CHAPTER X. General Survey of the Situation and the Need of the Hour

GENERAL SURVEY OF THE SITUATION AND THE NEED OF THE HOUR

From the foregoing it is easy to see that the sooner the established facts of the fundamental physical basis and reactions of the addiction-states become matters of medical, sociological, administrative, and lay knowledge, the earlier there will be a rational and practical consideration of the use as well as of the abuse of narcotic drugs, and a beginning of solution of the narcotic drug problem.

Lack of knowledge of the fundamental and constant physical reactions and phenomena, and of the characteristic clinical manifestations of this disease, and of the physical suffering of drug deprivation is in a very large measure responsible for failure in its therapeutic handling in the past, and indirectly responsible for whatever is unjust and misdirected in the framing of the various laws, and also for a great part of whatever incompetency and lack of wisdom has appeared in their administration.

Lack of knowledge of the disease facts of narcotic addiction is also responsible for the practical absence of widespread provision for humane and intelligent handling, for much of the jeopardy and fear on the part of the medical practitioner towards these cases, and for the existence of conditions resulting in the rapid growth and increase of the worst evils of the present situation.

The worst evils of the narcotic drug situation are not, as is widely taught, rooted in the inherent depravity and moral weakness of those addicted. They find their origin in opportunity, created by ignorance, neglect and fear, for commercial and other exploitation of the physical suffering resulting from denial of narcotic drug to one addicted. 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. This exists to its present extent because conditions have been created which make smuggling and street peddling and criminal and illicit traffic tremendously profitable, and it would not exist to its present extent otherwise. It is simply and plainly the exploitation of human suffering by the supplying to desperate and diseased individuals, at any price which may be demanded, one of the necessities of their immediate existence.

Such exploitation would become unprofitable on any large scale if the disease created by continued administration of opiates were recognized as it exists and its physical demands comprehended and provided for in more legitimate and less objectionable ways.

One of the most important and immediately available of these ways is the honest practitioner of medicine. If the average practitioner of medicine were made familiar with the physical facts of addiction-disease, and its phenomena and reactions, and were encouraged by both legal and medical authoritative support to admit addiction-disease patients to his practice, to be cared for just as other patients to the best of his honest therapeutic ability and judgment--if he were taught to regard them as sick people whom he could help--if he were relieved of uncertainty as to the meaning and possible interpretation of laws and regulations, and as to the possible action or lack of action and attitude of his medical brethren and medical organizations towards him--the best available, honest, humane and intelligent machinery would be set in motion for the immediate care of the average honest sufferer from addiction-disease, and for the discouragement of underworld or underground exploitation. This has been demonstrated. It would react furthermore as a stimulus to the education of the physician, to familiarize himself with the scientific and medical facts of this disease.

Another immediate provision is the establishing under proper supervision and management, especially as to competent medical management, and without possibilities of humiliation and interference with self-support, of stations or clinics at which those who for financial or other reasons are unable to secure reputable and honest medical help, may obtain their necessary opiate at minimum expense and in physically necessary amounts to enable them to work and support themselves and families, without resorting to underworld associations and illicit commerce. Such clinics might be established in connection with the various hospitals on the same basis as their other medical and surgical clinics or dispensaries, and in connection with various health departments. In them the narcotic addict could not only be supplied with opiate medication, but taught the nature of his disease and the elements and principles of its control and be given such medication other than opiate for the relief of such associated or intercurrent conditions as might exist. Such clinics would have great educational value, as well as fulfilling a therapeutic need.

Pending further study and investigation and education into narcotic drug addiction-disease and the conditions surrounding it, and pending the widespread acceptance and recognition of practical and desirable procedures in the handling of the disease, and pending the provision of sufficient and scientifically adequate accommodations for the army of those who seek relief--legitimate supply of the drug of addiction under medically competent and intelligent direction fulfills a great economic and sociologic and medical need.

The financial possibilities of commercial exploitation of the sufferings of addiction-disease, combined with general ignorance of the true nature of the addiction condition, are responsible for the tremendous increase of late of narcotic addiction, of non-medical or non-therapeutic origin, among the youth. In ignorance of actual physical results, not knowing nor ever having been told that they are contracting a disease of torturing manifestations, actuated by curiosity and search for adventure, in some cases stimulated by unfortunate spectacular publicity, the youths fell easy prey to the agents, male and female, of the drug trafficker. The trafficker’s intended consummation is reached when these youths finally become, to their surprise and consternation, through the development of addiction-disease and physical dependence upon narcotic drug, enforced and continued customers and in some cases, virtual slaves.

Those who are interested in prostitution and in so-called “white-slavery” would do well to turn their attention to the chains forged by the suffering, and the fear of suffering, experienced by those who have developed narcotic drug addiction-disease.

It is this class of youthful addicts that has so alarmingly increased since the enforcement of the various narcotic laws. I have previously called attention to this situation, and also to the fact that for this increase the laws themselves are not so much to be blamed as is the totally inadequate meeting of the clinical and therapeutic and educational needs of the narcotic drug situation. There has been practically no organized scientific, medical or public health activity, so far as I know, directed towards the clinical and laboratory investigation of this disease--towards a dispassionate review, analysis and testing out of the truths and errors of its literature--towards an investigation of the scientific and other qualifications and experience of those whose utterances or writings influence medical and lay opinion and action, towards the establishing of pathological and physical facts and reactions and of clinical symptomatology and phenomena as fundamental bases for its rational handling and therapeutics, and for practical education of the public as to its sufferings and dangers.

The neglect of this education is largely indirectly responsible for illicit traffic in narcotic drugs. Illicit and underground traffic exists because it is profitable. This is the direct and immediate reason for its existence. Every new addict made of an adventurous youth means a new customer for the smugglers and vendors. If that adventurous youth had been taught the facts of the physical hell of the “withdrawal signs” of opiate addiction-disease--if he knew the sufferings attendant upon body-need for opiate drug--if he knew that any red-blooded animal will develop this physical body need if opiate drug is administered for a sufficiently prolonged period--that no living being is immune to the development of this disease--if he thought of addiction as he thinks of tuberculosis, and as he is now being taught to regard venereal-disease, instead of it as being something vague and surrounded by a halo of adventure and experience, he would not fall an easy victim to the agents of the trafficker. In other words, the most potent activity in the arrest of development of even the vicious and criminal aspects of the narcotic addiction situation lies in education. Laws and their enforcement in the control of the incorrigible and vicious will always be a necessity, but laws and their administration alone are not sufficient for the control of the many-sided addiction situation. Even in the control of smuggling and illicit traffic we need the application of every available influence capable of exertion, not only upon its end results but upon the machinery of its origin and development. As so much of it originates and develops through ignorance, the method of its remedy lies in education, education as to the facts of narcotic drug addiction-disease.

It is ignorance also that has stamped the honest and innocent, worthy and intelligent, and often illustrious sufferer from narcotic addiction-disease with the attributes and characteristics of the inherently irresponsible or otherwise incapable of self-guidance and self-restraint. The ignorance of the facts of addiction-disease has taken from these people even their ordinary legal and public rights in any issue which involved the possible revelation of their addiction. It has placed them in a position where any procedure which might reveal their narcotic medication would expose them to public gaze as members of a popularly despised and unworthy class of individuals. Until very recently the testimony of a known narcotic addict has been almost as a rule of no value in a court of law. Irrespective of a life-time of honesty and accomplishment, the revelation of a minute might destroy the reputation and standing of many years. Whatever the injustices or grievances suffered by an addict, he could not hope to evoke the protection or rights accorded an ordinary individual under statute law without the practical certainty, if his addiction became revealed, of personal, social and economic detriment far in excess of the legal rights to which he was entitled. The continuation of whatever is spurious or unworthy in methods of handling, advertised or otherwise, lies partly in the fact that the former patient cannot afford, however great his physical or other damage, to make public the existence of addiction-disease by the instituting of a suit for malpractice or other civil or criminal procedure. This alone has been one of the factors in lack of progress and in the persistence of narrow vision or false conception. He is in effect, however high his personal, moral and other status, deprived of some of his constitutional rights, simply because he has developed addiction-disease.

The great numbers of innocent and worthy unsuspected sufferers from this disease, who could not by any stretch of wildest imagination, be regarded as mentally or morally abnormal or subnormal have therefore been placed in a position where they could not afford to demand their rights or state their case. Their problems are only recently beginning to receive general consideration. Their cases have compelled us to revise our conception of the narcotic addict, and to question ourselves as to the necessity for their continued addiction over the years of their addiction. For their own good and that of society, what shall we do with them, and what can we do for them? In the present state of public opinion and public attitude towards narcotic addicts in general would it benefit either them or society to class them merely as “drug addicts” along with the drug-users of other types of individuals and other personal characteristics for administrative handling by detailed administrative supervision and control? Can the same administrative and other methods which admittedly must be employed to protect society from the manifestly unfit accomplish anything of good in the cases of these responsible and valuable citizens?

Until there is a truer understanding of addiction-disease, and a wider appreciation of the facts that the personal attributes of its victims differ as widely as those of cardiac or any other disease condition, and that merely because a man has contracted this disease is no reason for regarding him as in any way unworthy or unfit--will stringent and drastic forcible regulative measures directed against mere use of narcotics work out to the advancement or hindrance of ultimate solution and to the ultimate benefit or harm of society? These are the questions to be applied to all restrictive administrative activities. The problem of the care of the worthy and innocent addict in such a way as not to unnecessarily harm him nor deprive his family and society of his competent activity is just as important as the handling of the addict of the type of individual from whom society must be protected. The large numbers of worthy and valued citizens who are individually and personally social and economic assets and who are sufferers from addiction-disease constitute a very important consideration in the narcotic problem.

They certainly are not fit subjects for enforced custodial and correctional handling, and if such were forced upon them they would be seriously harmed, personally, socially, economically and physically. Very many of them our equals or betters, we have no right to subject them to associations and experiences which we ourselves would rebel against and be humiliated by simply because they have developed a disease condition from which no one of us is immune.

Where is the blame for their continued addiction? Certainly not because of lack of effort on their part. Addicted for years, they have tried one after another of the various and diverse treatments and so-called cures without success or benefit. Is the blame theirs for lack of success and cure, or has there been something wrong in our treatment and handling of them? Did we know enough about addiction-disease to treat them intelligently and to exercise upon their cases the same professional skill and technical ability that we have been educated and trained to apply to other diseases? In the light of present available clinical information and study, and in the light of recent and competent laboratory research, we are forced to admit that we have not treated our addiction sufferers with sympathetic understanding and clinical competency, and that the blame for past failure to control the narcotic drug problem rests largely upon the educational inadequacy of the past.

We are in a stage of transition in our concepts of, attitude towards, and handling of the narcotic addict. Serious consideration of drug addiction as a problem of clinical and internal medicine, and of experimental laboratory research is a comparatively new thing to a majority of the medical profession, and of course also to legislators and administrators. We should all remember that no matter how strong we are in our beliefs and theories, there are many others whose experiences and results have caused them to hold just as strongly to opposite theories and beliefs, and that we are all on trial for the validity and extent of practical application of our beliefs and theories.

Each new theory or belief that is brought forward should be taken simply for record and investigation. Much that we believe to-day we know to-morrow to be based upon misinterpretation and lack of complete information. Much that we believed in the past to apply to and solve conditions, we found later to have been merely based upon observations of distracting incidentals or non-basic aspects and phases. What we need is competent, disinterested, and honest effort to get together and evaluate all available material of whatever sort and from whatever source. If it were possible of accomplishment, it would be of advantage to get together in open and frequent discussion the various workers in the field. We are all partly wrong and partly right. There is no one of us who cannot learn from any one of the others. The real end of effort should be, not to prove one or another of us right, but to take each from the other whatever is of value and all to contribute in true scientific spirit of broad tolerance towards the ideas of others and of willingness to correct or modify ideas and theories of our own, searching for no panaceas or specifics, medical, legislative or administrative, simply hunting for truth wherever we may find it and applying it intelligently to meet the needs of the individual.

There is too much work to be done, and the situation is too urgent for remedy, to permit of longer delay in scientific approach. Under present conditions, no man’s announcement of theory or of remedy is to be taken as ultimate authority, but simply as his opinion based on his personal deductions, and his personal experience, to be evaluated in accordance with the extent and variety of his personal experience in the light of his individual ability and training.

Education and training are the best hopes we have as a foundation for the alleviation of present conditions and the prevention of their further spread. Lack of appreciation of and of ability to recognize and meet varied and various clinical and other indications for treatment and handling under widely different circumstances and in widely differing individuals means failure in a majority of cases, and throws a burden upon society and a complexity of problems upon municipal, state and federal authorities which they are unable to meet. Each class of workers should be working in its own field in co-operation with those working in other fields, none trying to dominate the rest, but each giving to the others credit for honest effort and appreciation of difficulties to be made easier if possible.

All possible forces should be encouraged to the work of study and investigation and education. A campaign of medical and lay investigation and education will require a much shorter time than a continuous trying out of various panaceas, medical, legislative or administrative. Also, it will bring far more satisfactory and earlier results. The narcotic wards of our great charity hospitals should be made use of for honest unbiased and trained clinical and laboratory study. The narcotic addict himself should be given a much wider hearing than he has in the past received. The mass of honest and intelligent narcotic addicts should be encouraged to tell their stories and their experiences, and should receive a fair and unbiased hearing as to the reactions upon them of various measures proposed. We, doctors, legislators, administrators are in truth as much on trial with the narcotic addict and with society for our understanding and handling of the narcotic addict and his problems as the addict is for his condition.

The remedy is plain, and the necessity for immediate activity is obvious. Education--scientific medical and lay, administrative and public health education is the lacking element or factor in the solution of the many sided narcotic drug problem. Appreciation of addiction-disease and what it may mean in the individual should be as widespread and as comprehensive as possible and at the earliest possible moment.

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Without a basis of generally recognized and widely appreciated fundamental facts, there can be no competent treatment, legislation, administration or judicial decision. There can be no competent evaluation of the merits and defects of various measures promulgated, medical, legislative or administrative. There can be no competent selection of those in whose hands shall lie the handling of a tremendous problem, a problem of disease, of sociology, of economics, of public health and welfare. There can be no competent evaluation of the remedies advanced, nor of the qualifications and true authority of those who recommend them. Under such conditions various measures or procedures in their adoption or discarding or application must depend more upon the publicity and other influence of their proponents than upon their intrinsic values.

There are always some things about any condition which either are or are not, some things which are physically determinable. The basic facts of addiction-disease are now physically determinable. There are many material and obvious and easily demonstrable physical facts of greatest value to the medical profession and to the laity, facts which are still but little appreciated, and not widely known.

These facts in addiction-disease could be easily investigated. The various conflicting statements of different schools of thought or of observers working from different angles should be investigated, evaluated and correlated--taking from each whatever is useful, determining its true sphere of application and making it available to all. Every possible interest or worker should be encouraged, and every source of information sought out, not least among them the honest and intelligent sufferer from addiction-disease of many years duration whose knowledge of the facts of his condition, and efforts to control it, and search for and trial of remedy and remedies for it, and the experiences and problems, social, economic and personal, which its possession has forced upon him would constitute a touchstone of greatest value for the determination of validity of promulgated measures and procedures.

The wards of the great charity hospitals, the institutions of science and medical experiment and research, the Departments of Health, and the Public Health Services are in existence and are equipped for the early determination of clinical, and laboratory facts, and for their dissemination. These are the things towards which their activities are directed in other diseases and conditions affecting public welfare and public health. It would take a very short time to determine the physical facts of addiction-disease--to establish finally and conclusively its clinical symptomatology and constant reactions and phenomena for authoritative and educational dissemination. Every one of us who has written in description or exposition of his study and observations, together with what we have written and taught, should be made the subject of critical and unbiased investigation, and whatever of truth we have stated should be made the possession of all. The experimental development of addiction-disease in dogs and other experimental laboratory animals, the symptoms and phenomena observed in them recorded by instruments such as the sphygmomanometer and the sphygmograph and paralleling similar records and observations upon the addicted human, the reactions of the serum of these animals injected into the non-addicted of their species are not to be lightly ignored, and should be matters of common scientific knowledge. The manifestations of addiction-disease in the new-born developed in the infant’s body prenatally long before vice or habit or appetite can be possibly considered as causative factors, demand more than casual consideration and have a significance much deeper than as occasional curiosities.

An educational campaign as to the facts of addiction would save many an innocent person from the contraction of the disease, and many a present sufferer from unintelligent handling. Authoritative bodies with sufficient power and independence might easily institute unbiased review of what is written, and trial and proving out of what is stated by various writers, and give out their findings for the guidance of future work and action. Hospitals and public institutions for the handling of narcotic addicts may be erected. Without comprehension of addiction-disease and full and complete familiarity with its manifestations, the possession of those who work in them, will they accomplish anything of good?

The deduction from the testimony of the Whitney Investigation and from other sources leads to the conclusion that one of the reasons why the narcotic addict does not go to many of our present institutions is that he is more afraid of them, and anticipates more suffering in them than he cares to face in view of the fact that neither from previous personal experience or from repute he has little hope of being discharged from them in a condition of physical competency with his addiction mechanism arrested. He sees no use in going through them only to come out in a condition where he will have to revert to his opiate to enable him to endure and work. This is not an all-inclusive statement. It expresses, however, the frequent response of the addict seeking advice when asked why he does not go to the municipal institutions for treatment. Again then the work of those in the institutions will be the determinating factor in their success or failure, and their education is the dominant element required for success. Some interesting observations upon this point will be found in the Yearly Report for the Department of Correction of New York City, 1915.

Of public clinics the same thing may be said. Whether they react to the benefit of the addict and of the community, or to the harm of the addict and community will depend upon their intelligent understanding and competent management.

Hospitals and clinics might be made into sorely needed educational centers for the training of doctors and nurses to go out and take up the work of the care of the addict--either private or institutional.

Education is the great need of the hour. Until it is accomplished all else will fail. Until we all know what we are dealing with, how can we hope to successfully handle it? It is to be hoped that the time is not far distant when in every medical school and hospital will be taught in principle and practice, in class-room and clinic all that is known or will be known of the pathology, symptomatology, physical phenomena and rational therapeutics of narcotic addiction-disease. It is to be hoped that in school and college, in pulpit and press, the facts of addiction will be presented in their practical existence, stripped of spectacularity; a calm, cold presentation of basic facts. There is no subject upon which philanthropy can better expend its forces than to this end of education as to addiction-disease and humane help to its sufferer.

In the past the problem of control of addiction has been “What shall be done with or what shall be done to the narcotic addict to make him stop using drugs?” It is now gradually coming to be realized that the true problem is “What can be done for the narcotic addict to relieve him of the physical necessity of using drugs?” and “What can be done to so educate the public as to the facts of addiction, so that this disease will claim as few victims as possible?”

In this change of attitude lies the hope for the future. Some of the narcotic addicts will have to be done with or done to. They are the inherently irresponsible, vicious or defective. They demand care and restraint irrespective of their addiction. The mass of addicts, however, need something done for them. They are clinical problems of internal medicine, victims of a definite disease, characteristic in its symptomatology, reactions and phenomena, a disease which will before long come to be known as clinically and therapeutically controllable and arrestable.

APPENDIX

HUMAN DOCUMENTS--PERSONAL STATEMENTS

The great importance of the real story of the sufferer from narcotic drug addiction-disease has been referred to several times in this book. It had been my first intention to include in the course of the various discussions, stories and statements of narcotic drug addicts illustrative of the various matters discussed, and to take them from my own collection of addiction histories.

That I might avoid any personal controversy, however, as to their personality or reliability, and also to make such statements free from any possible hint of influence or bias, I have taken them from medical literature and am using them as an appendix.

In December, 1917, American Medicine published a special addiction number, containing statements written for it by addicts of evident and vouched for intelligence and standing, stating their personal experiences and personal views.

Through the courtesy of American Medicine and its editors, I am reproducing these, believing that they are of great value and that they illustrate many of the discussions which appear in this book.

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HUMAN DOCUMENTS

For obvious reasons the names of the authors of these contributions are not given. The editor, however, has every one of them, and has taken especial care to establish the authenticity and good faith of each article. Each contribution appears as received.

THE PERSONAL SIDE OF DRUG ADDICTION

SOME VIEWS ON DRUG ADDICTION--PERSONAL AND LEGAL

BY A PROMINENT MEMBER OF THE NEW YORK BAR

A half dozen years ago I had a long, severe attack of gallstones and inflammation of the gall-bladder. I suffered so much pain that the physicians gave me morphine for nearly a year. When I got better I tried my very best to get along without the drug, but could not. I came to a physician in New York for treatment who had made a special study of drug addiction and is a recognized authority on that subject. However, he could not help me at that time on account of a recurrence of my gall-bladder inflammation with severe jaundice and fever.

Since that time I have tried repeatedly to stop and reduce the quantity of the drug, but have found it impossible because of the physical pain and exhaustion due to the lack of the drug. This is unbearable. I have since then kept my daily amount of morphine medication at a minimum which permitted me to work and to maintain good health and bodily function. The idea which I have heard so often expressed, that addicts tend to increase their daily intake of narcotic, is certainly untrue in my case, and there seems to me no reason nor temptation to do so. I have simply found the smallest amount which would keep me from physical suffering, and have experienced no difficulty in maintaining that dosage, except in occasional emergencies of gall-bladder attacks or other crises, after which I found it a simple matter to discontinue the excess dosage. As I have never experienced the slightest pleasurable or sensually enjoyable sensations from the administration of morphine, there seems to me no foundation for this prevalent idea of tendency to increase. It may be true of the degenerate who has become addicted, but it certainly is untrue in my case, and must be untrue of the thousands like me whose misfortune it has been to become afflicted with this condition.

Recently I have again consulted specialists, and it seems that with my condition I must continue the administration of morphine for the present, and perhaps for the rest of my life. Physical conditions render present attempts to discontinue its use impractical, undesirable and dangerous.

Now what am I to do under the present “Drug Habit” laws of this State? I am a lawyer long past middle age--have held important state and judicial positions, and many positions of responsibility and trust. It would be ruinous to me if my addiction condition became public.

This law was enacted to control the drug traffic and to stop the evils which are connected with it. In many respects it is an excellent law, but the provisions which require the record of the name, age and residence of the addict to be filed in the Board of Health Office is outrageous. It does not affect the underworld, for they don’t care and avoid registration by not going to those who have to register them. But see the position of a man who has a good reputation and standing in the community--forever recorded in the records of the State Board of Health as a “dope fiend,” even though his condition is not the result of his own acts or desires and absolutely beyond his control.

This part of the law which requires the recording of the name, age and residence of the addict should be repealed. The only effect of these provisions is to record the addict as what everybody considers a “dope fiend” or force him to go to the smugglers for his drug. He must either place his good name and social and economic position in constant jeopardy or in some way or other evade the law with its attendant penalty, and constant fear of detection. I should not be surprised if it finally develops to be the fact that a majority of decent sufferers from this condition have chosen the latter course as the lesser of evils.

I am informed that the Health Department has recently issued monthly registration blanks to physicians, demanding, in addition to the name, age and residence of the addict, the date and amounts of each prescription together with other information as to the individual cases treated. This makes conditions still more obnoxious and unbearable. Furthermore, this action of the authorities of the Board of Health is unwarranted and illegal. There is nothing in the powers of the Board of Health which permits them such action, and such action is without any justification in the letter of the law or in any possible interpretation of the spirit and intent of the law.

The data demanded were submitted to the Legislature as provisions in the law when the bill was being considered, and were rejected. The Health Department is usurping the powers of the Legislature, which it has no authority to do. The law plainly states what the physician shall report and the Board of Health has no power to require additional matters. Such action constitutes illegal interference with the rights of physician and patient as to matters of treatment and as to violation of professional confidence. It is my opinion that a narcotic addict might have grounds for legal procedure against a physician who furnished such information as the Health Department demands.

Conditions in New York today, affecting the honest addict, constitute in effect persecution of the sick. It is bad enough to be afflicted with this disease. Agonizing as gall-stone attacks have been, the physical suffering from lack of morphine in an addict is worse. Added to this is the knowledge that your name is on file at Albany, and perhaps elsewhere, as an addict. You know that disclosure of your condition will ruin you and disgrace your family. You are potentially subject to leakage from those records and the attendant possibilities of blackmail and other persecution. Such conditions tend to force and undoubtedly have forced many innocent and honest addicts of good social and economic standing to become criminals by obtaining their necessary opiate medicine through illegal channels.

Something certainly should be done to remedy existing conditions and existing laws. The great State of New York should not place its unfortunate sick in their present position.

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THE PERSONAL HISTORY OF A MEDICAL ADDICT

BY A WELL-KNOWN AMERICAN PHYSICIAN

When the suggestion was first made by a medical friend that I should write a short account of my personal experience as a drug addict, particularly in reference to my status as a practitioner of medicine, the idea, for obvious reasons, was repellent, notwithstanding the fact that my identity should not be disclosed. But after mature deliberation, I realized that it is largely due to this natural reticence on the part of those in position to speak, that the unfortunate addict is regarded as a social pariah by the general public, and that until the medical profession shall acquire more accurate and less distorted knowledge of this serious question, we cannot hope for any improvement along these lines. Until this is done, cruel and unjust laws will be enforced, wretched victims will be imprisoned as felons, and what is more distressing, these unfortunates will, in many instances, be subjected to torture to which death is preferable--and not infrequently results. All this is based upon the accepted theory that drug addiction is a vicious habit requiring only a little fortitude and strength of will on the part of the wretched victim to rid himself of it, while the saddest feature of it all is that this canker, eating at the very heart of the nation itself, blighting and destroying the lives of many useful men and women, is not being reached.

That the average medical men can remain so hopelessly, I might say criminally, negligent of the true conditions of drug addiction is a cause for wonder as well as condemnation. If the perusal of my paper induces even one conscientious physician to seek more definite information upon this tremendously vital subject, my efforts shall not have been in vain. And now for my story.

At the age of 24 I had finished my medical and hospital courses and was ready to begin my career. My plans had long been formed with reference to entering the army as a surgeon; the decision having been made for two reasons, first as a matter of predilection; secondly, for lack of means to sustain me during the time usually required to establish a private practice.

Then a tragedy occurred that blasted my hopes for the army and altered my entire future.

The examinations were scheduled for the late spring; in January I had come down from my home in New England to New York to complete some clinical work. Generally, I was in bad shape, and about that time I began having attacks very suspicious of angina pectoris. Finally I consulted a great specialist, who after thorough and repeated examinations, frankly told me that from overwork and long hours of study my heart had become enlarged and badly disordered functionally--that I need never hope to pass the physical examination required for entrance to the army. He prescribed rest and freedom from care--two remedies entirely beyond my reach.

It was then that I went to a far distant city in the West to begin my career on a small amount of borrowed capital. It would be useless to dwell upon my struggles, hampered as I was by lack of funds and ill health, but in due time I became established. During the first few years my heart attacks were infrequent, but as work increased they returned, especially after an attack of typhoid fever which left my heart in a most disturbed state. Naturally, all remedies were tried with an occasional rest, but to no avail. One night after a very trying day I was called to an obstetrical case; while hurriedly dressing I felt the premonitory symptoms of a heart attack; it was then in a state of desperation T took my first hypodermic. The attack was aborted, but the next day I was desperately sick. I may here add that at no time did I ever experience any of the ecstatic sensations described by some from a dose of morphine--it steadied my heart, but for some time after it was followed by a general malaise.

My obstetrical work increased rapidly and I frequently found it necessary to resort to the one remedy that proved efficacious. As was natural the time came when I found that the daily necessity had become fixed.

Having been taught that it was only a habit that required self will and force of character to abandon--both of which I knew I possessed--I was not particularly worried, as I had planned a long vacation when summer came, which I would devote to the accomplishment of my purpose. But for certain unavoidable reasons the vacation became impossible, and the next winter found me with added responsibilities.

During all this time I had constantly struggled against the increase of the drug. If under great pressure I was obliged to take an additional amount, as soon as it was over I began to reduce. There were occasions when I succeeded in taking only a fraction of my accustomed dose, but if a call came, I was either obliged to refuse it, or resort to the needle.

While naturally I had taken no one into my confidence, the habit had been so insidious and gradual that I had failed to realize how necessary it was that it should not be suspected. I did not consider myself an addict and only awaited a propitious occasion to relieve myself of it, but that winter I awoke to the realization that some radical step must be taken or my professional reputation would be damaged.

In the midst of this perplexity I developed an attack of la grippe and judging from past experience I felt that I would be confined to the house for some time, so resolved to take advantage of the enforced rest and abandon the use of the drug.

It was a hazardous and probably unwise decision, but I reasoned it was for the best. At the end of three weeks, after days and nights of physical and mental torture, I was able to leave my bed, freed from the specter that had haunted me, but for the time a wretched type of humanity. Four weeks of rest in the country enabled me to return to my practice, and although the heart attacks mercifully remained in abeyance, it was only by sheer force of will that I could accomplish my routine work, resting every spare moment that was afforded me, often refusing calls.

At the end of six months my work had so increased that the heart symptoms began to trouble me. The situation was desperate. Besides a wife and two children depending upon me I had other obligations, and was still in debt from my illness. I was unfitted for any other form of business.

I shall not enter into a discussion of the ethics of my act, but after sleepless nights of deliberation I reached the decision to return to the remedy that alone would enable me to attend to my duties, knowing all that it involved, but hoping that by constant vigilance to lessen the baneful effects of the drug until some day when I should be free to leave off work and again be cured.

During the years that followed, this object was ever before me, always fighting against an increase, devoting my vacations always to the same cause. In a measure I succeeded. I never progressed to extremely large doses, and I watched for and combatted any possible symptoms of peculiarity or degeneration that are supposed to obtain with the addict. I felt no sense of moral inferiority or degradation, nor did I deplete my strength with useless anticipation of dreaded possibilities. I would do all that lay in my power to preserve myself and the future lay in the hands of fate.

During these years success came to me. My clientele grew both in size and character. Positions of trust were conferred upon me, such as the examinership for some of the most important insurance companies, presidency of the County Medical Society, etc. I was elected visiting physician to two of our largest hospitals, and for some years did special work for the federal government, the nature of which for obvious reasons I do not care to mention.

In mentioning these facts, I do so with no vainglorious idea of boasting, but simply to record the history of my career. At the same time I used sometimes to ponder over the anomaly of my position--realizing with what horrified promptness the public would strip me of my honors, and transform its patronage and good will to contempt and pity, if it suspected the truth, although from its continued patronage my work was evidently entirely satisfactory. Even my intimate friends would shrink from me if the truth were known. Yet my philosophy and natural optimism sustained me.

It was at the end of about fifteen years that my circumstances were such that I felt in position to leave off work and take the long anticipated “cure.” The institution selected was one whose methods seemed most reasonable. I stated to the specialist that I was anxious to be cured as rapidly as possible, and was willing to undergo whatever was necessary, to the limit of my endurance.

The three weeks that followed I remember as a horrid nightmare of mental and physical agony. The method was not intended to be harsh, and the physician was well-intentioned, though far from scientific.

In my desire for rapid recovery I overestimated my powers of endurance and my nervous system sustained a shock from which it has never recovered, but I persisted, with the assistance of my wife who remained with me and without whose assistance I should have lost my reason.

When I left the sanitarium I was no longer an “addict,” but a wretched neurasthenic. Naturally the possibility of returning to my practice in this condition was not to be thought of so I began making plans to spend the winter in southern California. Here again the fates interposed. It was the autumn when the sudden financial panic swept the country, wrecking the fortunes of so many and tying up the resources of so many others. I was among the latter. There was nothing for me to do but to return to practice which I did after a further rest of six weeks--I need not add that in a short time I was again depending upon the drug to sustain me in the work that I was obliged to resume.

During the next five years I directed every energy towards shaping my affairs with the one end in view--that of retiring from practice and getting permanently well. By this time my two sons had finished their education and were established. My income was sufficient to provide us with the comforts, if not the luxuries of life. So with a heavy heart, but with a feeling of gratification, I abandoned the practice that I had acquired and sustained through so many years of bitter and sometimes heart-rending struggles.

My hopes for speedy restoration were doomed to disappointment. I should have realized that when release suddenly came from the long years of daily combat with so powerful an antagonist, a decided reaction must be the natural sequence. It came in the form of an almost complete prostration, that only by force of will prevented from permanently overcoming me; but more than two years elapsed before I felt equal to the effort of again submitting myself to treatment.

This time I selected a well-known specialist in the Middle West. I bared my entire life to his scrutiny, placing myself absolutely in his hands. Forty-eight hours as an inmate of the institution convinced me that I had made an unfortunate selection; but from a sense of false pride at being a “quitter” and a belief in my own powers I remained. The methods were absolutely crude and unscientific, the food poor and unsuitable, and the entire environment unfitted to the well being of such patients as I was.

At the end of seven weeks I was visited by the one most interested in me, who took me from my bed, from which I could not have arisen without assistance, and brought me East. It is true that the amount of the drug that I had been taking had been reduced to a very small amount, but at the expense of a badly shattered nervous system which required many months to regain even its partial normal status.

This fall I am in New York and have placed myself under the care of a physician who, while not claiming to be a specialist has, in my opinion and the opinion of many others, the clearest conception of the meaning of drug addiction and its pathology. His opportunities for the study of these cases have been most unusual. His methods are both humane and scientific. Through him I have the hope that should time be allowed me I shall when I am summoned to the great unknown, be freed from the chains that so long oppressed but failed in the end to overwhelm me and compass my ruin.

* * * * *

DRUG ADDICTION FROM THE VIEWPOINT OF AN AFFLICTED PHYSICIAN

BY A PROMINENT MEDICAL MAN, FORMERLY A HEALTH OFFICIAL OF AN AMERICAN CITY

Maximum efficiency of every individual member of this nation is necessary today as never before in its history. Hence any condition responsible for lessened efficiency on the part of thousands of citizens is a thing to be seriously considered, especially when among these are to be found a large proportion of men and women who would otherwise be useful workers in every important field of activity.

Addiction to narcotic drugs is today depriving the country, either wholly or partially, of the services of thousands of individuals who but for this handicap would be entirely fit (many of them preeminently so) for work of the utmost importance. This is a problem of the first magnitude and one which will have to be solved largely by the medical profession.

But the medical profession as a whole is utterly lacking at the present time in such knowledge of addiction as is needed to enable them to attack the problem. For these reasons I feel it to be my duty to do my “bit” as a medical man, to put on record some of the lessons which, from years of personal experience, I have learned as to addiction itself, and the methods of treatment with which I have had experience in my efforts to be cured.

The subject is too important to excuse anything but the utmost frankness in speaking of the serious misconception which medical men only too generally share with the masses in regard to the subject of addiction. Unless the profession realizes its own ignorance, all point will be taken from the appeal which I wish to make to the physicians of this country to lose no time in equipping themselves to deal adequately with this great problem.

It may well be imagined that the task which I have thus set myself is no easy one, viewed from any one of half a dozen angles. Yet, if I am correct, in believing that I can thereby make a small contribution to the cause which now means so much to all of us, I must do so regardless of every difficulty.

Addiction with me goes back a number of years, covering in fact, almost my entire career as a physician. During this entire time, as will be more fully referred to, I have tried cure after cure, besides having, time and again, sought by own efforts to rid myself of this burden. I have naturally during these years studied and thought much about the problem which has meant so much to me. All this by way of showing why I believe that my experiences and opinions should have some value.

First of all, let it be clearly understood that the addiction which I shall discuss is limited strictly to opium and its derivatives; first, because my own experience is limited to this group and, second, because much that I shall have to say does not apply to all so-called habit-forming drugs to an equal extent, and to some of them not at all. Addiction as thus limited is as true a disease as any with which the human body is afflicted.

To look on the opium addict as a man with a vicious habit which he could quit if only he truly cared to do so displays a profound misunderstanding of plain facts. As well claim that a man with typical malarial infection has simply become so accustomed to having chills and fever at a given hour on certain days that when this hour arrives he quakes through mere habit as to claim that the equally characteristic and even more pronounced and distressing symptoms which manifest themselves when the addict is deprived of his drug are due to habit, that is, to “a condition which by repetition has become spontaneous.”

We would, as a matter of fact, be less absurd in the former instance than in the latter; for we could argue the case out with our malarial friend, telling him he could conquer his “habit” by the exercise of will power, and--provided we argued long enough--we might convince ourselves that we were right because he would cease to shake, his fever would subside and until the next crop of parasites was turned loose in his blood stream, he would to all intents and purposes feel a well man, while in the latter case the more we talked of habit--that is, the longer the addict was deprived of his dose--the plainer would become the picture of a disease-racked body and a tormented mind.

I do not, of course, mean to offer the above comparison as either perfect in itself, or as sufficient to establish the claim that addiction is a true disease. The fact that it is a disease has impressed itself on all competent observers of a sufficient number of cases, and must be accepted. Yet it is astonishing to find that many educated physicians do not know this, while an even larger number, though readily admitting that addiction is a disease, nevertheless show, both by their manner of discussing the subject and by their attitude towards addicts seeking their advice, that this is little more than a verbal concession on their part.

If, however, it be argued that the contention as to addiction being a disease is vitiated by the fact that an occasional addict stops taking his drug by “will power,” that is, without taking treatment, we can point to an even larger proportion of mild cases of malarial fever in which spontaneous cure has come about. But this does not prove that the one, any more than the other, is not a disease.

Indeed, there could be no stronger argument in favor of the fact that addiction is an actual disease than the very phenomena presented by the occasional addict who stops taking the drug by “will power.” Neither medical writers nor literary geniuses, whether themselves addicts or mere observers, have yet succeeded in presenting a true picture of the tortures which this involves. There could be no greater error than to regard cure as dating from the time the last dose was taken. When, in these cases, cure comes at all, it is only after weeks, or months, of horrible existence, during which kind nature brings about a more or less complete restoration of body and mind not alone from the disease of addiction, but also from the profound shock of unskilled or unwise withdrawal. Will power has enabled the addict to abstain from taking the drug, while nature cured the disease.

There has been no time during all the years of my addiction that I have not earnestly longed to be free from its clutches. This is sufficiently proved by the many efforts which I have made to find a cure, each time at great personal sacrifice and expense, each time only to have my hopes shattered, after untold suffering and fresh disillusionment.

But a real cure I have thus far been unable to find. I have tried everything that seemed to offer a chance: gradual reduction, self-conducted and at institutions, the Keeley cure several times, and since then all of the vaunted cures, as each appeared in turn, advocated by men of high standing in the medical profession. Concerning this last class, I have each time hoped that such men could not be totally in error as to the practical results of their methods, notwithstanding what has seemed to me the most bizarre pathology on which they have claimed these methods to be based.

I might, perhaps, have been warned by certain palpable danger signs, but I have been too anxious to find the cure. I cared not at all how mistaken their pathology; for I could not believe that men of such standing could be equally mistaken as to the success or failure of what went on under their very eyes.

And right here let me set down what has impressed me as inexcusable neglect of these cases by most of these self same “big” men of the medical profession. One after another I have found physicians who receive and undertake to treat cases of addiction brought to them by the lure of high professional reputation and medical articles in which is painted a glowing picture of some new and wonderful cure. And, one after another, I have found these men of high professional standing giving to their cases not even enough time and attention to enable them to form an intelligent opinion as to their condition and progress, much less what would be needed for the proper study and treatment of one of the most difficult and distressing ailments which afflict mankind.

Moreover, comparing notes with medical men who have been fellow patients under similar circumstances (many of them, I may remark, of the highest type, as men and as physicians), there has been among us a universal sense of shame and indignation that men with such reputation and standing should lay the medical profession open to the justly founded criticism of extortion and neglect of duty, frequently of seemingly rank commercialism, even including the splitting of fees with quacks and charlatans of the worst sort.

In saying that I have found no cure, I do not mean that I have never succeeded in getting to the point where I could get along for shorter or longer periods without the drug. Many times I have succeeded by myself in gradually reducing the dose to a minimum and then making the final plunge and taking none at all for some time. What this has meant I will not undertake to describe. Several times I have managed to keep from using the drug for a while after taking treatment of one kind or another. But have I been cured?

Let no one thoughtlessly reply that the very fact of my having on each of these occasions reached a point where, according to my own statement, I was able to live without the drug, constitutes proof that I was cured, or that when I started to use it again I was merely yielding weakly.

What has actually happened has been this. Each time that I have succeeded, in one way or another, in reaching a point where I was no longer taking the drug, I have, even while the suffering was still acute, been filled with a sense of happiness and hope that enabled me to stand it thankfully. I have argued with myself that, being then able even to exist without the drug and, for a while finding this existence day by day a little less of torture, I might reasonably hope for continued improvement. I have not expected miracles, but I have felt that each week should be easier, until, after a period of some few months, I should again be normal.

But this has not come about. Always I have reached a point where progress seemed to stop, and beyond this point my system refused to react. Occasionally this standstill has been quickly reached, that is, I could not react beyond a point where I was unable to sleep, where my legs ached atrociously, and where I was so completely unstrung that life was unendurable. At best, progress has continued for a few weeks, after which, though resting well, having a prodigious appetite and not undergoing marked physical suffering, I have actually been far from normal. This was shown, on these special occasions, chiefly by my inability to do satisfactory work, by my tiring altogether too easily and by a general feeling of unrest and disquietude.

I realize the difficulty of so describing my condition during these most favorable occasions as to show at all convincingly that I was not actually cured and that, in consequence, my resuming the taking of the drug was anything but a relapse. This, however, I must not attempt to do, since the main contention which I wish to make is here directly led up to.

And, hard as is the whole task I have set myself in writing this account, this special part of it is peculiarly difficult, involving the risk of appearing to set a false value on certain personal considerations.

My life has been an active and useful one. I have done work which I know to be good and which has brought recognition. Successful work, even in a given line of endeavor, is not always due to the same qualities in different men. My own work has been characterized by the exercise of careful judgment and the power of accurate analysis, qualities which I have always been credited with possessing. Now, after the most favorable of the so-called treatments which I have taken, and after allowing considerable time for complete recovery, I have in no instance regained these most essential requisites for my work, and thus I have been placed in a position where I would either have had to discontinue my work, or else do the only thing which made the resuming of that work possible. And always there has been the absolute conviction that this state of affairs was due to my not having been actually cured. On this point there has not been one iota of doubt.

Perhaps if I had been able at such times to take a complete rest of six months or even a year, I might have been fully restored, but this has not been possible. I have not been able to remain away from work for over five or six weeks after the “cure” proper, and even this has, as may well be understood, been a severe drain, when I have taken some cure or other at as short intervals as I could manage to get together sufficient funds and the opportunity to leave my practice.

Of course it may be argued that, rather than return to the use of the drug and thus again be able to live a life as nearly approaching normal as is possible for an addict, it would be better to refrain from using the drug, even though this involved never again being able to do those things which, to the ambitious man, are essential to make life worth the living. I submit that it is a high motive and not a low one which makes a man willing to pay the price rather than live a vegetative existence when he knows himself capable of better things. To understand this point of view it must be remembered that the addict gets no rosy dreams, no wonderful journeys into a beautiful and unreal world, no artificially enhanced powers beyond those of the non-addict, but at best only such equanimity and energy as are the latter’s happy possessions.

My point, therefore, is that my resorting to the drug after having stopped its use a number of times does not mean that I have many times been cured, and many times relapsed, but that I have not been truly cured. When the latest “cure” which I have taken has left me, even after weeks, still suffering acutely and continuously, and not improving in the slightest so far as I could see, I have taken the drug again for relief from torture no longer bearable. After “cures” which have left me in decidedly better plight but in the intolerable condition last described above, and with progress at a standstill, I have taken the drug only after calmly surveying the situation, and as the lesser of two evils.

I must reiterate my strong desire to find a cure, a real cure, one deserving the name; that is, a cure which will leave me normal, without need of the drug, and able to do the work which I must do in the world unless I am willing to be a slacker. But until I can find such a cure (and, in spite of my unhappy experiences, I will keep up the quest) I would have only contempt for myself as a physician and as a rational being if I failed meanwhile to make the best compromise possible, namely, to take each day, just as I would take thyroid substance were I suffering from hypothyroidism, a sufficient amount of morphine to enable me to attend to life’s duties and to occupy in the world that useful place which my qualifications enable me to occupy.

One of the great hardships under which every addict suffers is the constant dread lest his affliction become known and he be branded a “morphine fiend,” a term which should be prohibited, or at least never used by an intelligent physician. What this exposure would mean to a man of standing in his community I need not explain. This risk he must always run, but it would be robbed of some of its terror if the nature of addiction were better understood.

Therefore the law now existing in some states requiring the registration of addicts is little short of barbarous. So little possible good can be accomplished by this law that one is tempted to believe that its passage was not instigated primarily by honest, though misguided zealots but by quite another class. The addict, in his efforts to find a cure, has learned something of a class of men, who, posing as public benefactors, are in reality a shrewd set of rascals, capitalizing the misfortunes of the addict most successfully. If such men were not the originators of the idea of registration, certainly they, and not the body politic, are its chief beneficiaries, since it affords them an authentic list of prospective victims.

As for the effect of this law on the addict, it merely adds further to his dread of exposure. Think of the position of a man of prominence and respected in his community, having his own feelings as have other men, holding equally dear the sensibilities of those he loves, living under the constant dread that his necessities may any day force him to seek aid in a state in which his name will, as it were, be added to a rogues’ gallery!

My plea is for realization of the great need for finding some means whereby the individual addict may get real relief and whereby addicts collectively may be restored to such condition as will render them capable of performing those services of which our country is now in need.

I am confident that I am understating the case when I say that nine addicts out of ten earnestly desire to be cured. Why should they not? They get no pleasure out of taking the drug, but only relief from intolerable suffering which they must otherwise endure. Hence to be free both from this suffering and from the necessity of getting this relief by artificial, and at present exceedingly costly, means is bound to appeal to them. Most addicts, I am confident, are willing to go through whatever acute suffering may be involved in any really rational treatment which will, after a reasonable time, restore them to normal condition.

Experiences such as I have described above are, I know, the rule and not the exception with those who have tried the various so-called cures. They can hardly be called satisfactory. Even admitting that they may prove successful in a small proportion of cases, relatively few addicts are able to find the means of taking them, such as I have been able to make for myself in the midst of a very active life.

Surely a disease having so definite a symptomatology and, I believe, so plain a pathology, must be susceptible of rational cure. That such a cure has not yet been found by those who so loudly proclaim to have found one I honestly believe. Whether others have devised more promising lines of treatment I frankly do not know.

But a cure must be found which does more than any I have succeeded in finding. In what other disease would a patient who, after reaching a certain point, beyond which he could not progress towards recovery, be told that from then on everything rested with him, although he himself knew that his need for help was really as great as it ever was? In what other disease would any physician worthy of the name calmly tell a patient that, having taken a “cure,” he was, ipse facto, cured, and become highly incensed when the patient pleaded that his condition was in many respects more desperate than before treatment?

The medical profession must seriously study addiction. Of material there is, unfortunately, an abundance. Some high authority should see that every facility is afforded the proper persons for employing it. It is not unlikely that many of the “cures” which have been advocated have in them some elements of good, properly selected and properly applied in each individual case. Possibly competent investigation, furnished with every facility, might result in the discovery of a truly specific cure. I have long thought that there was such a possibility in more than one direction, but investigation of these would involve very careful and laborious work, as well as considerable cost. Here indeed, would seem to be a wonderful opportunity for philanthropy.

But while such a specific cure would be an untold blessing, we need not find one in order to meet the situation--at least, much more successfully than it is being met at present. Coordination of the entire problem of addiction, in the hands of the few men whose work in this field is most promising (and the men I have in mind are not those with whose vaunted cures I have had such unhappy experiences) would almost certainly lead to valuable results.

While every effort should be exerted to determine the best lines of treatment, meanwhile there is a great deal which should be done in other directions. Let the medical profession help in bringing about better understanding of addiction--first, of course, learning this themselves. Until the addict can be offered rational treatment, the profession should do what it can in making the lives of addicts less unbearable by removing from the public mind some of the gross misconceptions concerning addiction, seeing to it, especially, that these unfortunates are not stigmatized as “morphine fiends” and that they are given the means of obtaining, without risk and hardship and almost prohibitive cost, the supply of their drug which, until they are cured, is to them as necessary as the air they breathe.

But the finding of a real cure or treatment--not necessarily specific, not a thing to be applied indiscriminately in every case, but a rational method of handling addiction as other well known diseases are handled--is the great aim, or, if it be that sufficient is already known by some men in the profession as to the rational handling of addicts, let these men be found and their services subsidized by the government and used to the fullest extent, in teaching others, and these still others, until there is built up a system extending over the entire country, capable and equipped for giving to every addict the opportunity for cure. This is a crying need in our country today. Surely there must be somewhere recognition of this fact and resources enough to make it possible for this need to be supplied.

* * * * *

A PLEA FOR THE BROADER CONSIDERATION OF NARCOTIC DRUG ADDICTION BY THE MEDICAL PROFESSION

BY A PRACTICING PHYSICIAN WHO HAS MET THE PROBLEM IN HIS OWN FAMILY

In view of a recent experience of mine in seeking intelligent medical help for a near relative whom I learned was a narcotic drug addict, I take pleasure in recounting experiences of the past few months in the handling of such a case, and in calling attention to the conditions which my investigations have shown me to exist in our profession.

My line of professional activity had not brought me knowingly into touch with narcotic drug addiction, and I entertained the prevailing medical opinions in regard to it.

About five months ago I received a letter couched in apologetic language from a practitioner in another state informing me that a younger brother of mine had been under his care for a number of days suffering from withdrawal symptoms occasioned by inability to purchase morphine, and advising me to place him in some institution where he could be restrained.

I immediately began asking my colleagues where I could send such a case, and was amazed at the general lack of knowledge in regard to and sympathy for these unfortunates. In truth no one could point out a single institution where such a patient could be sent with any hope that he might be handled in a humane and intelligent manner.

My investigations of the institutions they suggested showed this to be the fact.

Most every one seems to regard those suffering from this condition as being of a lower order of humanity, unwilling or too weak-minded to help themselves and fit subjects only for association with what is commonly known as the “underworld.” I wish to say that I myself have undergone a very complete revision of mind regarding these cases since the case of my brother has compelled me to investigate them. I have known my brother too well and for too many years to believe that he can possibly be placed in any such category.

I have made careful inquiries into the circumstances and origin of his addiction, and the results are absolutely convincing that the first administrations of the narcotic were to meet therapeutic indications and were continued without his knowledge or appreciation of its actions or ultimate results. I know that he has never experienced any pleasure from the narcotic, and I know that when the condition of addiction manifested itself he did not know what was the matter with him. He only knew that narcotic relieved intense suffering. I had never seen a case of addiction to my knowledge before I went to see him in response to the letter I received. The clinical symptomatology of withdrawal of an opiate was truly a revelation to me. That the condition from which these patients suffer is a distinct disease cannot be questioned by any intelligent observer.

I have found that the majority of patients who begin the use of opiates do so in search of relief from pain, and are not aware of the fact for a long time that the suffering they endure when the drug is discontinued is due to a disease they have contracted. Apparently the medical profession is also ignorant of this fact.

A more pathetic sight I have never seen than one of these patients who has been suddenly deprived of his medicine. They will tell you that they will become insane or be driven to suicide if they cannot obtain relief from their suffering. Hence their willingness to obtain the drug at any cost. I have come to believe that any man is justifiable in lying or stealing to escape the agonies I have witnessed.

It seems a crime that we of the profession have gone so long without any attempt to study or understand the disease which we in our daily rounds are constantly creating. Certainly our standard medical literature contains little if anything of value in regard to this condition, and investigation of the claims and procedure of the widely advertised so-called “treatments” and “cures” readily convinces one of their unworthiness.

I know that much can be done for the cure of these patients by an intelligent effort on the part of the medical profession, and a willingness to open their minds to the clinical facts of this condition and to handle it like other diseases.

In search of information I have gotten into touch with cases of addiction other than my brother’s, and I find that the majority of them are desperately anxious to be cured. They tell me, however, that institutions such as jails, workhouses, lunatic asylums, alcoholic wards of the charity hospitals, and those that they have tried of the advertised cures are places of insufferable torture from which they emerge in worse condition than that in which they entered.

There are estimated to be as many as 500,000 or more addiction cases in the State of New York alone. I ask in all earnestness, is it not worth while to try to do something more than we are doing for these sufferers?

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INDEX

Abnormalities, getting rid of, in preliminary stage, 83

Acidosis in opiate addiction, 48

Addict, criminal or vicious, handling of, 108 drug, as a surgical and medical risk, 85 coöperation of, 72 often unknown and unsuspected, 7 honest, and need of competent medical care, 109 and custodial care, 28 medical, personal history of, 140 mixed, 115 narcotic, failure to understand, 5 will coöperate and suffer, 6

Addicts, drug, accidental or innocent, 28 age of, 24 and influenza and pneumonia, 86 majority of, 17 often understand own cases, 7 what type or class become, 23 innocent and worthy, what shall we do with them? 129 narcotic, average individuals, 3 often men and women of high ideals, 3 worthy and innocent, problem of, 128 youthful, 125

Addiction, author’s definition of, 20 beginning stage of, 30 development of, 29 disease, author’s conclusions, 40 a chronic condition, 93 in newly born infant, 24 may afflict all classes, 19 mechanism of, 36, 41 rational handling of, 61 treatment of, and legitimate medical practice, 99 drug, a medical problem, 28 among soldiers, 117 and defectives, 16 a plea for broader consideration of, 156 and the average person, 17 as a sequelae of war, 120 contraction of, in the army, 118 in surgical cases, 85 medical problem of, 21 methods of treating, 50 origin of, 25 so-called specific, treatment of, 55 unsuspected, 26 viewpoint of physician afflicted with, 146 wrongly described, 14 established, stage of, 31 narcotic, a demonstrable disease, 59 a recognized menace, 4 classed as a vice or morbid appetite, 4 opiate, as a war problem, 117 complicated with cocaine, 3 picture wrongly painted, 2

Adequacy, metabolic and organic, relation to other disease conditions, 92

Administration, narcotic drug, regulation of, 65

“After Care” or convalescence, 53

Age of addicts, 24

American Medicine, human documents from, 137

Antidotal substance, 42

Any one liable to drug addiction, 8

Attempts at administrative and police control, 4

Attitude of drug addict, 71 of lawmakers to drug addiction, 102 of medical profession, 50 personal, of physician to drug addict, 70 to drug addicts, author’s unjust, 12

Auto-intoxication and autotoxicosis, 46

Balance, drug adequate, importance of establishing and maintaining, 92 narcotic drug, and minimum daily need, 66 and operative procedure, 92 necessity of maintaining, 67

Basis of success, 132

Beacon-light of hope for drug addicts, 14

Belladonna, use of, 55

Bellevue Hospital, early work in alcoholic and narcotic wards, 2

Care, custodial, and the honest addict, 28

Cases demonstrating presence of antidotal substance, 43

Catharsis, non-irritating, 79

Cause of withdrawal symptoms, 38

Causes of failure in solving drug problem, 5

Clinics, drug, need for, under competent medical direction, 124 public, 135

Cocaine, habitual use of, 115

Committee appointed by Secretary of Treasury, report, 14

Complications, avoided by intelligent patients, 78

Conclusions of author, 40

Condition, another disease, relation of functional balance to, 92 drug patient’s, as index of successful treatment, 75

Considerations, fundamental, 11

Convalescence, and “after care,” 53

Coöperation of drug addict, factors which determine, 72

Cure of drug addiction, What constitutes? 76

“Cures,” basis of, 55

Custodial care and the honest addict, 28

Danger of restrictive legislation, 123

Dangers of belladonna, hyoscine, pilocarpine, etc., 80

Data, institutional, lack of, 58

Defectives and drug addiction, 16

Definition of term “narcotics,” 114

Deprivation, forcible, danger of, 53

Development of addiction stage, 29

Discontinuance of narcotic drug, difficulties of, 69

Disease, addiction, rational handling of, 61 drug addiction, nature of, 23

Documents, human, 137

Dosage, narcotic drug, in relation to withdrawal symptoms, 75

Doses, therapeutic, and toxic stage of normal reaction to, 29

Drug, narcotic, balance, 67 definite body need for, 37

Drugs, narcotic, and the physical condition established, 21 may afford pleasure, 3 legitimate use of, in peace and war, 114 prescribing and dispensing of, 100 relations of laws to, 95

Du Mez’s recent paper, 38

Education and training, 131 lay, medical and official, needed, 109 neglect of, and illicit traffic, 126

Efficiency, functional, nutritional and metabolic importance of, 92

Efforts, author’s early, 11

Elimination, competent, not measured in bowel movements, 81 of opiate, and cell tolerance, 46

Evils, chief, of present drug situation, 122

Exploitation, commercial, and its financial possibilities, 125 of physical suffering, 123

Facts concerning drug addiction, necessity for unbiased medical investigation of, 101 significant, 13

Fear, constant, addict lives in, 92

Function, inhibition of, 46

Gioffredi, investigation of, 26, 38

Handling, institutional and custodial, and certain types of addicts, 108 of criminal or vicious addict, 108 preliminary to withdrawal, 62 rational, of addiction disease, 61

Harrison Law, effect on medical profession, 96 reasons for failure of, 96 wise in purpose, 95

Hirschlaff’s experiments, 26, 38

History of medical addict, 140

Hyoscyamus, use of, 55

Ignorance, the harmful effects of, 127

Immunity to narcotic drugs, 4

Inefficiency, medical, 6

Infant, newly-born, and addiction disease, 24

Influenza and pneumonia in drug addicts, 86

Information, clinical, paucity of, 58

Intervals, long, between doses, desirable, 77

Introduction, 1

Jennings’ studies of acidosis, 48

Kobert’s and Toth’s studies, 38

Law, Harrison, failure of, 96 makers, attitude to drug addiction, 102 What has it done for the addict? 102

Laws and old conceptions of drug addiction, 96 and their relations to narcotic drugs, 95 drug, enforcement and increased suffering of addicts, 96

Magendie’s findings, 38

Marme and oxydimorphine, 38

Mechanism, essential, of addiction disease, 41 of narcotic drug addiction disease, 36 of protection, 47

Medication, ignorant or unavoidable, and drug addiction, 27 opiate, indispensable and legitimate, 116 “specific,” fallacy of, 56

Misunderstanding of addict, cause of early failures in treatment, 5

“Narcotics,” definition of term, 114

Need, drug, minimum daily, 66 of the hour in study of drug addiction, 130 narcotic drug, and mental and muscular work, 69

Observation in Bellevue, sixteen months, day and night, 3

Observations on physical or body reaction, 32

Opiate, withdrawing, simply one stage, 92

Opiates, and their unique properties, 116

Organizations, medical duty of, 104

Origin of addiction, 25

Oxydimorphine and Marme theory, 38

Panaceas, search for, 56

Patients, intelligent, and the avoidance of complications, 78

People, eminent, and drug addiction, 27

Philanthropy and its opportunity, 135

Physician, average, is inexpert in handling addiction disease, 108 suffering from drug addiction, viewpoint of, 146

Physicians, honest, and their responsibility, 103

Pilocarpine, use of, 50

Practice, legitimate medical, 95

Practitioner, honest, and control of illicit drug traffic, 123

Principles, basic, of addiction-disease handling, 65

Problem, drug, still unsolved, 5 of drug addiction, ultimate solution of, 108 of the care of the innocent and worthy addict, 129

Profession, medical, attitude of, 50

Prostitution and “white-slavery,” 125

Protection, bodily, against opiate, 42 mechanism of, 47

Pulpit and press, duty of, 135

Purgation, excessive, warning against, 81

Purpose, chief, of most lay and medical workers, 96

Questions that confront the American people, 136

Reaction, normal, stage of, 29 to therapeutic and toxic doses, 29 of drug addicts to therapeutic agents, 68

Reduction, enforced, below bodily need, dangers of, 69 slow, 51

References to recent literature, 39

Regulation, legislative and administrative, 105 of intervals of narcotic drug administration, 66

“Relapses” and production of antidotal substance, 45

Report, 1915, of New York Dept. of Correction, 72 Preliminary, of Whitney Committee, 110

Responsibility for drug addiction laid on medical profession, 102

Restoration of drug addict to health, 83

Side, personal, of drug addiction, 137

Solution of drug problem, ultimate, 108

Stage of study, preliminary to withdrawal, 63 preliminary, abnormalities in, 83

Stages of addiction development, 29

Stool, “typical,” of Towns treatment, 79

Study, clinical and laboratory, lack of, 91 of patient, essential as preliminary to withdrawal, 63

Substance, antidotal, to opiate, and bodily protection, 42

Suffering, physical, and drug addiction, 20

Survey of the situation, 122

Terms that should be eliminated, 9

Testimony of Whitney Committee, deductions from, 134

Theories, author’s wrong, 12

Tolerance, explanation of, 38 increased, stage of, 30

Traffic in narcotic drugs, illicit, 103

Treatment, importance of regulating intervals of narcotic drug administration in, 65 rational, of addiction disease, 61 so-called specific, 55 specific, author’s disbelief in, 80

“Underworld” and desperate necessity of addict, 28

Use, legitimate, of narcotics in peace and war, 114

Valenti’s studies, 26, 38

Veterans, Civil War and drug addiction, 24

Views, personal and legal, of drug addiction, 137

Whitney Committee. Hearings, testimony of, 107

Withdrawal accompanied by use of various drugs, 51 forcible, and suicide, 53 stage of, 62 sudden, 53 symptoms, 35

Withdrawing of opiate simply one stage, 92

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Transcriber’s Notes

Errors and omissions in punctuation have been fixed.

Page 27: “physicial sufferings” changed to “physical sufferings”

Page 39: “Deutch. med” changed to “Deutsch. med”

Page 66: “normally functionating individual” changed to “normally functioning individual”

Page 76: “continued maintainance” changed to “continued maintenance”

Page 100: “oppose as illegitimatc” changed to “oppose as illegitimate”

Page 101: “he is forccd” changed to “he is forced” “physical nced” changed to “physical need” “should mcet” changed to “should meet” “would be eagcrly” changed to “would be eagerly”