quite as constiping as morphine, that it exerts an even more depressing effect on the appetite and the sexual functions, does not, however, contracts the pupils. I have given myself thousands of injections over a period of years with unsterilized, in fact dirty, needles and never sustained an infection until I used demerol. Then I came down with a series of abcesses one of which had to be lanced and drained. In short demerol seems to me a more dangerous drug than morphine. Methodone is completely satisfying to the addict, an excellent pain killer, at least as addicting as morphine. I have taken morphine for acute pain. Any opiate that effectively relieves pain to an equal degree relieves withdrawal symptoms. The conclusion is obvious: any opiate that relieves pain is habit forming, and the more effectively it relieves pain the more habit forming it is. The habit forming molecule, and the pain killing molecule of morphine are probably identical, and the process by which morphine relieves pain is the same process that leads to tolerance and addiction. Non habit forming morphine appears to be a latter day Philosopher’s Stone. On the other hand variations of apomorphine may prove extremely effective in controlling the withdrawal syndrome. But we should not expect this drug to be a pain killer as well.
The phenomena of morphine addiction are well known and there is no reason to go over them here. A few points, it seems to me, have received insufficient attention: the metabolic incompatibility between and alcohol has been observed, but no one, so far as I know, has advanced an explanation. If a morphine addict drinks alcohol he experiences no agreeable or euphoric sensations. There is a feeling of slowly mounting discomfort. The alcohol seems to be short-circuited, perharps by the liver. I once attempted to drink in a state of incomplete recovery from an attack of jaundice (I was not using morphine at this time.) The metabolic sensation was identical. In one case the liver was partly out of action from jaundice, in the other preoccupied, literally, by a morphine metabolism. In neither case could it metabolize alcohol. If an alcoholic becomes addicted to morphine, morphine invariably and completely displaces alcohol. I have known several alcoholics who began using morphine.They were able to tolerate larges doses of morphine immediately (1 grain to a shot) without ill effects, and in a matter of days stopped taking alcohol.The reverse never occurs. The morphine addict can not tolerate alcohol when he is using morphine or suffering from morphine withdrawal. The ability to tolerate alcohol is a sure sign of disintoxication. In consequence alcohol can never be substituted for morphine directly. Of course a disintoxicated addict may start drinking and become an alcoholic. During withdrawal the addict is acutely aware of his surroundings. Sense impressions are sharpened to the point of hallucination. Familiar objects seem to stir with a writhing furtive life. The addict is subject to a barrage of sensations external and visceral. He may experience flashes of beauty and nostalgia, but the overall impression is extremely painful – (Possibly his sensations are painful because of their intensity. A pleasurable sensation may become intolerable after a certain intensity is reached.)
I have noticed two special reactions to early withdrawal: (1) Everything looks threatening; (2) mild paranoia. The doctors ans nurses appear as monsters of evil. In the course of several cures, I have felt myself surrounded by dangerous lunatics. I talked with one of Dr. Dent’s patients who had just undergone disintoxication for a pethidine habit. He reported an identical experience, told me that for 24 hours the nurses and the doctor 'seemed brutal and repugnant.' And everything looked blue. 119
And I have talked with other addicts who experienced the same reactions. Now the psychological basis for paranoid notions during withdrawal is obvious. The specific similarity of these reactions indicates a common metabolic origin. The similarity between withdrawal phenomena and certain states of drug intoxication is striking. Hashish, Bannisteria Caapi (Harmaline), Peyote (Mescaline) produce states of acute sensitivity, with hallucinatory viewpoint. Everything looks alive. Paranoid ideas are frequent. Bannisteria Caapi intoxication specifically reproduces the state of withdrawal. Everything looks thrightening. Paranoid ideas are marked, especially with overdose. After taking Bannisteria Caapi, I was convinced that the Medicine Man and his apprentice were conspiring to murder me. It seems that metabolic states of the body can reproduce the effects of various drugs. In the USA heroin addicts are receiving an involuntary reduction cure from the pushers who progressively dilute their wares with milk, sugar and barbiturates. As a result many of the addicts who seek treatment are lightly addicted so they can be completely disintoxicated in a short time (7 to 8 days). They recover rapidly without medication. Meanwhile any tranquil-lizing, anti-allergic or sedative drug, will afford some relief, especially if injected. The addict feels better if he knows that some alien substance is coursing through his blood stream. Tolserol, Thorazine and related
'tranquillizers,' every variety of barbiturate, Chloral and Paraldehyde, antihistamines, cortisone, reserpine, even shock (can lobotomy be far behind?) have all been used with results usually described as 'encouraging.' My own experience suggests that these results be accepted with some reserve. Of course, symptomatic treatment is indicated, and all these drugs (with possible exception of the drug most commonly used: barbiturates) have a place in the treatment of the withdrawal syndrome. But none of these drugs is in itself the answer to withdrawal. Withdrawal symptoms vary with individual metabolism and physical type. Pigeon chested, hay fever and asthma liable individuals suffer greatly from allergic symptoms during withdrawal: running nose, sneezing, smarting, watering eyes, difficulty in breathing. In such cases cortisone and antihistamine drugs may afford definite relief. Vomiting could probably be controlled with anti-nausea drugs like thorazine. I have undergone ten 'cures' in the course of which all these drugs were used. I have taken quick reductions, slow reductions, prolonged sleep, apomorphine, antihistamines, a French system involving a worthless product known as 'amorphine,' everything but shock. (I would be interested to hear results of further experiments with shock treatment on somebody else.) The success of any treatment depends on the degree and duration of addiction, the stage of withdrawal (drugs which are effective in late or light withdrawal can be disastrous in the acute phase), individual symptoms, health, age, etc. A method of treatment might be completely ineffective at one time, but give excellent results at another. Or a treatment that does me no good may help someone else. I do not presume to pass any final judgements, only to report my own reactions to various drugs and methods of treatment. Reduction Cures. – This is the commonest form of treatment, and no method yet discovered can entirely replace it in cases of severe addiction. The patient must have some morphine. If there is one rule that applies to all cases of addiction this is it. But the morphine should be withdrawn as quickly as possible. I have taken slow reduction cures and in every case the result was discouragement and eventual relapse. Imperceptible reduction is likely to be endless reduction. When the addict seeks cure, he has, in most cases, already experienced withdrawal symptoms many times. He expects an unpleasant ordeal and he is prepared to endure it. But if the pain of withdrawal is spread over two months instead of ten days he may not be able to endure it. It is not the intensity but the duration of pain than breaks the will to resist. If opiate to alleviate the weakness, insomnia, boredom, restlessness, of late withdrawal, the withdrawal symptoms will be prolonged indefinitely and complete relapse is almost certain.
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Prolonged Sleep. – The theory sounds good. You go to sleep and wake up cured. Industrial doses of chloral hydrate, barbiturates, thorazine, only produced a nightmare state of semiconsciousness. Withdrawal of sedation, after 5 days, occasioned a severe shock. Symptoms of acute morphine deprivation supervened. The end result was a combined syndrome of unparalleled horror. No cure I even took was as painful as this allegedly painless method. The cycle of sleep and wakefulness is always deeply disturbed during withdrawal. To further disturb it with massive sedation seems contraindicated to say the least. Withdrawal of morphine is sufficiently traumatic without adding to it withdrawal of barbiturates. After two weeks in the hospital (five days sedation, ten days
'rest'), I was still so weak that I fainted when I tried to walk up a slight incline. I consider prolonged sleep the worst possible method of treating withdrawal.
