In brief then, and to recapitulate, the legitimate use of narcotics will be roughly divided under two broad heads. The first is the necessary administration of opiate to those who are not addicted for the control of emergency or other indication with which every competent physician or surgeon is familiar. To use opiate as indicated in such cases is not only legitimate, but failure to use it would be inhuman and barbarous and result in the loss of many lives and in the making of wrecks of many others. The second is the administration of opiates to those unfortunates, who either through their own ignorance or carelessness, or through unavoidably or otherwise prolonged legitimate or necessary medication have developed in their body the condition of opiate addiction-disease, until such time as their disease can be arrested by competent medical care of their addiction-disease mechanism.
As to addiction created in war time, there is considerable amount of information. This is not the time nor the place for detailed discussion of that information. Calm consideration of it should, however, suffice to still the voice of any objections and irrefutably answer arguments criticizing existence of war-time addiction. The greatly lacking and needed element in its consideration and handling is appreciation of it as physical, controllable and arrestable disease. The laity and the mothers and other relatives and the friends of those in the Army and Navy will not exhibit panic and fear once the intangible horror and vague and morbid and erroneous picture of the “dope fiend” is in its application to opiate addiction erased from popular conception and replaced by comprehension of a definite physical disease clinically controllable and in most cases therapeutically remediable.
To what extent narcotic drug addiction-disease will prove to be a medical sequela of war and of necessary war-time medication may never be made a matter of accurate statistics. The popular and prevailing attitudes towards and conception of the condition and of its possessor tend to influence towards desperate concealment rather than to encourage self-revelation. As has been stated before addiction-disease followed the Civil War, occasional cases recently existing and possibly still existing among the few remaining veterans of that struggle, addiction dating back to Civil War medication. The Spanish War and necessary medication added to the list of war-time contracted addiction-disease. Of addiction among those participating in the last war, it is at present wise to simply recognize the condition, and to hope that as the addiction-disease sufferer, developed through necessary war-time medication becomes known, he will not have to carry the addiction stigma of past attitudes and conceptions, and that we shall be in a position to accord him intelligent and humane consideration and handling as a deserving sick man, whose disease was contracted in our defense.
CHAPTER X
GENERAL SURVEY OF THE SITUATION AND THE NEED OF THE HOUR
From the foregoing it is easy to see that the sooner the established facts of the fundamental physical basis and reactions of the addiction-states become matters of medical, sociological, administrative, and lay knowledge, the earlier there will be a rational and practical consideration of the use as well as of the abuse of narcotic drugs, and a beginning of solution of the narcotic drug problem.
Lack of knowledge of the fundamental and constant physical reactions and phenomena, and of the characteristic clinical manifestations of this disease, and of the physical suffering of drug deprivation is in a very large measure responsible for failure in its therapeutic handling in the past, and indirectly responsible for whatever is unjust and misdirected in the framing of the various laws, and also for a great part of whatever incompetency and lack of wisdom has appeared in their administration.
Lack of knowledge of the disease facts of narcotic addiction is also responsible for the practical absence of widespread provision for humane and intelligent handling, for much of the jeopardy and fear on the part of the medical practitioner towards these cases, and for the existence of conditions resulting in the rapid growth and increase of the worst evils of the present situation.
The worst evils of the narcotic drug situation are not, as is widely taught, rooted in the inherent depravity and moral weakness of those addicted. They find their origin in opportunity, created by ignorance, neglect and fear, for commercial and other exploitation of the physical suffering resulting from denial of narcotic drug to one addicted. The many widely advertised drug cures derive their prosperity from the desperate desire of the narcotic addict to be cured of the condition which may at any time cause him intense physical suffering. The worst evil of the narcotic situation in the past few years, and especially since the enforcement of restrictive legislation, without provision for complete investigation of the whole situation, for education, and adequate treatment of disease aspects, is the rapid growth and spread of criminal and underworld and illicit traffic in narcotic drugs. This exists to its present extent because conditions have been created which make smuggling and street peddling and criminal and illicit traffic tremendously profitable, and it would not exist to its present extent otherwise. It is simply and plainly the exploitation of human suffering by the supplying to desperate and diseased individuals, at any price which may be demanded, one of the necessities of their immediate existence.
Such exploitation would become unprofitable on any large scale if the disease created by continued administration of opiates were recognized as it exists and its physical demands comprehended and provided for in more legitimate and less objectionable ways.
One of the most important and immediately available of these ways is the honest practitioner of medicine. If the average practitioner of medicine were made familiar with the physical facts of addiction-disease, and its phenomena and reactions, and were encouraged by both legal and medical authoritative support to admit addiction-disease patients to his practice, to be cared for just as other patients to the best of his honest therapeutic ability and judgment—if he were taught to regard them as sick people whom he could help—if he were relieved of uncertainty as to the meaning and possible interpretation of laws and regulations, and as to the possible action or lack of action and attitude of his medical brethren and medical organizations towards him—the best available, honest, humane and intelligent machinery would be set in motion for the immediate care of the average honest sufferer from addiction-disease, and for the discouragement of underworld or underground exploitation. This has been demonstrated. It would react furthermore as a stimulus to the education of the physician, to familiarize himself with the scientific and medical facts of this disease.