GLYCO-HEROIN, SMITH
Report of the Council on Pharmacy and Chemistry
The following report was submitted to the Council by a referee and publication authorized.
W. A. Puckner, Secretary.
Glyco-Heroin, Smith (Martin H. Smith Co., New York) is marketed in a showy “patent-medicine” type of package, the label on which announces the presence of 1⁄2 grain of heroin to the fluidounce and admits the presence of 3.5 per cent. alcohol, an active ingredient that is not discussed in any way in the literature sent out by the manufacturer.
The composition of Glyco-Heroin, Smith, is given as follows: “Each teaspoonful represents: Heroin 1⁄16 grain, White Pine Bark 31⁄2 grains, Ammonium Hypophosphite 3 grains, Balsam Tolu 1⁄4 grain, Hyoscyamus 1 grain, Glycerin Q. S.” The alcohol is not mentioned in the formula.
The advertising matter says of the merits of the formula:
“Despite the fact that heroin, which is universally recognized as an invaluable respiratory sedative, is a conspicuous element of Glyco-Heroin, Smith, the other constituents, henbane, ammonia hypophosphite, balsam tolu and white pine bark are factors of no less importance; indeed, it is through the concerted action of its several ingredients that the preparation proves so notably beneficial in the class of affections in which it is indicated. The constantly increasing popularity of the preparation in the treatment of respiratory affections is the best adducible evidence of its value in such disorders.”
The absurdity of this assertion will be appreciated on comparing the nature, quantities and activities of the several ingredients. Thus, while heroin, a potent habit-forming drug, is present in unusually large proportions, tolu, an innocuous or comparatively harmless product, is said to be represented by 1⁄4 grain, a relatively small quantity, hardly sufficient to impart even a distinctive taste or flavor. Ammonium hypophosphite, in the amount said to be present, may be considered to be practically useless, while the dose of hyoscyamus, an additional narcotic, is fairly large. The white pine bark present is probably as active as would be a corresponding amount of white pine shavings or of turpentine sufficient to give the preparation a slight odor. The vehicle, glycerin, is claimed to be “notably advantageous,” but not a word occurs in the discussion by the manufacturer in regard to the presence of alcohol, which is certainly quite as active medicinally as the balsam of tolu and contributes fully as much to the flavor or taste of the preparation as does the white pine bark.
In prominent type on the outer label of the trade package we are told that the preparation is intended for the treatment of “COUGH, ASTHMA, PHTHISIS, PNEUMONIA, BRONCHITIS, LARYNGITIS, WHOOPING-COUGH AND KINDRED INFECTIONS.” In much smaller type: “Glyco-Heroin (Smith) is distinctly a product designed expressly for the use of physicians.” The circular included with the trade package, however, bears statements which would tend to encourage self-drugging by the layman, and in view of the manner in which the preparation is exploited are undoubtedly intended to do so. For instance:
“Bronchitis.—In the acute form of bronchitis, Glyco-Heroin (Smith) acts most happily. It tends to diminish the congestion and inflammation of the lining of the air passages, relieves the pain and institutes repair....
“Phthisis.—In the treatment of the cough of phthisis, Glyco-Heroin (Smith) is used with the most gratifying results. It checks the night sweats, acts favorably upon the reflexes, increases expectoration and induces refreshing sleep.
“Asthma.—The preparation diminishes the intensity of the paroxysms and lengthens the intervals between their recurrence. By the administration of the preparation, asthmatic attacks can frequently be aborted.
“Pneumonia.—In the initial stage of pneumonia, the preparation exercises a calming, antipyretic and sedative effect. In the latter stages of the disease, the analgesic and expectorant properties of the product are well displayed.
“Whooping-Cough.—Administered in doses of from five to ten drops this preparation affords surprisingly satisfactory results. The cough rapidly loses its spasmodic character and the frequency of the paroxysms is considerably diminished.”
How cruelly misleading the literature put out by the manufacturer of this nostrum is, will be apparent from a comparison of the rather large dose of heroin in a teaspoonful of the nostrum and the directions on the package that:
“The adult dose of Glyco-Heroin (Smith) is one teaspoonful repeated every two hours or at longer intervals, as the case may require.
“Children of 10 or more years, from a quarter to a half-teaspoonful.
“Children of 3 years or more, 5 to 10 drops.”
A WICKED FALSEHOOD
Included in much of the advertising matter that has been put out is the bare-faced untruth that the preparation does not produce narcotism or habituation. Here is a quotation from an undated circular:
“Glyco-Heroin (Smith) is decidedly preferable to preparations containing codeine or morphine, by reason of the fact that it does not produce narcotism, constipation, gastric disturbance nor habituation, even though its administration be protracted.”
That this assertion is not in keeping with facts is evidenced by the recent report of a study on the sale and use of heroin made by the U. S. Department of Agriculture. From the information gathered it appears that the sales of heroin and heroin-containing preparations have increased greatly, particularly in those states which have rigid laws preventing the indiscriminate sale of morphin and cocain. Investigation of the subject establishes the fact that many drug victims who formerly used morphin and cocain, and who under the new laws find it difficult to obtain these substances, have begun using heroin, the sale of which is not as yet carefully restricted under state laws. The drug is said to be fully as dangerous as morphin, and by many is held to be much worse, for the reason that it occasionally kills the victim outright, and its habitual use is far harder to overcome than that of other drugs.
Phillips,[48] in discussing the prevalence of the heroin habit, reports, among others, the case of a physician aged 60 who began to take heroin because he suffered from a chronic cough and thought there was no danger of habit from the use of this drug because he believed the statements of various manufacturing firms who claimed that there was no danger of habit.
In a pamphlet now being distributed to the medical profession, entitled, “Glyco-Heroin (Smith), an exposition of its components together with references to its value in the treatment of Bronchitis, Cough, Cough of Phthisis, Laryngitis, Pneumonia and allied disorders of the Respiratory Tract,” the several alleged uses of the nostrum in the treatment of cough, “Regardless of the nature of its underlying cause,... whether of recent origin or of long duration,” are discussed at length, and eminent practitioners with degrees extending the width of the printed page are quoted in support of the statements made. While it may be permissible for a theoretically trained medical tyro who lays claim to the right of appending the abbreviations M.A., M.D., D.C.L., L.R.C.P. to his name to laud a heterogeneous habit-forming cough-syrup like Glyco-Heroin, Smith, similar testimonials from a man entitled to append Ph.G., M.S., M.D. to his name makes one doubt the value of the training, either scientific, pharmaceutical or medical, that has been given the poor unfortunate who, according to his own statements, indiscriminately doses a female patient of 7 and a male patient of 40 with huge doses of heroin every two, four or six hours.
The danger of contributing to the spread of the heroin habit by the use of preparations of this type is indicated by an editorial in The Journal of the American Medical Association,[49] which points out that although heroin and its hydrochlorid have been in use but a few years they have already established themselves among the habit-forming drugs and have become sufficiently conspicuous in this respect to awaken the thinking public to the deplorable results for which they may become responsible. Phillips,[49] in the article mentioned above, quotes Petty, who reports that in the last 150 cases of drug habit coming under his care he saw eight cases of heroin addiction. Three of these were initial cases; in one the patient had been cured of the opium habit, but following an operation heroin was prescribed, and the habit followed. The remaining four patients purposely substituted heroin for morphin, to which they had been addicted.
THE GROWTH OF HEROIN ADDICTION
The imminent danger of substituting heroin for either morphin or cocain is shown by the fact, reported by the U. S. Department of Agriculture, that during the early months of 1913 the coroner’s office in Philadelphia County, Pa., held inquests on five sudden deaths from heroin poisoning. In each case the victim was a heroin fiend and took an overdose. Drug fiends are apparently able to consume relatively large quantities of morphin or cocain, but any sudden and material increase in the amount of heroin taken is liable to prove fatal. As indicating the wide sale of this substance, it is known that one druggist in Pennsylvania whose store is located in an undesirable section of his city has been buying heroin tablets in 25,000 lots.
GLYCO-HEROIN, SMITH, A “PATENT MEDICINE”
The popularity of Glyco-Heroin, Smith, as a household nostrum is suggested by the fact that one of the larger department-store type of drug-stores in the city of Philadelphia lists this preparation in its “patent-medicine” catalogue at $1.75 per bottle and sells it freely to all who care to buy. This is due to the fact that Pennsylvania, like many other states, does not include heroin in the prohibited list of habit-forming drugs that can be supplied only on physicians’ prescriptions.
To what extent Glyco-Heroin, Smith, is responsible for developing the rapidly growing heroin habit is of course problematic. It is reasonable, however, to suppose that a preparation, each teaspoonful of which contains so large a dose of heroin as does this nostrum, when taken as repeatedly and as indiscriminately as is directed by the manufacturer, would offer possibilities for harm sufficient in number to induce the thinking medical practitioner to avoid its use altogether and at least to suggest to even the most commercial dabbler in the healing art the desirability of carefully considering its potency for harm before endorsing its use in the treatment of “cough and kindred affections.”—(From the Journal A. M. A., June 6, 1914.)