KNOT HEART - Almeida Theatre

Interview with PsychiatristAbigail Cruttenden in rehearsalPhoto: Matt Humphreydespite having lots of things going for her. I think it’s interesting that David Eldridge has chosenheroin rather than cocaine, which would have been a snugger fit with what the media stereotype is fora cocaine addiction. And certainly, we see plenty of people in our clinic who come from higher socioeconomicclasses who have got problems with heroin.AP: What are the addictive properties of heroin itself as a drug?Dr OBJ: At a neuro chronological level when you smoke or inject heroin, the drug gets into your bloodstream and it goes to your brain. When it’s in your brain it sits on what’s called opioid receptors, andin doing so gives the body a range of physical and psychological effects. It would make people feelrelaxed, it would make the pupils go to pinpoint and it would give muscle relaxation. One of thepsychological effects, which draws people into addiction, is this sense of being, what’s called an‘honoraic state’, it’s a dreamlike state, where people feel absolutely relaxed and calm and as if all theirworries have drifted away. That can be a very appealing – obviously, dangerously appealing – state forsome people. Heroin is also a very strong analgesic, a painkiller, and it’s also used in other forms likecodeine. Heroin is one of a group of drugs called opioids, and heroin is an illegal version but there arelots of legal versions of opioids such as codeine phosphate, which is used all the time to manage pain.Opioids are very successful as an analgesic, but of course along with those analgesic effects, by beingprofiled with the receptors they sit on, they have a range of other effects.Because both opium and heroin are illicitly manufactured from the poppy harvest, and so whereascodeine phosphate is pharmaceutically made, as a pure substance, opium and heroin are madedirectly from poppy seeds and so the danger for that is you don’t ever quite know what the purity of itis, because it’s made from plants and so the purity varies, sometimes dramatically. And that can haveits own risks for people using the drugs – in that they’re not quite sure what’s in the drug they’reusing, but also what strength it is.AP: How do you treat addiction? Is there a cure?Dr OBJ:There are some very good treatments available for people with drug problems in general andheroin problems in particular. Broadly speaking they are divided into treatments that reduce the harm41Resource Pack: The Knot of the Heart