Opioid

“ The mere fact that a physician has reduced a narcotic addict’s opiate intake from a large dosage to a very small dosage, or indeed has denied him any opiate at all for a considerable length of time, is no evidence that he is curing or [Pg 76] has cured his patient of addiction-disease. Unless the physical mechanism of body-need for an opiate has been completely and actually quieted, the patient may have in his body for perhaps weeks and months after the last administration of the drug, a physical demand for it. The taking of opiate does not constitute opiate addiction-disease. ”

“ Of the prescriptions furnished by physicians I found that forty-two per cent were filled the second time, and of those refilled twenty-three per cent contained opium in some form. Again, twenty-eight per cent of all prescriptions are filled a third time; and of these, sixty-one per cent were for opiates; while of the twenty per cent taken for the fourth filling, seventy-eight per cent were for the narcotic drug, proving, beyond a doubt, that it was the opiate qualities of the medicine that afforded relief and caused the renewal. ”

“ In other inflammations of the bowels, and in acute rheumatism, I have seen the disease much prolonged, and I believe sometimes rendered fatal, by the too early administration of opiates, either along with cathartics, or at their intervals; while a small dose of opium given after sufficient evacuations produces absorption only by its stimulus, and much contributes to the cure of the patient. We may have visible testimony of this effect of opium, when a solution of it is put into an inflamed eye; if it be thus used previous to sufficient evacuation, it increases the inflammation ”

“ Some forms of this drug are found in nearly all the various patent medicines so freely sold as a cure-all for every mortal disease. Opiates are an ingredient in different forms and proportions in almost all the soothing-syrups, cough medicines, cholera mixtures, pain cures, and consumption remedies, so widely and unwisely used. Many deaths occur from the use of these opiates, which at first seem indeed to bring relief, but really only smother the prominent symptoms, while the disease goes on unchecked, and at last proves fatal. ”

“ In some, before their condition was recognized, their tolerance for or dependence upon opiate had proceeded to a point where their bodies’ demand for morphine was imperative and their withdrawal suffering unendurable. In others, before body need was completely established—with their stamina and nervous resistance below par from sickness and suffering—they have been unable to forego opiate’s supportive and sedative and pain-relieving action, or to endure the nervous and other symptoms attendant upon its withdrawal after even a brief period of administration. ”

“ When there is not much fever, and the patient is debilitated with age, or the continuance of the disease, a moderate opiate, as twenty drops of tincture of opium, or one grain of solid opium, may be taken every night with advantage. ”

“ The opiates possess combined actions and powers not found in any other group of drugs. In therapeutic doses they support the heart and circulation, they relieve pain, they hold in check excessive activity of the glands of internal secretion with all their associated phenomena of exhaustion and collapse; they control spasm and they give sleep. In no other drugs or group of drugs are these properties combined as they are in the opiate group. In emergency medication, opium and its alkaloids, especially morphine, are the medications often most responsible for the saving of life and reason. ”

“ I have already spoken of the two ways in which the opium or morphia habit is formed. A patient of a nervous temperament, suffering from some painful or spasmodic disease, is attended by a physician, who administers one of these drugs, by the mouth, rectum, or subcutaneously. The relief to suffering is magical, and persists so long as the effect of the drug lasts. With a return of the pain comes the natural desire to have it relieved, and as the narcotics just spoken of have been found especially efficacious the patient desires its repetition. ”

“ The immediate effect of opiate to the addict, depending upon the extent of tolerance, and the reaction of the patient, in dosage not too much in excess of physical body need, is apparently support to function, the restoration or maintaining of normal circulation and nerve and glandular balance, prevention or relief of the agonizing withdrawal pains and manifestations and of impending collapse. ”

“ Others have received injury, where inflammation has been beginning, by the universal practice of giving a large dose of opium immediately on delivery, without any indication of its propriety; which, though a proper and useful medicine, where the patient is too feeble, when given in a small dose, as 10 drops of tincture of opium, or half a grain of solid opium, must do a proportionate injury, when it is given improperly ”

“ Naso-pharyngeal Tablets.—Useful in nasal catarrh and pharyngitis.
* Opium.—Is a valuable drug, but it is also a poison, and great care should be observed in using it. Opium is narcotic and sedative in its action; it relieves pain of all kinds. Useful in diarrhœa, dysentery, cramp and colic. Promotes perspiration and checks vomiting. Sometimes it will cut short a cold or mitigate an attack of malaria.
No preparation containing opium should be given to children without medical advice, and the same is true as regards persons suffering from kidney disease. ”

“ From the hour this pain begins to manifest itself it continues (in any average case of a year's previous habituation to the drug) for at least a week without one second's lull or exhaustion. A man may catch himself dozing between spasms of tic-douloureux or toothache; he never doubts whether he is awake one instant in the first week after dropping his opium. One patient whom I found years ago at a water-cure followed the watchman all night on crutches through his tour of inspection around the establishment. ”

“ A very common source of this habit lies in the continued administration of an opiate in regular medical treatment without the patient’s knowledge or consent, or in the persistent use of a patent medicine, or of a headache or catarrh powder that contains such a drug.
The man who takes an opiate consciously or unconsciously, and receives from it a soothing or stimulating or pleasant effect, naturally turns to it again in case of the same need. The time soon arrives when the pleasurable part of the effect—if it was ever present—ceases to be obtained ”

“ The fact that a patient is using an opiate drug, and that he uses, within reasonable limits, a larger or smaller amount of that drug, is a matter of very minor importance as compared with his general functional, nutritional, and metabolic efficiency. This is true as a general proposition in the handling of any case of narcotic drug addiction, and is vastly more true in the handling of cases of other conditions or diseases, operative or otherwise, that are complicated by narcotic drug addiction-disease. ”

“ Let any physician who reads these lines pause and reflect how many times in his life he has seen lasting or serious evil results from drugs.
Accidents happen, but they are the offspring of carelessness. Sometimes, also, unexpected and temporary extreme results surprise us, as when an opiate purges, or five grains of an iodide prove to be gravely poisonous. These occurrences are due to individual peculiarities, which we can as yet neither explain nor anticipate. One man can take opium with almost the impunity which belongs naturally to birds. Another is put to sleep by the dose you give a baby. ”

“ If a stone sticks in the ureter with incessant vomiting, ten grains of calomel must be given in small pills as above; and some hours afterwards infusion of senna and salts and oil, if it can be made to stay on the stomach. And after the purge has operated four or five times, an opiate is to be given, if the pain continues, consisting of two grains of opium. If this does not succeed, ten or twenty electric shocks through the kidney should be tried, and the purgative repeated, and afterwards the opiate. The patient should be frequently put into the warm bath for an hour at a time. ”

“ The adults who indulge are, according to my experience, of three classes: There are some who in the course of disease attended with long-continued acute pain, like neuralgia pain, have found relief from opium, and who having so become habituated to its use keep up the habit sometimes because they feel that they can not sleep without the drug, and sometimes because they have learned to experience a real luxury from its use. ”

“ The medical profession, so far as I have conversed with them, and I have consulted with some of the most eminent, are not generally well informed on any thing beyond the specific effects of the drug as witnessed in ordinary medication. In the absence of sufficient authority, it may be safer to say that the remoter consequences of the disuse of opium consist in a general disorder and derangement of the nervous system, exhibiting itself in such particular symptoms as are most accordant with the temperament, constitutional weaknesses, and personal idiosyncrasies of the patient. ”

“ The portability and ease of exhibition which belong to morphia—the fact that it fails to sicken some persons in whom any other opiate produces violent nausea—its usual certainty, rapidity, and uniformity of action, and the ability which it possesses to produce the characteristic effects of the narcotic after other preparations have become comparatively inert, make it the most general form in use among opium-eaters of long standing. ”

“ 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. ”

“ Nights made weary and days uncomfortable by pain once more suggested the same unhappy refuge, and after a struggle against the supposed necessity, which I now regard as half-hearted and cowardly, the habit was resumed, and owing to the peculiarly unfavorable state of the weather at the time, the quantity of opium necessary to alleviate pain and secure sleep was greater than ever. The habit of relying upon large doses is easily established; and, once formed, the daily quantity is not easily reduced. ”

“ Opium is the chief member of the second division of Narcotics, which consist of medicines that, in their action on the heart, are about intermediate between Stimulants and Sedatives, and in their secondary action, on the intellectual functions produce in them, the condition of sleep (p. 239.) Opium produces at first some stimulation, and exhilaration of the mind, with a full pulse, and general febrile excitement. This soon subsides, and is succeeded by drowsiness and sleep. Large doses cause slowness of the pulse, slow and difficult breathing, and coma. ”

“ He gets, simply, relief from suffering. The opiate drug has become his only immediate means of securing and maintaining a physical efficiency, a semblance of normality. No other drug will take its place. He can take tremendous doses without toxic effect. In this stage, if the drug is denied or withdrawn without competent handling, his suffering and incompetency is not, as in the previous stage, a matter of days but may persist for weeks or months after no narcotic has been administered. ”

“ There are persons who do not experience relief from opiates, but on the contrary, have the pain aggravated by their use. Strong green tea, or hop tea, will occasionally give relief in mild attacks, or where decided opiates are not productive of benefit.
“Where a feeble, or disturbed state of the nervous system gives rise to headache, aperients are to be taken as recommended above; and stimulants are to be employed, as camphor, ammonia, compound tincture of valerian, æther, &c. ”

“ Thus without [257] intention one finds one's self bound to the drug, its fast victim. The sanatoria of our country are crowded with people who are trying to free themselves of a drug habit into which they have drifted unintentionally if not altogether unknowingly. What is true of opium is equally applicable to other narcotics.
239. The Right Use of Narcotics. In the hands of the physician, narcotics are a great blessing. In some cases, by relieving pain, they give the system the rest necessary for overcoming the cause of the pain. ”

“ Uneasiness, corresponding to the irritations of dressing a stump—may continue a year longer; a few victims of the habit outlive a certain opium-prurience, which has also its analogue in the occasional titillation of a healed wound—these are comparatively tolerable; but, if we expect to save a patient's life, we must not protract an agony which so absolutely interferes with normal sleep as that of the opium-eater's for longer than three months in the case of any constitution I have thus far encountered. ”

“ If the facts of addiction-disease were widely known and applied to its proper handling and remedy, there should be no hysteria concerning and no criticism against legitimate opiate medication; even if unavoidably continued to the point of creating this condition. That opiate-addiction is one of the medical problems of war is recognized and must be openly met. In many cases, just as in private civil practice, the physician is confronted by a choice of evils. To save life or reason he must continue opiate medication even into and past the danger zone of beginning opiate addiction. ”