Narcotic drug

“ The many widely advertised drug cures derive their prosperity from the desperate desire of the narcotic addict to be cured of the condition which may at any time cause him intense physical suffering. The worst evil of the narcotic situation in the past few years, and especially since the enforcement of restrictive legislation, without provision for complete investigation of the whole situation, for education, and adequate treatment of disease aspects, is the rapid growth and spread of criminal and underworld and illicit traffic in narcotic drugs. ”

“ The idea that narcotic drug addiction should be accorded a basis of weakness of will—neurotic or otherwise, inherent or acquired—and should be classed as a morbid appetite, a vice, a depraved indulgence, a habit, has been generally unquestioned and the prevailing dogma for many years. It is very unfortunate that we have paid so little attention to material facts and have made so little effort to explain constant physical symptomatology on a basis of physical cause, and that there has not been a wider recognition and more general acceptation of scientific work that has been done. ”

“ There are very many addicts who have, out of their past experience and study upon themselves, competently controlled their own narcotic-drug-disease during treatment for other conditions, operative or medical. The number of narcotic addicts is not few who have been cared for [Pg 91] medically with nursing attention, or have undergone operations for the remedy of various surgical conditions, have recovered, convalesced and been discharged without the physician or surgeon becoming aware that his patient was addicted. ”

“ He knows that he experiences no sensuous gratification or other pleasure from its administration. He knows that he uses a narcotic drug simply and solely because he has to use it to escape physical incompetence and physical agony. As I said before, almost without exception the narcotic addict has proceeded of his own accord, or under the direction and advice of others, on the theory of exercising will power, and resisting temptation. ”

“ Narcotic drug addiction-disease in the man who is vicious or criminal or defective or degenerate should be treated as narcotic drug addiction-disease, as any other disease is treated in the same individual. ”

“ The many wrecks of addicts to be seen trying through insufficient supply of narcotic drug, self-poisoned with other drugs which they have purchased, alcohol, bromides, coal tar products, cocaine, and of late hyoscine—their addiction disease unrelieved and undiminished—are sufficient argument against mere reduction of dose, below physical body need. ”

“ The physician or surgeon should realize that the use of a narcotic drug by a patient under his care is of very little immediate importance compared with the satisfactory recovery of his patient from the condition for which he is treating him. ”

“ If anything has been demonstrated conclusively concerning narcotics it is that the methods of the past, legal, administrative, and medical, have not solved the narcotic drug problem, nor controlled the narcotic drug situation, nor been successful in the handling of the narcotic drug addict. ”

“ Whatever or whoever the narcotic addict was before his use of opiate drugs—whatever had been the character and circumstances of the initial administration of narcotic drug—after a time, as I have repeatedly written elsewhere, after addiction-disease has once developed, the history of every opiate addict is that of suffering and of struggle. ”

“ Consequently, the fewer number of times in a day a dose of narcotic drug is administered, the greater amount of competent metabolism is present—the more adequate is the patient’s elimination and nutrition—the smaller amount of opiate or its product lies stored in inhibited and atonic cells, and the smaller amount of antidotal substance is manufactured for the protection of the body, and to some extent, the smaller amount of opiate is required. ”

“ There should be some way to dissociate entirely, conclusively and finally in the minds of the public the illegitimate and underworld traffic in narcotic drugs from the efforts of the honest physician to practice rational and scientific medicine in the help of the worthy and deserving addict. ”

“ Misconception of them and neglect of sufficient consideration of them is the tragic aspect of the narcotic drug situation, and causes tremendous individual and economic wastage. They do not in any way associate with underground traffic unless or until driven to it by failure of legitimate sources of opiate medication, or by the surrounding of legitimate sources with such restrictions as make the man of standing and reputation, afflicted with addiction-disease, fear possible publicity and economic detriment. ”

“ It will be found upon careful examination that they are average individuals in their mental and moral fundamentals. Among them are many men and women of high ideals and worthy accomplishments, whose knowledge of narcotic administration was first gained by “withdrawal” agonies following cessation of medication, who have never experienced pleasure from narcotic drug, are normal mentally and morally, and unquestionably victims of a purely physical affliction. ”

“ The regulation of the narcotic drug traffic of the underworld or “underground” is not the business of the medical profession, and the burden of responsibility for it should not be placed upon the shoulders of the medical profession or the consequences of it made to react upon the head of the honest physician and innocent addiction sufferer. ”

“ It cannot be denied that in some cases unscrupulous holders of medical degrees have availed themselves of existing conditions in such a way that their supplying of opiates to narcotic addicts constitutes simply traffic in narcotic drugs and not the intelligent practice of medicine. ”

“ It should not be necessary to recall to memory many cases of upright, honorable and competent and apparently healthy men and women who have been narcotic addicts over very many years, unknown to but very few or none of their relatives or friends or even physicians. As has been stated before, their apparent immunity to the supposed stigmata of narcotic drug action was not due to the fact that they were on a higher mental or moral plane than their less fortunate fellows, or that they were possessed of sufficient will-power to resist temptation in the over-indulgence of their so-called appetite. ”

“ They proceed through the mild discomfort and nervousness of the previous stage to the definite manifestations and constant unmistakable withdrawal phenomena to be described. The patient endures physical suffering and displays all the clinical evidence of it. There can be no question of will-power in this stage, nor of desire for narcotic drug for any other purpose than to escape physical suffering. Whether the patient was primarily an innocent and unconscious recipient of the drug, or of the class of the vicious and weak, he is now fundamentally a sick man, afflicted with a physical disease. ”

“ The honest physician has no desire to dodge responsibility for his handling of narcotic addicts to the best of his ability, nor should he have any objection to a reasonable responsibility and accounting for narcotic drugs used in that handling; especially since the taking of narcotic drugs has in certain of its phases, developed as a serious situation entirely outside of the medical profession, in which situation these drugs are non-professionally supplied and used to such an extent as to constitute a public menace. ”

“ It is only here and there that the practitioner of internal medicine has been sufficiently inspired by scientific interest to seriously consider narcotic drug addiction and to make a clinical study of its actual physical manifestations and phenomena. ”

“ Most physicians have at some time or other made effort to rescue some victim from drug addiction, and as a rule have given over the effort as hopeless, because even when they had succeeded in taking his narcotic away from the patient, usually after an experience trying and exhausting to both, the patient has resumed narcotic administration—according to the patient, because he had to—according to the average observer, because he wanted to. ”

“ In exact proportion as the drug of addiction is present in the body to neutralize or oppose some antidotal poison, is the patient free from withdrawal symptoms and from physical craving for the narcotic drug. ”

“ Legislation which is unduly stringent or is capable of unduly stringent administration may have unfortunate reaction and influence upon honest effort in the care of the deserving sick. Restricting beyond reasonable limits the care of the honest narcotic drug addict simply tends to make it impracticable and dangerous for the average medical man to have anything to do with narcotic addicts, and to drive the honest and deserving patient into the underworld, into the insane asylum or to suicide. ”

“ It is a fact that the narcotic drugs may afford pleasurable sensations to some of those not yet fully addicted to them, and that this effect has been sought by the mentally and morally inferior purely for its enjoyment for the same reasons and in the same spirit that individuals of this type tend to yield themselves to morbid impulses, curiosities, excesses and indulgences. ”

“ With inhibition and auto and other toxemia eliminated or reduced to a minimum, the patient can go through many years, an apparent normal man, well-nourished, reactive, in good physical tone, mentally sane and physically competent. Under these conditions he shows practically nothing abnormal as long as he gets properly administered, his accustomed narcotic drug, in the amount of its minimum physical requirement or body-need. ”

“ The control of auto and intestinal intoxication in narcotic [Pg 79] addiction is as a rule of easy accomplishment if the patient is uninhibited and in functional balance and is not over-supplied or under-supplied with the drug of his addiction. The narcotic addict who is non-toxic and in drug balance and is not harassed by worry or fear needs practically no more drastic methods of elimination than his non-addicted brother. If he is over-dosed his elimination is inhibited; if he is under-dosed his eliminative powers are not capable of response. ”

“ It seems strange that a condition of as powerful influence over body function and metabolism as is exerted by the addiction mechanism of narcotic drug-disease should not long ago have received exhaustive and complete clinical and laboratory study along the lines of its manifestations and influences, as well as along the line of reduction and deprivation of the drug of addiction. ”

“ The paramount issue of legitimate narcotic medication is that of the opiates. Opiates form and must continue to form the most indispensable medication, emergency and otherwise, for shock, wounds and allied conditions. It may be safely stated that of all emergency medication, the opiates would be the last to be surrendered by the intelligent physician or surgeon. This is true of every day civil practice and its importance is increased tremendously under conditions of active warfare. ”

“ They should be classed as innocent or [Pg 28] accidental addicts—normal and worthy sick people. They earnestly desire treatment and help, and once their addiction process is completely arrested do not tend to return to narcotic drug use. ”

“ One of the most needed achievements in the line of practical remedy is the admission of narcotic drug addiction-disease to its legitimate place as an accepted part of the practice of internal medicine and the stimulating of education concerning it among medical practitioners, medical students and nurses. ”