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Addiction and Opiates

Addiction and Opiates

CHAPTER 2 THE EFFECTS OF

CHAPTER 2 THE EFFECTS OF OPIATES take them. In commenting on this attitude, Schultz observes: When they reach the end of the reduction, with complete withdrawal, there is not the same reaction of euphoria as after abrupt withdrawal, for several reasons. First, they are never really sure that they are getting less than they should anyway, and, in fact, they are always in a paranoid, suspicious state thinking they are not getting a square deal. They believe they are being fooled by sterile hypodermics and resent this idea because they often think they can detect when no more narcotics are given them, although they actually do not. When they are still getting opiates they sometimes believe they are getting sterile water (they call it "aqua" or "Swanee River" or "onion juice"); and, vice versa, they often think they are getting morphine when plain saline is given them."(16) One addict reported to me that he had been similarly deceived in a hospital, and that when he discovered it he left at once, resenting "their making a fool of me." He had been getting sterile hypodermics for ten days and was feeling quite well until an attendant, whom he had bribed to find out how much morphine he was getting, disclosed the truth. Instances of this kind are quite common. Indeed, it is remarkable that veteran addicts who have run the gamut of experiments with the drug can be deceived about its effects. Needless to say, individuals who have not bad, previous experience are much more readily and completely deceived. The patient who receives therapeutic drug treatment, or who becomes dependent upon morphine, does not ordinarily report anything more than relief from pain. If he has withdrawal symptoms, the latter are usually identified as symptoms of his disease, the after-effects of surgery, and so on. It seems evident that opiates do not produce an uncanny or extraordinary state of mind. In fact, if incidental events which serve as signs of the drug's presence are manipulated, the injection itself cannot even be recognized. In other words, nearly all the direct effects of the drug which last beyond a few minutes after the shot are such that they could easily be attributed to other causes if they appeared in isolation. Knowing that he is addicted, the addict ascribes his mental changes to the drug, not because they are recognizable as such but because they always accompany the shot. The characteristic impact of the drug, coupled with the changes in feeling tone intimately associated with the injection, assures him that it was an opiate and nothing else. In addition, the withdrawal symptoms inevitably remind him of the need for a further supply. When all these incidental aspects of addiction are taken out of his control, the patient becomes uncertain of his feelings, and the psychological satisfaction derived from the belief that he is receiving morphine may closely simulate the cyclic changes that occur with actual injections. During an abrupt withdrawal, without substitute medication, it is quite impossible to deceive an addict into believing that his distress is due to any cause other than a shortage or absence of opiates in his system, It will be noted that all deception involves the suppression of the drug's physical impact and the absence of pronounced withdrawal symptoms. When either of these two factors is clearly identified, deception is no longer possible. The point may be made in another way by comparing opiates with other drugs that do produce sensational and spectacular effects, such as LSD. It is impossible to imagine an LSD user going on a "trip" without realizing it, or experiencing the LSD effect from eating a cube of sugar which he erroneously believed to contain the drug. While there has been considerable interesting research in recent years on the placebo effect in other areas, very little of it has been done with addicts or with the opiates. The unexploited possibilities of this sort of a research enterprise are suggested by certain events following World War 11. It was reported by some investigators that a new form of addiction to heroin had been found among juveniles. Its peculiarity was that it involved Do withdrawal symptoms. It later appeared that this idea was derived from the heavy dilution of the drugs sold by the peddlers, so that addicts who believed themselves to be addicted were in fact using such a heavily diluted product that the), were not getting enough to maintain physical dependence. Some of these users were themselves surprised and humiliated, when, after claiming to have big habits, they experienced little distress upon withdrawal. The peddlers bad, in effect, administered a gradual reduction cure without their customers realizing it! Direct and Indirect Effects The addict's claim that he feels normal under the influence of drugs obtains further support from the fact that the study of the effects of opiates upon the body and bodily functions have uncovered either only minor injurious effects or none file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33]

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 file:///I|/drugtext/local/library/books/adopiates/chapter2.htm[24-8-2010 14:23:33]

PRESCRIPTION ADDICTION
Opioid Addiction