Addiction and Opiates

CHAPTER 2 THE EFFECTS OF OPIATES
at all that can be traced directly to the drug. Allusion was made earlier to the prevalence of constipation, tooth decay,
and reduced appetites among addicts. Some of these, such as tooth decay, for example, are not traceable directly to the
drug. There are persons who have used drugs for long periods of time and who have no tooth decay at all. This
suggests that this particular ailment is associated with some incidental aspect of the addict's way of life rather than
with the drug per se. The same may be said of the depression of sex activity, since users sometimes report no such
effect and may even regard the drug as an aphrodisiac.
Apart from the above considerations, if it is asked whether the regular use of drugs such as morphine and heroin
produces any major bodily malfunction or destruction of tissue, the answer on the basis of available evidence must be
that apparently it does not. W. G. Karr, professor of biochemistry at the University of Pennsylvania, commented as
follows:
The addict under his normal tolerance of morphine is medically a well man. Careful studies of all known medical tests
for pathologic variation indicate, with a few minor exceptions, that the addict is a well individual when receiving
satisfying quantities of the drug. He responds to work in the normal manner. His weight is normal. His cardiac and
vascular system is normal. He is as agreeable a patient, or more so, than other hospital cases. When he is abruptly
withdrawn from the drug he is most decidedly a sick individual.(17)
Light and Torrance reach a similar conclusion. They observe:
... morphine addiction is not characterized by physical deterioration or impairment of physical fitness aside from the
addiction per se. There is no evidence of change in the circulatory, hepatic, renal or endocrine functions. When it is
considered that these subjects had been addicted for at least five years, some of them for as long as twenty years, these
negative observations are highly significant.(18)
In view of such typical findings, any attempt to attribute decay of "character" or of "moral sense" to the drug must be
regarded as unwarranted, since there are no known physiological or neurological changes to which they may
conceivably be related. Moreover, in the therapeutic administration of opiates to patients who are unaware of what
they are receiving, no such results have ever been reported. In fact, the trend has been in the opposite direction. After
an exhaustive review of reports on the alleged effects of opiates, Terry and Pellens in 1928 concluded: "Wherever the
truth may lie, the evidence submitted in support of statements ... dealing with type predisposition and with the effects
of opium use on mental and ethical characteristics is, in our opinion, insufficient to warrant the opinions
expressed."(19) This Conclusion still appears valid.
It was noted early in this chapter that the user who characteristically maintains that he feels normal under the drug's
influence also characteristically describes the effects of the drug with great enthusiasm. This seeming inconsistency
arises from the different points of reference in the two assertions. When the user says he feels normal he refers to the
interval between shots, which may be taken as four hours here for illustrative purposes. The praise he bestows on the
drug's effects refers to the sensations that occur when the injection is made and immediately after. These might be
called "impact" effects. They may last for five to ten minutes in the case of intravenous injections. The intensity of the
pleasure the addict obtains from them depends in considerable part on the intensity of distress or depression
immediately preceding the shot. It is from this contrast between the way the addict feels before and the way he feels
after an injection that be derives his ideas of the desirable effects of the drug. Viewed in this light the apparent
inconsistency of the addict's claims vanishes and the importance which he attaches to "feeling the shot," that is, the
impact effect, is made more intelligible. When I confronted addicts with the- inconsistency involved in simultaneously
talking of the wonderful effects of drugs and of feeling normal under its influence, some were ready to concede that it
was probably the relief of beginning withdrawal symptoms that created the favorable impression of the drug. Another
idea was that it was simply a reflection of the intensity of the addict's craving; that he enjoys the drug so much because
be desires it so intensely rather than because it is inherently enjoyable.
The ideas that the drug addict's inner life is serene and' untroubled, that he lives in a world of drug-induced fantasy
and dreams, or that his life is dominated by ecstasy are completely false. The average American addict is in fact a
worried, troubled, and harried individual. Misery, alienation, and despair. rather than pleasure and ecstasy, are the key
features of his life. After the honeymoon period, the user usually feels trapped by the inexorable rhythm of his habit
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