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Major Studies of Drugs and Drug Policy
The Opium Problem, Terry and Pellens - Table of Contents

THE OPIUM PROBLEM

BY CHARLES E. TERRY AND MILDRED PELLENS

1928

PREFACE TO THE ORIGINAL EDITION

Personnel of committee-Objects-Scope of work-Procedure.

INTRODUCTION

The problem-In the United States-Controversial aspects-Method of study-Terminology.

CHAPTER I-EXTENT

Numbers involved-Difficulties of determination-Current statements- Estimates from importations-Estimates from surveys-Early statements, 1867-1871-Michigan survey, 1878-Chicago study, 1880-lowa study, 1885-Massachusetts study, 1888--Vermont study, 1900-Jacksonville Survey, 1913--Tennessee survey, 1915--Treasury Committee, 1918-New York City Clinic, 1919-Narcotic Drug Control Commission, 1920-Los Angeles Clinic, 1920-Shreveport Clinic, 1919-1923-Summary survey and estimate table-Recent analysis of certain surveys, Kolb and Du Mez-Analysis and discussions.

CHAPTER II-DEVELOPMENT OF THE PROBLEM

Historical review of use of opium-Use by Sumerians and Assyrians, Mention in Eber's Papyri-Homer's Iliad-Known to Hippocrates, Theophrastus, Virgil-Virtues described by Galen-Discovery of alkaloids--Therapeutic uses-Appreciation of euphoric effect-De Quincey -The hypodermic syringe-Influence of Civil and other wars-Influence of opium smoking-Patent medicine industry as factor-Secret addiction remedies--Medical education-Professional indifference-Production of heroin-Views on safety and dangers of heroin-Early warnings -Effect of prohibitory laws-Underworld traffic-Effect of professional attitude and training.

CHAPTER III-ETIOLOGY

Incompleteness of studies-Faulty generalizations-Racial and individual tendencies-Effect of climate-Influences of medical use-Use in infancy and childhood-Use of hypodermic-Painful illnesses--Use for pain and for euphoria-Massachusetts study as to causes-Pichon's studies-Psychical influence-Patent medicines and self-medication Evil associations-Dissipation-Chinatown-"Contagion'--Influence of personality make-up -Curiosity-Craving for stimulants and sedatives-Report of British Departmental Committee on Morphine and Heroin Addiction-Table, replies to questionnaires, Treasury committee reports Replies to questionnaires of Committee on Drug Addictions-Criminal tendencies and associations.

CHAPTER IV-GENERAL NATURE

Definitions, effect on control measures-Early opinions and terms-Psychical and ethical effect-Like alcoholism-Morphinism not morphinomania-A vice, habit, appetite-Mental and physical disease-An uncontrollable craving-A real disease-A psycho-physical disorder-A psychosomatic affection-A true disease-A drug, auto- and intestinal intoxication-A true organic disease-A Psychical disturbance-A functional poisoning-A neurosis or psychosis--A pernicious habit-A definite physical disease-A pathologic entity.

CHAPTER V-PATHOLOGY-SOMATIC AND PSYCHIC CHANGES

Reports of findings scanty-Incompleteness of studies-Functional disturbances-Individual tolerance and intolerance-Fatty degeneration of heart and liver-Morphin in liver-Mental deterioration-Ethical changes -Crystals in blood-Effect on leukocytes--Epithelial changes-Lowering of resistance-Arrest of phagocytosis,-Character changes-Hallucinations and delusions-Brain cell changes-Effect on endocrine system Pleasure and deterioration-Generative functions depressed-Changes in cortical cells--Changes entirely functional-The blood in morphinists and heroinists-Coagulability-Number of red cells-Number and changes in white cells--White cell resistance The blood during withdrawal-Number and varieties of red cells-Hemoglobin percentage Red cell resistance-Leukocytosis--Differential findings--Leukocytic resistance-Similarity to infectious processes-Changes in liver morphologic and functional-Digestive tract-Albuminuria and sediment findings Nature of albuminuria-Abscesses--The skin and teeth-Sexual apparatus-Eliminatory crises-Stages of psychic changes--Pulse in tolerance ,and withdrawal-Relapse due to psychic changes--Other causes of psychic changes than the drug-Effect of opium on dog's intestine-Effect on respiration in dogs--Lipoid changes-Constitutional make-up of users Excretion of morphin-Mental effects-Inhibitory effect of opium Auto-intoxication-Allergic reaction-Changes in viscosity of blood Withdrawal phenomena due to organic causes-Digestive hemoclastic reaction-Morphin delirium-Effect of chronic poisoning on growth of rats-Effect on vegetative nervous system-Resulting Psychical changes -Lowered biotonus-Resemblance to manic-depressive states-Relationship to hyper- and hypothyroidism-Selective absorption by nervous system-Effect on basal metabolism-Effect on nutrition-Review of mechanism of tolerance-Conditioned salivary reflex-Somatic and psychic habituation-Specificity of habituation-Evidence of diphasic poisoning-Vagus-sympathetic balance of vegetative nervous system Relationship of tolerance to uremic changes-Effect on unstriped muscle -Sensitiveness of intestinal muscles not lost-Brain cell changes Calcium and potassium blood concentration-blood changes in dogs.

CHAPTER VI - PATHOLOGY (continued) - TOLERANCE - DEPENDENCE-WITHDRAWAL

Tolerance-formation admitted-Dependence questioned-Codein toIerance, committee report-Elimination of codein--Codein not addiction forming-Codein addiction-forming-Contradictory opinions-Case reports, codein addiction-Dual action of opium alkaloids-Tolerance to eukodal-Effect of eukodal and parakodin on animals--Questionnaire study on codein addiction--Oxidimorphin theory-Hyperacidity in morphinism-Tolerance similar to true immunity-Specific antitoxin formed Morphin storage in brain and liver-Inhibition of glandular function Release of inhibition-Hypersecretion and glandular engorgement-Enithelial desquamation-Eliminatory crises-Increased power of organism to destroy morphin as explanation of tolerance-Denial of antitoxin formation-Increased ability of body cells to withstand morphin-Brain extract of morphinized animals, properties-Precipitation reaction of morphin serum-Increased ability of organism to destroy and cell immunity both reasons for tolerance-Complement fixation tests and anticomplementary action in morphin serum-Ability of liver to destroy morphin-Withdrawal symptoms due to retained excrementitious matter-Aggressins produced by morphin-Progressive cell adaptivity Effect on circulation of injections of morphinized serum-Loss of cell sensitiveness in chronic poisoning-Specificity of morphin poisoning Effect on vegetative nervous system of chronic poisoning and of withdrawal-Tolerance and withdrawal due to antitoxic substance in blood Chemical changes in nerve cell composition cause of withdrawal-Personality changes and sensation obtunding with reactions-Metabolic changes in rats caused by thyroid, thyroidectorny and morphinism-Psychiatric aspects-Lowering of threshold of resistance-Effect on brain lipoids--Relationship to permeability of cell membrane-Reaction to intradermic injections-Congenital addiction-Effect of withdrawal on pregnancy-Withdrawal symptoms in new-born-Case reports-Prolongation of pregnancy-Morphin in placental circulation-Transmission to fcetus--Questionnaire studies of Committee on Drug Addictions-Tables

CHAPTER VII-SYMPTOMATOLOGY

Detection of chronic use-Classification of symptoms unsatisfactory Abstinence symptoms diagnostic-Symptoms in smokers-Symptoms in chronic poisoning and in withdrawal-Mental symptoms-The skin and mucous membranes--Pupils-Kidneys & organs-Nervous system-
Vasomotor symptoms---Reflex irritability-Lachrymation-Coryza-Neuralgic pains--Insomnia-Vomiting and purging-Constipation-Pulse irregularity-Collapse-Effects vary in individual salivation in dogs-Nutrition in dogs--Withdrawal symptoms in dogs-Withdrawal like an infectious disease-The "vital need'--Mental state in withdrawalRespiration-Circulatory symptoms---Syncope-Oliguria and anuria-Albuminuria-Glycosuria--Casts--Memory damaged-Character changes-Effect on volition-Interference with secretion and excretion-Fever Circulatory disturbances in dogs--Vegetative nervous system and endocrine disturbances-Addiction and withdrawal symptoms in dogs.

CHAPTER VIII-TYPES OF USERS

Classification desirable--Factors to be considered-Incompleteness of data-Dangers of generalizing from available material-Sex Distribution-Michigan survey-Chicago study-Iowa study-Jacksonville survey-Tennessee survey-Philadelphia series--Treasury committee-New York City prison cases--New York City clinic series--Discussion-Age Distribution-Chicago cases--Iowa case Jacksonville series-Tennessee series--Philadelphia hospital cases--Bellevue Hospital cases, New York New York City clinic cases--Lambert's cases - -Court cases, New York Teachers College questionnaire study, New York-School children--Juvenile court studies--Use by children exaggerated or unfounded-Age of convicted addicts in certain prisons--Form of Drug Used-Therapeutic choice-Individual selection-Influence of illicit traffic, reasons--Heroin among young males--Effect of prohibitory laws on use of heroin-Table by drugs used-Other Classifications-Conditions in England, 1871-Individual opinions of types involved by authors from 1871 to 1922-Contradictory views due to studies of selected cases--Effects of other drugs, "mixed addiction'--Effect of environmental factors on "type" determination-Dangers of conclusions based on insufficient data-No one type of user-All groups susceptible-Relation to crime

CHAPTER IX-TREATMENT

Early efforts-Influence on treatment of current views on nature-Prophylactic considerations--Gradual reduction-Abrupt withdrawal-Rapid reduction--Substitution-Levinstein's method-Rapid withdrawal with bromideg--Erinmeyer's method-Jennings' method-Rapid detoxication, Sollier-Hyoscine treatment, Lott-Pettey's treatment-Use of heroin, Morel-Lavall6e-Lambert-Towns treatment-Bishop's principles, interval of dosage, elimination, rational therapeutic considerations, individual adaptation of procedures-Comparative values of certain methods Sceleth's method-Dercurn's method-Riverside Hospital method-Effect of albumen and venesection in detoxicating dogs-Wholey's method Methods of Dupouy, Wuth, Mignard, Itemer, David, Krauss, Rojas and Belbe-Narcosan treatment-British Departmental Committee on Morphine and Heroin Addiction-Narcosan compared with abrupt withdrawal, Johnson-Kolb-Vegetable protein treatment.

CHAPTER X-CONTROL-INTERNATIONAL

Slizoighai Conference-Countries represented-Early treaties with Siam and China-Treaty with Japan-Philippines Opium Commission-Wright's letter to the President-Resolutions of commission-Response to U. S. Circular-Report of American delegates-Comment on Hague Opium Convention of 1912-Powers signing the convention-Resolution presented-Countries not signing the convention-Final Protocol of Second Opium Conference-Exports from U. S. prohibited-Third International Opium Conference-Instruction to American delegates--Report of American delegates-Final Protocol of Third International Opium Conference--Peace Conference articles on Opium Conventions-Article 23 of the covenant of the League of Nations-Resolution of League- Advisory Committee on Traffic in Opium-Resolutions of Council-Requirements; of countries-Reports and resolutions of Council and various committees-Action of Third Assembly on import and export certificate system-Fourth session of Advisory Committee-Abuse defined-Causes of abuse-Determination of abuse-Amounts required for medical and scientific purposes-Prevention of abuse-Hearings and Resolutions of Committee on Foreign Affairs--Resolution as passed by Senate and House of Representatives-American Delegation to Fifth Session of Advisory Committee 1923-American proposals-Resolutions of Advisory Committee-Reservations of Indian Government-Resolutions of Fourth Assembly, Sept. 1923-Extracts from minutes of Assembly-Resolutions of Council Dec. 1923-Sixth Session Aug. 1924-Recommendations of Conference-Resolutions of meetings of Mixed Sub-Committee-Second International Opium Conference Nov. 1924.

CHAPTER XI-CONTROL (continued)-NATIONAL

Act of 1909-Treaty of 1880--Tariff laws-Results of Act of 1909-Bills presented but not passed-Harrison Act and Amendments----Regulations of Secretary of the Treasury-Treasury decisions-Court decisions -Discussion of law and regulations-Jones-Miller Act-Federal Narcotics Control Board-Amendment of June 7, 1924-Creation of Bureau and Commissioner of Prohibition-Control of narcotics vested in Prohibition Bureau-Estimates for medical needs, discussion-Proper method for determining needs,-Maryland study-Studies of Committee on Drug Addictions-Discussions-Needs based on sales by manufacturers, discussion.

CHAPTER XII-CONTROL (continued)-STATE

Historical-Drugs included-Exceptions-Channels of distribution-Records required-Smoking opium-First anti-opium laws--Special provisions-Provision for addicts-Registration of addicts-Definition of addicts-Enforcing agency-Penalties--Legislation in New York State -Whitney Hearings-Department of narcotic drug control-Provisions of Whitney Law-Regulations under law-Annual report of commissioner -New Orleans clinic-Objects of dispensary-Treatment-Legal status of clinic.

CHAPTER XIII-CONTROL (continued)-MUNICIPAL

Jacksonville clinic-New York City clinic-Hospital treatment-Health department regulations New York City-Comments of Judge Collins- Court cases of addiction-Ages-Numbers committed-Sex distribution of court cases-Report to New York State Association of Magistrates- Present conditions-Shreveport clinic-Historical sketch-The dispensary-Results-Resolutions of medical society-Los Angeles clinic-Reports of director-List of clinics.