Scattered around the Web, mostly at sites dealing with drug addiction, is a seemingly authoritative “Cocaine Timeline” that includes this 1912 milestone: “U.S. government reports 5,000 cocaine-related fatalities in one year.” The number seems awfully high, given that the federal government’s Drug Abuse Warning Network (DAWN) counted about 4,000 “drug misuse deaths” involving cocaine in 2004, when the U.S. population was three times what it was in 1912.
The U.N. International Narcotics Control Board cites the estimate of cocaine-related deaths circa 1912 as evidence that the legal availability of cocaine, which the Harrison Narcotics Act of 1914 effectively banned for nonmedical use, led to widespread abuse and addiction. But it turns out the number is bogus.
The original version of the timeline cited Steven Karch’s A Brief History of Cocaine as the source for the estimate. “According to a U.S. government report,” Karch writes in the 2006 edition, “the total number of deaths from heroin and cocaine in the United States constitutes a smaller proportion of the total population now than it did in 1912, when the number exceeded 5000.”
Karch then confusingly compares “the total number of deaths from heroin and cocaine” in 1912 to the number of “cocaine-related deaths” today. Given this juxtaposition, it’s easy to see how readers might conflate the two categories. But where did Karch get the first number? Although he does not identify which “U.S. government report” he has in mind, Gabriel Nahas’ 1989 book Cocaine: The Great White Plague seems to provide the answer: “According to a 1912 official publication by M.I. Wilbert and M.G.
Motter of the United States Treasury Department, cases of fatal poisoning, excluding those due to alcohol, numbered 5,000 in one year and the majority were related to opium or cocaine.”
Note that we have gone from “cocaine-related deaths” to “deaths from heroin and cocaine” to “cases of fatal poisoning.” A table in the report cited by Nahas provides mortality figures, based on Census Bureau data, for deaths by poisoning in the years 1900 through 1910. The highest total—excluding alcohol, “inhalation of poisonous gases,” lead, and “other occupational poisonings”—is for 1909, when it was 4,503. If you round that up, you get 5,000, which presumably is how Nahas arrived at his number. (Nahas, now 89, was too ill for an interview.) But the conclusion that most of these deaths “were related to opium or cocaine” appears to be Nahas’; the table does not say anything about either drug.
Since DAWN data indicate that cocaine is rarely used for suicide, it’s not clear the 2,462 suicides by poison in 1909 should be included. Leaving them out reduces the number of fatal poisonings to 2,041. Of those, 1,779 (87 percent) were described as “acute poisonings,” a category in which cocaine probably did not play a large role. Fatal overdoses are more likely to involve opiates, often in combination with other depressants. And then we have to consider the role of every other unspecified poison. It seems safe to say, based on the very report Karch and Nahas cite, that the annual number of cocaine-related deaths in the years leading up to the Harrison Narcotics Act was much smaller than 5,000.
Going further would be foolhardy, given the uncertainties that continue to surround “cocaine-related deaths.” A recent DAWN publication warns that “not every reported substance is, by itself, necessarily a cause of the death or even a contributor to the death.” A 2008 article in the journal Forensic Science International concludes that it is “very difficult to attribute a death to cocaine,” that “isolated blood cocaine levels are not enough to assess lethality,” and that “we can affirm that cocaine can be responsible for the cause of death only when there is a reasonably complete understanding of the circumstances or facts surrounding the death.” If we don’t really know how many Americans died as a result of cocaine use last year, what chance do we have of figuring out how many died a century ago?