In this occasional series we record the views and personal experience of people who have especially contributed to the evolution of ideas in the journal's field of interest. Beny Primm grew up in West Virginia and qualified in medicine from Geneva on a GI ticket. Specializing in anesthesia, he developed an interest in heroin addiction. He set up a treatment service in poor black communities and went on to a widely influential career at national and international levels.
Addiction (A): Beny, could you tell us a little about your family background, what life was like when you were growing up, and when you first became interested in medicine?
Beny Primm (BP): I grew up in West Virginia. My mother had trained as a teacher, but she and my father worked as servants for several years so they could save enough money for my father to attend a school of mortuary science. In 1921 they were able to open a funeral home, and my mother went back to teaching school. When I was growing up I always admired the doctors. They had nice cars and everyone respected them. The kids used to throw rocks at cats and dogs, but not at the doctors' dogs. The doctors were good friends of my father, so I learned to know them very well—Dr Thompson and Dr Whittico. I will never forget how Dr Whittico used to make house calls on horseback. I became enamored by that and I wanted to become a doctor. From the time that I can ever remember that is all I wanted to do. I used to play as a doctor and my brother would play as a funeral director. It worked out pretty much as my parents wanted it to. They wanted me to become a doctor and my brother to become a funeral director, and that is what we did.
‘The kids used to throw rocks at cats and dogs, but not at the doctors' dogs.’
A: When you graduated from college did you go directly to medical school?
BP: No. I finished college in May 1950 and in August went directly into the Armed Services, the 82nd Airborne division. Because I was in the Reserve Officers Training Corps as a college student I went in as a Commissioned Officer. I married Delphine, who was a teacher, in 1951.
A: How long were you in the Airborne?
BP: About three-and-a-half years. I was the first black officer integrated into the 456th Airborne Field Artillery of the 82nd. President Truman had decreed that the entire officer corps would be integrated and that black officers would now command white troops just as white officers commanded black troops. I came out of hospital after I broke my leg in a car accident to a lily-white unit where I was made the battalion intelligence officer as a first lieutenant, even though the job usually required a major.
ENTERING MEDICAL SCHOOL
A: Although you were an officer you decided to leave the military and go to medical school.
BP: I always wanted to go to medical school. Of course, it was very difficult when I initially applied and I was not admitted. That is when most of the guys had come back from the service and used their GI Bill to finish college. All the guys who had been pre-med applied to medical school. There must have been about 5000 black applicants that year and only about 300 places in the whole country where they could go to school. No blacks could go to medical school below the Mason Dixon Line at that time, except for the traditionally black schools, Howard and Meharry, which had classes of about 100 students each, and there would be just one or two at other schools.
A: So you decided to apply to schools in Europe?
BP: Exactly. I had a friend who went to the University of Geneva and who had graduated at the time I was leaving the service. He had suggested that I should apply over there. I applied to Heidelberg and Innsbruck because I had taken German in college. I did not apply to Geneva because I did not know any French; so I was accepted to Innsbruck and Heidelberg, and I sailed on 5 October 1953 to go to Europe, to go to medical school at Heidelberg.
A: But you later transferred to Geneva?
BP: Yes, I did. At Heidelberg you could not get your GI Bill money. I did not know that before I went. But you could get it in Switzerland, Holland, France and Italy, so I applied to school in Holland and was accepted into Nijmegen. I spent a day or two in classes there, but I just could not understand the language. Then a friend of mine said to try Geneva. So I went down to Geneva and I was accepted. Delphine joined me there. One of our three daughters was born in Geneva.
A: Did you come back to the United States after graduating?
BP: Yes, I came back in 1959 and did an internship at what is now Nassau General Hospital on Long Island, NY and also did an anesthesia residency there. The residency program had started just that year and I was the first resident. I finished in 1963 and then I went to Harlem Hospital to work as an anesthesiologist.
BECOMING INTERESTED IN ADDICTIONS
A: What got you interested in problems of addiction?
BP: Because, at Harlem Hospital, I had become so good at conducting anesthesia for trauma cases, they put me on that service from about 4 p.m. on Friday until Sunday morning, and during that time we would get many, many surgical trauma cases from gunshot wounds and stab wounds and so forth. Most of these cases were associated with substance abuse either directly or indirectly, and I wrote a paper about that. Melvin Yahr, who was the Dean of the affiliation contract between Columbia University and Harlem Hospital, saw the paper. I had suggested in that paper that when somebody came in, no matter what their diagnosis, medical or surgical, if they had a substance abuse problem somebody should go and see that person and encourage them to do something about their drug abuse problem. I had seen so many cases that were associated with substance abuse coming back in for trauma—almost 87% of all the cases—and I stated that in the paper. Mel Yahr recognized that, pulled me off anesthesia and told me he wanted me to direct a program at Harlem Hospital that would see to it that every patient who came there who had a substance abuse problem would be seen by people talking to them about obtaining treatment for their problem.
‘. . . we would get many, many surgical trauma cases from gunshot wounds and stab wounds and so forth. Most of these cases were associated with substance abuse . . .’
A: At some point you made addiction your full-time activity. How did that come about?
BP: At Harlem Hospital I became more and more involved with treatment of these individuals—that is, referring them to treatment. There was no treatment at Harlem Hospital. Beth Israel had a satellite program of methadone maintenance at Harlem Hospital which I was not very happy with, because in order to get onto that program you had to be admitted to Manhattan General Hospital, which Beth Israel ran at that time, and then be put onto methadone maintenance. Well, I thought, why should we in Harlem have to send someone downtown to Beth Israel in order for them to get drug treatment? Why couldn't we have that at Harlem Hospital? That did not come about, and I fought like the devil in the hospital politics and with the Addiction Services Agency, which at that time controlled treatment in New York City. That did not occur, so I began to be very revolutionary in my actions and began to take over buildings in Harlem, under an organization called NEGRO, which was the National Education Growth and Reconstruction Organization, run by Dr Thomas W. Mathews, who was a prominent black neurosurgeon. He had a building in Queens for a hospital unit where I could detoxify addicts, get them back onto the straight and narrow, and then get them jobs and into therapeutic communities after we got them to detoxify from heroin.
TAKING OVER BUILDINGS
A: What happened then?
BP: I left Harlem Hospital and became involved with what was then called Interfaith Hospital, which treated the addicted. I directed that institution for about a year, a year-and-a-half, and eventually started taking over buildings in Harlem to do what I always wanted to do—to set up drug treatment in the Harlem community. We took over a State-owned building and set up treatment, and were ordered out by the Governor; I was almost arrested and put in jail for having done that. Although I had a disdain for methadone maintenance treatment, because I felt that one could go from methadone to abstinence, I later found out that could be a disaster. I began to change my views about methadone maintenance and decided to take on the task of helping the VERA Institute to set up drug treatment programs in Brooklyn and Harlem. Then, with a grant from the National Institute on Mental Health (NIMH), I was able to set up the Addiction Research and Treatment Corporation (ARTC) in Brooklyn.
A: Can you tell us about ARTC's evolution?
BP: ARTC, commonly known as ‘Beny Primm's program’, was originally called the Addiction Research and Treatment Corporation, because we were supposed to carry out both research and drug abuse treatment at the same time and look at the impact of what we were doing in the society within the geographical areas where we would establish the program. We had a mandate to treat 5000 patients who came with this grant from NIMH: in Brooklyn, 2500; in Harlem, 2500. I was able to talk to the community and to establish a program in that building in October 1969, even though we had pickets outside. The reason that New York City supported us was that the mayor, John Lindsay, was going to be the Democratic Party's choice to run for President after Bobby Kennedy was killed. Kennedy had wanted to do something for New York and Lindsay had been criticized for not having adequate drug treatment in the city, where there was an ongoing heroin epidemic, and so he had to establish something. So we were also given a grant through the Model Cities program. I was chosen as someone who could be both the administrator and the physician to run the program. Today we have 2500 patients in both Brooklyn and Harlem. We have expanded from those first drug treatment programs to seven different sites for the treatment of substance abuse—opioid abuse and people addicted to alcohol.
‘ARTC, commonly known as “Beny Primm's program . . .”’
A: Beny, you mentioned pickets at the program and resistance to methadone. Would you expand on that a little?
BP: In 1969 there were a number of pickets. A group called Nat's Coming—a name from the slave rebellion led by Nat Turner—were a very active group during the whole Black Power movement. They had pickets there, and I was often confronted with knife-wielding and machete-wielding guys who were from Nat's Coming. I would challenge them and they would challenge me and finally they backed away and we were able to establish our program. We have had continued resistance over the years, but we have still been allowed to function.
A: How were your relationships with other treatment groups in New York?
BP: We had constant difficulties with the therapeutic communities here in New York at that time. They were unalterably opposed to methadone and of course they, along with a more conservative group who wanted drug treatment but certainly did not want methadone as a treatment, made it very difficult to function politically and to attract people to our programs. Eventually we broke through that problem.
‘We had constant difficulties with the therapeutic communities . . . in New York at that time. They were unalterably opposed to methadone . . . , along with a more conservative group who wanted drug treatment but certainly did not want methadone . . .’
A: What led to the breakthrough? What factors gave you increasing acceptance?
BP: We had something that was established with ARTC—we had three study groups. We had a study group to look at the impact of this program on criminality, another at the impact on social standing, and another at the impact on medical problems. So we had Harvard looking at it, with Jim Vornberg as Chair of the criminality investigation and the impact it would have; Yale, with Herb Kleber in charge of looking at the medical impact of the program; and Irving Lukoff, an eminent sociologist at Columbia, looking at the social impact of the program. Those three schools of great prominence in the country then made reports periodically on the impact of our program; those reports were good, and we began to experience not considerably less, but less opposition to our existence.
MOVING ONTO THE NATIONAL SCENE
A: Now, at some point you moved from the local scene to the national scene.
BP: During the 1970s I had visited with Dr Jerome Jaffe in Chicago, who had set up IDAP, the Illinois Drug Abuse Programs. I had learned a great deal from him about what to do and how to do it, and here in New York I tried to duplicate what he had done in Chicago. Then after I had set up my program here and it was running for about 2 years—roughshod running—Jerry was asked by the President and the policy staff of the White House Domestic Council to go to Viet Nam and try to do something about the heroin addiction problem among US military personnel there before they came home. He asked me to go with him. Jerry was also picked to set up a national office at the White House, the Special Action Office for Drug Abuse Prevention (SAODAP). So I went to Viet Nam and did some work there and came back and worked with Jerry at SAODAP. I think my greatest contribution to that effort was to go to different organizations—Veterans Administration, Army posts, Army hospitals—to talk to them about how to treat the addicted people who came back from Viet Nam. That began to popularize some of the things that I had done here in New York.
A: But you also continued to run your programs in New York and to become more involved with academic aspects of addiction?
BP: At the time, I was invited to join the Committee on Problems of Drug Dependence (CPDD). They asked me to speak at their meeting at the University of Michigan. Maurice Seevers was chairman of the department of pharmacology at the University of Michigan and he was also president and chairman of the board of the CPDD. I went there and made a speech called ‘Methadone is no answer’. I said there had to be other things that accompanied methadone in order for it to be as effective as it was reported to be. From that meeting I became somewhat well known, and I also came to be seen as an enemy by the people who were running methadone treatment programs. That went quite well to establish me as a person who was looking at the problem from another perspective. I spent the next 2 years in and out of the White House consulting with Jerry and conducting both things in New York City and speaking all over the country about the efficacy of comprehensive treatment with data from the reports that came out of the research at ARTC. Lukoff's report on our program was not favorable. He thought that the impact on the social lives of these people was not what it had been predicted to be; they were still participating in criminal behavior; they were still on welfare; they were still abusing their significant others and their children. But I continued to develop programs in New York and to travel around the country to help start drug treatment programs in other parts of the nation.
A: I have heard a story about a life-changing lunch at the White House Mess. Can you tell us about that?
BP: One day I was having lunch at the White House Mess and was sitting at a table with a couple of other people, but I did not know them. They were talking about Public Works Improvement Project grants. Now, these grants were given to Appalachia. Appalachia is an area I was very familiar with because I had grown up in Williamson, West Virginia, right in the heart of Appalachia, in the heart of the coal fields. So I said: ‘Appalachia? I know that area very well; I used to live there as a boy. But I think it's unfair to the cities. I'm from the city now. I live in New York City where the people themselves need help like you're giving to streetlights and roads and bridges. We have all that in New York City, but the people need to be rehabilitated and you need to focus on the cities and these areas of concern that I am reminding you of so it will be fair to cities in other parts of the country.’ The person I directed this to looked at me and said: ‘Doctor, that's interesting’.
A. And in follow-through?
BP: Some time later I had a visit from John Erlichman and Jeff Donfeld, of the White House Domestic Council. Erlichman came to ask me to support Congressman Rooney's bid for re-election from the district in which my program was located in Brooklyn. (He also told me that Rooney had never had a black or a Puerto Rican on his staff.) Rooney was chairman of the Armed Services committee and they were afraid he was going to lose; they wanted to give something to his district that would heighten his popularity so he would be re-elected. Erlichman said he had heard about what I had said about Public Works Improvement Project grants and about helping people coming out of drug treatment to get jobs, to get trained, and that I had made the statement that if they would give grants to that it would very helpful to me. He said they would be willing to do that. He said they would give me $1.2 million to obtain a building and to have people trained to work at the Brooklyn Navy Yard, and I would come to a press conference for Congressman Rooney, where they would announce a Public Works Improvement Project grant for my program to do this at $1.2 million a year for the next 10 years. I said I would be more than happy to help. As I was leaving the meeting I got up to go and he said: ‘By the way, Doctor, how are you registered to vote?’. I said: ‘I'm an Independent’. Erlichman said: ‘An Independent? I think the President would like to see you become a Republican. He is getting ready to appoint you to a couple of advisory committees and it would look better if you were a Republican.’ I went that day to change my registration from Independent to Republican.
‘Erlichman said: “An Independent? I think the President would like to see you become a Republican . . .”.’
A: That was the first of a number of Presidential committees that you served on for the next few years?
BP: I was appointed right after that meeting to the National Drug Abuse Advisory Council; and then there were a number of other committees, but not until during the Reagan Administration. During that time I was appointed to the Immunodeficiency Virus Epidemic Committee, where I contributed knowledge about the treatment of human immunodeficiency virus (HIV) in individuals who were addicted to drugs and infected with HIV. During the time between the middle 1970s to the 1980s there was a hiatus, where I was working on my own program with people who were HIV-infected. People said it was a disease of heroin addicts, hemophiliacs and Haitians. It was a horrible time for all those individuals who were thought to be responsible for this dreadful disease that had no cure. During that period I was working feverishly to warn the country, and particularly the African American community, about HIV and its problems.
HEADING THE OFFICE ON TREATMENT IMPROVEMENT
A: What came next?
BP: Then Vice President George H. W. Bush asked me to come to Washington to talk to him about what I could do if he became President to help him address the substance abuse problem and what to do to change the focus of the nation. When he was elected he established the Office of Treatment Improvement (OTI) at the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). I was appointed to head that office. Later, OTI became the Center for Substance Abuse Treatment (CSAT) after ADAMHA was re-organized into the Substance Abuse and Mental Health Services Administration (SAMHSA) as it exists today. I served at OTI and CSAT until 1992 or 1993 and then returned to New York, and have been running my drug treatment programs in New York ever since. During the administration of President George W. Bush, I was appointed to the President's Advisory Commission on HIV and AIDS. I served on that commission two terms—by the way, the only person to serve two terms—to make policy and suggestions for what should happen in our nation to impact the HIV epidemic, but particularly in the African American community.
A: So, as a result of this visibility at the highest levels of government, you are often consulted when the government is making new appointments and policies. Can you tell us something about that?
BP: The Office of National Drug Control Policy (ONDCP) was established during the first Bush administration. One of the first directors was the police commissioner from New York. I was asked about his suitability, would he be a good person? I said ‘yes’. After that there were others who served at ONDCP whom I recommended. I certainly recommended Herb Kleber, who became a deputy director when Bill Bennett headed the office. I also recommended Andrea Barthwell, who became a deputy director for demand reduction.
A: You continued to have influence at CSAT even after you left, didn't you?
BP: Yes, I did. I recommended Westley Clark to head CSAT, but they named David Mactas, who served briefly. I was very influential in getting Westley Clark, who is a lawyer and a psychiatrist and holds a master's degree in public health, appointed to the job and he has been there ever since. My influence at that level has been very strong and I am still consulted, no matter whether it is a Democrat or Republican administration, about whatever has been important about substance abuse. HIV disease has been an area in which I have gained some prominence and influence.
A: You also have consulted internationally, is that not so?
BP: Yes. I have represented the United States, with former Secretary of Health Louis Sullivan, at international conferences on HIV and acquired immune deficiency syndrome (AIDS). I have represented the United States at the World Heath Organization in considering the HIV/AIDS problem. I have traveled to East and West Africa talking about AIDS for the United States Information on AIDS.
A: Do you still have ongoing communication with people in those countries about their AIDS and addiction programs?
BP: Not as much now, because once the President's Emergency Plan for AIDS Relief (PEPFAR) in those nations was formed, I have not had that much influence. Earlier on there was, unquestionably, input that I had. I was awarded the Surgeon General's medal for my work in HIV/AIDS/and substance abuse.
A: You mentioned that you have been a member of CPDD and have been attending their meetings for some time. You recently were given the Morrison Award by CPDD. Can you tell us about that?
BP: Yes. I was given the Morrison Award. It is for work with the federal government. Michael J. Morrison was an administrator and an important facilitator of the work of CPDD. The Morrison Award was given to me because they had such great respect for the work that I had done in government, although I was not a researcher, and for my commitment to the CPDD—much like Morrison. I was the first recipient of this CPDD award and I was very happy with that. That may have been the same time that Lee Robins was awarded the Nathan B. Eddy Award for her work in Viet Nam. Lee was the first woman on the CPDD and I was the first black. The CPDD now has a scholarship named after me to help young minority researchers gain access to the meetings of the College.
‘I was the first recipient of this CPDD award . . . The CPDD now has a scholarship named after me to help young minority researchers . . .’
A: Beny, with all those professional activities, how did you find time for family and leisure?
BP: I probably did not take as much time for family as I should have. I have four wonderful daughters, three from my marriage to Delphine, who died in 1975, and one from a relationship with a physician colleague. Two of my daughters are psychiatrists. I now have two granddaughters. After Delphine died, Barbara Gibson, who was a clinical social worker and a colleague at ARTC, was an important person in my daughters' lives until her death in a car accident in 1999. As for recreation, I played basketball until I was 60, and I still play tennis and a little golf. I have a summer home on Martha's Vineyard, and I go frequently to Houston, Texas, where my fiancée lives.
THE IMPORTANCE OF ADDICTION MEDICINE FOR ALL NATIONS
A: Beny, you have been in the field of addiction treatment services almost from its earliest days. Do you have any thoughts on its expansion and what you see as evolving in terms of addiction treatment either in this country or world wide?
BP: I am still concerned about the lack of embrace of the importance of addiction medicine by all nations, but particularly here at home, where we have come up with a treatment modality that has been very effective in turning some people's lives around so they have become responsible citizens. We did so with the use of ‘controversial’ methods. These methods are not controversial to us, because these are medically sound, proven methods of rehabilitation that should be more used and popularized world-wide. We have not been able to do all that we could do to influence populations about the good of medically assisted treatments that are out there. There are probably many more that are out there if we could spread the word to pharmaceutical companies about developing therapeutics for this population. Mostly, we need a platform from which we could tell people about addiction and let them begin to see, as we see happening now, that this is a disease, and not something that can be treated with a ‘lock them up and throw the key away’ approach. Many people still think that the only way to do something about this problem is to be punitive—but we should be treating the mental health problems that are associated with this condition; certainly, all the health problems that are associated with it. As to the social stigma—we need to make sure that those are reduced so people can become whatever they would dream to be if we allowed them to do so without putting the weight of imprimatur that is so negative on their disease.
A: What would you say to a young professional thinking about entering the field of addictions?
BP: Young doctors who are trained in a specialty need to know why they are going into this field, so that they can defend against the questions and criticisms from colleagues for having chosen to work with the addict population; but it is a field that is critically important to medicine.
A: Thank you, Beny, for your many contributions to our field.
The opinions expressed in this interview reflect the views of the interviewee and are not meant to represent the opinions or official positions of any institution or organization the interviewee serves or has served.