and occupies a fraction of opium’s bulk. Unlike opium, it can be more readily transported without police detection. Consequently, heroin use appeared within weeks after the anti-opium law passed (see “j” in Fig. 1). Heroin production required industrial-grade chemicals, trained chemists, equipment, high-risk capital, and security-all elements not required for opium production (see “k” in Fig. 1). This led to further increases in the cost of sustaining addiction to narcotic drugs (see “1” in Fig. 1) and to further theft and economic burdens on family (see “m” in Fig. 1). Thus, the total effects of war and the anti-opium law were (1) increased economic burdens on addicts and their families, (2) increased theft, and (3) increased police corruption.
Social events and narcotic
addiction
59
Extended fomlly Alienotlon of deprived of d food, clothing, -*d’cted Person from fomlly etc.
Anh-opum
low
refugee areas
Fig. 2
EfSects on Addicts These military and legislative changes, followed by changes in price and availability of narcotic drugs, had major effects on addicts themselves. Perhaps most important was the economic effect. Formerly most tribal addicts grew their own supply of opium. Non-tribal peoples bartered rice or other goods for opium. Urban dwellers supported large addictions on fairly small sums of money (U.S. $8 to $15 per month). Later, even small narcotic habits were relatively expensive (U.S. $30 to $60 per month in urban Vientiane and U.S. $12 to $20 in more remote refugee areas closer to supply routes). As a consequence of these economic changes, addicted people began to use smaller amounts of narcotic drugs. Of 40 addicts interviewed in 1971, all had cut down on their opium usage (Westermeyer, 1974). Most reported daily dosages that had ‘been reduced from one-half to one-quarter of their previous amounts. No addicts among the 40 interviewed were using opium more than twice daily (though 3-times-a-day usage was commonplace in 1965-67 (Westermeyer, 1969)). A few were using only once a day in order to stretch their opium supply (see “a” in Fig. 2). Opium smoking had been the common mode of opium usage among all opium addicts, although it was a wasteful method since much drug was lost through volatilization. Addicts preferred this method because it produced a more rapid, more pleasurable effect than eating opium. On the other hand, opium eating was less wasteful of the drug. By 1971 only a minority of addicted people could afford to take opium entirely by smoking. Most of the remainder ate opium during the early part of the day and smoked it only in the evening. Impoverished addicts used only the oral route of administration. (See “b” in Fig. 2.) The effect of refugee movements and higher opium costs compounded the financial problem of opium addiction for families. Many refugee farmers were not able to obtain work. The need of refugees to purchase food and to replace abandoned cooking and farming implements depleted their scarce resources. Since most people in Laos live within an extended kin group, an addicted uncle or grandfather caused Anancial strain on a large group of people. Under these circumstances, some addicts-who had previously been accepted within the family-became alienated from the family. (See “c” and “d” in Fig. 2.)
60
JOSEPH WESTERMEYER
Theft also became a problem, especially in refugee camps. This problem was unexpected, since refugees moved as entire intact villages and theft was not a prevalent problem among villagers. During previous refugee moves, people had merely moved from one mountain to another and were able to raise opium-poppy after settling into the new area. As large-scale refugee movements took place, and as people moved onto the plains where opium-poppy could not be raised, theft became prevalent (see “e“ in Fig. 2). This in turn led to passage of the anti-opium law in late 1971, which led to the appearance of heroin. which further raised the cost of narcotic drugs (see “f,” “g” and “h” in Fig. 2). Initially the general concensus among opium addicts was that heroin was “too intoxicating.” Seasoned opium addicts often became lethargic and unable to work (or even walk) for .an hour or two after using it. Heroin addicts also had the urge to smoke again within 4-6 hr, whereas opium addicts could function for 8-12 hr without another dose of opium. The situation regarding heroin changed dramatically within 1 yr. Among 439 people voluntarily treated for opium addiction between September, 1972, and June, 1973. 17.3% were using heroin part or all of the time (Westermeyer, 1976). Opium addicts traditionally sought treatment for their condition, and a variety of “folk treatments” for addiction were known in Laos (Westermeyer, 1973). It was not unusual, then, that addicts sought treatment in facilities provided by the Laotian government after 1972. Quite unexpected, however, were the large numbers who sought treatment at considerable inconvenience and some expense to themselves: about 3000 addicts were treated in two different government-sponsored programs during 1973374. In addition, treatment approaches were accepted which would not have been popular earlier. For example, over 2000 addicts voluntarily went to a program located at a Buddhist temple that required “cold turkey” withdrawal (see “i” in Fig. 2). DISCUSSION
In 1965-67 opium addiction was a problem of the individual and his family. Addicts worked to raise or purchase their own opium supply in a culturally approved way. Impoverished addicts unable to raise or purchase their own opium resorted to begging, not to theft. War and refugee movements changed these conditions greatly. Village leaders and government officials began to report increased theft associated with narcotic addiction. In response to this, an anti-opium law was passed. This in turn led to increased cost of opium and the appearance of heroin addiction. The Laos case provides an example of the effects produced by decreased drug availability and increased cost. Under the pressure of high costs and low availability, addicts limited frequency of self-administration. They used a less satisfying, but more economic route of administration to stretch their supply (i.e. oral use of opium rather than smoking). Large numbers of addicts also voluntarily sought treatment. High cost/low availability of narcotic drugs had harmful effects for addicts, their families. and society. It led to the appearance of heroin addiction, worsening financial problems among addicts’ families, corruption, and increased theft by addicts. This association of crime with high cost/low availability of narcotic drugs has been described
Social events and narcotic
addiction
61
in the United States by Hughes et al. Similar events occurred in China during her early post-imperial days when anti-opium laws had been passed but could not be fully implemented: in 1925 an American physician, the captive of Chinese bandits for 10 weeks, noted the tendency of most bandits to be opium addicts (Howard, 1927). In sum, from the perspective of reducing or eliminating problems related to narcotic addiction, restricted availability (as opposed to no availability) is a mixed blessing. Although less drugs are consumed and addicted people seek treatment in increasing numbers, social and family problems increase. Of course, this is not to say that open availability has fewer untoward effects for severity as a whole than restricted availability. An hypothesized relationship of availability to social problems is presented in Table 1. Acknowledgements-The author would like to thank Dr Kamphay Abhay (Minister of Health. Laos) and Dr Charles Weldon (Public Health/AID/Laos). This study was supported in part by the Minnesota MedicaI Foundation, the International Programs Office at the University of Minnesota, and the National Institute of Drug Abuse (grant number 5 TO1 00040-02).
REFERENCES Barney, G. L., The Meo of Xieng Khouang Province, Laos. In P. Kunstadter (Ed). South-east Asian Tribes. Minorities. and Narions Princeton, NJ: Princeton University Press, 1967, p. 271-294. Burchett, W., Mekong Upstream, Hanoi Red River Publishing House, 1960. Dommen, A. J.. Conflict In Laos. New York: Praegar Publ. 1960. Howard, H. J.. Ten Weeks with Chinese Bandits, London John Lane, Bodley Head, 1927. Hughes. P. H., Baker. N. W., Crawford, H. A. Kc JalTe, J. H., The natural history of a heroin epidemic, American Journal of Public Health, 1972, 62, 995-1001. Langer, P. F. & Zaslog, J. J., North Vietnam and the Pathet Lao: Partners in the Strugglefor Laos, Cambridge, MA-Harvard University Press, 1970. Le Bar. F. & Suddard, A., Laos Hew Haven, CT-Human Relations Area Files, 1960. Westermeyer, J.. The use of alcohol and opium by two ethnic groups in Laos, Transcultural Psychiatric Review, 1969, 6, 148-151. Westermeyer, J., Use of alcohol and opium by the Meo of Laos, American Journal of Psychiatry, 1971. 27, 1019-1023. Westermeyer, J., Folk treatments for opium addiction in Laos, British Journal of Addictions, 1973, 68, 345-349. Westermeyer, J., Opium dens-a social resource for addicts in Laos. Archives of General Psychiatry. 1974. 31, 237-240. Westermeyer. J.. Opium smoking in Laos-a survey of forty addicts, American Journal of Psychiatry. 1974, 131, 165-l 70. Westermeyer, J.. The pro-heroin effects of anti-opium laws, Archives ofGeneral Psychiatry, 1976, 33, 1135-l 139.