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Addiction and Opiates

Addiction and Opiates


CHAPTER 2 THE EFFECTS OF OPIATES a sensitive man, with certain neurotic ailments, may be tremendously impressed with the soothing qualities of the drug, and by contrast with his usual state of mind, may feel intense pleasure. On the other hand, a prosaic and stolid person, with no sense of strain or conflict, may be wholly unaffected.(6) A good account of the most common initial effects was given by Louis Faucher, who experimented on himself while preparing a thesis on morphinism at the medical college of the University of Montpellier.(7) He took one dose each day for six days, stopped for fifteen days, and then repeated the experiment. He wrote: The initial effects were pleasant.... Then, for a brief moment I noticed a feeling of unusual well-being; my bed was more pliable, the objects in my room seemed more familiar, my body seemed lighter. I also had at the same time two unpleasant experiences.... Then when everything became silent again I began to experience the euphoria of morphine. It made the night sweet for me; I can scarcely express in any other way the subtle pleasure that I experienced. It is true I noticed nothing extraordinary; I had no illusion or hallucinations. My breathing was easier and freer. I thought about my personal affairs, my work and my dislikes. Things that had seemed difficult now seemed easy. Some of the problems of real life appeared to me in a new guise, with their solutions perfectly obvious.... It was nothing. It was scarcely noticeable. But it was good.(8) Withdrawal Symptoms The regular administration of opiates, extending over a period of time, creates a physiological need for its continuance. Once habitual use is stopped, a number of distressing symptoms appear, increasing in severity in proportion to the period of addiction and depending upon the size and frequency of the dosage. In fact, no matter why the drug was first taken, its continued use leads to a periodic, artificially produced depression and distress which disappear immediately upon repetition of the dosage. After about three weeks of regular daily use, the abstinence symptoms apparently increase at an accelerated tempo and rapidly become very severe and even dangerous. A discussion of almost any aspect of the drug habit invariably involves a consideration of these withdrawal symptoms, which are uniquely associated with the use of opiates. Animals and infants, as well as adults who unwittingly receive drugs, suffer withdrawal symptoms which are similar to those of the addict. This fact demonstrates that the distress is not "imaginary" but is based upon disturbances of organic functions. A. B. Light, E. G. Torrance, and their co-authors have provided an excellent chronological account of the withdrawal symptoms accompanying the discontinuance of opiates, based on observation and experimentation with American underworld addicts who submitted themselves for cure at the Philadelphia General Hospital. They described the behavior of their patients during withdrawal as follows: As the time approaches for what would have been the addict's next administration of the drug, one notices that he glances frequently in the direction of the clock and manifests a certain degree of restlessness. If the administration is omitted, he begins to move about in a rather aimless way, failing to remain in one position long. He is either in bed, sitting on a chair, standing up, or walking about, constantly changing from one to another. With this restlessness, yawning soon appears, which becomes more and more violent. At the end of a period of about eight hours, restlessness becomes marked. He will throw himself onto a bed, curl up and wrap the blankets tightly around his shoulders, sometimes burying his head in the pillows. For a few minutes he will toss from side to side, and then suddenly jump out of the bed and start to walk back and forth, bead bowed, shoulders stooping. This lasts only a few minutes. He may then lie on the floor close to the radiator, trying to keep warm. Even here he is not contented, and he either resumes his pacing about, or again throws himself onto the bed, wrapping himself under heavy blankets. At the same time he complains bitterly of suffering with cold and then hot flashes, but mostly chills. He breathes like a person who is cold, in short, jerky, powerful respirations. His skin shows the characteristic pilomotor activity well known to those persons as "cold turkey." The similarity of the skin at this stage to that of a plucked turkey is striking. Coincident with this feeling of chilliness, he complains of being unable to breathe through his nose. Nasal secretion is excessive. He has a most abject appearance, but is fairly docile in his behavior. This is a picture of his appearance during the first eight hours. Often at the end of this period the addict may become extremely, drowsy and unable to keep his eyes open. If he falls asleep, which is often the case, he falls into a deep slumber well known as the "yen" sleep. It takes unusual noises to file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33]

CHAPTER 2 THE EFFECTS OF OPIATES awaken him. The sleep may last for as long as eight or twelve hours. On awakening, he is more restless than ever. Lacrimination, yawning, sneezing, and chilliness are extreme. A feeling of suffocation at the back of the throat is frequently mentioned. Usually at this stage, the addict complains of cramps, locating them most frequently in the abdomen, but often in the back and lower extremities. A right rectus rigidity with pain localized over the appendical region is not uncommon; one can easily be misled in the diagnosis, since at this stage a leucocytosis is frequently present. Vomiting and diarrhea appear. He may vomit large quantities of bile-stained fluid. Perspiration is excessive. The underwear and pajamas may become saturated with sweat. Muscular twitchings are commonly present; they may occur anywhere, but are most violent in the lower extremities. He may sit in bed with his leg flexed, grasping it tightly below the knee, fearing the twitch will suddenly throw it into a complete extension which be cannot control. If he is handed a cigarette to smoke, his hands tremble so violently that he may have difficulty in placing it in his mouth. The tremor is so marked that he is unable to light it himself. He refuses all food and water, and frequently sleep is unknown from this point. It is at this stage that he may one minute beg for a "shot" and the next minute threaten physical violence. Nothing can make him smile. He will beat his head against the wall, or throw himself violently on the floor. Any behavior which he thinks will bring about the administration of the drug will be resorted to. Occasionally he may complain of diplopia. Seminal emission in the male and orgasms in the female frequently occur. We believe that the height of these withdrawal symptoms is reached somewhere between the period of forty-eight hours and seventy-two hours following the last dose of the drug taken. The readministration of the drug promptly brings about a dramatic change. The patient becomes exceedingly docile almost with the puncture of the hypodermic needle. in a few minutes he begins to feel warm, and the goose flesh and perspiration are no longer visible. He speaks about a "heaviness" in his stomach, but regards this as a welcome symptom presaging relief. In a period ranging from thirty minutes to one hour the tremors disappear. He has become strong and well. He no longer walks with bowed head and stooped shoulders. He stands erect, is quite cheerful, and lights his cigarette like any normal person. He becomes profuse in his apologies for his conduct during the abrupt withdrawal of the drug.(9) Mild withdrawal symptoms appear after a very few injections provided that the injections are sufficiently large and are spaced close enough to each other to produce a cumulative effect. As use continues, it becomes necessary, if the withdrawal symptoms are to be prevented from appearing, to increase the amounts taken and to take more doses per day. As the withdrawal symptoms become more intense, the effects of the injections that eliminate them become correspondingly more pronounced. In the earliest stages of use both withdrawal distress and euphoria may be so slight as to go unnoticed. With repeated and increased doses both the distress and the euphoria are greatly increased; the latter particularly by the fact that it is augmented by relief of withdrawal. Eventually, as will be indicated later, the positive euphoria obtainable from the drug diminishes or vanishes, leaving the addict with two main sources of gratification: (i) relief of withdrawal symptoms and (2) impact effects that are felt immediately after an injection for a period of perhaps five to ten minutes. Reversal of Effects According to Sandoz, the continued administration of morphine causes the following changes in initial effects: The duration of the effect of the morphine is shortened. Whatever untoward effects were present at the beginning disappear. The same dose will become less and less effective, or must be increased in order to obtain the same effect. More than this, the original feeling of unusual well-being can no longer be obtained; under the influence of morphine the chronic user will simply feel "normal."(10) In the beginning phases of addiction, the pleasurable effects of drugs, other than those that occur at the time of injection, tend to diminish and vanish. As this occurs, and as withdrawal distress increases, the psychological significance of the doses changes. Whereas they at first produced pleasure, their primary function becomes that of avoiding pain, that is, withdrawal. The addict seems to continue the use of the drug to avoid the symptoms which he knows will appear if he stops using it. This change or reversal of psychological effects appears to have its counterpart on the bodily level, for here too the effects of morphine and heroin upon the addict are very different from and in some respect the opposite of what they file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33]

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