The narcotic drug problem

by Ernest S. Bishop

Tracings 2, 3 and 4 were made at about fifteen minute intervals. They were made following experimental hypodermic injections of morphine sulphate to determine the extent of opiate need and organic dependence upon opiate medication, and the amount of opiate required to restore organic function and tone.

Tracing number 4, taking into consideration the asthenic and exhaustion condition of the patient, shows full support to circulation with some overaction.

Tracing number 5 was taken an hour or two after tracing number 4 to determine the holding power of the dosage administered, after the circulation had reacted from the immediate stimulation of the opiate medication. This tracing, interpreted and considered together with the clinical manifestations at the time, was decided to be about normal for that patient at that time.

This patient would have died, not from pneumonia with cardiac complications, but from insufficient control of the mechanism of opiate addiction-disease.

On balanced and indicated daily morphine dosage, patient made very rapid recovery and has continued well and active.

Such cases as this, where addiction-disease co-exists or is intercurrent with other medical or with surgical conditions, are not as uncommon as may be supposed. That they are frequently unrecognized the histories of many narcotic addicts demonstrates, and is discussed later. Board of Health and Insurance mortality statistics are undoubtedly very incomplete upon this situation. Addiction, regarded as a habit or indulgence, may easily be overlooked or disregarded as a cause of death, direct or contributing. It may easily be omitted from returns made out, however actually important a part in the final issue may have been played by the influences, upon body function and upon physical resistance and recuperation, of an unappreciated and inadequately controlled addiction-disease.

It is earlier stated that the common idea of the addict to narcotic drugs as a poor risk is an undeserved reputation, and is not to be laid at the door of addiction existence itself. In very many cases of opiate addiction, the opposite of the popular belief is true. The opiate addict, if his addiction mechanism is competently appreciated, its reactions accurately estimated, and its influences wisely controlled, is quite other than a bad risk. Indeed the mechanism of addiction and the opiate which caused it can often be handled in such a way in the control of glandular, circulatory, nervous and other function and reaction as to aid in the carrying over of emergencies, medical and surgical. A case in point is an emergency operation on the pancreas, performed upon a man in extremis, whose unexpected recovery and convalescence astonished all observers by being remarkedly rapid and uncomplicated, due unquestionably in large part to the early recognition and clinical handling of his addiction-disease, and the possibilities it created for unusual opiate medication.

It has been my experience at times, when called in medical consultation upon post-operative cases whose lack of repair and slowness of recovery could not be accounted for, to discover an unsuspected addiction, and to find that the lack of repair and slowness of recovery was due simply and slowly to the want of comprehension of, or to inadequate control of addiction mechanism existing in the patient.

Many opiate addicts when about to undergo operation, have provided for possible contingencies by the concealment of, or by outside provision for, a supply of opiate sufficient in amount to meet their physical needs. There are very many addicts who have, out of their past experience and study upon themselves, competently controlled their own narcotic-drug-disease during treatment for other conditions, operative or medical. The number of narcotic addicts is not few who have been cared for medically with nursing attention, or have undergone operations for the remedy of various surgical conditions, have recovered, convalesced and been discharged without the physician or surgeon becoming aware that his patient was addicted. This is not a comment in criticism upon my professional brethren. In my own experience such a case is a matter of quite recent occurrence. A patient treated by me in a hospital, for conditions other than addiction, one day unexpectedly revealed to me the fact of long standing addiction. The patient had been afraid to tell me about this condition until thoroughly convinced of my attitude towards it, and had secured opiate medication elsewhere.

It seems strange that a condition of as powerful influence over body function and metabolism as is exerted by the addiction mechanism of narcotic drug-disease should not long ago have received exhaustive and complete clinical and laboratory study along the lines of its manifestations and influences, as well as along the line of reduction and deprivation of the drug of addiction. In view of the above it would seem to be of vastly more importance at the present time that the mass of practitioners of surgery as well as of medicine should understand and be able to control action and reaction in a narcotic addict as a result of his addiction-disease mechanism, than it is that they should attempt the mere reduction or denial of the drug of addiction.