CLASSIFICATION OF HABIT-FORMING DRUGS
Opium is the basis of almost all the habit-forming drugs. There is no other drug known to the pharmacist that has a similar action or can be used as a substitute when a definite tolerance of it has been established. The chemists have given us more than twenty different salts or alkaloids of opium in various forms and under as many different trade names, and I regret to say that they are busy working in their laboratories to put upon the market injurious drugs under various supposedly harmless disguises, but intended in the end only to deceive.
MORPHINE
Morphine is the active principle of opium, and until a few years ago only crude opium or morphine was used for medical requirements. Morphine is intrinsically far worse than opium itself, for opium has certain properties which partly counteract the effect of the morphine that it contains. But morphine is not only the active principle, but the actively evil principle, of the drug.
The user of morphine always retains his faculties. He is usually capable of intelligent conversation. Unlike the alcoholic’s brain, his is not inflamed. It is impossible for the physician intelligently to discuss his symptoms with an alcoholic; with a victim of drugs, on the other hand, he can thresh out every detail of the case.
Later codeine was placed upon the market, supposedly an innocent alkaloid of opium, non-habit-forming, but still capable of eliminating pain and suffering due to illness or injury. After taking up this work, my investigations soon led me to realize that it was not the quantity of the drug taken which produced the drug habit, but the regularity of the dosage. I also found from my clinical comparisons that codeine has only one eighth the strength of morphine, yet in the end just as surely a producer of the drug habit similar to that of morphine itself.
HEROIN
At this writing the most harmful form of opiate with which we have to deal is heroin. This preparation of morphine was first put upon the market by German chemists about fifteen years ago, the word “heroin” being nothing more than a trade name. It was first used in cough mixtures, and was widely discussed in the medical and pharmaceutical press, where it was claimed that all the harm of morphine had virtually been eliminated in this product, which, without having the depressing effect of morphine, at the same time preserved its stimulating effect. A great number of physicians themselves have acquired the habit of taking opiates in this form, believing at the outset that they were not harmful drugs.
My investigations soon showed me that heroin is three times as strong as morphine in its action, and for that reason its use sets up definite tolerance more quickly than any other form of opiate. For the same reason it shows more quickly a deleterious effect upon the human system, the mental, moral and physical deterioration of its takers being more marked than in the case of any other form of opiate.
Until the Federal Pure Food Law was passed we did not know that many of the well-known, advertised medical preparations contained quantities of various salts or alkaloids of opium. The unsuspecting users of patent medicine were making themselves confirmed drug-users unwittingly, and did not realize how necessary the habit had become to them until for one reason or another they had been deprived of their usual daily dosage.
The reader may imagine my surprise when, although a layman, I found that the physician, to whom we had looked for guidance in administering and prescribing these drugs, knew nothing about them beyond their physiological action; that their medical training both in college and in clinics had left them in virtual ignorance of the whole question. The physician freely prescribed or administered these various drugs, while laymen were able to buy over the counters of druggists prescriptions containing definite quantities of them. Unknowingly, the doctor and the druggist were creating great numbers of drug-fiends.
Physicians do not yet know over how long a period such drugs can be administered in regular daily dosage without setting up a tolerance, after which the patient cannot be deprived of the drug. If the public had been better advised on this subject, it would have been able to protect itself, and would have been more careful about what it took.
COCAINE
Outside the opium group, there is at present only one other drug that must be considered as habit-forming, and that is cocaine. The prostitution of this drug from its proper uses is absolutely inexcusable. It was first used medicinally about thirty years ago, and as an anesthetic only. Its administration upon the nose by specialists in that field of surgery soon established the fact that it not only deadened tissue, but set up a certain stimulation which for the time being made one feel abnormally strong or mentally active. This was the beginning of its common use in the shape of so-called catarrh cures. Only a small quantity—from five to ten per cent.—was used. The tissue of the nose is very susceptible to the action of drugs. When it is applied in this way, the circulation takes up the drug as quickly as if taken hypodermically. Unscrupulous chemists and physicians have unloaded upon the world a drug which is beneficial when taken medicinally, but one that has reaped a harvest of irresponsible victims, in which murder, all forms of crime, and mental and moral degeneracy have conspicuously figured, and all for financial gain.
The habit was first generally spread through the medium of catarrh-cures. Cocaine contracts and deadens the tissue with which it comes in contact, and thus, as in the case of catarrh, relieves the patient from discomfort, making him feel, indeed, as if there were no nose on his face. Its effect, however, lasts only from twenty to thirty minutes.
This is one of the reasons why the cocaine habit is so easily formed. A man taking any powerful stimulant is sure to feel a corresponding depression when the effect of that stimulant has died away, and it then becomes necessary for him to take more of the drug in order to buoy himself up and restore himself to the point of normality. It is among cocaine-users, therefore, not a yearning for any abnormally pleasurable sensation which sends them back again and again to their dosage, but merely their desire to be measurably restored to the comfort which is natural to the normal state. It must be apparent, however, that as soon as it has become necessary for any one to resort to the use of a drug in order to rise to the normal there has been a marked depreciation, physical or mental, and probably both. This explains the fact that many criminals are found to be cocaine-users. No drug so quickly brings about a mental and physical deterioration. It is virtually certain to be a short cut to one of two public institutions, the prison or the madhouse. It will send the average person to the prison first because it is an expensive drug, and the craving for it is more than likely to exhaust his financial resources and then drive him to theft. It is the most expensive of all drug habits. I have known victims who habitually used one hundred and twenty grains a day, at a cost of about seventy dollars a week. This undoubtedly explains the great number who have been made criminals by using cocaine. One who uses it thereby diminishes his earning capacity; while, on the other hand, one who must have it must have money, and much of it.
It may be that this matter of cost explains why the under-world has suddenly taken up heroin instead of cocaine. The former is much cheaper.
HYPNOTICS
While I have only touched upon the opium group and cocaine, I wish to put myself on record now as saying that there is no class of drugs so sure in the end to bring about a deterioration of the physical being as the frequent use of the hypnotic group, or coal-tar products, the sleep-producers. I have never seen more pitiable cases than those who have come to me after they had been taking regularly, during a considerable period, some cure for sleeplessness. This habit not only produces an extreme neurotic condition, but changes the entire temperament of a person. It will turn the most beautiful character into an extreme case of moral degeneracy.
Insomnia, headaches, and such ailments spring from a disorganized physical condition. Trying to alleviate them by the use of powerful drugs does not remove the cause, but compounds the physical disabilities which produce these unfortunate physical results. Some day I hope to see as stringent a legal regulation of the sale of these drugs, used for this common purpose, as there now is of opium and its products and cocaine.
SLEEPING-POWDERS, OR HYPNOTICS
The time cannot be far distant when both Federal and State governments will recognize the danger that lies in the unrestricted sale by druggists and the uncurbed administration by physicians of sleeping-powders, or hypnotics. It cannot be denied by any one who is thoroughly familiar with the subject of habit-forming drugs that in such substances may lie a peril comparable to that inherent in cocaine and opium compounds. Hypnotics of many varieties can be obtained at any drug store in the United States without a doctor’s certificate. The sale of bromides is absolutely unrestricted. The many and varied coal-tar products, of which veronal is the leader, with trional, suphonal, medinal, as close followers, and the numerous proprietary remedies, such as somnose, neuronidia, bromidia, Peacock’s bromides, etc., may be mentioned as preparations which are widely advertised and openly and energetically sold, and all of which are definitely dangerous.
COAL-TAR PRODUCTS
Preparations for headaches and neuralgia are notably dangerous. There can be no doubt of the necessity for legal restriction of the sale of anti-kamnia, phenalgin, orangeine, Koehler’s headache remedy, shac, all coal-tar products notable for their production of anemia and depression, and undoubtedly responsible for the presence of many men and women in the mad-houses of the land. The chemist whose genius is responsible for the introduction of caffeine to overcome the depressing effect of some of the other component parts of these preparations has put hundreds of thousands of dollars into the pockets of the manufacturing druggists and has saddled the world with a great and unnecessary weight of physical and mental degeneration.
THE PERIL OF THE DRUG-STORE
Not least among these preparations that have most importantly contributed to the tragic army of drug-users in the United States have been various diarrhea remedies and other bowel correctives containing a large amount of straight opium. Morphine, opium, and heroin appear in many cough-mixtures in habit-forming quantities and are offered for sale everywhere save in New York State, where recent legislation somewhat restricts the traffic. Indeed, in every State except New York there are few druggists who do not make up and sell preparations of their own containing codeine, morphine, heroin, or some of the derivatives of opium.
No druggist has a right to prescribe any of these powerful drugs. The American public has fallen into the bad habit of trusting the druggist when it should go to the physician. A dozen times every day in the experience of the average American druggist a customer enters who says, “I want something to make me sleep,” or, “I want something to cure my headache.” Without hesitation, and without blame, for with him the custom has probably been unconsciously built up, the druggist reaches to his shelf and dispenses preparations in which the utmost peril lurks—preparations containing ingredients which should be sold only on the prescription of a physician. Under the present law, as I think it exists in every State, druggists cannot prescribe, but they can advise customers to purchase advertised preparations and those which they themselves compound.
Only a very powerful drug can stop a headache as quickly and completely as Americans have come to demand. The preparation must be strong enough to deaden disordered nerves, and being chosen because it will be generally effective, not selectively effective, as in the case of a remedy chosen after an intelligent diagnosis has revealed the nature of the trouble to be treated, it is virtually certain to have no curative qualities whatever. Hundreds of deaths have resulted from unwisely experimenting with such preparations. Most of us have peculiar idiosyncrasies with regard to certain drugs. I have seen patients who could not take so much as two grains of veronal or trional without flushing, itching, and similar symptoms. With such people large doses might bring about serious results and even death.