Drug Addiction and the Practice of Public Health in Late Imperial and Early Soviet Russia

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Drug Addiction and the Practice of Public Health in Late Imperial and Early Soviet Russia

Р.A. Vasilyev

The relatively short period from 1914 to 1932 witnessed a radical change in the attitudes of both governmental authorities and professional communities towards drugs and addiction. Before the First World War, Russians could easily buy cocaine or heroin at a pharmacy, medical science did not view addiction as a serious social problem. There was practically no government regulation or legislation concerning recreational drugs. By the early 1930s, however, the market of recreational drugs had been heavily regulated, drug sale had been criminalized, and physicians and criminologists had begun to label drug addicts as bourgeois, degenerate, or otherwise socially anomalous people who should be sent to special camps. An important turning point occurred in late 1924, when Soviet authorities issued two decrees that provided a legal definition of criminal drug sales, signaling the start of a more intensive struggle against drug abuse. This paper examines the social practice of late Imperial and early Soviet public health in order to evaluate the evolution of “in-the-field” medical approaches towards opiate, cocaine and cannabis addiction. It focuses on the period when drug use was first constructed as a delinquency, and thus as a social problem requiring immediate intervention. It examines attempts of physicians and pharmacists to restrict and control drug production, distribution and sale; sanitary propaganda and other prophylactic measures; and the establishment of special institutions for the treatment of addicts. It is concerned only peripherally with the judicial prosecution of drug dealers and drug addicts.

Keywords: drug addiction, public health, late Imperial Russia, early Soviet Russia, opiates, cocaine.

imperial Soviet period addiction public health

Наркомания и практика здравоохранения в позднеимперской и раннесоветской России

П.А. Васильев

За относительно короткий период с 1914 по 1932 г. в отношении как правительственных организаций, так и профессиональных сообществ к наркотикам и наркомании произошли радикальные изменения. До Первой мировой войны подданные Российской империи могли легко купить кокаин или героин в аптеке, а медицинская наука не считала наркоманию серьезной социальной проблемой. Государственное регулирование и законодательство, касающееся наркотиков и наркомании, практически отсутствовало. К началу 1930-х годов, напротив, рынок наркотиков был жестко зарегулирован, торговля наркотиками криминализована, а врачи и криминологи стали клеймить наркоманов как «буржуазных», «дегенеративных» или «социально аномальных» людей, которые подлежат отправке в специальные лагеря. Важной поворотной точкой стал конец 1924 г., когда советские власти издали два декрета, давших правовое определение торговле наркотиками, и подали сигнал к более интенсивной борьбе с наркотизмом. В данной работе рассматривается социальная практика позднеимперского и раннесоветского здравоохранения и дается оценка эволюции врачебных подходов к зависимости от опиоидов, кокаина и каннабиса. Основное внимание уделяется периоду, когда употребление наркотиков впервые было определено как «отклоняющееся поведение». Рассматриваются попытки врачей и фармацевтов ограничить и контролировать производство, распространение и продажу наркотиков, санитарно-пропагандистские и иные профилактические меры, а также работа специализированных учреждений для лечения наркоманов. В меньшей степени затрагиваются вопросы судебного преследования продавцов наркотиков и наркоманов. Основной акцент сделан на эволюции медицинских подходов к предотвращению и лечению наркомании на примере крупного городского центра европейской части России -- Санкт-Петербурга--Петрограда--Ленинграда. Работа основывается на документах органов здравоохранения, медицинских, научных и образовательных учреждений из нескольких архивов Санкт- Петербурга. Многие документы ранее не были использованы историками и фактически впервые вводятся в научный оборот.

Ключевые слова: наркомания, здравоохранение, позднеимперская Россия, раннесоветская Россия, опиаты, кокаин.

In 1914-1932, Russia experienced a series of radical changes, including but not limited to the First World War, the collapse of the Romanov imperial system, the Bolshevik revolution, and the Russian Civil War. Audacious socialist experiments and radical utopian projects characterize this period, as does increasing government regulation On already increasing government regulation of the economy during the last years of Imperial regimes, see: Kitanina T. M. Rossiia v pervoi mirovoi voine 1914-1917 gg.: Ekonomika i ekonomicheskaia politika. St. Petersburg, 2003.. Drug addiction also emerged as a specific social problem during this period; the First World War is widely perceived as an important catalyst worldwide Lisovskii V. T., Kolesnikova E.A. Narkotizm kak sotsial'naia problema. St. Petersburg, 2001. P. 24.. Scholars have noticed a trend towards the “democratization” of drug addiction, in other words, the “contamination” of previously “clean” social groups, including workers, soldiers, sailors and so forth Lebina N. B. Povsednevnaia zhizn' sovetskogo goroda: Normy i anomalii: 1920-1930 gody. St. Petersburg, 1999, P. 29; Shkarovskii M. V. “Sem' imen “koshki”: Rastsvet narkomanii v 1917-1920-e gody // Nevskii arkhiv: istoriko-kraevedcheskii sbornik. Iss. 3. St. Petersburg, 1997. P. 467.. Perhaps even more importantly, Russian society after the Great War confronted a dramatic increase in the number of drug addicts, especially among children, teenagers and young people.

A relatively short period from 1914 to 1932 also witnessed a radical change in the attitudes of both governmental authorities and professional communities towards drugs and addiction. Before the First World War, Russians could easily buy cocaine or heroin at a pharmacy, medical science did not view addiction as a serious social problem. There was practically no government regulation or legislation concerning recreational drugs. By the early 1930s, however, the market of recreational drugs had been heavily regulated, drug sale had been criminalized, and physicians and criminologists had begun to label drug addicts as bourgeois, degenerate, or otherwise socially anomalous people who should be sent to special camps. An important turning point occurred in late 1924, when Soviet authorities issued two decrees that provided a legal definition of criminal drug sales, signaling the start of a more intensive struggle against drug abuse.

Quite surprisingly, no major study has sought to explain the puzzling change in attitudes between 1914 and 1932. The topic remains largely unexplored, even though several authors have briefly discussed the developments of the period. For some obvious reasons, Soviet historiography largely ignored the history of drug addiction in 20^th century Russia For a critique of Soviet Marxist historiography with its tendencies to mythologize and conceal, see: Goriacheshnyi i triumfal'nyi gorod”: Petrograd: ot voennogo kommunizma k NEPu: Dokumenty i materialy / ed. by M. V. Khodiakov. St. Petersburg, 2000. P 11-12; Lebina N. B. O pol'ze igry v biser: Mikroistoriia kak metod izucheniia norm i anomalii sovetskoi povsednevnosti 20-30-kh godov // Normy i tsennosti povsed- nevnoi zhizni: Stanovenie sotsialisticheskogo obraza zhizni v Rossii, 1920-30e gody / ed. by T Vihavainen. St. Petersburg, 2000. P 7; Musaev V. I. Prestupnost' v Petrograde v 1917-1921 gg. i bor'ba s nei. St. Petersburg, 2001. P 5.. New authors interested in drug addiction have emerged since the late 1980s, but the historical picture that they have tried to reconstruct remains mostly fragmentary. Many scholars have published articles and book chapters that at least touch upon the social history of drug addiction in Russia Popov V. A. Bor'ba s narkomaniei i toksikomaniei detei i podrostkov v 20-30-e gody // Sovetskoe zdravookhranenie. 1989. N. 5. P 67-70; ShkarovskiiM. V. Leningradskaia prostitutsiia i bor'ba s nei v 1920-e gody // Nevskii arkhiv: istoriko-kraevedcheskii sbornik. Iss. 1. Moscow, 1993. 1. P 387-411; Lebina N. B. Tenevye storony zhizni sovetskogo goroda 20-30-kh godov // Voprosy istorii. 1994. N 4. P 30-42; Lebina N. B. Narkoman iz narkomata i klub morfinistov revoliutsionnogo Baltflota // Vechernii Peterburg. 12 April 1996; Lebina N. B. Belaia feia, ili Kak “navodili marafet” v Sovetskoi Rossii // Rodina. 1996. N 9. P 64-66; Shkarovskii M. V. Sem' imen “koshki...; Lebina N. B. Povsednevnaia zhizn'...; Musaev V. I. Prestupnost' v Petrograde.; Lebina N. B., Chistikov A. N. Obyvatel' i reformy: Kartiny povsednevnoi zhizni gorozhan v gody nepa i khrushchevskogo desiatiletiia. St. Petersburg, 2003. See also: Lebina N. B., Shkarovskii M. V. Prostitutsiia v Peterburge: (40-e gg. XIX v. -- 40-e gg. XX v.). Moscow, 1994., but there is no major contribution from the perspective of the history of medicine Naturally, there are numerous books on the history of relevant medical and research institutions written by medical historians (e.g., Tochilov V. A. and others. Kafedra psikhiatrii i narkologii // Sankt-Peter- burgskoi gosudarstvennoi meditsinskoi akademii im. I. I. Mechnikova 90 let. St. Petersburg, 1997. P 99-106; Shabrov A. V., Romaniuk V. P Bol'nitsa Petra Velikogo -- klinicheskaia baza Sankt-Peterburgskoi gosudarstvennoi meditsinskoi akademii imeni I. I. Mechnikova. Vol. 1 (1903-1945). St. Petersburg, 2001; Shabrov A. V., Romaniuk V. P Sankt-Peterburgskaia gosudarstvennaia meditsinskaia akademiia imeni I. I. Mechnikova. Vol. 1. St. Petersburg, 2006; and especially Akimenko M. A., Shereshevskii A. M. Istoriia instituta im. V. M. Bekhtereva na dokumental'nykh materialakh]. In 3 vol. St. Petersburg, 1999-2001; Akimenko M. A.: Razvitie psikhonevrologii v Institute im. V. M. Bekhtereva v XX veke. St. Petersburg, 2005; Institut imeni V. M. Bekhtereva: ot istokov do sovremennosti (1907-2007). St. Petersburg, 2007). However, these works are often characterized by factual and other errors, have little critical treatment of primary sources, and in the end do not produce any serious theoretical generalizations other than the grand narrative of the respective institution's successful development throughout the turbulent 20^th century.. Perhaps even more importantly, most studies have essentially confined themselves to the narrow period between 1917 and the early 1920s, neglecting both the emergence of social problems during the First World War and the decline of cocaine and opiate addiction in the late 1920s.

Additionally, contemporary historiography focuses largely on legal changes and the role of law enforcement in fighting drug addiction. Such works retain a rather essentialist understanding of drug addiction as an unequivocal social problem to be “solved” through government intervention. Such an approach neglects the existence of diverse regimes of drug prohibition throughout history. The decision to prohibit or legalize this or that psychoactive substance, whether alcohol, marijuana or cocaine, depends on arbitrary historical conditions, not the actual degree of psycho-physical harm or addictiveness Friedman M. Foreword // After Prohibition: An Adult Approach to Drug Policies in the 21^st Century / ed. by T. Lynch. Washington, 2001. P vii.. Two important exceptions can be found in works by Mary Schaeffer Conroy and Alisher Latypov Conroy M. S.: Abuse of Drugs other than Alcohol and Tobacco in the Soviet Union // Soviet Studies. 1990. Iss. 42. P 447-480; Drug Use and Abuse in Tsarist Russia // M. S. Conroy. In Health and in Sickness: Pharmacy, Pharmacists and the Pharmaceutical Industry in Late Imperial, Early Soviet Russia. Boulder, 1994. P 200-218; Soviet Pharmaceutical Business During It First Two Decades (1917-1937). New York, 2006; Latypov A.: Central Asian tabibs in post-Soviet archives: Healing, spying, struggling, and `exploiting' // Wellcome History. 2001. Iss. 43. P 8-9; Healers and psychiatrists: The transformation of mental health care in Tajikistan // Transcultural Psychiatry. 2010. Iss. 47, N 3. P 419-451; The Soviet doctor and the treatment of drug addiction: “A difficult and most ungracious task // Harm Reduction Journal. 2011. Iss. 8, N 32.. Both scholars reject essentialist understanding of drug addiction, pay close attention to medical texts as primary sources, and focus on a larger chronological period. However, both generally concentrate on theoretical constructions of drug addiction in medical texts, neglecting the practice of drug control and addiction treatment. In addition, Latypov focuses strongly on Central Asia, a region that, while important, is peripheral to our concerns.

Understanding the transformation of Russian attitudes toward psychoactive substances is further complicated by the fact that the most basic terms used to describe “drugs” and “addiction” were subject to constant negotiation and re-definition in the period under discussion About a half-successful attempt to resolve the existing contradictions, see: Lisovskii V. T., Kolesnikova E. A. Narkotizm kak sotsial'naia problema... P 12.. In the early 20^th century there was no unanimity about whether substances such as tea, coffee and tobacco were “drugs” Concerning a perspective that combines cocaine with tea, coffee and beer, but excludes heroin, see: Sholomovich A. S. Narkotizm kak sotsial'no-patologicheskoe iavlenie i mery bor'by s nim sredi rabochikh // Voprosy narkologii: Sbornik. N 1 / ed. by A. S. Sholomovich. Moscow, 1926.. The Russian terms to describe such substances, such as iady, narkotiki, or durmany, were also hotly debated Regarding a critical treatment ofpoison/medicine contradiction in the history of addiction research, consider Lindesmith A. R., Gagnon J. H. Anomie and Drug Addiction // Anomie and Deviant Behaviour: A Discussion and Critique / ed. by M. B. Clinard. London, 1964. P 162-163.. Medical experts also disagreed about whether to describe the resulting medical problems as nar- komaniia, narkotizm, or as more specific conditions such as morfinizm, kokainizm and so forth Cf. internal definitional inconsistencies in the major soviet edited collections voprosy narkologii: voprosy narkologii: sbornik. N 1; Voprosy narkologii: sbornik. N 2 / ed. by A. S. Sholomovich. Moscow, 1928.. A contemporary observer Aleksander Sholomovich spoke of the “horrific spread of cocaine, ether and morphine addiction” Sholomovich A. S. Narkotizm kak sotsial'no-patologicheskoe iavlenie. P. 49., but ether was, in fact, a rather minor drug in Russia, while opium, heroin and cannabis, which Sholomovich failed to mention, were very widely used. Nevertheless, cocaine, opiates and hashish can still be singled out, since Russian society first experienced the abuse of these drugs as a serious social problem only after the Great War. The use and abuse of alcohol, tobacco, tea and coffee have much longer histories in Russia. For the purposes of this paper, therefore, I adhere to the contemporary understanding that the term “drugs” includes cocaine, opiates, hashish, and ether but not coffee, despite the limitations and implications of this approach for the analysis of medical texts.

Late Imperial medical and criminological texts repeatedly linked drug addiction to decadence and “degeneration,” both physical and mental. Both were closely associated with civilization, technological progress, free-market capitalism, urbanization and secularization Danillo S. N. O vliianii nekotorykh iadov (spirt, opii, gashish) na soznanie u cheloveka. St. Petersburg, 1894; Reimer N. K. lady tsivilizatsii. St. Petersburg, 1899; Otchet o doktorskom dispute N. N. Lange // Rossiiskaia psikhologiia: Antologiia / ed. by A. N. Zhban. Moscow, 2009. P. 474-515.. This tradition was developed further in the early Soviet period, when drug addiction was constructed as a social problem related to modernity and capitalism, and thus alien to the socialist system See, e.g.: Aronovich G. D. Nabliudeniia i vpechatleniia sredi kokainomanov // Nauchnaia medi- tsina. 1920. Vol. 6. P. 676-685; Semashko N. A. O kokainizme i bor'be s nim // Izvestiia TSIK SSSR. 1925. Jan. 4 ; Sholomovich A. S. Narkotizm kak sotsial'no-patologicheskoe iavlenie...; Rapoport A. M. Kokainizm i prestupnost' // Moskovskii meditsinskii zhurnal. 1926. N 1. P. 46-55; Golant R. Ia. Problemy morfinizma: (Klinicheskie i dispansernye nabliudeniia, eksperimental'nye issledovaniia) // Trudy gosudarstvennogo in- stituta meditsinskikh znanii (GIMZ). Iss. 5 / ed. by N. K. Rozenberg. Leningrad, 1929. P. 17-32.. The “democratization” of drug addiction led physicians to differentiate between full-fledged “drugs” on the one hand, and “minor” poisons, such as alcohol and tobacco, on the other. Nevertheless, the statistical data available show that alarmism about an “epidemic” of cocaine addiction should be treated skeptically. Alcohol remained the drug of choice in Russian cities, even during the 1914-1925 period of vodka prohibition. The physicians' reaction to the drug problem was largely inadequate to the scale of the problem and often took the form of a “moral panic,” which contributed to the potentially dangerous politicization of cocaine and opiate addiction Lebina N. B. Tenevye storony. P. 30.. Despite the existing alternatives, the majority of physicians eventually supported active government interference and regulation in the drug market Concerning a detailed discussion, see: Vasilyev P: Modernity, Jewishness and Addiction Research in Late 19th and Early 20^th Century Russia and Germany // Jewish Studies at the CEU. 2011. Vol. VI. P. 107118; Evoliutsiia predstavlenii o narkotikakh v rossiiskikh meditsinskikh tekstakh (1890-1930-e gody): Ot `iadov tsivilizatsii' k `perezhitkam kapitalizma' // Biulleten' Germanskogo istoricheskogo instituta v Moskve. 2012. N 6. P. 53-65; Medical Science, the State, and the Construction of the Juvenile Drug Addict in Early Soviet Russia // Social Justice: A Journal of Crime, Conflict, and World Order. 2012. Vol. 38, N 4. P. 31-52..

Apart from large-scale social projects, however, physicians also discussed medical solutions. Given the poor financial situation, unwieldy bureaucracy and inadequately trained medical personnel, several solutions proposed by physicians concerned medical propaganda, sanitary education and prophylaxis. Many Soviet doctors declared the necessity of propagandizing healthy lifestyles, especially through popular books, newspapers and films Semashko N. A. O kokainizme i bor'be.; Ziman R. M. O kokainizme u detei // Voprosy narkologii: sbornik. N 1. P. 30.. David Futer, for example, complained that “there are no special films, slides, fiction books on sanitary education and particularly about the dangers of drugs made for children and teenagers” Futer D. S. O detiakh-narkomanakh // Moskovskii meditsinskii zhurnal. 1925. N 10. P. 62-63. Cf. also other problems of popular medical propaganda: Tsentral'nyi gosudarstvennyi arkhiv Sankt-Petersburga (TSGASPb). F. 3215. Op. 1. D. 307. L. 129.. Other authors advocated special laboratories and libraries, or the introduction of free-of-charge consultations Sholomovich A. S. Narkotizm kak sotsial'no-patologicheskoe iavlenie. P. 49-50., particularly emphasizing the importance of preventive campaigns for high risk groups, such as children, youth, criminals and the homeless (besprizorniki) Futer D. S. O detiakh-narkomanakh... P. 61; Rapoport A.M. Kokainizm i prestupnost'... P. 48, 55; Kutanin M. P Voprosy teorii i praktiki morfinizma // Trudy pervogo vsesoiuznogo s'ezda nevropatologov i psikhiatrov / ed. by V. A. Beliaev. Moscow, 1929. P. 40..

Almost every work on the subject discussed establishing special drug clinics (dis- pansery) for addicts, specifically referring to American and Western European experience in this area Bliumenau E. B. Okhmeliaiushchie durmany: Tabak, kokain, morfii, opii, efir i gashish, ikh vred i posledstviia. Leningrad, 1925. P. 61; Ziman R. M. O kokainizme u detei... P. 31; Sholomovich A. S. Narkotizm kak sotsial'no-patologicheskoe iavlenie... P 48; Gorovoi-Shaltan V. A. Morfinizm, ego rasprostranenie i pro- filaktika // Voprosy narkologii: Sbornik. N 2. P 52-53; Dubrovich G. Klinicheskaia kartina kokainizma v detskom vozraste // Voprosy narkologii: Sbornik. N 2. P 74; Sholomovich A. S. Teoriia i praktika bor'by s narkotizmom: tezisy po narkologii dlia medikov. Moscow, [S. a.]. P 3-4; Bakhtiiarov V.A. K voprosu o nar- komanii // Trudy nauchno-issledovatel'skikh institutov Sverdlovskogo oblzdravotdela: Sbornik. N 7. Sverdlovsk, 1936. P. 199.. Nikolai A. Semashko, Peoples' Commissar of Public Health, planned to establish such clinics in large cities, assigning them various “medical, educational and inspectorial” tasks and highlighting the success of similar institutions in the struggle against tuberculosis and sexually transmitted diseases Semashko N. A. O kokainizme i bor'be. Cf. also argumentation for the establishment of drug clinics on the local and district [raion] level: TSGASPb. F. 3215. Op. 1. D. 306. L. 1-2, 12, 29g; TSGASPb. F. 3215. Op. 1. D. 307. L. 130. The raion principle of organization corresponded nicely to Leningrad physician Nikolai Tutolmin's idea of organizing struggle against addictions from the grassroots (TSGASPb, F. 4301, Op. 1. D. 3414. L. 2-2rev).. He envisaged that such institutions would have the right to intervene in the personal lives and professional careers of the patients. In another article, David Futer described the practical tasks facing clinics simply as to “catch and heal child addicts” Futer D. S. O detiakh-narkomanakh. P. 62..

This paper examines the social practice of late Imperial and early Soviet public health in order to evaluate the evolution of “in-the-field” medical approaches towards opiate, cocaine and cannabis addiction. It focuses on the period when drug use was first constructed as a delinquency, and thus as a social problem requiring immediate intervention. It examines attempts of physicians and pharmacists to restrict and control drug production, distribution and sale; sanitary propaganda and other prophylactic measures; and the establishment of special institutions for the treatment of addicts. It is concerned only peripherally with the judicial prosecution of drug dealers and drug addicts.

Cocaine and opiate addiction was primarily an urban phenomenon, and, as Valentina B. Zhiromskaia has noted in her study of early Soviet cities, urban social structures were much more complex, dynamic and controversial than those in rural areas Zhiromskaia V. B. Sovetskii gorod v 1921-1925 gg.: problemy sotsial'noi struktury. Moscow, 1988. P. 4.. Nataliia B. Lebina has argued that for Russia St. Petersburg/Petrograd/Leningrad has always been something of a “deviant” and “ambivalent” city, and, as such, it presents an advantageous location for the study of “norms” and “anomalies” Lebina N. B. Povsednevnaia zhizn'... P 16-17.. Accordingly, my paper seeks to establish a nuanced local picture of the evolution of medical treatment of drug addiction, rather than trying to construct a model of drug abuse in early Soviet Russia on a national scale For an example of such an ambitious attempt, consider Stanislav E. Panin's short article: Panin S. E. Potreblenie narkotikov v Sovetskoi Rossii (1917-1920-e gody) // Voprosy istorii. 2003. N 8. P 129-134. -- Conroy's 1990 article is a much more detailed work, but it is also bound to provide a broad overview and contain several factual errors by attempting to cover the whole territory of the Soviet Union and a time span of more than 70 years..

A case study examining one major Russian city, this paper draws on previously unknown sources found in several St. Petersburg archives.

The paper specifically draws on documents from public health, medical, research and educational institutions, supplemented with popular medical literature. I have used the materials of the Central State Archive of St. Petersburg (TSGASPb), the Central State Archive of Scientific and Technical Documentation of St. Petersburg (TSGANTDSPb), the Archive of I. I. Mechnikov North-Western State Medical University (formerly I. I. Mechnikov St. Petersburg State Medical Academy), and the Bekhterev Museum of V. M. Bekhterev St. Petersburg Psychoneurological Research Institute. A substantial portion of these materials has not been previously researched, particularly those concerning the organization of pharmaceutical control and the struggle against “social diseases” during the mid- to late 1920s. Nevertheless, most available archival material consists of official documents from local Soviet institutions, sources which have certain limitations and require a critical attitude Cf., e.g., Deviantnost' i sotsial'nyi kontrol' v Rossii (XIX-XX vv.): Tendentsii i sotsiologicheskoe osmyslenie / ed. by Ia. I. Gilinskii. St. Petersburg, 2000. P. 47.. Archival documents record the sale and abuse of drugs in much less detail than other “negative social phenomena” of the period, such as crime, child homelessness, alcohol abuse, prostitution, sexually transmitted diseases, tuberculosis and so on. Drug addiction is almost always discussed with strong pejorative connotations Cf. also: Lebina N. B. Povsednevnaia zhizn... P 28..

A Gray Market: Public Health and Drug Distribution

While existing scholarship on the history of drugs in late Imperial and early Soviet Russia generally accepts the contemporary image of a “black market” for drugs Such perception is apparently borrowed from the contemporary world where state-funded `Wars on Drugs' are fought in most countries, the markets for recreational drugs are heavily regulated, and moral panics related to drugs are launched from time to time by physicians and the media., cocaine and morphine were in fact semi-legal “gray market” substances during that period. The everyday practice in many areas of public health (especially dentistry, ophthalmology, otorhinolaryngology and gynecology) greatly depended on the use of these substances as medicines. Not until the late 1920s did it gradually become possible to reduce the use of these drugs in the practice of public health.

Contemporaries perceived the permissive trade in drugs as a factor contributing to their misuse. They specifically targeted private clinics and pharmacies, irresponsible state-employed doctors/pharmacists and foreign trade. Nevertheless, there was a general feeling that the causes of drug addiction were closely linked to the lack of strict control over import, distribution and sale of recreational drugs Cf. TSGASPb. F. 2815. Op. 1. D. 526. L. 40 rev.; Semashko N. A. O kokainizme i bor'be...; Bliumenau E. B. Okhmeliaiushchie durmany... P 61-62; Voprosy narkologii: Sbornik. no. 1. P 88, 90; Gorovoi-Shaltan V. A. Morfinizm, ego rasprostranenie.. P. 51-52.. In 1917-1918, for example, private pharmacies, then being phased out, provided a major source of cocaine. Subsequently, cocaine was frequently sold at state pharmacy depots, hospitals and pharmacies TSGASPb. F. 2815. Op. 1. D. 526. L. 40 rev..

The association of morphine with the medical profession was especially strong, even though awareness of its addictive qualities had emerged as early as the 1870s Cf. a detailed German work on the subject: Gossmann J. Ьber chronischen Morphiummissbrauch // Deutsche Medicinische Wochenschrift. 1879. P. 34-36. See also: Erlenmeier A., Sole P Morfinizm i ego lechenie. St. Petersburg, 1899.. Morphine was widely used in the practice of public health as an excellent painkiller. Naturally, demand increased dramatically during the First World War, not only in Russia, but around the globe. Morphine was frequently prescribed to soldiers with serious injuries, and many became addicted. Furthermore, a substantial number of physicians and nurses, trying to overcome nervous strain and psychological shock, and overconfident in their ability to control their drug use, also became addicts Rapoport A. M. Kokainizm i prestupnost'... P. 46; Gorovoi-Shaltan V. A. Morfinizm, ego rasprostranenie... P. 47; Golant R. Ia. Problemy morfinizma. P. 24, 25; Lebina N. B. Povsednevnaia zhizn... P. 28-29; Petrograd na perelome epokh: Gorod i ego zhiteli v gody revoliutsii i grazhdanskoi voiny / ed. by V. A. Shishkin. St. Petersburg, 2000. P. 93..

Morphine was widely distributed through the national network of hospitals and pharmacies, and it was quite common for drug addicts to obtain morphine with forged pre- scriptions Cf., e.g., GolantR. Ia. Problemy morfinizma... P. 29.. Ernst Joлl has famously asserted that in wartime conditions “the prescription of opiates ... was less restrained than in the time of peace ... Medical-legal supervision ... was not strict enough, and the persons entrusted [with the storage of drugs] were not careful enough while giving away these medicaments” Joлl E. Die Behandlung der Giftsuchten. Alkoholismus, Morphinismus, Kokainismus usw. Leipzig, 1928. S. 26-27.. There are numerous recorded cases of doctors taking drugs during the Great War and the early Soviet period See: Bulgakov M. A. Morfii // Bulgakov M. A. Sobranie sochinenii. Ann Arbor, 1982. P. 99-129; TSGASPb. F. 4301. Op. 1. D. 2538. L. 250.. Nearly every medical institution had some morphine addicts during the war Panin S. E. Potreblenie narkotikov. P. 130., several of whom had connections to medical professions Shkarovskii M. V. Sem' imen “koshki”... P. 469; Lebina N. B. Povsednevnaia zhizn'... P. 28; Petrograd na perelome. P. 93 etc.. For example, statistics from the Military-Medical Academy in Petrograd for the years 1919-1922 show that almost a half of the addicts were physicians, nurses, medical students, or members of their respective families Gorovoi-Shaltan V. A. Morfinizm, ego rasprostranenie. P. 47..

Medical approaches to drug addiction during the last years of the Imperial regime

Scholars have noticed that neither government authorities nor professional communities perceived drug addiction as a serious social problem in the late Imperial period Lincoln W. B. In War's Dark Shadow: The Russians before the Great War. New York, 1983. P. 351; Lebina N. B. Povsednevnaia zhizn'... P. 28.. Official control over drug distribution and use posed practical difficultiessince there was then no legal definition of criminal drug sale. Certain psychoactive substances were indeed regulated, including cocaine, morphine, opium, ether, heroin, and extract of Indian hemp, and some administrative rules governed their storage and distribution at pharmaceutical institutions. Nevertheless, the rationale behind such laws had more to do with limiting access to poisons than the recreational use of addictive substances For example, consider : Rossiiskaia Farmakopeia. 6^th ed. St. Petersburg, 1910. P. 541-546.. Criminal responsibility was envisaged only for failure to comply with the rules of drug sale at pharmacies. Punishments were not severe Ulozhenie o nakazaniiakh ugolovnykh i ispravitel'nykh. Ugolovnoe ulozhenie (stat'i, vvedennye v deistvie). Petrograd, 1916. P. 178-179.. The absence of government regulation and legislation concerning recreational drugs testifies to the relative scarcity of drug addiction: neither authorities nor society at large saw occasional drug use among certain subjects of the empire as a social problem. Instead, Russian social consciousness understood ether and morphine primarily as poisons. No evidence suggests that the Imperial Russian government felt that it was necessary to fight drug addiction using the Penal Code.

However, as discussed above, the First World War aggravated the problem of drug addiction. Various authorities introduced a number of relevant counter-measures in 1915-1916, but these were largely local, ad-hoc initiatives Ulozhenie o nakazaniiakh... P. 14-15; Ob uchrezhdenii Glavnogo upravleniia gosudarstvennogo zdravookhraneniia // Sobranie uzakonenii i rasporiazhenii pravitel'stva (hereinafter referred to as SU), 1916. N 252. P. 2448.. The legal understanding of drugs, drug sale and drug addiction remained largely unchanged.

Since drug addiction was not perceived as a major social problem in the Russian Empire, it becomes difficult to analyze what solutions were proposed. As problems generally were identified at the personal level, solutions offered by late Imperial physicians tended to have a narrow focus on individual medical treatment The situation with alcohol was different. As alcohol addiction already presented a serious social problem at the end of the 19^th century and was perceived as such, physicians would often offer various professional (medical), social and cultural proposals that were supposed to eliminate alcoholism.. Following the fin-de- siecle trend of “therapeutic pessimism" the majority of late Imperial texts pertaining to the 1914-1917 period have surprisingly little to say even about the practical treatment of drug addiction as an individual condition. They were silent about addiction as a social problem.

Revolutionary medicine fights drug addiction, 1917-1924

Intensification of medical and sanitary influence in 1925-1929

The government and local public health authorities had implemented most of the measures proposed by medical specialists by the end of the 1920s. The end of 1924 marks a certain chronological boundary because of two important decrees: “On measures for regulating the drug trade” (November 6) and “On adding article 140-d to the Penal Code” (December 22). The former prohibited “the free trade in all strong drugs that can be used for different kinds of intoxication and are detrimental to people's health (cocaine and its salts, opium and its derivatives, such as morphine, heroin etc.)”. It regulated the production, import and export of drugs. For the time being, violators were prosecuted under articles 136 and 141 of the Penal Code, which specified rules for trade and state monopolies. The prescribed punishments took the form of prison terms ranging from 6 months to a year O merakh regulirovaniia torgovli narkoticheskimi veshchestvami // SU. 1924. N 85. P 1216-1217..

Article 140-d, introduced in late December, officially punished “production, storage with the aim of sale and sale of cocaine, opium, morphine, ether and other intoxicating substances without proper permission” with a prison term under 3 years. A stronger sentence of no less than three years was specified for the same crime conducted as a business, or for organizing a drug den O dopolnenii Ugolovnogo kodeksa statei 140-d // SU. 1925. N 4. P 58-59.. Thus, the Soviet government had obviously decided to adopt stricter repressive measures and to set about gradually systematizing relevant legislation: the struggle to eliminate drug addiction was becoming more consistent.

In early January 1925, People's Commissar of Public Health Nikolai A. Semashko published a front-page article in Izvestiia TSIK SSSR, “On Cocaine Addiction and the Struggle Against It” Semashko N. A. O kokainizme i bor'be.. Semashko was clearly interested in explaining recent legal developments to a broader audience. He dealt not only with cocaine abuse, but with a variety of other drugs. Semashko claimed that Article 140-d did not punish drug addicts, but instead imposed a penalty upon “the parasite that makes a profit from a morbid predisposition” Ibid.. He then demanded various economic and sanitary-educational measures, thus outlining a complex programme for fighting drug addiction, which he envisioned would be carried out quickly and completely. Despite the ideologically charged character of Semashko's article, it is clear that in late 1924 and early 1925 central public health agencies managed to gather considerable momentum against drug addiction.

In fact, in the second half of the 1920s stricter controls were imposed on the production, import, circulation and sale of drugs. Archival documents reveal that local authorities in Leningrad quickly took up the central government's initiative. For instance, circular note N. 27 from the Leningrad Region Public Health Section (Lengubzdravotdel) on 29 December 1924 required heads of local public health offices, clinics, pharmacy depots and pharmacies to “urgently provide information on the available quantity of ... narcotic drugs,” (including cocaine, a stimulant) as of 1 January 1925, and to specify “requests for narcotic drugs necessary until 1 October 1925.” The requested documents were promptly supplied, even from hospitals TSGASPb. F. 4301. Op. 1. D. 1532. L. 105; 111, 134-292, 319-321, 345-345 rev., 347..