Addiction and Opiates

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
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