The narcotic drug problem

by Ernest S. Bishop

Some writers, especially those associated with municipal or state institutions of penology and correction, lay emphasis upon the case of the so-called “mixed addict.” The crimes of violence with which addiction has become associated in the popular mind are practically never connected with the action of opiate drug. They are, however, characteristic of the cocaine crazed individual. When they are performed by a so-called “mixed addict” they are the result of cocaine habituation rather than of opiate addiction. Such crimes of violence as are committed by the opium or morphine addict are well explained in the Report of the Treasury Investigation Committee in the following words, “There are many instances of cases where victims of this disease were among people of the highest qualities morally and intellectually, and of the greatest value to their communities, who, when driven by sudden deprivation of their drug, have been led to commit felony or violence to relieve their misery.”

This erroneous grouping of so-called “habit forming drugs” is to some extent responsible for a misconception of opiates and of opiate use and opiate result to such an extent that, there is unfortunately manifested at times a lack of appreciation of the very important legitimate uses of these drugs.

The paramount issue of legitimate narcotic medication is that of the opiates. Opiates form and must continue to form the most indispensable medication, emergency and otherwise, for shock, wounds and allied conditions. It may be safely stated that of all emergency medication, the opiates would be the last to be surrendered by the intelligent physician or surgeon. This is true of every day civil practice and its importance is increased tremendously under conditions of active warfare.

The opiates possess combined actions and powers not found in any other group of drugs. In therapeutic doses they support the heart and circulation, they relieve pain, they hold in check excessive activity of the glands of internal secretion with all their associated phenomena of exhaustion and collapse; they control spasm and they give sleep. In no other drugs or group of drugs are these properties combined as they are in the opiate group. In emergency medication, opium and its alkaloids, especially morphine, are the medications often most responsible for the saving of life and reason. It is not necessary to argue this point with any intelligent physician or surgeon. For the benefit of the laity, however, and for the benefit of the occasional fanatic and hysterical reformer it is well to state that without the use of morphine and other opiates the mortality among the sick and wounded would be vastly greater, and many of those who might survive in spite of its non-administration to them would bear for the rest of their lives physical and mental and nerve consequences of gravest character. The lives and minds that have been saved by the timely administration of an opiate drug are incalculable. One has only to talk with those who have worked under the stern necessities and emergency conditions of warfare to appreciate this fact. There is no known drug which will replace clinically and therapeutically the opiate group. At present it is as indispensable in meeting emergency indications as is the scalpel of the surgeon.

It would be entirely unnecessary to discuss or to apparently defend the use of narcotics in peace as well as in war-time medication if it were not for the fact of recent recognition of the wide existence of opiate addiction in the civilized world. Combined with this is the belief, often met, that as a result of prolonged opiate administration, a certain proportion of soldiers have developed this condition. If the facts of addiction-disease were widely known and applied to its proper handling and remedy, there should be no hysteria concerning and no criticism against legitimate opiate medication; even if unavoidably continued to the point of creating this condition. That opiate-addiction is one of the medical problems of war is recognized and must be openly met. In many cases, just as in private civil practice, the physician is confronted by a choice of evils. To save life or reason he must continue opiate medication even into and past the danger zone of beginning opiate addiction. Lack of popular recognition, appreciation and comprehension of this fact, in the present status of narcotic addiction, contains grave dangers of hysteria and of undeserved and irresponsible criticism. That this criticism is based on ignorance makes it none the less unpleasant and hampering to efficient service.

It should be at once and widely taught that the cases of opiate addiction that follow war time administration of opiate do not constitute a new medical problem, but simply constitute additional cases of a disease which has existed insufficiently appreciated in this country for over half a century. When the conditions under which wounded and sick must be handled in the emergencies of war, and the higher percentage of urgent and severe cases are taken into account, it will be found that the proportion of wounded and sick soldiers with this addiction-disease is no greater and is very probably not so great as the proportion of people in civil life and practice who have in the past contracted this disease, and are even at present contracting it as a result of opiate medication, unavoidably or otherwise continued to the point of addiction.

As the facts of addiction-disease development as a result of unavoidable military therapeutics become known it will be well to remember that the conditions are no different in character and exist in no greater relative proportion than the same conditions in civil life and practice. The principal difference lies in the greater opportunity for early recognition.

As to the illegitimate or non-therapeutic contraction of addiction within the army, its dangers are no greater and possibly not as great as in civil life. Some non-medical cases of addiction may have developed within the ranks of the army. It may be said of them, however, that army life and activity and training probably saved many more or less idle and ignorant youths imbued with a spirit of curiosity, and with lack of normal outlet for physical and nervous surplus energies, from the associations and environments which have been taken advantage of by those associated with illicit commerce in the creation of the addict of non-medical origin, which has so increased in the past four or five years.

It is my belief that the gathering together of young men presents an opportunity for the education of the youth as to the physical and disease facts of opiate addiction which should be of incalculable benefit in the solution of the narcotic problem and in the suppression and prevention of “underground” and underworld narcotic traffic.

The foregoing opens to discussion another legitimate use of narcotics. This use is the intelligent administration of opiate in the control and therapeutic handling of whatever cases of addiction are found to exist. The situation within the army as regards addiction is in the general indications for its handling, identical with the situation existing in civil life. The man who has fully developed opiate addiction-disease will have to have his opiate supplied to him intelligently and with proper appreciation of the symptomatology and reactions of addiction-disease until there is equipment and educated personnel provided for his intelligent and competent handling. Under any other immediate arrangements, the addicted soldier, just as the addicted civilian, will in his desperation and physical torments of bodily need for opiate drug, endeavor to smuggle, steal or otherwise obtain in any way possible this medication.