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Addiction and Opiates

Addiction and Opiates


CHAPTER 2 THE EFFECTS OF OPIATES are on the non-addict. In the latter the first effects of the drug are to produce disturbances of normal bodily functions. With continued administrations as tolerance and physical dependence are established, most but not all of these disturbed functions seem to return to normal or nearly so. A new body equilibrium or "drug balance" is established and is upset only or primarily when the drug is stopped. Many biologically oriented investigators have noted this fact and pointed to the necessity of distinguishing between opiate effects observed in non-using subjects and those found in addicts. Erlenmeyer, a German investigator, wrote as follows on this point: The continued administration of morphine exerts an entirely different effect on a morphinist from that exerted by a single medium dose of morphine injected into a healthy person. While this latter causes nausea, even vomiting, feeling of faintness, heart weakness, pulse acceleration and lowering of the blood pressure, the former occasions just the opposite feelings, sensations and states ... namely pleasant feeling, euphoria, increased power, and, in the heart and vessels, strengthening of the contraction, invigoration of the pulse, and rise of the blood pressure. Since every morphinist has once had the first morphine injection, there arises the question: by what means and at what time of the continued abuse does this reversal of effect take place? Is it brought about as follows: The morphine, originally foreign to the body, becomes an intrinsic part of the body as the union between it and the brain cells keeps growing stronger; it then acquires the significance and effectiveness of a heart tonic, of ail indispensable element of nutrition and subsistence, of a means of carrying on the business of the entire organism. . . . This reversal does not occur abruptly, but very, very gradually. If morphine is withdrawn before this reversal, the abstinence symptoms do not appear."(11) Although Erlenmeyer's apparent assumption that the initial effects of morphine arc always or usually unpleasant may be incorrect, his main point is one that has been made in one form or another by many investigators. Amsler, for example, argued that morphine has two effects on a nontolerant individual: a narcotic or depressing one which lasts a relatively long time and is followed by a short period of stimulation. As addiction progresses, the stimulating phase gradually becomes dominant and reduces and finally eliminates the depressing phase. (12) An explanation or theory, of addiction cannot be based on the first effects of the drug on the beginner if these effects are reversed or vanish when addiction is established. Moreover, the initial effects of the drug may never be experienced at all by a hospital patient who is unconscious and they may be unnoticed by other patients who are seriously ill or in great pain. Addiction may nevertheless follow from these circumstances and from any others that involve regular use or administration over a sufficient period of time. The theoretical problem posed by addiction is therefore altogether separate and distinct from that of accounting for the initial use of drugs. Since an unconscious person may have drugs administered to him to the point of establishing physical dependence, it appears that mere use of drugs does not constitute a unitary or homogeneous pattern of behavior which could be accounted for by one general theory applicable to all such use. The central theoretical problem of addiction concerns, not the initial use, but the continued, voluntary and regular use of drugs after physical dependence has been built up. Taking regular, closely spaced doses (for example, four hours apart), the beginner soon notes a feeling of slight depression before each shot, and a vague depletion of energy signaling the beginning of the withdrawal symptoms. Following the injection, his energy is revived, his efficiency, both mental and physical, is restored, and he is again prepared to go about his ordinary affairs. An injection delayed beyond the usual time will bring greater relief, varying according to the depression preceding it. Various methods of administering the drug produce different effects. For example, intravenous injection brings an intense physical thrill, sometimes compared by the addicts to sexual ecstasy. The sensation is momentary. On the other band, oral use of opiates causes a gradual transition of feeling tone, with relief as the primary sensation. Some addicts find pleasure in making the puncture with the needle, and in playing with the injection; others who are "needle-shy" find the puncture distasteful and may avoid using the needle altogether. Addicts almost invariably assert that, apart from the physical impact of injections, they feel "normal" or "usual" under the drug's influence. At the same time, with apparent inconsistency, they also extravagantly praise its effects upon them. To say that one feels normal is, of course, not entirely the same as saying that one is normal. American addicts, for example, are chronically afflicted by constipation, their appetites for sex and food are commonly reduced, and they have much more tooth decay than does the general population. Mortality rates of addicts are not exactly known, but they are undoubtedly high. These are items of which addicts are well aware, and they have many other troubles besides. When they say they feel normal they refer to a state of mind, not to the state of their bodies, their finances, or their social relations. file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33]

CHAPTER 2 THE EFFECTS OF OPIATES In the above sense, there is only one authoritative source on how a given addict feels, and that is the addict himself. The tendency of the outsider who learns about addiction from the mass media is to assume that the drug user who sacrifices so much and undergoes so many deprivations and miseries for the sake of his habit must obtain an extraordinary euphoria from it-in other words, that the drug must make him feel very extraordinary indeed. The idea that addicts experience uncanny psychological pleasures and live a life of ecstasy is false on the face of it and is denied by them. Their denial must be accepted unless evidence can be produced to discredit it. Available evidence, however, tends to confirm the user's view. For example, it is conclusively established that under appropriate circumstances addicts can be deceived into believing that they are receiving drugs and are under their influence when in fact they are not. They may also be led to believe that they are not under the influence of drugs when they in fact are. An illustration is provided by a gradual reduction method of curing addicts that has been practiced in this country and that has also been used elsewhere. These cures involved gradual reduction of dosage with saline solution substituted gradually for the drug until after a period of time (such as two weeks) the patient was being given only saline and no drugs at all. In some of these systems the injections were continued on a regular basis for a -period of time after complete withdrawal of the drug bad been effected. The addicts, who were not told what the program was, often thought they were still getting drugs after it had been discontinued and others thought they were off drugs when in fact they were still receiving substantial doses. I have interviewed ex-patients who sheepishly admitted that such deception had been successfully practiced on them for as long as ten days. One addict said that he knew of two women who had received water or saline for an entire month under the impression that it was morphine. It is also reported that addicts who demand drugs for insomnia can sometimes be put to sleep with a sterile hypodermic if they believe it is morphine. Conversely, when they have been given a morphine injection and have been told that it was a non-opiate drug, they may continue to complain. Instances of this kind have been so generally noted in the literature and reported so often by addicts that the possibility of such deception must be considered an established fact. Dr. Charles Schultz performed an experiment in which half of a group of subjects were put on a seven-day reduction treatment, and the other half on a fourteen-day schedule; for the former, the daily dose was reduced by one-seventh, and for the latter by one fourteenth.(13) As a result, some patients on the fourteen-day schedule thought they were receiving the seven-day treatment, and after the expiration of seven days began to show great nervousness and restlessness, one subject even resorting to an apparently simulated convulsion. When it was explained to them that they had been put on a fourteen-day course, and that they were still getting half of their beginning dosage, all symptoms disappeared at once. (14) A similar illustration is furnished by a former addict, a soldier who was wounded at the front and lay unconscious in a hospital for several days. Opiates were freely administered to him, but when he regained consciousness he did not realize that he was under the influence of drugs until the characteristic and unmistakable distress of withdrawal appeared. In a personal communication to me, a physician reported that a woman patient about to undergo a painful operation had asked him not to administer opiates under any circumstances, explaining that, although an abstainer, she had once been addicted and that a single injection might cause a relapse. Even if it were a matter of life and death, she begged that no opiates be given her, The doctor agreed, but after the operation the patient suffered such intense pain that a narcotic prescription became absolutely necessary, and was administered orally disguised in liquid form. It made the patient more comfortable and relieved the pain. Since she was not aware that she had received the opiate there was no relapse into the former habit. Later she thanked the doctor for his support of her program of abstinence. R. N. Cbopra and his collaborator performed an ingenious experiment along the same lines. They disguised opium by administering it in oil of citronella as "tonic number X" to patients in a Calcutta hospital who complained of pain and demanded relief.'(15)" This device revealed the malingering addict, for be always continued to complain after the opium bad been taken, while nonaddicts admitted that they felt relieved. The absence of a distinctive or unusual state of mind produced by the drug is clearly revealed by another interesting phenomenon. The addict's common complaint during a cure of the gradual reduction type, is not that he suffers from withdrawal, but that be cannot "feel the shots." When such a point is reached many addicts demand that the drug be discontinued entirely, preferring not to prolong the suspense; since they cannot feel the injections, they may as well not file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33]

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