Opium (15 page)

As addiction deepens, the addict grows even more mentally and physically lethargic, lacking concentration and becoming forgetful. The body debilitates and becomes emaciated as appetite for food is lost: the voice grows hoarse, constipation develops with amenorrhoea and sterility in women or impotence in men. Medical complications include hepatitis and liver damage, blood poisoning, venereal diseases, skin infections and fungal diseases, swelling and collapsing of veins too frequently used for injections, respiratory diseases, tuberculosis, psychosomatic disorders, advanced tooth decay and nervous tremors. The memory is impaired to such an extent even everyday practicalities are overlooked and the addict withdraws into an inner world. Hearing and sight, however, become acute: tiny noises are amplified and bright lights are painful. Waking hours may be filled with hallucinations with sleep bedevilled by nightmares.

This developing pattern of addiction, essentially the same for opium as for morphine or heroin, has long been known. The April 1837 edition of the quarterly journal
The Chinese Repository,
published in Canton and Macau, contained an article on a series of paintings by a Chinese artist called Sun Qua which illustrated the downfall of an opium smoker from health and wealth to pain and poverty. The subject was the son of a wealthy businessman who inherited his father's business, the pictures described as follows:

1. This picture represents the young man at home, richly attired, in perfect health and vigour of youth. An elegant foreign clock stands on a marble table behind. On his right is a chest of treasure, gold and silver; and on the left, close by his side, is his personal servant, and, at a little distance, a man whom he keeps constantly in his employ, preparing the drug for use from the crude article, purchased and brought to the house.

2. In this he is reclining on a superb sofa with a pipe in his mouth, surrounded by courtesans, two of whom are young in the character of musicians. His money now goes without any regard to its amount.

3. After no very long period of indulgence, his appetite for the drug is insatiable, and his countenance sallow and haggard. Emaciated, shoulders high, teeth naked, face black, dozing from morning to night, he becomes utterly inactive. In this state he sits moping, on a very ordinary couch, with his pipe and other apparatus for smoking lying by his side. At this moment, his wives – or a wife and a concubine – come in; the first finding the chest emptied of its treasures, stands frowning with astonishment, while the second gazes with wonder at what she sees spread upon the couch.

4. His lands and his houses are now all gone; his couch exchanged for some rough boards and a ragged mattress; his shoes are off his feet, and his face half awry, as he sits bending forwards, breathing with great difficulty. His wife and child stand before him, poverty stricken, suffering with hunger, the one in anger, having dashed on the floor all his apparatus for smoking, while the little son, unconscious of any harm, is clapping his hands and laughing at their sport! But he heeds not either the one or the other.

5. His poverty and distress are now extreme, though his appetite grows stronger than ever; he is as a dead man. In this plight, he scrapes together a few coppers cash, and hurries away to one of the smoking-houses, to buy a little of the scrapings from the pipe of another smoker, to allay his insatiable cravings.

6. Here his character is fixed; a sot. Seated on a bamboo chair, he is continually swallowing the fæces of the drug, so foul, that tea is required to wash them down his throat. His wife and child are seated near him, with skeins of silk stretched on bamboo reels, from which they are winding it off into balls; thus earning a mere pittance for his and their own support, and dragging out from day to day a miserable existence.

Just as the way drugs are taken affects the speed and intensity with which they have an effect, the means of taking them also affects the rate with which addiction develops and may affect the ease of withdrawal. Addiction from opium smoking takes the longest, followed by opium-eating. Orally administered morphine or heroin results in quicker addiction but the greatest impact comes by intradermal, intramuscular or intravenous injection. Organic factors, such as an individual's metabolism, also play an important role in the addiction syndrome.

Morphine and heroin addiction develop much more quickly than that of opium because they are far more concentrated. It therefore follows that police narcotics officers do not – as they frequently seem to do in films such as
Lethal Weapon
and
Beverly Hills Cop
– stick their finger into a suspected drugs haul and lick it to see what they have: such behaviour is a sure-fire way to attain an addiction.

A morphine addict is not usually hooked by the first injection. It may take several weeks of daily doses, or it may take months, before signs of chronic morphine habituation occur: but with continued use addiction is a certainty. Chronic addicts rarely survive to old age and may succumb to a relatively mild disease, or they become so weak as to die from simple infirmity. Death may come within weeks or they may linger on for years: there is no set pattern.

Of all the opium-based drugs, heroin is the most addictive and addiction can start with the very first dose. Curiously, heroin itself appears to have little adverse physical effect upon the body, much of the addict's considerable health problems deriving from his or her life-style and the fact that today many simultaneously use cocaine to counteract heroin's numbing effect.

Opium and its derivatives have posed problems for decades. Even now, although doctors and scientists understand the chemical make-up of opiates, they still have little idea how the various parts operate and there is still no guaranteed antidote.

Without an assured remedy, doctors have over the years devised scores of ways to try to fight addiction. Addicts were purged to eradicate toxins, given other opiates or opiate-like drugs as a substitute or an antagonist for certain withdrawal symptoms, and all methods tried to reduce the pain of withdrawal. Some doctors believed withdrawal was psychological or psychosomatic. Others believed it was life-threatening, yet others did not. Until well into the twentieth century, most doctors regarded addiction as they did disease: treating the symptoms but not the cause. The only common denominator was that no addiction could be reversed without the dedicated co-operation of the addicts themselves, but few fought their habit by themselves.

Thomas De Quincey was one who did. His addiction was abhorrent and he tackled it himself, yet never managed a complete cure. Of his attempt, he wrote: ‘I triumphed. But infer not, reader, from this word … triumphed, a condition of joy and exultation. Think of me as one, even after four months had passed, still agitated, writhing, throbbing, palpitation, shattered…'

When morphine was discovered it was promoted as a cure for opium addiction: then, when heroin arrived it was claimed to cure morphinism. Professor Louis Lewin, in his book
Phantastica,
tells of a Chinese opium smoker who offered a reward to anyone who could rid him of his craving. One man succeeded who, with his success behind him, promptly went to Hong Kong and set up a thriving clinical business: his ‘cure' was morphine injections.

Such quackery was noted by Dr D.W. Osgood of the Foochow (now Fuzhou) Medical Missionary Hospital in 1878, who observed:

There are several varieties of pills and powders extensively advertised among the Chinese as unfailing specifics for opium smoking. Many, if not all, of these contain opium or morphia and the patient finds he is as much a slave to his medicine as he previously was to his pipe.

Osgood's own treatment was somewhat different:

total discontinuation of opium in any form from the time of entering the asylum … Chloral hydrate and Potassium Bromide for the first three or four days as required. A pill consisting of belladonna, gentian, valerian, quinine and ginger is given morning and evening.

With such a regime, he was convinced he could achieve a 99 per cent success rate if the patient had ‘the required grace and grit'. By contrast, Lewin firmly believed there was no substance which could cure or even alleviate opiate addiction which did not itself contain opium or a derivative.

As the patent medicine industry of the nineteenth century expanded, a parallel industry set up within it offering self-administered treatments for addiction, many of them containing the original addictive substance. Entrepreneurs, quick to see the market, cooked up various concoctions such as the ‘Normyl cure for Alcohol and Drug Addictions' which contained alcohol and strychnine. ‘The Teetolia Treatment' consisted of alcohol and quinine and the ‘St. George Association for the Cure of the Morphia Habit' cure contained morphine and salicylic acid. All these remedies were fraudulent, offering hope without foundation and they were frequently overpriced. Some were bizarre: the leaves of the Malayan ‘anti-opium plant' offered a quick cure but the only active ingredient in it was tannin.

Until the 1920s, it was believed withdrawal and convalescence were sufficient to break an addiction, the treatment maintaining the physical health of the addict, on occasion addressing the physical side-effects, such as pulling decayed teeth, and bolstering his courage with psychological help. Healthy activities were encouraged such as plenty of fresh air, exercise, sports, personal hygiene and Turkish baths to sweat toxins out of the pores. Confinement was also frequently recommended. Levinstein counselled locking addicts in a cell for up to a fortnight under medical supervision. During the first four or five days, he suggested the attendant nurses be female because male staff were more susceptible to patient bribery. The cell was to be sparsely furnished, but the addict was allowed alcohol, especially champagne, port wine and brandy. Ice compresses were applied for the inevitable headaches whilst general pain was treated with bicarbonate of soda, chloral hydrate and frequent warm baths during which stimulants, such as beef tea with port wine or champagne, were given. For some reason, champagne figured in other addiction treatments: in their account of treatment for withdrawal Allbutt and his co-worker, W.E. Dixon, noted:

Whatever the value of auxiliary drugs, the importance of nourishment is much greater … When the nausea or vomiting are troublesome, cold-meat jellies, iced coffee with or without cream, iced champagne, and the like, must be tried by the mouth, and supplemented by nutritive enemas. As the stomach becomes more capable of work, turtle and other strong soups, and like generous restorative foods, must be pressed on the patient; and gentle massage used to promote absorption and blood formation.

Judging from such a menu, most cures were aimed at the wealthy. The cost of treatment was high and most doctors ignored the poor whilst those who were concerned with addiction amongst the working class mainly turned their attention to restricting supply.

In Europe, wealthy addicts mostly attended private doctors but in the USA sanatoria were founded to address the problems. Not that the patients were any better off there for many of these establishments were as fraudulent as the patent cures: they were the nineteenth-century equivalent of some modern slimming farms and in certain instances made fortunes for their proprietors who vied with each other with extravagant claims.

The emperor of the cure-masters and fraudsters was Charles B. Towns. In 1901, he arrived in New York which had a substantial addict population. Travelling from his native Georgia, he was on the look-out for business opportunities, having been a life-insurance salesman, reputedly the most successful south of the Mason-Dixon Line. After failing in a stock-brokerage firm, he saw an opportunity in addiction treatments and invented his cure, details of which he kept secret. He somehow managed to dupe Theodore Roosevelt's physician into recommending him to Assistant Secretary of State Robert Bacon who arranged for Towns to visit China, promoting his concoction with the War Department which was seeking a cure for Soldier's Disease, and with the American delegation to the Shanghai Opium Commission in 1909, when Towns claimed he had cured 4000 opium addicts in the city. Towns became internationally renowned and was fêted by politicians, who were under pressure to do something about addiction and who lauded him for his altruism, for it was reported Towns took little financial reward from his work.

Towns's formula, finally published in 1909, was made up of one part the fluid extract of prickly ash bark, one part the fluid extract of hyoscyamus and two parts 15 per cent tincture of belladonna. This was to be administered with a complete evacuation of the bowels (usually by enema), doses of the addictive substance, castor oil and strychnine. After three days, the addict was said to pass a green mucous stool which signified the end of his discomfort and addiction. Towns's enemies and competitors referred to his formula as the ‘Three Ds' – diarrhoea, delirium and damnation. By 1920, he and his cure were seen to be what they were – fakes: Towns was by then a wealthy man.

Gradually, the painful reality was realised: there was no hard-and-fast easy cure. Every conceivable scientific and quack avenue seemed to have been explored, but the rate of relapse was huge. All the cures did was temporarily divorce addicts from their drug.

In 1926, the Departmental Committee on Morphine and Heroin Addiction of the British Ministry of Health (better known as the Rolleston Committee), judged that gradual withdrawal was better than rapid but added that this was only phase one in a long treatment which could only be effective if the patient was educated in his or her problem as well as assisted with the symptoms. The patient's mental outlook and attitude were integral to the process and it was not deemed successful until the addict remained free of drug usage for between eighteen months and three years.

Over the years other less fraudulently inspired curative techniques derived from America. One of these was called CDT – Carbon Dioxide Therapy. Addict patients were made unconscious with nitrous oxide then forced to breathe a mixture of 30 per cent carbon dioxide and 70 per cent oxygen for between 20 and 40 inhalations. A coma was induced. As recently as 1972, one of the main proponents of the therapy, Dr Albert A. La Verne, lectured on its efficacy but trials were abandoned in the same year after the death of a patient and a drop in research funding. Another therapy involved the use of lysergic acid diethylamide, or LSD. Suggested in 1952 as a cure after being used with alcoholics, it was tested on volunteer addict inmates in several prisons in Maryland. Treatment consisted of five weeks' intensive psychotherapy culminating in a very heavy LSD dosage of 300 to 500 micrograms. About a third had not resorted to heroin six months after release from jail, although whether this was due to the psychotherapy or the LSD trip it is impossible to say: a number of the convicts said the LSD helped them gain an insight into their problem. Development of the therapy was halted by a lack of research facilities.