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Addiction and Opiates

Addiction and Opiates


CHAPTER 2 THE EFFECTS OF OPIATES file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33] PART I The Nature of the Opiate Habit CHAPTER 2 THE EFFECTS OF OPIATES A nondrinker engaged in the 'study of alcoholics might deliberately get drunk once himself in order to understand his subjects better. There are, however, two excellent arguments for not doing this in the case of opiates. First, the effects of a small amount of drugs upon a non-addict are in almost no sense comparable to their effects upon an addict; indeed, in many respects, they are quite the opposite, and the difference not only is one of degree but is definitely qualitative as well. Second, the experiment would be too dangerous. Under normal circumstances a man can deliberately make himself drunk and can be none the worse when he recovers. But it is doubtful whether anyone can use morphine long enough to acquire the same experiences as an addict without himself becoming one. Since the first injections of morphine which a non-addict receives are usually gratifying, either in a positive sense or because of the relief from pain afforded, it is the popular impression that the pleasure of the addict must be immensely greater, especially in view of the enormous sacrifices that he makes to keep himself supplied with the drug. Plausible as this notion seems, it is nevertheless fallacious. The effect of opiates upon the human organism constitutes a problem for physiologists and biochemists. We are here concerned mainly with the question of how the physiological and psychological effects of the drug are perceived by the addict. Initial Effects The first effects of injections of opiates administered to non addicts are, as we have said, usually but not always pleasurable. The sensation or experience varies greatly depending upon the person, the setting, the mood of the user, and the size of the dose and the manner in which it is taken. The intravenous method of use produces the sharpest and most noticeable impact. In some instances, as Becker has reported with respect to marihuana, the beginner experiences effects which he does not recognize as being associated with the shot, no doubt because he anticipated something else.(1) Sometimes, even in the case of individuals who later become addicted, the initial injections may produce unpleasant sensations such as headache, dizziness, and nausea. There are also some persons who appear to have something like an opiate allergy, so that the drug, even with repeated use, does not produce pleasurable feelings but leads instead to increasing discomfort and distress. Such persons are very rare. They do not, of course, become addicted. To the average person, however, the first dose may bring sleep, or it may, especially if it is small, stimulate him to extra activity or mental effort. Under different circumstances the same person will be variously affected, even though the dose is of the same strength. When the subject is depressed or fatigued the effects of a small dose are usually much more noticeable then when be is normal and in good spirits. In fact, the more closely he approximates a normal condition, the less likelihood there is of his noticing any reaction at all when be takes the first dose. The learning processes involved in the first trials of the drug are illustrated by incidents related to me by addicts. For example, a man who experimented with opiates in the presence of two addicts reported that be felt nothing except nausea, which occurred about half an hour after the injection. It took a number of repetitions and some instruction from his more sophisticated associates before this person learned to notice the euphoric effects. In another instance an individual who complained that she felt nothing from two closely spaced injections amused her addicted companions by rubbing her nose violently while she made her complaints. A tingling or itching sensation in the nose or other parts of the body is a common effect of a large initial dose. Experiments made by Beecher (2) with non-addicted subjects who were given injections of various kinds of drugs, including heroin, along with placebos, provide a more sober perspective on initial effects of opiates than that which is often projected in the popular literature. Beecher's subjects did not know what particular drug they were given nor did those who received placebos know this fact. All were asked to report on the degree of pleasure or displeasure they felt

CHAPTER 2 THE EFFECTS OF OPIATES after being given what they supposed to be a drug. Those who received placebos reported greater pleasure than those who were given heroin. This result may well have been produced by the unpleasant initial effects that sometimes occur and to which allusion has already been made. It is of interest that the addict redefines such effects as desirable and welcomes them because they are indications to him of good quality drugs. The disagreeable effects that sometimes accompany the first few trials of the drug ordinarily disappear after a few or several repetitions of the dose. There then follows in most cases what has been called a "honeymoon" period during which the person on his way to addiction increases the size of his dose and for a time experiences a more intense euphoria. The latter has often been described in the popular literature. It appears to consist largely of a subtle feeling of being at home in the world and at peace with it. The effect is more marked if the individual is depressed, fatigued, or troubled when be takes his shot. One of my addicted subjects commented as follows on the drug's effects: Contrary to the belief entertained by many, if not most, a dose or a series of doses of opium derivatives does not produce a supernormal state. It does not produce the ability to do things better, to think or reason with greater clearness than would be possible without the drug. It is true that in some conditions of mind or body, and perhaps during the short initial period of addiction, the drug will seemingly lift one up to a state where the perceptibilities are sharpened, where the senses are better able to cope with any given situation than would be the case without drugs. But a careful analysis of the condition of the individual would usually elicit the fact that he was considerably below par, in some respect, before he took the drug. All that it has done is to restore him to a normal, or nearly normal, state of mind and body. Opiates do not produce spectacular or uncanny states of mind like those attributed to LSD. There are no hallucinations, waking dreams, illusions, or other psychotic-like effects associated with them. Popular writers have sometimes attributed such effects to heroin and other opiates probably because they have been influenced more by literary stereotypes or a desire to create a dramatic effect than by the actual testimony of addicts. The latter too is often colored by the user's craving for the drug, which leads him to retrospective exaggeration. Friedrich Chotzen observed in 1902: Nearly all authors agree that the chronic abuse of morphia in contra-distinction to other poisons gives rise to no special psychosis. . . . When mental disturbances occur in chronic users of morphine, these are referred for the most part to contemporary complicating poisoning by other poisons, especially alcohol, chloral hydrate, and cocaine.(3) Along similar lines, Lawrence Kolb observed in 1925: There is no destruction of protoplasm such as follows prolonged excessive use of alcohol. Neither nerve cells nor fibers degenerate; consequently, the drug cannot produce diseases analogous to Korsakoff's psychosis, acute hallucinosis, or alcoholic multiple neuritis, and hospitals for the insane have remarkably few cases diagnosed as drug psychoses. Such psychoses are so rare that one is led to suspect that case 7-2 is typical of most of those that do occur. [This was a case of the use of cocaine and morphine in combination.(4) The initial effects then consist largely of a general dulling of sensibilities, accompanied by a pleasant though not sensational or uncanny state of mind which is characterized by freedom from pain and worry and by a quickened flow of ideas. It should be emphasized again that normal, healthy persons may fail to notice any initial effects whatsoever if they are not on the watch for them. As C. Edouard Sandoz has stated: The widely spread belief that morphine brings about an uncanny mental condition, accompanied by fantastic ideas, dreams and whatnot, is wrong, notwithstanding certain popular literature on the subject. The most striking thing about morphine, taken in ordinary doses by one who is not an addict, is that it dulls general sensibility, allays or suppresses pain or discomfort, physical or mental, whatever its origin, and that disagreeable sensations of any kind, including unpleasurable states of mind &re done away with. In fact, the suppression of pain is the only outstanding effect of morphine when given for that purpose. The more normal a person feels, the less marked, as a rule, the effects will be."(5) Naturally, the evaluation of the first effects of opium will vary in accordance with the character of the individual. Thus file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33]

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