Journal of Criminal Law and Criminology

Volume 61 | Issue 2 Article 15

1970 The alN line Test I--Development and Implementation Stanley E. Grupp

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Recommended Citation Stanley E. Grupp, The alN line Test I--Development and Implementation, 61 J. Crim. L. Criminology & Police Sci. 296 (1970)

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THE NALLINE TEST I-DEVELOPMENT AND IMPLEMENTATION*

STANLEY E. GRUPP

Stanley E. Grupp, Ph.D., is an Associate Professor of Sociology at Illinois State University, Normal, Illinois, who has been interested in the Nalline Test for since he began research for his Ph.D. dissertation in 1963. He has published two other articles dealing with aspects of this test, and has served as an editor of The Positive School of Criminology (University of Pitts- burgh Press 1968). Among his professional activities he has served as consultant for the Department of Mental Health Drug Abuse Programs, State of Illinois, 1967-8.-Enn-oR.

This is the first of three articles dealing with the agents.2 The exact mechanism of the antagonistic Nalline Test as a narcotic control device. In the effect of Nalline in the presence of is un- present discussion consideration is given to the known.3 early history of Nalline as a detector of drug users, Major uses of Nalline are: in the treatment of to the effects of Nalline, to pupil measurement as severe narcotic-poisoning overdosage; in the an indicator of narcotic use, and to the implemen- treatment of respiratory depression following the tation of the test in the relatively elaborate and administration of opiates in medical treatment, for extensive programs making use of it in California example, anesthesia, surgery, obstetrics, including and Illinois. The second article will consider the respiratory depression in the newborn infant of an rationale sustaining the Nalline Test as a narcotic -addicted mother; and as a means for 4 control device. Objections to and limitations of the diagnosis or detection of illicit users of opiates. Nalline Test as well as an assessment of it will be The focus of attention in this study is on the latter. presented in the third article. There are few discussions of the multiple aspects EARLY HISTORY of the Nalline Test in the literature.' The following The antagonistic effect of Nalline to discussions assemble and discuss some of the data was recognized as early as 1943 by Unna as the that are needed for an integrated appraisal of the result of experimental studies with animals.5 Nalline Test. Unna's observation was supported by Hart and The Nalline ( or N-Allylnormorphine) 2In addition to Nalline one other narcotic antagonist, Test emerged as a narcotic control measure in the Lorfan (levallorphan) has had limited use in anti- late 1950's. Nalline is the trade name of Merck narcotic testing programs. The uses of Lorfan are simi- lar to those of Nalline. For a brief description of its uses and Company, Inc. for nalorphine hydrochloride. see, LoRA-N (LEVALLoRPHA TARTRATE), Package in- Nalline is the common label. It is a synthetic sert, Roche Laboratories, Division of Hoffmann-La opiate antagonist and as such has the effect of Roche Inc. (Nutley, New Jersey, April, 1965). For an extended and technical consideration of the narcotic counteracting the physical effects of opiates. This antagonists emphasizing their chemical and pharma- is to say that given the presence of a sufficient cological qualities and their clinical applications, see, concentration of an opiate, the injection of a FOriES, SWERDLOW AM SIR, NAcoTIcs Am N - conc ANTAGONISTS (1964). given amount of Nalline will precipitate the ab- 3 For a discussion of the chemical action of Naine stinence syndrome. It is this antagonistic effect see Dr. Henry Elliott's discussion in CONFERENCE ON THE USE OF NALXINE IN NARCOTIC CONTROL, Depart- which forms the basis for the Nalline Test used in ment of Justice, State of California, Fresno, April 1-2, some narcotic control programs. The nature and 1960, 22. 4 For an early discussion of these various uses see details of this use are described below. Nalline is ISBELL, Nalline-A Specific Narcotic Antagonist: Clini- the most commonly used of several anti-narcotic cal and Pharmacologic Observations, THE MERCx RE- PORT, 23-26 (April, 1953). See also, NAINF; HYDRO- * Adapted from Stanley E. Grupp, "The Nalline CHLORIDE (Nalorphine Hydrochloride), Direction Test and Addict Attitudes," unpublished doctoral dis- Circular, Ph. 181705, Merck Sharp and Dohme (West sertation, Indiana University, 1967. Point, Pennsylvania, October, 1962), 10-15. 1 One exception is the consideration of several facets 'UNNA, Antagonistic Effect of N-Allyl-normorphine of the narcotic control aspects of the test by Thorvald Upon Morphine, 79 JOURNAL OF PHARMACOLOGY AND Brown. See, BROWN, THE ENIGMA OF DRUG ADDICTION, ExPERniENTAL THERAPEUTIcs 27-31 (September, Ch. 9 (1961). 1943). 19701 THE NALLINE TEST I

McCawley in 1944.6 Experimentation with human pleasant relaxation, a sense of well-being, dis- subjects at the Addiction Research Center, Public satisfaction, constriction of the pupil of the eyes, Health Service Hospital, Lexington, Kentucky in daydreams, giddiness, drooping eyelids, inability the early 1950's led to the recognition that Nalline to co-ordinate voluntary muscular movements, may serve as a detector of surreptitious users of nausea, and vomiting. Larger doses may induce 7 narcotics. In addition to Doctors Fraser and sweating and anxiety in addition to the above Isbell and others at the Addiction Research Center, reactions.8 Isbell observes that, several persons in California contributed to the development of the test. They are Dr. Charles T. In nontolerant, nonaddicted persons doses Hurley, who experimented with Nalline at the of 5 mg. or less of nalorphine have very little Angelus Emergency Hospital in East Los Angeles effect other than slight pupillary constriction from 1954 to 1957 and Dr. James G. Terry, Chief and depression of respiratory mental volume. Medical Officer of the Santa Rita Rehabilitation Doses of 10 mg. cause mental changes and Center (Alameda County), Pleasonton, California, definite measurable physiological effects. who started experimenting with Nalline at least Doses of 15-60 mg. are very likely to cause as early as 1955. Dr. Terry was active in the first severe mental reactions, including hallucina- 9 full-scale Nalline testing program initiated in Oak- tions. land, California in April, 1956. The intensity of the abstinence syndrome which is EFFEcrs immediately produced by Nalline depends on the In general it may be said that the behavior of quantity administered, the potency of the ad- Nalline depends upon the presence or absence of dicting drug, the length of addiction, the amount of time since the last intake opiates in the system and upon the amount of of the opiate and the type of opiate consumed. Nalline introduced into the system. It is noted that Each of these are im- Nalline will not substitute for opiates, and there portant variables. Several of them are directly are no definite symptoms of abstinence upon with- related to the question of sensitivity of the Nalline drawal of Nalline. Test and will be considered in a later article. In strongly addicted persons, In nonaddicted persons, both physical and as the amount of Nalline mental effects of Nalline vary in kind and degree is increased the severity of the abstinence syn- from individual to individual. Small amounts of drome increases. "The greater the tolerance, the Nalline introduced into normal volunteers and greater the severity of the abstinence phenomena dose of antagonist." 10 previously addicted persons induce a variety of produced by a given Regardless of the tolerance symptoms which may include drowsiness, a level that has been 6 HART & McCAwLEY, The Pharmacologyof N-Allyl- built up, Nalline in small amounts does not pre- normorphine as Compared With Morphine, 82 JotuNrA cipitate severe withdrawal symptoms. Isbell ob- OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICs, serves that "In strongly addicted persons, 1 mg. 339-348 (December, 1944). For a bibliography of early research articles involving Nalline see, NALInrE Hy- of Nalline will precipitate slight but detectable DRocioR DE (Nalorphine Hydrochloride), op. cit., abstinence, 3 mg. causes moderate abstinence, 5 supra7 note 4 at 19-24. mg. severe abstinence, and 10 mg. very severe See, FRASER, VAN HomR & ISBELL, Studies on N-Allylnormorphine in Man: Antagonism to Morphine 8With regard to the effects of Nalline on nonaddicted and Heroin,and Effects of Mixtures of N-Allylnormor- persons see, MosE, Attorney General and Director, phine and Morphine, 231 TnE AERICAN JomURAL or Department of Justice, California, A REPORT ON THE MEDIcAL SCIENCEs 1-8 (January, 1956); FRASER, SYNTHETc OPIATE Anrn-Naxconc TsTING PROGRAM, Human Pharmacology and Clinical Uses of Nalorphine 10 (1961). See also, Isbell, Thoughts on the Nalorphive (N-Allylnormorphine), 41 MEDICAL Cmcs op NoRTH Test for the Diagnosis of Addiction, Unpublished paper AMERICA 393-403 (March, 1957); IsBELL AND FRASER, presented at a meeting sponsored by the California Addiction to and , 99, pt. 2 Department of Public Health, Berkeley, California, JoURNAL oF PHARMACOLOGY AND ExPERIMENTAL January 8, 1958, 1 and 2. TmRAPEuTIcS 355-397 (August, 1950); ISBELL, Nal- Isbell, ibid., 1. line--A Specific Narcotic Antagonist: Clinical and Phar- 10ELuor in CONFERENCE ON TE USE or NALN macologic Observations, op. cit. supra note 4 and IN NAtconc CONTROL, op. cit. supra note 3 at 21. In WIIMER, FRASER AND ISBELL, N-Allylnormorphine: addition to the immediacy of the abstinence syndrome Effects of Single Doses and Precipitation of Acute "Ab- produced by Nalline which is in contrast to the gradual stinence Syndromes" During Addiction to MorPhine, onset of actual withdrawal, the abstinence signs pre- or Heroin in Man (Post Addicts), 109 JouR- cipitated by Nalline differ in that they are reported to NAz OF PHARMACOLOGY AND ExP ERnENTAL TERA- last only a few hours. See, WAY, The Pupil Test for PEUcs 8-20 (September, 1953). Diagnosing Narcotic Usage, 7 TRIANGLE 152 (1965). STANLEY E. GRUPP [Vol. 61 symptoms." U This observation is in part sustained a narcotic control measure seems to have been first by Captain Thorvald Brown of the Oakland, suggested by Terry and Braumoeller. In the words California Police Department and a person with of these observers, "The pupillary response alone considerable experience with an on-going Nalline is an accurate, sufficient, and sensitive index of testing program, who observes that 3 mg. of Nalline narcotic addiction or of occasional use, or of the will not cause serious distress in the average user.12 absence of narcotics." 16 Stemming in part from The physical and mental reaction resulting from the work of Terry and Braumoeller and supported 85,000 anti-narcotic tests, most of which were by their experimentation with Nalline in 1954- Nalline Tests, has been reported by Dr. Charles T. 1955, the first full-scale Nalline testing program Hurley, formerly a Medical Consultant on Narcotic was initiated in Oakland, California in 1956. Control to the California Department of Correc- Terry and Teixeira describe the emergence of tions. Hurley notes that "marked medical reac- their interest in the pupil measurement procedure tions" were observed in only 127 instances or to identify opiate users as follows: fifteen hundredths of one percent of all cases. On the whole the reactions do not appear especially We... reviewed the medical literature on serious. They include sixty local injection reactions, Nalline particularly the contributions from fifteen faintings, and thirteen withdrawal symp- the United States Public Health Service at toms.18 Lexington, Kentucky. They had devised a technique of testing a suspected addict using PUPIL MEASUREMENT three doses at twenty minute intervals. Their technique was designed to produce outright One of the more consistent indicators of opiate withdrawal symptoms. Several addicts were use is found in the pupil of the eye. Opiates are brought to S.R.R.C. (Santa Rita Rehabilita- notorious pupil constrictors ().14 Dilation of tion Center) from the outside and received the the pupil, soon after the injection of small amounts test as outlined at Lexington. It rapidly be- of Nalline in persons using opiates, is one of the came clear to us in the moderate to heavy mostpersistent antagonistic effects of Nalline, and narcotic user the test given in this fashion it is this action that forms the basis of narcotic would promptly produce withdrawal symp- control programs. In nontolerant persons Nalline toms just as stated by the United States produces constriction of the pupil. Specifically, the Public Health authorities. We then felt that test as used in narcotic control involves measure- the three doses were cumbersome and time ment of the pupil before and after the injection of consuming and possibly a single dose would Nalline, to determine, either on this basis alone or be sufficient. Using a single dose of 5 mg. of using this as one of a number of criteria, whether Nalline we tested several more addicts. We or not the individual has been using opiates. learned as much from one dose as we did from Dilation of the pupil upon the introduction of three.... It became our goal in all future Nalline in the presence of opiates was recognized testing of addicts not to produce withdrawal in the reports of Isbell, Fraser and others in the symptoms because of the discomfort attached early 1950's.15 The possibility of using this effect as but only a response in the size of the pupil. 11Thoughts on the Nalorphine Test for the Diagnosis of We felt then as we feel now that this goal was Addiction, op. cit. supra note 8 at 3. 12 far more humane. The enlargement of the THE ENIGMAr OF DRUG ADnicT oN, op. cit. supra note 1 at 303. pupil is painless whereas nausea, vomiting, 13HuRLEY, Anti-Narcotic Testing: A Physician's diarrhea, and muscular cramps are certainly Point of View, 27 FEDERAL PROBATION 36 (June, 1963). 1 The constrictive function of the opiates upon the discomforting, disconcerting, and not neces- pupil of the eye has long been recognized. Terry and sary for diagnosis. An enlargement in the size Pellens, for example, contains twelve references to the of the pupil following an injection of Nalline is effect of opiates on the pupil. See, TERRY & PELLENS, TrE Opro[ PRoBLEM (1928). the first change observable in the suspect ad- 15 See, for example, FRASER, Human Pharmacology and Clinical Uses of Nalorphine (N-Allynormorphine), normorphine in Man: Antagonism to Morphine and op. cit. supra note 7; FRASER, Nasn, VAN HoRN AND Heroin and Effects of Mixtures of N-Allynormorphine IsiBELL, Use of Miotic Effect in Evaluating and Morphine, op. cit. supra note 7. in Man, 98 ARcHiVES INTERNATIONALES DE 16 TERRY & BRAuMOELLER, Nalline: An Aid in De- PHA~RcoDYNTA'M ET DE TIHERAPrE 443-451 (1954); tecting Narcotic Users, 85 CALIFORNIA, MErncnE 300 and FRASER, VAN HoRN AND ISBELL,Studies on N-Allyl- (November, 1956). THE NALLINE TEST I

dict. It is measurable, it is a sign not a symp- test will now be related to the amount of the 7 tom and detects the early user.' anti-narcotic administered. 19

Thorvald Brown, who has worked closely with To this end, Dr. Hurley has described the physical Dr. Terry in the Nalline testing program in Oak- structure of the testing procedures in Southern land, California and Alameda County, gives Dr. California in part as follows: Terry full credit for the development of the pupil measurement procedure as a means of identifying ... mechanical convergency devices are used narcotic users. Regarding pupil measurement and electrical methods of continuously vary- Brown states: ing and accurately controlling light are also used. The individual sits in a chair converging The technique developed by Dr. James Terry on a mechanically-moving cyclic fixation point is an adaptation of the procedure formulated about 4 to 6 feet away. Facing him but only by Dr. Isbell and associates at Lexington. The 45 degrees to the left and about 4 to 6 feet latter method was developed for the purpose from him is a 100-watt, green, outdoor decora- of determining the extent of addiction and tive spot light. The intensity of this light dependence in each patient for the purpose is controlled by a variable rheostat on the of treatment. Dr. Terry's test, as used by physician's desk. Under conditions of constant Law Enforcement Agencies, is much simpler. and reproduceable convergence and lighting, It is an innocuous time-saving and safe test the initial diameter of the pupil is measured which can be administered in any office or by comparing the pupil size with a standard clinic. Its purpose is not to diagnose the ex- pupillometer card and recorded. The individ- tent of addiction, nor is it given with the view ual is then given his specific injection of anti- in mind of prescribing treatment. Its primary narcotic. After 15 minutes this is repeated in function is to detect and isolate those who the same conditions of convergence and have been using narcotics, so that enforced lighting. The size of the pupil is measured the abstinence and follow-up can be provided second time. If the pupil has changed an ade- and control measures instigated.18 quate amount, this is the end of the test; how- A number of factors affect the diameter of the ever, if further information is needed, the pupil including the intensity of light, convergence, pupil will be read again every 10 minutes up and adaptation. These factors must be controlled to a 45-minute period. The test is done on an if maximum results with the Nalline Test are to entirely ambulatory basis2 0 be obtained. In sum, maximum results from the test can be expected only if the proper physical The California Department of Public Health has setting is maintained. Dr. Hurley observes: described in considerable detail the recommended procedure to be followed in Nalline testing. In- Maximum stability of the pupillary system can be established with good light control, numerable precaulions are suggested including the convergence control, and adequate preadapta- recommendation that the subject be placed in 21 tion. Sensitivity of pupil response to drug bed if addiction is suspected. One observer has effects under these conditions is governed by suggested that if all of the precautions recom- the proper choice of initial pupillary diameter. mended by the California Department of Public Having established these conditions, the 19Hurley, Factors Controlling the Accuracy and variability of the pupil mechanism has been Sensitivity of Anti-Narcotic Tests, Paper presented to reduced to a minimum. The sensitivity of the the Committee on Drug Addiction and Narcotics, Na- tional Academy of Sciences-National Research Council, 17 TERRY & TEIxEIRA, SANTA RITA REHABILITATION February 3, 4 and 5, 1964, Washington, D.C. Quoted CLUNic: TEN YEAR REPORT, Alameda County Sheriff's by special permission of Dr. Hurley. Department, Oakland, California, H. P. Gleason, 20 Hurley, Anti-Narcoic Testing: A Physician's Sheriff, 11-12 (1949-1959). Point of View, op. cit. supra note 13 at 32-33. "8Brown, Three Years of Nalline, Paper presented at 21California Department of Public Health in Con- Joint Meeting of the Northern-Central California Nar- junction With the Bureau of Narcotic Enforcement, cotics Officers Association with Southern California Department of Justice, REcomMNDED PRocEnuRE Narcotics Officers, Palm Springs, California, October fOR NA.coTic USE TESTING OF PROBATIONERS AND 29-30, 1959 (mimeograph), 4. PAROLEES (1961). STANLEY E. GRUP[P [Vol. 61

Health were insisted upon the use of the Nalline pupil constricts, narcotic 2 use is not indicated and Test would be greatly restricted. 2 a negative test is recorded. If there is no change in A differentiation should be made between the the pupil several alternatives are possible, the development of the simplified technique of pupil- most common of which appears to be an equivocal lary measurement and the application of this pro- (questionable) recording. Depending on policy, cedure to the detection of surreptitious users of however, a no-pupil-change reading could also be narcotics. In the latter regard, Dr. James Terry recorded as a positive or perhaps as a negative 2 4 has played an important role. Dr. Harris Isbell test. played an active part in the rediscovery of the The above paragraph oversimplifies the com- utility of the pupil gauge or pupillometer.23 The plexity of the testing procedures. Testing pro- pupillometer as used in Nalline testing is typically cedures often vary from jurisdiction to jurisdiction an oblong 1 X 3 inch card, with black dots grad- and from time to time within a given jurisdiction. uated in diameter from 1 mm. to 5 mm. in .5 mm. The possibility of variations are several but include intervals. Sometimes the card takes a different such technical aspects as planned variation in the form; for example, a circular nature. time interval between the several pupil measure- ments, variation in the dose of Nalline administered TESTING RounINE and in the establishment of a baseline against Nalline testing procedures commonly permit the which variations of a given subject's pupil may be 25 testing of fifteen to twenty or more persons an assessed. hour. Testing is typically conducted in the prox- Naine testing is conducted on a regular and imity of a room large enough to permit all persons surprise basis. Regular testing is conducted at appearing for the test to be seated at one time. given times on predetermined days, so that the This observer has witnessed situations where as person in the program knows when he is to appear. many as thirty persons were present. Assuming In surprise testing the individual is typically in- the individual is not suspected of the use of nar- formed the day before the test is to be given. Thus, cotics the minimum total time spent at the Nalline if testing is done in the evening and the individual testing center by any one individual is approxi- is informed the morning of the day before, as many mately one-half hour while the maximum time is as thirty-five hours my elapse between the time probably no longer than one hour. of notification and the time of the test. In some The diameter of the subject's pupil is measured situations the testee is informed with as much as by means of a pupillometer and the reading is forty-eight hours notification. Policies on these recorded. Typically the physical setting and points vary considerably. testing procedures are not as elaborate as those Usually, persons tested are asked to give their specified by the California Department of Health. written consent to the test. This is done as a part Immediately following the pupillometer reading, of the processing after arrival at the testing station Nalline is injected subcutaneously. The typical and prior to the initial pupil measurement and dose is 3 mg. Narcotic antidotes are kept available injection of Nalline. Since practically all testing is in the event a situation of extreme withdrawal conducted as a requirement of probation or parole, should present itself. After fifteen to thirty minutes presumably refusal to take the Nalline Test could the subject's pupil is again measured, and if be interpreted as an automatic violation. The ob- indicated, the pupil may be read more than once. taining of wiitten consent appears to be motivated If dilation of the pupil is evident, the use of opiates by at least two factors: (1) the question of the is indicated, and a positive test is recorded. If the admissibility of the results of the test as evidence

2 WEINERG, Nalline as an Aid in the Detection and 24Dr. Guy R. Turgeon has observed that in some Control of Users of Narcotics, 48 CAT oRxA LAw RE- circumstances a minimal "constriction of a quarter of a vrEw 284 (1960). millimeter... is often an indication of narcotic use." 23 Dr. Isbell states that he "invented" or rediscovered Letter from Dr. Guy R. Turgeon, Medical Consultant, the use of the card with circles as a simple method of Narcotic Control, Parole and Community Services estimating pupillary size. Letter from Dr. Harris Isbell, Division, Department of Corrections, Los Angeles, January 12, 1965. Terry & Teixeira observe that the California,2 July 15, 1965. pupillometer was originally designed early this century 1It is apparent that implementing the latter type by two San Francisco oculists. See, TERY & TErXEmA, of testing variation requires a strong commitment to Nalorphine Testingfor Illegal Narcotic Use in California: making the best possible use of the Nalline Test. Of Methods and Limitations 2 TEI JounwAr. or NEw special importance in this regard is an examining phy- DRUGs 207 (July-August, 1962). sician who is interested in working toward this end. 19701 THE NALLINE TEST I if permission were not given, and (2) the possibility law enforcement programN It does not represent of civil action. The legal questions raised by this a major shift in the traditional law enforcement procedure are not considered here but have been approach to the narcotics problem, but is rather 26 discussed by other writers. an adjunct of it. In some jurisdictions a urine sample is collected Areas Considering the Test. Jurisdictions that at each Nalline testing routine so that positive or have considered using the Nalline Test include: the equivocal pupillometer readings can be further Pennsylvania Board of Parole; the Kings County, checked and clarified. New York, Probation Department; the New York State Division of -Parole; and the State of New INPLEMENTATION Jersey. In each of these instances the Nalline Test California and Illinois are the states most active was rejected for reasons such as the following: be more or equally in the use of the Nalline Test. Of the two, California other methods were felt to Test had ob- has made the more extensive use of the test and effective; it was felt that the Nalline characteristics; and because personnel for a longer period of time. Nalline testing was jectionable to administer the test. In 1959, initiated in California in 1956 and in Illinois on a could not be found Committee recom- modest scale in 1958. The active use of the test in a New York Joint Legislative these two states was continuing in 1968. Use has mended that experiments with the Nalline Test be subsequently also been made of the Nalline Test in Phoenix, conducted. However, the test was by several New York agencies.29 The Portland, and St. Louis. It has been used in Hong rejected although not Kong both in research and as an adjunct of treat- President's Advisory Commission, 27 Test, did recom- ment procedures to identify surreptitious users. specifically mentioning the Nalline mend that the Federal government establish a Still other jurisdictions have considered the test program and that as a con- without adopting it. civil commitment 'parolees Nalline testing is conducted as one aspect of a comitant of this program the individual periodically for tests series of efforts to control or treat the drug user. should be required to report In no jurisdiction is Nalline testing conducted as to determine, to the extent possible, whether he has relapsed to drug abuse." 3 0 Presumably the the single narcotic control measure. Its use has could include the Nalline Test. been as an auxiliary device, as an arm of formal suggested testing St. Louis, Portland, Phoenix. Nalline testing narcotic control procedures. It is most commonly was initiated in St. Louis in late 19571 and con- used as an adjunct to probation and parole super- tinued until May, 1962. The cessation of testing vision procedures. Thus to an appreciable extent seems to have been due primarily to the effects in the Nalline Test and its use, its interpretation to Missouri of the United States Supreme Court the drug user, and the part that it plays in the June, 1962 total narcotic control program, is a reflection of the decision in Robinson v. California, which said that addicts cannot be punished for general nature of the control program. The use of being addicts. Since this time no consideration the test reflects not only formally imposed control been given to the readoption of the test.n regulations but also to some extent the strengths had Portland started using the Nalline Test in 1959. and weaknesses of the extant probation and parole casework supervisory procedures. Nalline has been 2 Note, however, that Brown reports several exam- used almost entirely within the limits imposed by a ples of former addicts who "voluntarily submit to the tests with no strings attached" and gives one example 26 CoLuAN, Naline: Some Legal Implications in Its of a female probationer who "often requests more fre- Use, 3 JouRNAL or FORENSIC SCIENCES 425-430 (Octo- quent tests." It is probable that such examples are ber, 1958); CONRAD, The Admissibility of the Nalline conspicuous by their infrequency. See BROWN, Nar- Test as Evidence of the Presence of Narcotics, 50 THE cotics and Nalline: Six Years of Testing, 27 FEDERAL PROBATION JOuRNAL OF C nNAL LAW, CRMINOLOGY AND POIiCE 2 30 (June, 1963). SCIENCE 187-191 (July-August, 1959); PozE, Opiate 9 REPORT OF THE STATE OF NEW YORK JOINT Addiction I. The Nalorphine Test II. Current Concepts LEGISLATIVE ComTTEE oN NARcoTIC STuDY 1959, of Treatment, 20 STANFoRD MEDICAL BuLErTIN 1-23 Legislative Document (1959), No. 7, 127. (February, 1962); WEINBERG, Nalline as an Aid in the 0FNAL REPORT: THE PRES iEN'S ADvISORY Com- SSION ON NACOTIC AND DRUG ABusE, 72 (1963). Detection and Control of Users of Narcotics, 48 CA=l- 3 St. Louis Globe Democrat, October 17, 1957, p. 13. zORNiA2 7 LAW REvIEw 282-294 (May, 1960). HESS, CHASING TE DRAGON: A REPORT ON DRuG "Letters from Detective Sergeant Harold J. Bloss, ADDICTION IN HONG KONG, 126, 129, & 139 (1965). Narcotic Section Supervisor, St. Louis Police Depart- See also WAY, Control and Treatment of Drug Addiction ment, January 2, 1963, June 30, 1965, and Detective in Hong Kong, in NARcoTcs, Wilner & Kassebaum, Peter O'Connell, Narcotic Section, St. Louis Police eds., 285 and 287 (1965). Department, October 20, 1968. STANLEY E. GRUPP[V [Vol. 61

In 1965 it was reported that no more than three using areas of the state of California. The major or four persons a year had participated. The use use of the test in the state has been with parolees, of the test was discontinued in recent years because probationers, and since 1961, with civilly com- it was felt to be a "surveillant mechanism" as mitted persons. opposed to being a "specific therapy." It is not Parolees and civilly committed persons are 3 anticipated that the test will be readopted.8 supervised by the Department of Corrections, the Arizona's use of Nalline is similarly limited in agency responsible for most of the subjects in the scope. Although authorized by Arizona law, Nalline testing program in California. The Los Maricopa County (Phoenix) appears to be the Angeles County Probation Department appears only area in the state that has used the test. In to be the second largest user of the test. In addition, this county, parolees, probationers and volunteers it is given to probationers in areas of the state are tested on a regular weekly schedule with the other than Los Angeles County, and some testing possibility of some surprise tests. Nalline Tests are is done for other agencies; for example, the Cali- not checked by urinalysis. Since Natine testing fornia Youth Authority and the California Division was initiated in September, 1963, through Novem- of Motor Vehicles. In 1961 it was reported that ber 15, 1968, fifty-one persons had been admitted ninety-five per cent or more of the Naine testing to the program.U Naine testing in Arizona seems was being done on -probationers and parolees." destined to be a small program because there are Differences in the pattern of testing have con- relatively few addicts. sisted largely in the relationship between surprise California. California has made extensive use of and regular testing and in the use of urinalysis. Naline testing.35 The pattern of testing and the Reports received by this investigator from Cali- extent of this implementation has varied from fornia authorities on this point have not always time to time as well as from agency to agency and been consistent with each other. Apparently this from testing clinic to testing clinic. reflects the variability inherent in programs of The earliest formal recommendation in Cali- this nature, area differences, and the degree of fornia that Nalline be used to identify former drug intimate acquaintance with what is actually hap- users, "out patients" who had started to use pening at a given time. The testing patterns and narcotics again, seems to have been made in 1954 schedules have varied over time depending on 6 in a Citizen's Advisory Committee Report. As such factors as the type of schedule deemed most already indicated, the program in Oakland and desirable, including the funds available for the surrounding Alameda County was set up about program, progress of the individual, size of the two years later in April, 1956. By 1959 the pro- caseload, area of the state, availability of personnel gram had expanded to include all major drug to administer the tests, and the specific type of 13Letters from Dr. Thomas L. Meador, May 21, program the addict is in; for example, regular 1965 and November 21, 1968. Dr. Meador was formerly parole status, civil commitment, or a participant the City Health Officer, Bureau of Health, Department of Public Health, Portland, Oregon. He is now Assistant in the former Narcotic Treatment Control Pro- Health Officer, Department of Medical Services, gram. Nultnomah County, Oregon. 34Letters from Dr. Lad Mezera, Director, Bureau of The traditional testing pattern for regular Preventable Diseases, Health Department, Maricopa parolees has been four regular and one surprise County, Phoenix, Arizona, May 21,1965 and November 18, 1968. test a month. Testing patterns have been varied 3s 35Lorphan (levallorphan) has been used to a limited for both regular parolees and civilly committed extent in California; however, the predominant anti- 39 narcotic used is Nalline. In 1959 the California Depart- addicts. Similarly, the participants in the former ment of Public Health reported that three of fourteen Narcotic Treatment Control Program were sub- physicians experienced with the anti-narcotic testing program had made some use of Lorfan. Reported in 1 A REPORT ON TnE Svlq TIc OPIATE ANTI-NAi- THE ENIGMA orF DRUG ADDICTION, op. cit. supra note 1 COTic TESTING PROGRAM, op. cit. supra note 8 at 16. at 330. In 1965 it was estimated that less than 10 per I Letter from James W. Neiswonger Supervisor, cent of the tests use Lorfan. Letter from Dr. Guy R. Special Projects and Research, Parole and Community Turgeon, Medical Consultant, Narcotic Control, Services Division, Department of Corrections, Sacra- Parole and Community Service Division, Department mento, California, June 17, 1965. of Corrections, Los Angeles, California, July 1, 1965. 39Letter from Mr. S. A. Whiteside, Narcotic Pro- 36Citizen's Advisory Committee to the Attorney gram Administrator, Parole and Community Services General on Crime Prevention, NARconIc ADDIcTioN 32 Division, Department of Corrections, Los Angeles, and 40 (1954). California, November 4, 1964. 1970] THE NALLINE TEST I

jected to variable testing schedules. 40 During the however, urinalysis procedures were not com- spring of 1965 there appears to have been a general monly used. statewide cutback in the frequency of all Nalline The number of Nalline testing stations or testing.4' "Nanine Clinics" in existence in California has On June 1, 1964, the Department oi Corrections been variable. A variety of governmental agencies adopted the policy of corroborating all positive including probation departments, sheriffs' depart- and questionable Nalline Tests with a chemical ments, police departments, and local health de- test.42 A number of factors appear to have been partments have administered the "Nalline Clinics." involved in this change in policy. One of the con- The typical procedure, irrespective of the spon- tributing reasons was the recognition of certain soring agencies, is to make the facilities available limitations of the Nalline Test. Urinalysis is to other agencies in which case the sponsoring generally accepted as being a more sensitive agency is reimbursed for each test given. testing device than the Nalline Test. Dr. Guy With the exception of the Oakland Police De- Turgeon indicates that two factors were involved partment,45 to the best of this investigator's in the policy change, "the new availability of knowledge, reasonably complete and readily facilities for large-scale laboratory tests and the accessible data regarding the activities of the lack of Nalline testing in smaller cities where various testing clinics for any given year is not volume did not justify the setting up of a Nalline available."4 Information is spotty, inaccessible, or clinic." 13 As of mid-1965 some of the other agen- unavailable. Although the Bureau of Criminal cies and "Nalline Clinics" had started to cor- Statistics receives statewide Nalline Test reports roborate positive and questionable Nalline Tests on all persons tested this data is collated for 44 with a chemical test. positive tests only. Data relevant to the confirma- It is emphasized, however, that prior to the tion of the Nalline Test results by urinalysis is adoption of the chemical test by the Department not reported to the Bureau of Criminal Statistics. of Corrections the various formal reports in Cali- It is" not anticipated that the Bureau will expand its analysis and summarization of the Nalline fornia consistently recommended that the Nalline Test data. As of 1968 the Bureau will cease pro- Test not be used as the single criterion for deter- cessing this data and will no longer report positive mining the use of narcotics. Until June, 1964, tests.47 The substance of these facts is that for "0California Department of Corrections, ADrm- California we have no adequate statewide Nalline rsTRAvE BuLLruN No. 62/9013-14 (1962); California Department of Corrections, Research Division, Re- Test data upon which an analysis of the program search Report No. 19, NARcorrc TREATMENT CONTROL may be based. PROGRAM, PHAmsE I AND PHASE 11 7 (1963), and Re- Positive Nalline Test results have been reported search Report No. 25, NARcoTc TREATmENT CONTROL PROGRAM PHASE II 8-9 (1968). in annual state narcotics reports of drug arrests 4 At the Central Testing Clinic in Los Angeles, for and disposition data since 1961. The positive tests example, the average number of tests per month have that are reported are test failures of those persons decreased from approximately fifty-five hundred for the year ending in May, 1965 to an average of three "Since the inception of Naine testing in 1956 and thousand during the summer months of 1968. Letters continuing through 1964, statistical data sheets were from Dr. Guy Turgeon, Medical Consultant, Narcotic released by the Oakland Police Department which Control, Parole and Community Services Division, presented in considerable detail descriptive data about Department of Corrections, Los Angeles, California, the program. The compilation of this information was March 22, 1968 and September 19, 1968. stopped after 1964 because of excessive work and lack 42 One source states that urinalysis was initiated to of requests for information. Letter from Captain Thor- supplement the Nalline Test in California as early as vald Brown, February 9, 1967. 1963. See, E. C. Giulden, M.D., Chief of Research, 46The San Francisco Police Department provided California Rehabilitation Center, Corona, California, this investigator with a complete set of their data sheets Defection of Narcotic Use by Thin Film Chromatography, for the years 1960 through 1964 describing the activities 1 and 2 (Ditto abstract of paper in preparation for of the Nalline Clinic supervised until recent years by publication). the Department. This information is broken down by 43Letter from Dr. Guy R. Turgeon, Medical Consult- the agency for whom the tests are conducted and in- ant, Narcotic Control, Parole and Community Serv- cludes the sex, race, and results of the tests. The record- ices Division, Department of Corrections, Los Angeles, ing entity, however, is for the number of tests given California, July 1, 1965. and, therefore, it is not possible to determine the results 4"Letters from Mr. Claude Stetler, Senior Deputy for separate individuals. Probation Officer, Probation Department, County of 47Letter from Mr. Charles K. Bridges, Senior Crime Sacramento, California, June 15, 1965, and Dr. William Studies Analyst, Bureau of Criminal Statistics, De- G. McCormick, Chief Resident, The Fresno County partment of Justice, Sacramento, California, November General Hospital, Fresno, California, June 30, 1965. 6, 1968. STANLEY E. GRUPP [Vol. 61

in the program at the time of scheduled testing and probationers in the program in 1960. From and who are assumed to be arrested as the result the time of its initial use in 1959 by the Los Angeles of the positive test-that is, failure.43 The Bureau County Probation Department (reputedly the of Criminal Statistics assumes that persons testing second largest user of the test) through January 1, positive are arrested unless there is evidence t9 1966, 1,375 probationers had participated. Three the contrary and according to the opinion of one hundred and seventy-three were active cases on California authority, "Nearly all those testing the latter date. 2 In 1965 it was estimated that positive are arrested." 11 In view, however, of the there were 15 to 25 incoming and about the same multiplicity of programs and jurisdictions using number of outgoing cases in the Los Angeles the Nalline Test and the variable use which has County Probation Department each month."3 ostensibly been made of it, the assumption that Spokesmen from the California Department of all positive tests culminate in arrest may not be a Corrections are able to provide rough estimates of tenable one. If we assume that the reported failures the number of persons under their supervision do reflect the actual number of persons in the state involved in the Nalline testing program. During testing positive the value of the information is the summer of 1965 it was suggested that "possibly unfortunately vitiated by the fact that failures 2,000" persons had been given the test at least "include those who tested negative but had sus- once during that year. 4 One estimate of the total picious marks as well as those who obviously were number of persons involved in the program (under under the influence which precluded testing." 50 the supervision of the Department of Corrections) These and other factors contribute to the difficulty places this number at 15,000 different persons and in interpreting the Nalline Test failure data. In "probably more." 55 addition to the above these factors include in- Data regarding civil commitments in the Nalline complete information regarding number of persons program, all of whom are under the supervision in the program, number of tests given, and no of the Department of Corrections, is more complete. information about the nature of the program the Total commitments to the California Rehabilita- individual was participating in. All of these factors tion Center through December 31, 1966 were 6,243. vitiate the value of the reported positive Nalline Of these, 3,640 had been transferred to outpatient Test data. Irrespective of these serious limitations, status, and we may assume that most went into this data appears to be the best estimate that we the Nalline testing program."; have of positive test results (failures) for the entire Oakland, California represents a special situa- state of California. tion because it has the longest experience with the Only limited infoimation is available regarding the number of persons involved in the Nalline Nalline Test of any area in the United States and testing in California. In 1960, a formal report by "BAITsY, Nalline Control of Addict-Probationers, 3 the California Attorney General estimated that THE INTrERNATIoNAL JOURNAL oF THE AnDIcTioNs 134 (1968). about 1,500 parolees and probationers were being "Letter from Mr. J. W. Fitz, Supervising Deputy, tested each month. 51 This may be an understate- Special Assignment Office, Narcotic Treatment and ment. In Oakland alone there were 444 parolees Control Unit, Probation Department, County of Los 48 Angeles, California, June 22, 1965. Nalline Test failures resulting in arrests are re- 54Letter from Dr. Guy R. Turgeon, Medical Consult- ported as follows: 1961-644; 1962-525; 1963-772; 1964- ant, Narcotic Control, Parole and Community Services 998; 1965-551 and 1966-537. Los Angeles County has Division, Department of Corrections, Los Angeles, consistently contributed the majority of these failures. California, July 1, 1965. See, Bureau of Criminal Statistics, Department of 55Letter from Mr. James W. Nieswonger, Supervisor, Justice, NARconc ARRESTs AND DisPOSITONS n' Special Reports and Research, Parole and Community CAmiA, 1961, DRUG ARR.sTs Am DisposrrioNs Services Division, Department of Corrections, Sacra- IN CATnolmiA 1962, 1963, 1964, 1965, 1966, Yearly mento, California, June 17, 1965. A recent paper esti- reports (Sacramento, California). mates that in 1964 about 3,000 California parolees were 49 Letter from Mr. Charles K. Bridges, Senior Crime taking the Nalline Test an average of three times a Studies Analyst, Bureau of Criminal Statistics, De- month. See, ELLIorT, NomoF, PARKER, AND TURGEON, partment of Justice, Sacramento, California, November Detection of Narcotic Use-Comparisonof the Nalorphine 6, 1968. (Pupil)Test with Chemical Tests, 109 CALIFORNIA MEDI- 60Letter from Mr. Charles K. Bridges, Associate ciNE, 121 (August, 1968). Crime Studies Analyst, Bureau of Criminal Statistics, "1CIvI COMTMENT PROGRAM FoR NARcoTc AD- Department of Justice, Sacramento, California, De- Dic'rs 1961 THROUGH 1966, Summary Statistics, Cali- cember 16, 1964. fornia Rehabilitation Center Program, Department of SA REPoRT ON THE SNm=Tic OPIATE Awn-NAR- Corrections, Research Division, Administrative Statis- conc TEsTiNG PROGRAM, op. cit. supra note 8 at 16. tics Section, Sacramento, California, June, 1968, 4. 1970] THE NALLINE TEST I because Nalline testing records are available. The The Division of Narcotic Control conducts Nalline Oakland Police Department's statistical data testing for the Division of Supervision of Parolees sheets entitled, Oakland Police Department Nalline (which is also a division within the Department of Test Results, distributed through 1964, are one of Public Safety) and the Cook County Adult Proba- the more detailed of few such efforts to provide a tion Department. On January 1, 1970 the Division reasonably detailed breakdown of Nalline testing of Narcotic Control became a part of the Illnois information. Bureau of Investigation and the Division of Super- The reasons for the early emergence of the vision of Paroles was transferred to the Depart- Nalline Test as a formal narcotic control measure ment of Correction both with minor modifications in Oakland appear to be twofold: first, the fact in their names. These two agencies contribute that Dr. James Terry, one of the originators of virtually all of the subjects to the program in the test, was the Chief Medical Officer at the Illinois. Alameda County Rehabilitation Center, and In the program's early stages, testing was done second, the fact that the test had the support of in the private offices of the Cook County Chief key figures in the Oakland Police Department as Probation Officer. Limited space and limited well as of other Alameda County law enforcement personnel seriously restricted the program at this personnel.7 time. The need to include more persons in the The Oakland statistical data sheets present a program, to test more consistently, and to provide wide array of facts on a yearly basis including the more adequate space, was discussed in a legislative total number of tests conducted, test information commission report of 1961, which evidenced con- based on race and sex, and test information for siderable concern about the program, and in the parolees and probationers including the number 1960 annual report of the Division of Narcotic of tests conducted and the numbers of persons Control 0 A new Nalline Testing Center opened tested. Nalline Test results are presented for each in May, 1961, and the number of tests increased. of the above categories and several more. It is The interpretation of the test and the confidence unfortunate that the Oakland authorities felt it formally placed in it by the Illinois Department of necessary to abandon publication of this report. Public Safety is partly expressed in an Associated Illinois. Illinois has actively used the Nalline Press release announcing the opening of the center. Test since June, 1958. Initial use in 1958 and early The release stated in part: 1959 appears to have been largely exploratory in nature. The number of tests administered gradually Illinois is ready to begin a greatly im- increased and with expanded physical facilities in proved program of rehabilitation supervision mid-1961 they increased appreciably s for drug addict parolees and probationers. Nalline testing in Illinois was initiated following Opening of a new narcotics rehabilitation a recommendation by a Legislative Narcotics In- center in the South Side stockyards districts vestigation Commission in 1957.19 The Commission ... will be the signal for stepped-up spot further recommended the creation of a Division of checks of addicts under state supervision. Narcotic Control with authority to establish Nalline "clinics." The Division of Narcotic Control "We can check people who may be likely became a reality on January 1, 1958. subjects for addiction as well as those with Thus the responsibility for the administration use records," McMahon [Administrative of the Nalline Test in Illinois since its inception Assistant to the Director of Public Safety] said .... "There will be many benefits,... has been with the Division of Narcotic Control, a division within the Department of Public Safety. And the supervision is not just a structure. "I expect that we will catch many so-called 7 See, THE ENIGUA 9) DRUG ADDICTION, Op. Cit. supra note 1 at 289-291 and 293-294. 60Narcotics, Dangerous Drug and Hazardous Sub- 6sOver two thousand Nalline Tests were conducted stance Investigation Commission, A REPORT N THE in 1961 and more than four thousand in 1962. The num- INTEREST OF THE HEALTH AND SAFETY OF THE PEOPLz ber declined in 1963 to less than three thousand and OF THE STATE OF ILLiNoIs (Third Report), Report to remained at this level through 1967. the 72nd General Assembly-May 31, 1961, 13-19 51Narcotics Investigation Commission, ILLEGAL (Springfield, Illinois, 1961); and Department of Public NARcoTIcs... A PATTERN OF EviL!, Report to the Safety, Division of Narcotic Control, Acnvrrs RE- 70th General Assembly-March 25, 1957, 36-40 and PORT FOR THE YEAR ENDED DECEMBER 31, 1960, 7 46 (Springfield, Illinois, 1957). (Springfield, Illinois, February 15, 1961). STANLEY E. GRUPP[. [Vol. 61

small habit cases-those which have not yet As suggested by the above quotation a further developed into the overwhelming craving function of the position was that of the location which results in theft and robberies to get of "hospitals" or places of detention for addicts. money for dope. Gilbert H. Cross, the one and only person to "To the extent that we curb development of occupy the position of Rehabilitation Supervisor, addicts, we'll inhibit the market and the has commented as follows regarding the Illinois traffic in illegal drugs." 6 program: A strong, solid, effective basis has been laid This confidence in the Nalline Test as a narcotic for proper control, confinement, containment, control measure is repeatedly expressed in the rehabilitation, testing, and follow-up of the annual reports of the Illinois Division of Narcotic drug addict in the State of Illinois. It is, of Control. Witness, for example, a statement from course, too early to draw unwarranted con- the 1964 report: clusions, but we are confident that the major- In the opinion of experienced narcotic special- ity of the offenders locked in the jaws of ists, the tests seem to deter relapses, to pro- this program will never return to narcotic to detect addiction and, consequently, many of them long periods of abstinence, and 64 recidivism promptly. We feel that Nalline is will never return to crime. a valuable and efficient tool in the effective Gilbert Cross resigned April 30, 1962. The position probationary and parole supervision of de- of Rehabilitation Supervisor has never been toxified opiate addicts and when developed filled. to its fullest capacity will be an economical Illinois operates only one Nalline Testing Center. 62 way of restraining addicts from use. Its location is off South Halsted Street in the stockyards area and is immediately adjacent to In the early years of the Nalline testing program the Chicago office of the Illinois Division of in Illinois the position of Rehabilitation Super- Narcotic Control. Because all testing is conducted visor existed. Ostensibly this position was created at one location it is possible to describe reasonably to administer the Nalline Test and to co-ordinate accurately the procedural aspects of the program. it with other rehabilitative segments of the program. The predominant use of the Nalline Test in In sum, the test was conceived in part as one Illinois has been with probationers and parolees. aspect of a rehabilitative effoit. In addition: Conspicuously few tests have been given to other persons. The Division of Supervision of Parolees It was the responsibility of the Rehabilitation and the Cook County Adult Probation Depart- Supervisor to find suitable detention and ment are responsible for notifying their wards rehabilitation institutions in Illinois for the when to appear for testing. Both agencies rely on detention, processing, treatment, and safe- surprise testing and typically subjects are informed guarding of narcotic addicts both in the cate- by the parole or probation officer the day prior to gory of civilly committed addicts as well as their required appearance. for narcotic addicts sentenced under criminal Since 1963, two probation officers are assigned charges. The job necessitated the working out to caseloads limited to subjects in the Nalline of the most comprehensive plan for using program and assume the responsibility for noti- existing, or to be created, facilities for the fying their clients when to appear. The probation treatment of addicts, and the development ot officers are present at the time of testing and meet the pioper program for commitment and de- with their respective clients at some time during tention so that these people would not remain their appearance at the center. at large in the community as a focus of con- The Division of Supervision of Parolees operates tagion."8 differently. Caseloads composed entirely of nar- 61Bloomington, Illinois Pantagraph, May 9, 1961, cotic cases are not maintained. Similar to the p. 20. probation program, parolees are informed the day 6Department of Public Safety, Division of Narcotic Control, ANUAL REPORT FOR YEAR ENDED DECEmER 'AGLBERT H. CROSs, Rehabilitation Supervisor, 31, 1964 5 (Springfield, Illinois, April 7, 1965). ANN L REPoRT-ADmcT CONTROL AND REHABiLITA- 63A REPORT iN THE INTEREST OF THE HEALTH AND TiON, Illinois Division of Narcotic Control, Department SAFETY OF THE PEOPLE OF TIM STATE OF ILLINOIS, Op. of Public Safety 4-5 (Springfield, Illinois, October 10, cit. supra note 60 at 14. 1960). 19701 THE NALLINE TEST I

prior to testing that they are to appear. This Table 1 division, however, follows a policy of rotating its TOTAL APPEARANCES FOR NALLINE TESTS AND duty assignments at the Nalline Testing Center, PER CENT FOUND POSITIVE IN CHICAGO, one result of which is that the parolee may seldom, OAKLAND AND SAN FRANCISCO 1956-1966, perhaps never, see his own parole officer at the Chicagob Oakland' San Franciscod time of taking the test. The exception to this is the women, who, because they are fewer in number Year Number Per Number Per Number Per of Ap- Cent of Ap- Cent of Ap- Cent also have fewer women parole officers. pearances Positive pearances Positive pearances Positive One conspicuous difference between the Illinois and California Nalline programs is that since the 1956 - - 752 23.7 - - inception of the former, urinalysis has been con- 1957 - - 1,723 11.3 - - sistently used to corroborate positive and equivocal 1958 8 0 2,464 8.4 - - Nalline Tests. In addition, urinalyses are run on 1959 182 8.8 4,445 4.2 647 9.4 persons to whom the Nalline Test cannot be given 1960 262 12.2 6,309 3.3 3,337 3.7 because of medical contraindications or because 1961 2,418 2.9 8,397 1.6 5,027 1.5 1962 4,057 1.9 7,687 1.0 5,411 .6 they appeared too late. 1963 2,943 2.8 7,705 1.5 5,999 .3 The effect of the use of urinalysis is that the 1964 2,894 3.3 7,547 1.6 6,179 .7 Nalline Test in Illinois is definitely used as a 1965 2,898 1.3 7,677 .9 - - "screening device." That is, all persons suspected 1966 2,768 1.7 6,538 .9 5,659 .9 of using narcotics as measured by the Nalline Test have this suspicion corroborated by urinalysis. Total appearances for the test are used in this table Because of its greater sensitivity, testing by because they provide the best overall index of the pro- urinalysis of all positive and equivocal Nalline gram's magnitude. There are always a few persons, Test results, presumably insures that persons will however, who appear but for various reasons are not tested. If the persons who were not tested were excluded not be falsely accused of using narcotics. Also, the the proportion of positive tests would in some instances certainty of identifying those who are using nar- be slightly increased. cotics is increased. Thus, using this procedure, b Data includes Nalline Test results from parolees, only those tests showing a "false negative" result probationers, as well as a limited number of tests con- as measured by the Nalline Test will "slip through" ducted for civil commitments, the Secretary of State the net of the testing program. Driver's License Division and a few persons under a The Illinois Division of Narcotic Control has miscellaneous category. The figures for 1961 to date are consistently observed in its annual reports that an for parolees and probationers only. The presentation of adequate follow-up program involves both Nalline the Chicago data is made possible through the Illinois Division testing and urinalysis. Data collected by the of Narcotic Control, Department of Public Safety, Springfield, Ilinois. Mr. Charles Southern, In- Division includes the results of Nalline Tests and spector with the Division, has been of inestimable help urinalyses. The incorporation of urinalysis into the in collating data from official monthly reporting forms Illinois testing program seems to have come about from which this information is drawn. as the result of decisions which took place at the c Data abstracted from data sheets, OAxaAND PorCE policy formation stage between the Division and DEPARTMENT NAILINz TEST RESULTs, Oakland, Cali- the Mason-Grimm Clinical Laboratory of Chi- fornia. Information for 1965 and 1966 was provided by cago.e5 Malachi L. Harney, the first Superintendent Captain Thorvald Brown. Letter from Captain Thor- of the Illinois Division of Narcotic Control, has vald Brown, February 9, 1967. d Data provided observed that the decision to incorporate cor- by the Police Department, City and roborative urinalysis "did not arise from any County of San Francisco, San Francisco, California, courtesy of Mr. J. H. Vanderford, Narcotic Bureau, specific failures in any specific Nalline cases, but letter of July 7, 1965, and Mr. James Casey, Narcotic from a desire to avoid such a possibility." 11 Bureau, letter of February 9, 1967. 65 See, A REPORT IN THE INTEREST OF THE HEALTH Sr AND OF THE PEOPLE OF THE STATE OF ILLINOIs, The Division of Narcotic Control formally op. cit. supra note 60 at 19-34, and MASON & SHEPHE D Evaluation of Two Screening .Procedures for Detecting releases only limited statistical data related to its the Use of Opiates, 37 THE AzeRcAw JOURNAL oF involvement in the Nalline program. The annual CLINICAL PATHOLOGY, 176-181 (1962). 6 Letter from Mr. Malachi L. Harney, June 30, report typically contains one or two sentences 1965. regarding statistics of the program, but this is the STANLEY E. GRUPP [Vol. 61

extent of formally released data. Monthly reports intensiveness of the Nalline testing program in of the number of times persons appear at the each of the three areas. Evaluation of the program Chicago Testing Center and the results thereof, on the basis of the proportion of tests that are however, are assembled at the Center and sub- positive, however, is very hazardous. Innumerable mitted to the Springfield headquarters. Data is factors contribute to the number of positive tests, collected for both the Nalline Test and urinalysis. that is, failures. These factors include the con- The information recorded is in terms of the number scientiousness with which the reports are sub- of times persons appeared and the tests given. The mitted, the competency of the examiner, the pre- Division does not collect data relevant to the vailing practice regarding the interpretation of number of persons in the program. Neither does equivocal (no pupil change) tests, the prevailing the Division collect data on the average number drug-use patterns including the type and quality of tests given per individual during any one time of the drugs being used, the relative proportion of period. Therefore, from the data provided by the the total drug using population that is in the Nal- Division of Narcotic Control it is impossible to line program, the testing patterns that are em- estimate the number of persons in the program for ployed and the assiduousness with which the pro- any given year. The Adult Probation Department gram is implemented. of the Circuit Court of Cook County reports that from the period of June 3, 1959 to September 30, CONCLUSION 1962, 1,219 cases were supervised in the Nalline The Nalline Test emerged in the late 1950's as testing program. A similar inventory indicated that one of several auxiliary narcotic control measures 540 cases were supervised between October 1, 1967 accompanying law enforcement procedures and and October 2, 1968.6 As of December 4, 1968 was acclaimed in some quarters as a highly useful the Illinois Division of Supervision of Parolees had control device. The test has seen its most extensive placed 3611 parolees in the Nalline program since use in California whereas Illinois has made lesser mid-1961.Y use of it. Limited use of the test has been made in Information regarding the relative use of the other states. Nalline Test in Chicago, Illinois, Oakland, Cali- The implementation of the Nalline Test in fornia, and San Francisco, California in terms of California in contrast to Illinois, in virtually every the total appearances for the Nalline Test and the respect, appears to be more vigorous, more en- positive results during the several years of its use compassing and better articulated. A greater is presented in Table 1. Clearly many more tests commitment to the test in California is indicated. are being given in both Oakland and San Fran- This is true irrespective of the fact that Illinois cisco than in Chicago. Since the Chicago data has consistently corroborated selected test results represents the total testing situation in Illinois, it by urinalysis while California initiated this pro- falls far short of the composite California effort. cedure on a limited basis in 1964. In addition to It is impossible to compare the three areas on the the encompassing nature of the program in Cali- basis of the number of persons in the program fornia, there has been some experimentation with because of the absence of information from Chicago the test both in the technical sense and in terms and San Francisco. of varying the testing patterns. Comparisons on the basis of the number of It is noteworthy that while other states or agen- appearances for tests provides a crude index of the cies have considered the Nalline Test it has been 6 Letter from Mr. Edward Kozlow, Supervisor, rejected by most, sometimes by those who have Adult Probation Department, The Circuit Court of accepted other anti-narcotic testing procedures Cook County, Chicago, Illinois, October 28, 1968. I Letter from Mr. R. B. Johnson, Superintendent, which they consider to be more efficient. Interest- Division of Supervision of Parolees, Department of ingly this has occurred simultaneously with the Public Safety, Chicago, Illinois, December 4, 1968, courtesy of Clarence P. Nilles, Assistant Superintendent on-going use of the Nalline Test in California and and Robert Klasna, Parole Agent. Illinois.