I follow no “routine” and have no set procedure. I am guided, as in my handling of the other stages of addiction-disease, by the condition of my patient and his clinical requirements. There is no one procedure applicable to all cases of any condition in medicine and surgery. In narcotic addiction-disease, as in all other conditions of medicine and surgery, the man who will have the best results is the man who is possessed of the widest and most varied experience combined with intelligent observation, technical skill and clinical judgment in the selection of procedure best adapted to the needs of the individual case. Familiarity and experience with different methods and procedures reveals in each and nearly all of them some advantages and some defects. The wise man and the man whose results will most approach uniform success is he who can make intelligent selection and use of whatever is most applicable to the needs of the case he treats, either out of his own experience and discoveries, or out of his familiarity with the work of others.
An element in successful withdrawal of narcotic must also remain, as in everything else, the inherent personal gifts and qualifications of the individual operator. A man works best with the tools most adapted to his hand, and operators of different temperaments and of different experience and training will always disagree on points of procedure and technique. My own procedure in final withdrawal is determined largely by my study and measure of my patient and my patient’s reactions, addiction and otherwise, during my preliminary or preparatory work, selecting the time for final withdrawal of drug by consideration of similar factors as would be taken into account in an operation of election.
After a preliminary stage, or stage of preparation, in which I have gotten rid of all possible abnormalities, physical and psychical, with my patient robust and reactive, confident and expectantly happy, with autointoxication, and inhibition removed and the possible residues of opiate or opiate product no longer stored in atonic body cells—the addiction-mechanism, therefore, only kept in activity by the current intake of opiate, which if properly handled and the patient not subjected to exhausting strain and struggle and suffering, can be eliminated in a very short time. With these conditions consummated, I hasten elimination, keeping well away from exhausting purgation, maintaining my patient’s circulatory and other functions, and conducting as rapid a withdrawal as is compatible with my patient’s reactive condition and the reactions of his disease.
In other words, I endeavor by my conduct of the case to reverse the process of development of the physical addiction-disease with its concomitants and complications, as I find it in the individual case, arresting the addiction-disease mechanism only after I have cleared the clinical picture in so far as possible of all other considerations.
In a majority of cases by experienced choice of clinical procedure, combined with judgment and technical skill, the arrest of addiction-mechanism and the restoration of the narcotic addict to health and freedom from both opiate need and thought of opiate drug is a matter of assured accomplishment attended by little if any nervous strain and physical suffering.
Ability to accomplish this is not beyond the power or any competent practitioner, whether he reside in a hospital or is in private practice. All that is required is instruction or information as to the mechanism of addiction-disease, clinical demonstration of its manifestations and reactions and the same amount of experience in their handling as is expected of a man who treats any other disease.
I have purposely refrained in this book from discussion of technical details of therapeutic procedures, and of various medications, and of their various indications, contraindications, applications, dosage, etc. Such discussion, to be adequate and competent, would require much space and would distract from the general presentation of the problem, which is the purpose of this volume.
I have learned from experience in teaching and in treatment of cases that before there has been established appreciation of the whole personal and clinical problem and picture, and conception of its disease mechanism, and ability clinically to recognize and interpret symptomatology, discussion of technical details is premature and misleading.
CHAPTER VII
RELATION OF NARCOTIC DRUG ADDICTION TO SURGICAL CASES AND INTERCURRENT DISEASES
It is a common idea in the minds of both surgeons and physicians that an addict to narcotic drug is a difficult case for surgical handling and is a poor surgical risk. Numerous instances of surgeons refusing to operate upon a narcotic addict until the addict should have “stopped” the use of the drug, voice the almost prevailing attitude.