Prohibition and the medical profession

Prescribing alcohol during the era of Prohibition in the US was a lucrative business for some doctors

Alcohol is a drug, yet doctors can’t prescribe it. Am I the only one who finds this a bit of an anomaly?

Would making alcohol prescription-only help reduce its harmful effects? Not if the era of Prohibition in the US between 1920 and 1933 is anything to go by. Buying alcohol was illegal – unless you had a doctor’s note.

Many doctors, pharmacists, and dentists held permits which allowed them to prescribe quantities of rye whiskey, scotch, and gin for various conditions.

Daniel Okrent is the author of Last Call: The Rise and Fall of Prohibition. The book details how thousands of doctors sought such permits in the initial six months of Prohibition. In the absence of federal supervision, certain pharmacists and physicians transformed the intended medical exemption into a profitable business.

Some diluted alcohol, while others issued overly generous prescriptions. During Prohibition’s first year, doctors prescribed millions of gallons of medicinal alcohol. As a result of loopholes and weak enforcement, doctors often suffered no repercussions for prescribing more than the legal limit. The regulations were made stricter by the Willis-Campbell Act of 1921. However, as it still recognised the right of doctors to treat alcohol as medicine, the loopholes were left open.

The National Prohibition Act (also known as the ‘Volstead Act’) had permitted clergy members to utilise wine for religious services. The Act allowed farmers to possess up to 200 gallons of preserved fruit and granted doctors licenses to prescribe medicinal alcohol. Patients could then obtain their preferred alcoholic beverage at pharmacies. It all sounds rather lax and somewhat consumer-driven.

There were some safeguards. The law stated that patients couldn’t obtain more than a pint of “spirituous liquor” every 10 days, and that prescriptions couldn’t be filled more than once. Advocates of prohibition pushed for further limitations.

In the absence of federal supervision, certain pharmacists and physicians transformed the intended medical exemption into a profitable business

The 2021 Act is often referred to as the ‘Beer Emergency Bill’. The legislation banned prescriptions of beer and lowered the cap on alcohol, from a pint to a half-pint, per prescription. It also limited doctors to 100 prescriptions every 90 days.

Not surprisingly, not everybody could afford to get around Probition in this way as medicinal alcohol was expensive. It was something reserved for wealthier Americans.

And there was bootlegging, of course. Corn syrup was used to make moonshine supplied to drinking clubs and speakeasies. Patrons drank this despite the risk their drink might contain industrial alcohol.

According to Okrent, physicians’ prescribing power at the time became a way for some to get rich quick. And the number of licensed pharmacists tripled in New York. The rise was unrelated to any population surge that might otherwise have warranted an expansion of this magnitude. Securing a permit to fulfill prescriptions required minimal effort, and practitioners could charge exorbitant fees.

Prescribing alcohol during Prohibition wasn’t backed by any science at the time. Despite a lack of evidence, many physicians in the early 20th Century all but encouraged people to drink.

Clearly Prohibition didn’t do what it set out to do. In fact, more hard liquor was consumed at this time than before.

Reflecting on the shenanigans of Prohibition, maybe it’s just as well us modern doctors aren’t enabled to prescribe alcohol.