Only a decade ago, a heroin epidemic threatened Japan. An estimated 40,000 addicts provided a market for the growing traffic in hard drugs, and some users brazenly mainlined on street corners in such areas as Yokohama s Kogane-cho (Gold Town). Today, says Dr. Yoshio Ishikawa of the Sengayaen mental hospital, heroin addiction „has become a subject without a living example for study, like smallpox,“ and medical students may finish their entire education without seeing an actual addict. Police and narcotics agents face the same triumphant scarcity.
Heroin use in Japan has been virtually eliminated by stringent enforcement of a 1963 law that provided for harsh handling of both pushers and addicts. A life sentence is meted out for selling butsu (the Japanese gangsters‘ untranslatable coinage for heroin). Mere possession can mean several years in jail. To cut off the demand, the government required that every user caught be confined for at least 30 days of treatment. The most Draconian fact—by American standards—is that each addict’s treatment begins with „cold turkey,“ or withdrawal unassisted by chemical crutches such as methadone.
The ordeal can be excruciating. Early in the process, which can take a week or ten days, the addict’s eyes water and his nose runs while sweat pours from his body. By the third day, he is likely to be wracked by severe intestinal cramps, diarrhea, vomiting and nerve spasms. Goose bumps cover his body; they make his skin resemble that of a plucked fowl and give the process its name in the U.S. Cold turkey is rarely fatal—the Japanese claim 100% survival for those treated in hospitals—but the urge to commit suicide can be strong.
Verge of Hell. Many U.S. physicians believe that such agony is neither necessary nor desirable. They prefer to assist the addict through his withdrawal with other drugs (TIME, Jan. 4, 1971) and even to keep a patient on a heroin substitute indefinitely if necessary. But the Japanese, who have always taken a puritanical attitude toward drugs, regard this as a continuation of addiction.
The country’s first antidrug law, adopted in the 1880s, prescribed zanshu, decapitation with a samurai sword, for those trafficking in narcotics. Opium eating, a major problem in 19th century China, never caught on in Japan. After World War II, however, heroin began to gain a foothold. Rival gangs pushed the drug among prostitutes and in the underworld generally bringing Japan to what Tokyo Social Worker Michmari Sugahara called „the verge of hell.“
The authorities moved to end heroin use before it spread to the country’s teenagers. A government-financed public relations campaign, assisted by the press, lectured the public on the drug’s social, moral and medical dangers. The 1963 statute persuaded drug abusers that the government meant business. Some pushers reacted to the new law by simply dropping out of the business. In some brothels, the gangsters themselves forced girls to go through cold turkey; those reluctant to kick the habit were sometimes tied to their beds until withdrawal symptoms ended. Others were put in government-run hospitals that had been constructed specifically for drug offenders.
The medical profession cooperated fully with law enforcement agencies, taking the attitude that addiction is not merely a personal medical problem but an offense against society. Says Tokyo Narcotics Agent Hiromasa Sato: „Addicts found no alternative but to capitulate, and eventually submitted to cold turkey. Sayonara.“
Not for Export. Drug abuse has not been completely eradicated, of course. Youngsters now go in for glue sniffing and amphetamines, and a heroin arrest is still made occasionally. But Japan’s success has been dramatic enough to awe visiting American experts. Can the Japanese system be exported to the U S.? Many U.S. experts think not. Japan’s population is homogeneous, generally law-abiding and, where national goals are concerned, responsive to official appeals for cooperation. Americans are far more heterogeneous and resistant to authoritarian preaching. The young, in particular, insist increasingly on asserting their „individual rights.“ Many officials feel that it would be difficult to get wide support for a system that emphasizes the punishing process of withdrawal.
Dr. Vincent Dole of New York’s Rockefeller University Hospital, a pioneer in the use of methadone, argues that physicians should relieve, not increase, the suffering of the heroin addict. Most drug users apparently agree. Addicts are far more likely to turn themselves in for treatment if chemical substitutes are offered than if the prospect is cold turkey. The flaws in that argument are that American treatment programs have a high relapse rate and that the addiction epidemic is nowhere near being checked in the U.S.