Opium Addiction Among Medical Men

By J. B. Mattison

Medical Record, Vol. 23 (June 9, 1883), 621-23.

It was the writer's pleasure, some time ago, to dismiss from his professional care, within about a week of each other, six medical gentlemen, all recovered after addiction to morphia, hypodermically, varying from eight months to ten years.

This somewhat unusual occurrence, with the fact that the majority of his patients have been, are, and probably will be, members of the profession, and the statement elsewhere made that physicians form a large proportion of opium habitu6s in general, and the great majority of any professional class, make pertinent the title of this paper and warrant his inviting your attention for a brief time to a topic in which perchance some of you may have a personal and painful interest.

A recent Austrian author writes: "Quite an incredible number of our colleagues have fallen victims to it, and many have only just escaped. If medical men are charged; and it is to be feared, justly, with the propagation of this disease, owing to their carelessly, or for mere convenience sake, leaving morphia and a subcutaneous syringe with the patient, it may be regarded as their punishment that the demon morphinism finds among them his favorite victims."

A Prussian writer who, in 1877, gave the profession a valuable monograph on morphia addiction, cited sixteen cases under his care, of which medical men formed more than one-third, and a much larger proportion compared with any professional class.

The records of the Inebriates'Home, at Fort Hamilton, although that institution is mainly devoted to the treatment of alcoholic habitues, show a majority of the profession among those who have sought relief from the ravages of opium.

We have been informed, on the asserted authority of a resident physician, that, in a certain New England city, containing upward of one hundred medical men, between thirty and forty are addicted to some form of opium.

Much surprise has often been expressed, and the reason asked why so many physicians apply for, or are in need of, relief. So far as concerns the first query; and as having a personal reference, we have always deemed it due to the fact that our professional efforts being directed specially to this work, and a knowledge of this coming directly to the fraternity through the medium of the medical press, those who desired our aid availed themselves of the proffered service.

Another reason may be that the peculiar secretive character of this disorder, the fear of publicity, induces the most of non-professional victims to place themselves under the care of charlatans, who find in this especial quality a fertile field which they make haste to till to their profit, and, very often, their patients' loss; while medical men, on the contrary, not so likely to be duped by the specious promises of these pretenders, are less frequently beguiled by their blandishments, but extending their confidence to those whose skill and experience warrant, secure the aid which scientific treatments can now surely afford. As to why so many opium habitu6s are recruited from the ranks of our profession, it may be said that the physician's calling involving, as it often does, especial inroads on his mental and physical well-being, exposes him more than any other to the various influences which stand as factors in the etiology of this disease.

Then, again, addiction, hypodermically, is likely to prevail largely in medical circles, inasmuch as the very nature of this method requires a more or less intimate knowledge of morphia and the hypodermic syringe, which the average layman does not possess.

Then, too, may not this very knowledge and the frequent emPloyment of this potent agent for evil as well as good which the modern practice of medicine involves, disarm fear of its ill-effects, and make easy the occasional taking, which so easily and so soon forges the fetters of confirmed addiction?

In reviewing the causes of opium addiction among medical men, we find that in them, as in others, some form of neurotic disorder, involving, as has been truly said by your coming president, "a physical necessity," leads the list; and, so far as our experience goes, the most frequent has been that "opprobrium of medical art" -as Flint styles it-periodical headache. Any form, however, of persistently painful disturbance involves this risk, and, apropos of this point, the opinion of a medical gentleman-who, some years ago, was under our care, and who afterward gave to the profession a most graphic recital of his experience-may be of interest. "I proclaim it as my sincere belief that any physician afflicted with neurotic disease of marked severity, and who has in his possession a hypodermic syringe and Magendie's solution, is bound to become, sooner or later, if he tampers at all with the potent and fascinating alleviative, an opium habitu6.

"The first dose is taken, and mark the transformation. This overmastering palliative creates such a confident, serene, and devilmay-care assurance that one does not for once think of the final result. The sweetness of such harmony can never give way to monotony. Volition is suspended. You may not think of it when the pain for which it was taken subsides. But when distress supervenes, you go at once for the only balm that abounds in Gilead, and every additional dose is but another thread, however invisible, of which the web is made that binds us fast as fate."

Another special factor is the peculiar power that opium possesses to give strength, bring sleep, and relieve portendings incident to the anxious hours, the weary days, and wakeful nights, such as the experience of every busy practitioner so often involves. Again and again has this been told us, and, pre-eminently true is it whenonce under the opiate spell-a self -effort is made to escape. Scarcely a physician presents himself for our care who does not assert that, time after time, he has made an attempt in this direction, only to find that the demands of his calling proved fatal to his success.

Still another cause is the spirit of inquisitive research which occasionally permits a professional man to allow his zeal in the pursuit of knowledge to outrun his discretion.

Incidentally we may note the assertion-doubtless true-that the glamour of De Quincey's writings has proved fatally attractive to more than one, and Obersteiner relates this instance: "A young medical man gave the following account of his own case. While he was attending the hospital a patient was dismissed, suffering from carcinoma of the stomach, and who had been for a long time treated with subcutaneous injections of morphia. Next day the patient returned in a state of great excitement, and piteously begged for an injection, as otherwise he must die. This occurred in 1869, at a time when chronic morphinism and its phenomena were less known than now. As the physician was inclined to believe that the patient was romancing, he tried the experiment on himself to ascertain what the effects were. The result was that he formed the habit of morphinism, and never could overcome it."

He also cites another, of a medical man, aged thirty-two, who gave as one reason for his addiction that, "being assistant at the Physiological laboratory, he saw in himself an interesting subject of experiment."

A somewhat similar case has fallen under our own observation. Dr. A-, aged twenty-seven, was attacked with facial neuralgia so severe as to compel his taking one-fourth of a grain of morphia hypodermically, at bedtime, to secure ease and sleep. This amount was increased to one-half a grain per them during the following month, when, the neurotic disorder having subsided, the opiate was abandoned, with little or no inconvenience. Some time after this, a gentleman addicted to the use of morphia placed himself under his care. Then Dr. A-, as he asserts, without the least desire for opium, but solely from a wish to discover, if possible, some antidotal drug to aid him in the cure of his patient, began experimenting on himself with hypodermic morphia, with the result of falling a victim to its seductive influence; and yet, though he failed to make the wished-for discovery, managed the case of his friend so well that success crowned his effort, while he, despite every endeavor, was unable to extricate himself from the pit into which he had unwittingly fallen, and was compelled to seek aid for his relief. Unlike Obersteiner's patient, he made a very gratifying recovery, and is to-day well.

The subtly ensnaring power of opium is simply incredible to one who has not had personal observation or experience. One of the finest specimens of physical manhood we ever saw, a physician, who survived the horrors of Salisbury prison, when the death-rate averaged eighty per cent, fell a victim to morphia after only one month's hypodermic using. Happily, he recovered, took the lecture platform, and told of the bondage from which he escaped.

It may seem to some of you like an alarmist's opinion, yet we have no hesitation in expressing our belief that any physician using morphia, daily or oftener-especially hypodermically-for four weeks, incurs great risk of becoming an habitue; indeed, we think a still shorter usage might, with some, prove a snare.