THE NARCOTIC-DRUG EVIL A Disturbing Problem of Our Modern Civilization - By Milton Lewis (page 400)

THE word "drug" is generally applied to any substance used as a medicine or in making medicine. Aspirin, which alleviates pain and helps lower body temperature, and quinine, used in the prevention and treatment of malaria, are drugs; so are the sulfonamides (sulfa drugs) and the antibiotics, which have revolutionized medical practice and saved countless lives. Certain drugs, however, are taken not as medicines, but to satisfy a craving that has become an ingrained habit. These habit-forming drugs have brought misery to millions in every quarter of the globe.

Habit-forming drugs fall into two main groups: stimulants, or excitants, and sedatives, also known as depressants. The stimulant drugs excite the nervous system and keep the user alert, at least for a time; they include cocaine, marijuana and Benzedrine. The sedatives do not stimulate but lull. Taken in moderate quantities and upon the advice and prescription of a physician, they are legitimate remedies. They relieve anxiety and pain, cause mental and physical relaxation and often produce badly needed sleep. Taken in too large doses, however, these drugs may have very unfortunate physical and psychological effects. Opium and its derivatives are depressants; so are the synthetic substances demerol and methadone, used as substitutes for morphine. The depressants are also called narcotics (torpor-producing drugs), a term applied to certain stimulants as well.

In this chapter we shall deal with some of the more important excitants and depressants listed as narcotics. We shall consider the sources of these drugs and their effects upon their victims.

The effects of stimulant drugs

It has long been known that many Indians of Peru, Chile and Bolivia chew the leaves of the plant called Erythroxylon coca and that these leaves produce extraordinary effects. The chewers can do an incredible amount of work without showing signs of fatigue or hunger; they also seem mentally stimulated. Other effects, however, are not so desirable. Among other things, the chewers lose their desire for food and are very likely to suffer from malnutrition.

The active principle of Erythroxylon coca is an alkaloid called cocaine, one of the stimulant drugs; it was first isolated in 1853 (1859, according to some authorities). In its pure form cocaine consists of shiny crystals, which are bitter to the taste and produce numbness of the tongue.

The numbing properties of cocaine led a group of young physicians in Vienna to experiment with it as an anesthetic. One of these doctors, an ophthalmologist (a physician specializing in defects and diseases of the eye) decided to use the drug as a local anesthetic in an operation for the removal of a cataract. The operation was performed without causing the patient the slightest pain. It was found that cocaine could be used as an anesthetic in other areas of the body; it could be injected under the skin, or, in dental treatment, under the gums.

As cocaine came into more general use as an anesthetic, the medical world became aware that it is a habit-forming drug. Synthetic chemists, therefore, set to work to develop a substance that would produce the numbing effects of cocaine but would not be habit-forming. The result of their researches was a synthetic agent called procaine, a nonhabit-forming drug also known by its trade name of Novocain. Procaine is the most widely used anesthetic in dentistry today; it is often mixed with other drugs, such as tetracaine and propoxycaine.

Cocaine still serves to a limited extent as a local anesthetic; it is also used illegally as a powerful stimulant. The cocaine powder used by addicts is called "snow"; it is generally snuffed into the nostrils. Some addicts prefer to mix cocaine with heroin, producing what is called a "speedball."

Cocaine produces a temporary sensation of alertness, physical strength and increased working capacity. This stimulation is short-lived; it is followed by a feeling of utter fatigue and mental depression. To restore his sense of well-being, the victim seeks more cocaine. The drug is very unpredictable; the user may not be stimulated at all but may pass into a depressed state or even unconsciousness.

If a victim is deprived of the drug, irritability, sleeplessness and marked depression set in as a reaction to the previous effects of the drug. This reaction state may have dangerous consequences. The victim may have hallucinations and delusions of persecution, and as a result, he may commit a major crime.

The stimulant known as marijuana, or marihuana, in North and South America, is derived from the hemp plant, Cannabis sativa. The fibers of this plant are used in making rope and cord; the seed is an ingredient in bird-feed mixtures. The habit-forming drug is derived from a resinous substance in the flowers and leaves of the plant.

One of the earliest stimulants derived from , the hemp plant was hashish. The word "assassin" comes from hashish. At the time of the Crusades a Mohammedan sect committed secret murders while under the influence of hashish; they came to be known as hashshashin, or men addicted to hashish. The word hashshashin, transformed to "assassin," later came to refer to any hired or appointed murderer. Hashish is still used, particularly in the Middle East.

Marijuana is really a kind of hashish, in less concentrated form. It is sometimes taken by mouth; generally, however, it is prepared in the form of cigarettes, called "reefers," made by mixing tobacco with crushed hemp leaves. Most of the marijuana sold in the United States comes into the country illegally from Mexico; a considerable quantity, however, is prepared from plants grown in the United States. As a matter of fact, Cannabis sativa often flourishes unnoticed in vacant lots and along roadsides. The cultivation of the plant is not permitted in the United States. The medical profession does not use it in any form.

Marijuana cigarettes look homemade; they are sometimes wrapped in brown paper. When lighted, they have a distinct and unforgettable, smell. Marijuana produces a sort of composite effect. It acts on the higher functions of the brain in the same way that alcohol does. It serves as a depressant on the inhibitory functions; in other words, it releases the brakes of restraint. It also acts as a powerful stimulant. A curious effect of the drug is to make the user unduly sensitive to light; many marijuana addicts wear dark glasses.

The drug may produce a temporary sense of grandeur, increased strength and pleasure. It may also bring about a feeling of panic and anxiety, especially when taken in large doses. At this stage, the user may run amuck and even commit murder in what he supposes is self-defense. However, such extreme cases generally occur only when a concentrated dose has been taken. The repeated use of marijuana leads to dullness, mental lassitude and the destruction of will power. The Arab slave traders of other times were familiar with this effect of drugs derived from the hemp plant; they used them to make their slaves more docile.

The use of marijuana paves the way for addiction to more dangerous drugs. The smoker of "reefers" is apt to come in contact with a "dope pusher" --- a seller of illicit drugs ---who urges the smoker to try a more potent drug, such as heroin.

Some years ago the stimulant amphetamine was introduced on the market under the trade name of Benzedrine. This drug was prepared in pill form to combat mental depression in psychopaths; it was also used in the form of a liquid or as a gas in an inhaler. Nowadays Benzedrine is sometimes mixed with alcoholic beverages to make the mixture known as a "benny." In small doses the drug produces a feeling of well-being and strength; in somewhat larger doses it may lead to insomnia, loss of appetite, restlessness and apprehension. In still larger doses it may cause hallucinations and illusions of persecution. It may produce a strikingly rapid pulse and a marked rise in blood pressure.

The depressant, or sedative, drugs

Opium and its derivatives-particularly morphine and heroin - are the most dangerous of the habit-forming narcotic drugs. Opium is a product of the opium poppy plant (Papaver somniferum). The use of this plant goes back to prehistoric times; its original home was probably Mesopotamia. The Egyptians knew about opium hundreds of years before the birth of Christ; Greek and Roman doctors used it in their practice. Galen, a famous Greek physician of the second century A.D., wrote a glowing EULOGY OF Opium. This drug, said he, "resists poison and venomous bites, cures inveterate headaches, vertigo, deafness, epilepsy, apoplexy, dimness of sight, loss of voice, asthma, coughs of all kinds, spitting of blood, tightness of breath, colic, iliac poison, jaundice, hardness of the spleen, stone, urinary complaints, fevers, dropsies, leprosies, the troubles to which women are subject, melancholy and all pestilences."

Early Arabian physicians used opium too, particularly for headaches. During the ninth and tenth centuries, it was prepared in Asia Minor and carried to other parts of the world by Arab camel trains. In this way, the drug was introduced into Persia, India and China.

Opium became a very profitable article of trade after the sea route to the East was opened in the fifteenth century. The drug became so widely used in India that eventually the poppy plant was introduced there. Several hundred years later, in 1767, the East India Company started a thriving business, exporting opium from India to China. The opium-smoking habit became quite prevalent in China. It developed into such a menace in time that the Chinese government sought to prevent the importation of the drug. This ban was one of the causes of the so-called Opium War of 1839-42 between Great Britain and China.

The use of opium by drug addicts is now largely restricted to Asiatic lands. In the countries of the West, thrill seekers in the nineteenth century sometimes became addicted to the drug; the most illustrious of these victims, perhaps, was Thomas De Quincey, author of the famous CONFESSIONS OF AN ENGLISH Opium EATER. Nowadays, however, the derivatives of opium, particularly heroin and morphine, constitute the chief menace in the West.

Morphine is the best-known of those derivatives. First isolated about 1805, it was found to be more stable than opium; since it was more concentrated, it could be transported more easily. It became the "wonder drug" of the nineteenth century. Physicians hailed it (quite erroneously) as a cure for all kinds of ills, including cancer, asthma, tuberculosis and heart disease. The drug really came into its own after the invention of the hypodermic syringe in 1845. It was found that when morphine was injected through the skin by means of a hollow needle, it produced a much more rapid and far-reaching effect upon the body than when taken by mouth.

Doctors no longer believe that morphine is a universal remedy; yet they still consider it valuable in medical practice. It is used to relieve pain, check diarrhea, treat coughs, reduce blood pressure and lessen bleeding in hemorrhage. It also serves to bring about a deep sleep, from which the patient usually awakens feeling refreshed. The trouble is that morphine is dangerously habit-forming. The nineteenth-century physicians who extolled its curative virtues prescribed it so indiscriminately that by the end of the century addiction was an acute problem. If morphine does not make newspaper headlines today, it is only because other drugs, particularly heroin, have proved even more tempting to the addict.

The synthetic chemicals demerol and methadone are sometimes used as substitutes for morphine. Demerol is only one tenth as powerful as morphine in relieving pain. The danger of addiction when using this drug is not nearly so great as in the case of morphine, but it exists nevertheless. Methadone is as patent a painkiller as morphine. Normal patients are not very likely to become addicts to this drug. True morphine addicts sometimes use methadone as a substitute.

The most dangerously addicting of all the habit-forming drugs is heroin, which is derived from morphine. It was first isolated about the turn of the present century. It served practically the same purposes as morphine, but it was much more powerful. Morphine addicts turned to heroin in increasing numbers. Medical men came to recognize that the drug is altogether too dangerous to be used in medical practice. The United States now prohibits the importation, manufacture and sale of heroin. Unfortunately it is smuggled into the country in considerable quantities.

Most drug addicts in the United States today use heroin; it is also a serious problem in other countries. The drug is either injected in the skin or snuffed up the nostrils. After a dose of heroin the user generally feels relaxed and at peace with the world; but this is a passing phase, followed by a sensation of depression and fatigue. The addict then takes another dose, or "fix," in order to recover the former sense of well-being. Habitual users of heroin become weakened physically; they lose their appetite and suffer from insomnia. They live in constant dread of the day when they will not be able to get a "fix." Sometimes they commit crimes in order to obtain funds with which to buy the drug.

When a victim is deprived of heroin, his physical suffering is great. He has convulsions, diarrhea and pains in the abdomen and back. There is fever, nausea, twitching of the muscles and clammy perspiration. Despite a feeling of physical exhaustion the victim is unable to sleep. His skin is cold and covered with goose flesh; it looks like the skin of a freshly plucked turkey. Hence the phrase "cold turkey," meaning abrupt and complete withdrawal from heroin.

The apparently harmless barbiturates are really habit-forming depressants. These so-called "sleeping pills," or "goof balls," are usually taken by mouth in the form of capsules. The first barbiturate (barbituric acid derivative) was introduced in 1903 under the trade name of Veronal; at the present time there are at least sixty on the market. All the barbiturates phenobarbital (Luminal), Amytal and the rest-are essentially the same; the difference between them lies in the rapidity and duration of their sleep-producing effects. The much publicized truth serum is a barbiturate administered in doses just large enough to produce a semiconscious state much like a hypnotic trance. Barbiturates constitute more of a menace than is commonly recognized. The habitual user becomes a true drug addict; when barbiturates are withdrawn, there is considerable pain and general discomfort.

Is there a cure for the drug habit?

The only infallible "cure" for the narcotic-drug habit is not to fall victim to it in the first place. Therefore prevention is the chief objective of those who combat the evil. In any preventive program, it is vital to control the cultivation of the plants that yield potentially dangerous drugs; it is just as important to regulate the manufacture and distribution of these drugs. Various attempts have been made to draw up international agreements that would be binding on all nations; but these measures have met with only moderate success.

The United Nations has sought to deal with the drug evil. In 1953, for example, it drew up an International Opium Protocol, limiting and regulating the cultivation of the poppy plant and the production and export of opium. The protocol provided that regular reports on the opium situation were to be submitted to a Permanent Central Opium Board. A measure of this kind could be effective only if all the nations of the world would be willing to co-operate wholeheartedly; but unfortunately, this is not the case.

There is a considerable illicit traffic today in narcotic drugs. The United States is one of the principal targets of this traffic because of the huge profits to be made in that country in selling the drugs. It is said that one kilogram - about thirty-five ounces - of heroin, costing about $3,000 in Italy, brings about $3,000,000 in the United States.

Various methods have been employed to stem the flow of illicit drugs. Drugeducation programs have been launched. Federal agents (sometimes acting in cooperation with foreign police) and local authorities have broken up smuggling rings. Peddlers of drugs have been imprisoned and fined. There have been conflicting reports about the success of these measures.

For the treatment of drug addicts, there are two United States Public Health hospitals, one in Lexington, Kentucky, the other in Fort Worth, Texas; the latter is for male addicts only. The nation's sole treatment and research center concerning itself exclusively with drug addicts (both male and female) under twenty-one years of age is New York City's Riverside Hospital, located on North Brother Island in the East River. This institution was opened in July 1952.

Upon admission to the Riverside Hospital, a patient receives a complete physical examination and is then placed in a withdrawal ward for study for twenty-one days. The discomfort of withdrawal from drugs is eased by diminishing doses of substitutes. After a few days the addict is deprived of drugs entirely.

When the patient is released from the withdrawal ward, members of the staff ---psychiatrists, psychologists, nurses and social workers--- meet in conference and decide how to treat the case. While patients remain in the institution, every effort is made to transform them into useful members of society. They go to a school in which they are encouraged to develop skills, interests, good work habits and proper attitudes toward society. When they are considered to be ready to go out into the world again, they are discharged.

There is considerable difference of opinion concerning the effectiveness of the treatment at the Riverside Hospital. According to Dr. Rafael R. Gamso, medical superintendent of the hospital, the staff has "achieved a great deal of success in qualitative rather than in quantitative terms." This means that some addicts have been definitely cured, but that they form a minority of the total number of patients who have been admitted to the hospital. Unfortunately a number of Riverside "graduates" have been recommitted to the hospital because they have resumed their old habits. Some psychiatrists and psychologists maintain that there cannot be a complete cure if the patient returns to the environment that was responsible for the addiction in the first place.

Certain authorities have proposed what they consider to be a realistic approach to the problem of recidivism, or backsliding. They would set up a controlled medical-care program, under which addicts would continue to get as much of the addicting drug as they needed, while they were being treated. If treatment failed and the victim continued to use the drug, it would be supplied to him in a "drug clinic" at a cost in pennies (which is what such drugs are really worth). According to the advocates of this clinic plan, it would keep the addict from going to the underworld to purchase drugs or from committing crimes in order to pay the high prices that are asked.

Most law-enforcement officials, however, regard this clinic method of treating the drug problem with abhorrence. They point out that a similar plan was tried out in 1920 and failed miserably. Harry J. Anslinger, United States Commissioner of Narcotics, condemned the plan as preposterous. He pointed out that if addicts were to obtain their. favorite drugs for pennies in clinics, it would be only fair to provide other clinics where alcoholics could buy intoxicants at low prices. --- See also Vol. 10, P. 278: "Narcotics."