Remembering Pharmacy’s Past: Prohibition Era Medicinal Liquors

Editor’s Note: The following article is part of AIHP’s “Remembering Pharmacy’s Past” series, in which we highlight previously published articles that recount aspects of pharmacy’s long and colorful history. This article was authored by Aniel D. Russo, PharmD, and David Baker, BS, MBA, JD, Associate Professor, Western New England University College of Pharmacy & Health Sciences. This article was originally published in the Spring 2018 issue of the AACP History of Pharmacy SIG Newsletter. (Past issues of the newsletter are posted on AIHP’s website at this link.) Mr. Russo was one of Professor Baker’s PharmD students at the time the article was published. Professor Baker has been an AIHP member since 1983.

In the modern era, discussion of liquor and alcohol does not have the same impact as it did in January of 1920 when the Prohibition era began. Per the 18th Amendment to the United States (U.S.) Constitution, prohibition was enforced upon the sale, transport, and manufacture of alcoholic beverages, making possession of such illegal. [1] But was this truly the case?

As most know, “bootleggers” came into action, creating a market of illegal alcohol sales and distribution. However, many are unaware that alcohol was actually being distributed legally in one specific place: the community drug store. Under the guidance of the U.S. Treasury Department, physicians were granted the authority to prescribe medicinal alcohol. [2] The notion of alcohol prescriptions or ingestion for medicinal benefit may seem astounding today, but in years past this was not the case.

The Prohibition era did not just happen; it took decades to develop the federal and state legislative impetus that resulted in passage of the 18th Amendment. In the early 1800s, multiple Christian religious revivals resulted in a drive for temperance, based on the belief that alcohol and its consumption was the root of many evils. The temperance movements sparked calls for legislative restrictions. In 1838, Massachusetts was the first state to pass a law banning the sale of alcohol in certain quantities; however, in just two short years, it would be repealed. Later, in 1846 Maine passed the first statewide prohibition against all alcohol. By 1916, 18 more states would follow their example, banning the manufacture and the sale of alcohol. [3]

At the federal level, prohibition legislation began to advance during the early 20th Century. Due to the involvement of the U.S. in World War I, President Wilson introduced an executive order in 1917 prohibiting most alcohol production, except for low percentage alcoholic beverages (e.g., beer). The purpose of the order was to save grain for food production. At about the same time, Congress introduced an amendment to the U.S. Constitution that would, if ratified by the states within seven years of Congressional approval (it was actually accomplished in less than two years), create a “permanent” prohibition on the manufacture, sale, transportation, importation or exportation of alcohol within the U.S. Interestingly, the only activities involving alcohol not banned by what became the 18th Amendment to the U.S. Constitution were the private possession and personal consumption of alcohol. [4]

The National Prohibition Act, more commonly referred to as the Volstead Act, was the enabling federal legislation adopted to provide proper definitions of the prohibitions and the means by which to enforce them. It derived its common name from Andrew Volstead, the Chairman of the House Judiciary Committee, who helped steer its passage. Originally vetoed by President Wilson, Congress overrode his veto within a day, and the Volstead Act went into effect on January 17, 1920. [5] Exceptions to the prohibitions on alcohol included: wine for religious purposes, preserved fruit for possession by farmers, and various alcohols for prescribed medicinal purposes. [6]

From the beginning of the national Prohibition era of the United States in 1920 to its eventual end in early 1933, the use of alcohol for medicinal purposes was utilized by both the public and the medical profession. Used as a tonic, a stimulant, a preventive measure, and even as a cure for infections, alcohol was thought to have vital powers and to provide medicinal benefit throughout the history of man. Physicians utilized alcohol for a variety of ailments including anemia, high blood pressure, heart disease, typhoid, pneumonia, and tuberculosis. In addition, pharmacists found it to be n excellent diluent and solvent for many of the herbal formulations utilized at the time. [7]

In contrast to current practices like restricting alcohol usage in minors, and finding benefits primarily with red wines versus high content alcohols, the Prohibition era was witness to whiskey as the medicinal alcohol of choice and its usage in both adults and children, albeit in different doses. Commonly, adults were prescribed 1 fluidounce every 2-3 hours; whereas, children were prescribed ½-2 teaspoonfuls every 3 hours. [7]

Also, despite that since Roman times wine was the predominant alcohol of choice for medical applications, hard liquors became the “drugs of choice” during Prohibition. Prescriptions involving whiskey and brandy were the most popular alcohol products used for the treatment of acute conditions. [8]

Today, alcohol is considered a depressant, but Prohibition era prescriptive alcohol was primarily used as a stimulant. [9] Even Winston Churchill required medicinal alcohol. In 1931, he incurred minor injuries following an accident where he was struck by a car. However, he suffered from depression and pleurisy following the accident, for which Churchill’s doctor prescribed “naturally indefinite” amounts of alcoholic spirits with meals as a treatment. But Churchill’s doctor was not alone, as an estimated 15,000 prescribers applied for alcohol prescriptive permits in just the first six months of Prohibition. [6]

Before Prohibition began, the American Medical Association (AMA) was against the use of medicinal alcohol, believing its potential for abuse outweighed its benefits. On June 6, 1917, the AMA House of Delegates passed a resolution stating: “…Whereas Its [alcohol’s] use in therapeutics as a tonic or stimulant … has no scientific value; … Resolved, that the use of alcohol as a therapeutic agent should be further discouraged.” [10] However, the AMA ultimately backed giving prescriptive authority for liquor to physicians. In fact, in a 1921 survey conducted by the AMA, to which 32,585 U.S. physicians responded, 51% said that they believed in the therapeutic efficacy of whiskey. [8]

During the Prohibition era, few regulations were promulgated to suggest appropriate alcohol prescribing or to counteract improper alcohol prescribing. Patients could have ailments ranging from the very broad to the specific, and in turn, could easily fill alcohol prescriptions as long as they knew a prescriber willing to write them. Over the course of the era, it is estimated that a staggering 11 million alcohol prescriptions were written each year! [6] One account revels n the story of how one physician wrote 475 alcohol prescriptions in one day; that physician was later cited by the Prohibition Commissioner John Kramer. [6] Just like today, there were healthcare professionals who manipulated the system for profit.

A packet of prescription forms
(Form 1403) for medicinal liquor. Courtesy of the Rose Melnick Medical Museum.

To understand the context of the Prohibition era alcohol prescribing requirements, it is important to remember two things: both the 1951 Durham-Humphrey Amendment and the 1970 Controlled Substances Act were not yet law. Accordingly, there were no controlled substance schedules, permits, or regulations, except regarding labeling; and whether a drug required a prescription was at the whim of its manufacturer, not a federal agency. Yet, the Treasury Department set up a very unique system to obtain permits to manufacture, order, prescribe, and dispense alcohol; and for the public to obtain medicinal alcohol prescriptions, as well as the product.

To start, all those who wished to obtain a permit to manufacture, order, prescribe, and/or dispense medicinal alcohol had to file a Form 1404, in triplicate, to the Prohibition Director of their state. On the Form 1404, pharmacies were counseled to apply for an “I” permit, with which both the use and sale of intoxicating liquors was allowed. For a permit holder to purchase alcohol, form 1410 had to be utilized. [11]

In addition to the permit and ordering requirements, medicinal liquor prescriptions had to have several pieces of necessary information on them to be considered facially valid. Form 1403, the official alcohol prescription form, required information not seen on other prescriptions of the 1920s. Bearing many similarities to the modern day requirements for C-II controlled substance prescriptions, there are some noticeable differences.

Form 1403: The standard alcohol prescription used during the prohibition
era. Courtesy of:

Unique for its time was the fact that an alcohol prescription could not be refilled, much like a C-II today. In contrast, the “ailment for which prescribed” requirement on the stub kept by the prescriber was unique then as well as today. According to the American Medical Association, there were an abundance of ailments for which alcohol could be prescribed that by today’s standards would be very questionable, e.g. the post-traumatic depression of Winston Churchill. [12]

Beyond the requirements of the prescription form, there were still other restrictions. First, patients could only receive a pint or less of liquor every ten days (clearly, this was not often enforced if 1 fluidounce was recommended every 2-3 hours for some conditions). [2, 6]  Second, records had to be maintained by both the physician and the pharmacy. For example, forms 1455 and 1455a were required to maintain pharmacy records of purchases and dispensings of medicinal alcohol. In addition, pharmacies had to use Form 1418 for the recording of all alcohol dispensed, and Form 1421 for the recording of all alcohol used in manufacturing (e.g., compounding). A copy of all of these forms, maintained in duplicate, were to be submitted monthly to the state Prohibition Director. [11]

However, there were many loopholes available for pharmacists, physicians, and patients to get around the law. The dilution of alcohol prescriptions and poor recordkeeping was commonplace, allowing many pharmacists and physicians to make money from a public desiring, more than needing, alcohol. Physicians could write up to 100 prescriptions in as little as a month. There was a considerable lack of inspectors to check the records of the prescribing physicians and dispensing pharmacies. Even when an inspector would show up, the lack of proper recordkeeping made it hard to pinpoint shortages or withdrawals with any accuracy. Enforcement was so lax, that of the 64,000 physicians granted alcohol prescription permits, only about 170 had their permits revoked in any one year.[6]

Today there are a multitude of pharmaceutical manufacturers globally that supply pharmaceuticals for patients all over the world. In contrast, during the Prohibition era, only select alcohol-producing companies were granted the privilege (i.e., a permit) to manufacture and supply medicinal alcohol. One company in particular was American Medicinal Spirits (AMS), founded around 1920 by Otho Wathen in Louisiana, to meet the need for medicinal liquor during prohibition. AMS was one of only about 33 distillers in the entire country that were allowed to produce alcohol legally. Prior to Prohibition (in 1899), there were an estimated 965 distilling establishments. It is believed that Wathen established his distillery expecting that at the end of Prohibition, the market for alcoholic spirits would put his company at a great advantage over those not yet in operation. [13]

Some of the AMS bottles produced during the Prohibition era still exist oday. In fact, it was the discovery and purchase of one of AMS’s bottles, sans paper label and contents, by the authors that stimulated the research resulting in this paper. The bottle purchased had a very unique, star-burst, design; label areas front and back; and “Full Pint” and “The A-M-S Co.” embossed in the glass. Based on that, the exact product bottle, containing Kentucky Sunshine Whiskey, was found on the Internet. Note the “For Medicinal Use” notation on the paper label. If personally searching for Prohibition era bottles, be aware that if “FEDERAL LAW FORBIDS SALE OR RE-USE OF THIS BOTTLE” is on the label or embossed in the glass, those were produced subsequent to Prohibition, according to a federal law passed in 1935 and later repealed in 1964. [14] The reason for this post-Prohibition law was to prevent the refilling of legal-appearing bottles with black market alcohol. [14]

As the pharmacy profession, and its practice, continues to evolve with new medications and approaches to patient care, it is important to note the past to assist in the development of current and future practices. Although Prohibition did not last for an extensive period of time, it does provide insight into the first real attempts by federal and state governments to control the prescribing of a substance with abuse potential. It is interesting to note that many of our current-day state and federal controls on prescription drugs and controlled substances resemble these Prohibition era medicinal alcohol laws and regulations.

— Aniel D. Russo, PharmD 2020 and David Baker, B.S., M.B.A., J.D., Associate Professor, Western New England University College of Pharmacy & Health Sciences


[1] Congress enforces prohibition [Internet]. A&E Television Networks [cited 2018 Mar 31]. Available from:

[2] Gambino, Megan. During Prohibition, Your Doctor Could Write You a Prescription for Booze [Internet]. Smithsonian Institution; 7 Oct. 2013 [cited 2018 Mar 31]. Available from:

[3] Staff. Prohibition [Internet]. A&E Television Networks; 2009 [cited 2018 Mar 31]. Available from:

[4] Prohibition [Internet]. Digital History [cited 2018 Mar 31]. Available from:

[5] Kelly KC. The Volstead Act [Internet]. National Archives and Records Administration. National Archives and Records Administration 24 Feb. 2017 [cited 2018 Mar 31]. Available from:  

[6] Mejia, Paula. “The Lucrative Business of Prescribing Booze During Prohibition.” Atlas Obscura, Atlas Obscura, 16 Nov. 2017 [cited 2018 Mar 31]. Available from:

[7] Nespor, Cassie. “Medicinal Alcohol and Prohibition.” Melnick Medical Museum, 21 Dec. 2016 [cited 2018 Mar 31]. Available from:  

[8] “Physicians Favor Whiskey.” The Druggists Circular. 1922 Feb; LXVI (2): 75-6.

[9]. “Medicinal Alcohol.” The Ohio State University [cited 2018 Mar 31]. Available from:   

[10] Garrison, F. “The Medical Drama.” American Druggist and Pharmaceutical Record. 1922 Oct; LXX (10): 13–4.

[11] “Pharmacists and the Liquor Law.” The Druggists Circular. 1922 Mar; LXVI (3): 83-6.

[12] Holloway, April. “Alcohol as Medicine through the Ages.” Ancient Origins, Ancient Origins, 19 Jan. 2014 [cited 2018 Mar 31]. Available from:

[13] “American Medicinal Spirits Company.” BottleBooks, Digger Odell Publications 2004 [cited 2018 Mar 31]. Available from:

[14] Woods C. “Bottles marked “Federal Law Forbids…” [Internet].” Historic Glasshouse. 2010 [cited 2018 Mar 31]. Available from:

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