Antihistamines. – The use of antihistamines is based on the allergic theory of withdrawal. Sudden withdrawal of morphine precipitates an overproduction of histamine with consequent allergic symptoms. (In shock resulting from traumatic injury with acute pain large quantities of histamine are released in the blood. In acute pain as in addiction toxic doses of morphine are readily tolerated. Rabbits, who have a high histamine content in the blood, are extremely resistant to morphine.) My own experience with antihistamines has not been conclusive. I once took a cure in which only antihistamines were used, and the results were good. But I was lightly addicted at the time, and had been without morphine for 72 hours when the cure started. I have frequently used antihistamines since then for withdrawal symptoms with disappointing results. In fact they seem to increase my depression and irritability (I do not suffer from typical allergic symptoms). Apomorphine. – Apomorphine is certainly the best method of treating withdrawal that I have experienced. It does not completely eliminate the withdrawal symptoms, but reduces them to an endurable level. The acute symptoms such as stomach and leg cramps, convulsive or maniac states are completely controlled. In fact apomorphine treatment involves less discomfort than a reduction cure. Recovery is more rapid and more complete. I feel that I was never completely cured of the craving for morphine until I took apomorphine treatment. Perhaps the 'psychological' craving for morphine that persists after a cure is not psychological at all, but metabolic. More potent variations of the apomorphine formula might prove qualitatively more effective in treating all forms of addiction. Cortisone. – Cortisone seems to give some relief especially when injected intravenously. Thorazine. – Provides some relief from withdrawal symptoms, but not much. Side effects of depression, disturbance of vision, indigestion offset dubious benefits. Reserpine. – I never noticed any effect whatever from this drug except a slight depression. Tolserol. – Negligible results.
Barbiturates. – It is common practice to prescribe barbiturates for the insomnia of withdrawal. Actually the use of barbiturates delays the return of normal sleep, prolongs the whole period of withdrawal, and may lead to relapse. (The addict is tempted to take a little codeine or paregoric with his nembutal. Very small quantities of opiates, that would be quite innocuous for a normal person, immediately re-establish addiction in a cured addict.) My experience certainly confirms Dr. Dent’s statement that barbiturates are contraindicated.
Chloral and paraldehyde. – Probably preferable to barbiturates if a sedative is necessary, but most addicts will vomit up paraldehyde at once. I have also tried, on my own initiative, the following drugs during withdrawal
Alcohol. – Absolutely contraindicated at any stage of withdrawal. The use of alcohol invariably exacerbates the withdrawal symptoms and leads to relapse. Alcohol can only be tolerated after metabolism returns to normal. This usually takes one month in cases of severe addiction. 121
Benzedrine. – May relieve temporarily the depression of late withdrawal, disastrous during acute withdrawal, contraindicated at any stage because it produces a state of nervousness for which morphine is the physiological answer.
Cocaine. – The above goes doubles for cocaine.
Peyote,
In cases of severe addiction, definite, physical, withdrawal symptoms persist for one month at least.
I have never seen or heard of a psychotic morphine addict, I mean anyone who showed psychotic symptoms while addicted to an opiate. In fact addicts are drearily sane. Perhaps there is a metabolic incompatibility between schizophrenia and opiate addiction. On the other hand the withdrawal of morphine often precipitates psychotic reactions – usually mild paranoia. Interestting that drugs and methods of treatment that give results in schizophrenia are also of some use in withdrawal: antihistamines, tranquillizers, apomorphine, shock.
Sir Charles Sherington defines pain as 'the psychic adjunct of an imperative protective reflex.' The vegetative nervous system expands and contracts in response to visceral rhythms and external stimuli, expanding to stimuli which are experienced as pleasurable – sex, food, agreeable social contacts, etc. – contracting from pain, anxiety, fear, discomfort, boredom. Morphine alters the whole cycle of expansion and contraction, release and tension. The sexual function is deactivated, peristalsis inhibited, the pupils cease to react in response to light and darkness. The organism neither contracts from pain nor expands to normal sources of pleasure. It adjusts to a morphine cycle. The addict is immune to boredom. He can look at his shoe for hours or simply stay in bed. He needs no sexual outlet, no social contacts, no work, no diversion, no exercise, nothing but morphine. Morphine may relieve pain by imparting to the organism some of the qualities of a plant. (Pain could have no function for plants which are, for the most part, stationary, incapable of protective reflexes.) Scientists look for a non-habit forming morphine that will kill pain without giving pleasure, addicts want – or think they want – euphoria without addiction. I do not see how the functions of morphine can be separated, I think that any effective pain killer will depress the sexual function, induce euphoria and cause addiction. The perfect pain killer would probably be immediately habit forming. (If anyone is interested to develop such a drug, dehydro-oxy-heroin might be a good place to start.)
The addict exists in a painless, sexless, timeless state. Transition back to the rhythms of animal life involves the withdrawal syndrome. I doubt if this transition can ever be made in comfort. Painless wihdrawal can only be approached.
It is standard practice for cocaine users to sit up all night shooting cocaine at one minute intervals, alternating with shots of heroin mixed in the same injection to form a 'speed ball.' (I have never known an habitual cocaine user who was not a morphine addict.) The desire for cocaine can be intense. I have spent whole days walking from one drug store to another to fill a cocaine prescription. You may want cocaine intensely, but you don’t have any
