An Addiction Medicine Pioneer

Dr. Dave at Haight Ashbury Free Clinic.

Source: Courtesy Dr. Dave

When David E. Smith, M.D., now age 85, was a shiny new doctor just graduated from UCSF, he launched the first free medical clinic in the United States in San Francisco during the “Summer of Love” (1967). Known to people then (and now) as “Dr. Dave,” Smith’s initial plan was to help some of the tens of thousands of young people flocking to the area for sex, drugs, and rock ‘n' roll, most with little or no money. Some became ill from using hallucinogens and other drugs, and some developed addictions. Others suffered serious health problems, such as sexually transmitted infections (STIs) and other illnesses. The prevailing attitude of the medical establishment, and the community in general, was these people deserved whatever happened to them. Dr. Dave decided somebody needed to step up to take care of their urgent health care needs, and since nobody else was offering, that person would be him.

The rules of HAFC.

Source: Courtesy Dr. Dave

At first, Smith tried valiantly to obtain funding for his free clinic from the state to treat all these problems in one place, but to no avail. Rock stars and promoters of the time, aware of the kindness of Dr. Dave and his staff, helped fund the clinic, which became known as the Haight Ashbury Free Clinic (HAFC). David Smith was a role model to other physicians and became known as one of the fathers of addiction medicine in the United States, a title of which he is rightfully proud.

He still remembers when doctors were punished for treating people dependent on drugs. It hadn’t occurred to most people then that integrated, whole-person treatment was an option. Alcoholics Anonymous and Narcotics Anonymous existed, as did Synanon. That was pretty much it.

Free of Judgment

Providing no-cost health care in a “Health Care Is a Right” setting was not the clinic’s only key underlying principle in 1967—or now. Instead, a major goal was to offer judgment-free treatment. According to Smith, “The initial approach to addiction at the HAFC drug detoxification program revolved around therapeutic engagement, dealing with patients’ medical and psychiatric issues. The approach emphasized management of the problems that brought them into medical care.” If patients had underlying issues of depression or anxiety, those were dealt with to help them break away from drug use.

With patients experiencing multiple relapses, Haight Ashbury Free Clinic also had a mobile overdose "squad" carrying Naloxone to reverse ODs in 1971. "The most dramatic rescue was when Janis Joplin ODed in the Haight." The HAFC served as a meeting site for 12-step programs such as Narcotics Anonymous and referred patients to Alcoholics Anonymous groups in the neighborhood.

The detoxification techniques and protocols developed at the HAFC also helped nonpsychiatric physicians sign up to help those with substance use disorders (SUDs) and create the California Society of Addiction Medicine, medicalizing treatment of addiction throughout the state. Smith says this effort led to the nationwide development of the American Society of Addiction Medicine, founded by Ruth Fox, M.D., attracting young and idealistic physicians to a new field with new approaches, methods, and standards of practice used throughout the country.

Rockers Who Helped

George Harrison and friends.

Source: Courtesy Dr. Dave

Many rock stars helped fund Dr. Dave’s clinic, but some famous names include Jerry Garcia of the Grateful Dead, Janis Joplin, Jimi Hendrix, and George Harrison of the Beatles. Actors Dennis Hopper and Robin Williams helped too. Under the auspices of “Rock Medicine,” Dr. Dave and his volunteers began providing free medical care at rock concerts, talking down people with bad trips, helping concertgoers deal with adverse drug reactions and health problems, and assisting many thousands of patrons. The “Rock” doctors also helped rockers who overdosed or experienced drug abuse and dependence.

Methamphetamine Brought New Danger

Smith recalls when methamphetamine entered the drug scene. Because of his research at UCSF, he knew the drug would be a problem: When amphetamines were given to mice, they became violent. He recalls, “Methamphetamine dramatically changed a peaceful kind of culture into a violent community, and we had to develop specialized treatment.” Smith saw addiction as a physical, psychological, behavioral, and spiritual disease. Dr. Dave created the saying “Speed kills” to actively discourage methamphetamine use—in contrast with other popular sayings of the time, such as “Tune in, turn out and drop out” or “Better living through chemistry.” Smith's Speed Kills prevention message helped convince people the risks of use exceeded any benefits. He says, “Methamphetamine was so toxic,” remembering a terrifying Rolling Stones concert when meth-intoxicated Hells Angels stabbed a concertgoer to death.

Journal of Psychedelic Drugs

In 1967, Smith founded the oldest peer-reviewed journal examining the use of licit and illicit drugs that alter consciousness, a new periodical “to compile and disseminate objective information relative to the various types of drugs used in the Haight-Ashbury subculture.” Conceived and edited by Smith, the Journal of Psychedelic Drugs, shared information among locals, the HAFC, and medical colleagues. Smith refocused his journal on the displacement of the hippie subculture and psychedelic drugs by high-dose intravenous amphetamine users, who either burned out or turned to other drugs, like barbiturates and heroin, to ameliorate the speedy effects of the stimulants.

Vietnam Veterans

Smith says the clinic received its first federal funding in 1972 for a heroin detoxification program. Some Vietnam combat veterans came home addicted to heroin they used in overseas. “We were lefties from San Franciso. But even though they were in a foreign and unpopular war and ostracized by society, they knew we would be a place to get help. They came to our clinic for its nonjudgmental health care,” Smith recalls.

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Dr. Dave’s Current Views on Marijuana and Psychedelics

Although Dr. Dave does not think marijuana should be criminalized, his views toward the drug have considerably shifted since the 1960s, slowly over the years. He says, “More emphasis needs to be placed on preventive treatment, particularly in youth. I feel much more needs to be done on the health consequences of cannabis.” He adds, “There has been a substantial increase in cannabis dependence today with more potent forms of marijuana and with higher THC content.” Once dependent on marijuana himself, Smith became clean and sober with the help of a 12-step group emphasizing sobriety.

Smith is also concerned marijuana could become commercialized like tobacco. “One of the things I fear is big companies will promote marijuana to youths as big tobacco did while denying they cause addiction with health consequences.” Smith wrote a personal account of his concerns in a scientific paper on psychedelics. He worries large corporations may similarly misuse psychedelics if researchers discover psychedelics are effective treatments for depression, anxiety, and other psychiatric disorders.

Summary

Still active in community-based medical and addiction treatment and in the mutual support of physicians and other health providers, Smith is an inspiring speaker and addiction medicine consultant. He says it’s important to note he did not achieve his success alone and acknowledges the assistance of many others, such as his charismatic wife, Millicent Buxton-Smith, who pioneered recovery programs for nurses and others impaired by drugs. Millicent and the Smith family will be a big part of any update to his 1993 profile, Dr. Dave. Smith says, “At UCSF medical school, I learned important principles that have lasted me a lifetime when addiction issues were rarely taught.” For example, Smith notes that UCSF professor Dr. Earle Marsh wrote the chapter for physicians in the Big Book of Alcoholics Anonymous. “I appreciate that I stand on the shoulders of giants,” says Smith. “I do what I can to support the next generation in continuing our glorious addiction medicine movement.”