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HABITS THAT HANDICAP
HABITS THAT HANDICAP
_The Menace of Opium, Alcohol,
and Tobacco, and the Remedy_
BY CHARLES B. TOWNS
NEW YORK
THE CENTURY CO.
1916
Copyright, 1915, by
THE CENTURY CO.
_Published, August, 1915_
PREFACE
It is interesting to note that a year or more ago a few deaths from
bichlorid of mercury poisoning caused within a period of six months a
general movement toward protective legislation. This movement was
successful, and after the lapse of only a short time the public was
thoroughly protected against this dangerous poison. It will be observed
that the financial returns from the total sale of bichlorid of mercury
tablets could be but small. Had the financial interests involved been of a
magnitude comparable with those interested in the manufacture and
promotion of habit-forming drugs, I have often wondered if the result
would not have been less effective and as prompt. Bichlorid of mercury
never threatened any large proportion of the public, and those falling
victims to it merely die. Opium and its derivatives threaten the entire
public, especially those who are sick and in pain, and with a fate far
more terrible than death--a thraldom of misery, inefficiency, and
disgrace.
Lest somewhere there be found within the pages of this book remarks that
may lead the reader to suppose that I unduly criticize the doctor, and
therefore that I am the doctor's enemy, I feel that it behooves me to add
that in the whole community he has not one admirer more whole-souled.
PREFACE
Some years ago, Mr. Charles B. Towns came to me with a letter from Dr.
Alexander Lambert and claimed that he had a way of stopping the morphia
habit. The claim seemed to me an entirely impossible statement, and I told
Mr. Towns so; but at Dr. Lambert's suggestion, I promised to look into the
matter. Accordingly, I visited Mr. Towns's hospital, and watched the
course of treatment there at different times in the day and night. I
became convinced that the withdrawal of morphine was accomplished under
this treatment with vastly less suffering than that entailed by any other
treatment or method I had ever seen. Subsequently, I sent Mr. Towns
several patients, who easily and quickly were rid of their morphia
addiction, and have now remained well for a number of years.
At that time I had the impression that the treatment was largely due to
the force of Mr. Towns's very vigorous and helpful personality, but when
subsequently a similar institution was established near Boston, I became
convinced by observation of cases treated in that hospital that Mr.
Towns's personality was not an essential element in that treatment. His
skill, however, in the actual management of cases, from the medical point
of view, was very hard to duplicate, and Mr. Towns generously came from
New York, when called upon, and showed us what was wrong in the management
of cases which were not doing well. I do not hesitate to say that he knows
more about the alleviation and cure of drug addictions than any doctor
that I have ever seen.
All the statements made in this book except those relating to tobacco I
can verify from similar experiences of my own, since I have known and used
Mr. Towns's method of treatment.
I do not pretend to say how his treatment accomplishes the results which I
have seen it accomplish, but I have yet to learn of any one who has given
it a thorough trial who has obtained results differing in any considerable
way from those to which Mr. Towns refers.
The wider applications and generalizations of the book seem to me very
instructive. The shortcomings of the medical profession, of the druggists,
and those who have to do with the management of alcoholics in courts of
law seem to me well substantiated by the facts. Mr. Towns's plans for
legislative control of drug habits also seem to me wise and far-reaching.
He is, I believe, one of the most public-spirited as well as one of the
most honest and forceful men that I have ever known.
I am glad to have this opportunity of expressing my faith and confidence
in him and my sense of the value of the book he has written.
RICHARD C. CABOT.
INTRODUCTION
There is only one way by means of which humanity can be relieved of the
curse of drug using, and that is to adopt methods putting the entire
responsibility upon the doctor. Until the present legislation was passed
in New York State, no one had ever considered the doctor's responsibility;
this most valuable medical asset and most terrible potential curse had
been virtually without safeguard of any effective kind. Discussion of the
drug problem in the press dealt wholly with those phases which make
themselves manifest in the underworld or among the Chinese. I am
reasonably certain that until very recently the world had heard nothing of
the blameless men and women who had become drug-users as the result of
illness. This seems strange, since there are in the United States more
victims of the drug habit than there are of tuberculosis. It is estimated
that fifteen per cent, of the practising physicians in the country are
addicted to the habit, and although I think this is an exaggeration, it is
nevertheless true that habit-forming drugs demand a heavy toll from the
medical profession, wrecking able practitioners in health and reputation,
and of course seriously endangering the public.
I have elsewhere explained the fact that the medical man himself is
ignorant of the length to which he can safely go in the administration of
drugs to his patients. If he is ignorant of what quantity and manner of
dosage constitutes a peril for the patient, is it not reasonable to
suppose that similar ignorance exists in his mind with regard to his own
relations with the drug habit? As a matter of fact, I know this to be the
case; many physicians have come to me for help, and ninety-nine per cent.
of them explained to me that their use of drugs was the direct outgrowth
of their ignorance. If the man who practises medicine is unaware of what
will bring about the habit, what can be expected of the medically
uneducated citizen who is threatened by those in whom he has most
confidence--his doctors?
The wide extent of the drug habit in this country has not been apparent.
The man suffering from a physical disease either shows it or makes it
known; the man suffering from the drug habit presents unfamiliar and
unidentified symptoms, and far from being willing to make his affliction
known, through shame he tries to conceal it at all hazards. Until
legislation forced the victims of drug habits by hundreds into Bellevue
Hospital in New York, this great institution rarely had one as a patient.
The sufferer from tuberculosis would seek this hospital, feeling that
there he might find measurable relief; the drug-user shunned it, for he
was doubtful of receiving aid, and above all things he dreaded deprivation
without relief. No man or woman will go to any institution for relief from
the drug habit where the only treatment offered is that of enforced
deprivation, for he or she knows perfectly well that deprivation means
death. No human longing can compare in intensity with that of the
drug-user for his drug. Unrelieved, he will let nothing stand between him
and it; neither hunger, nakedness, starvation, arson, theft, nor murder
will keep him from the substance that he craves. Clearly humanity must be
protected against such an evil. And the physician must be saved from it,
for saving him will fulfil in a large measure the demand for the
protection of the public.
After the experience of the medical profession of New York State with the
workings of the Boylan Act, it is scarcely probable that strong
opposition to similar legislation will be made in other States. Even if
other States delay in the enactment of right legislation, the Boylan Act
may be considered not only a protective measure for the profession and the
people of New York State, but it may be safely accepted as an educational
pronouncement for the benefit of the medical profession everywhere. It
establishes for the first time the danger-line.
CONTENTS
CHAPTER PAGE
I THE PERIL OF THE DRUG HABIT 3
II THE NEED OF ADEQUATE SPECIFIC TREATMENT FOR THE DRUG-TAKER 27
III THE DRUG-TAKER AND THE PHYSICIAN 46
IV PSYCHOLOGY AND DRUGS 61
V ALCOHOLICS 76
VI HELP FOR THE HARD DRINKER 87
VII CLASSIFICATION OF ALCOHOLICS 113
VIII THE INJURIOUSNESS OF TOBACCO 140
IX TOBACCO AND THE FUTURE OF THE RACE 162
X THE SANATORIUM 174
XI PREVENTIVE MEASURES FOR THE DRUG EVIL 194
XII CLASSIFICATION OF HABIT-FORMING DRUGS 215
XIII PSYCHOLOGY OF ADDICTION 227
APPENDIX 265
HABITS THAT HANDICAP
HABITS THAT HANDICAP
CHAPTER I
THE PERIL OF THE DRUG HABIT
It is human nature to wish to ease pain and to stimulate ebbing vitality.
There is no normal adult who, experiencing severe pain or sorrow or
fatigue, and thoroughly appreciating the immediate action of an easily
accessible opiate, is not likely in a moment of least resistance to take
it. Every one who has become addicted to a drug has started out with small
occasional doses, and no one has expected to fall a victim to the habit;
indeed, many have been totally unaware that the medicine they were taking
contained any drug whatever. Thus, the danger being one that threatens us
all, it is every man's business to insist that the entire handling and
sale of the drug be under as careful supervision as possible. It is not
going too far to say that up to the present time most drug-takers have
been unfairly treated by society. They have not been properly safeguarded
from forming the habit or properly helped to overcome it.
It has been criminally easy for any one to acquire the drug habit. Few
physicians have recognized that it is not safe for most persons to know
what will ease pain. When an opiate is necessary, it should be given only
on prescription, and its presence should then be thoroughly disguised. A
patient goes to a physician to be cured; consequently, when his pain
disappears, he naturally believes that this is due to the treatment he has
received. If the physician has used morphine in a disguised form, the
patient naturally believes that the cure was effected by some unknown
medicine; but if, on the other hand, he has received morphine knowingly,
he realizes at once that it is this drug which is responsible for easing
his pain. If he has received it hypodermically, the idea is created in his
mind that a hypodermic is a necessary part of the treatment. Thus it is
clear that the physician who uses his syringe without extreme urgency is
greatly to be censured, for the patient who has once seen his pain blunted
by the use of a hypodermic eagerly resorts to this means when the pain
returns. Conservative practitioners are keenly aware of this
responsibility, and some go so far as never to carry a hypodermic on their
visits, though daily observation shows that the average doctor regards it
as indispensable. The conservative physician employs only a very small
quantity of morphine in any form. One of the busiest and most successful
doctors of my acquaintance has used as little as half a grain a year, and
another told me he had never gone beyond two grains.
Both of these men know very well that only a small percentage of
drug-takers have begun the practice in consequence of a serious ailment,
and that even this small percentage might have been decreased by proper
medical treatment directed at the cause rather than at its symptom, pain.
An opiate, of course, never removes the cause of any physical trouble, but
merely blunts the pain due to it; and it does this by tying up the
functions of the body. It is perhaps a conservative estimate that only ten
per cent. of the entire drug consumption in this country is applied to the
purpose of blunting incurable pain. Thus ninety per cent. of the opiates
used are, strictly speaking, unnecessary. In the innumerable cases that
have come under my observation, seventy-five per cent. of the habitual
users became such without reasonable excuse. Beginning with small
occasional doses, they realized within a few weeks that they had lost
self-control and could not discontinue the use of the drug.
FORMING THE HABIT
A very common source of this habit lies in the continued administration of
an opiate in regular medical treatment without the patient's knowledge or
consent, or in the persistent use of a patent medicine, or of a headache
or catarrh powder that contains such a drug.
The man who takes an opiate consciously or unconsciously, and receives
from it a soothing or stimulating or pleasant effect, naturally turns to
it again in case of the same need. The time soon arrives when the
pleasurable part of the effect--if it was ever present--ceases to be
obtained; and in order to get the soothing or stimulating effect, the dose
must be constantly increased as tolerance increases. With those who take a
drug to blunt a pain which can be removed in no other way, it is
fulfilling its legitimate and supreme mission and admits of no substitute.
Where it was ever physically necessary, and that necessity still
continues, an opiate would seem inevitable. But the percentage of such
sufferers, as I have said, is small. The rest are impelled simply by
craving--that intolerable craving which arises from deprivation of the
drug.
But whether a man has acquired the habit knowingly or unknowingly, its
action is always the same. No matter how conscientiously he wishes to
discharge his affairs, the drug at once begins to loosen his sense of
moral obligation, until in the end it brings about absolute
irresponsibility. Avoidance and neglect of customary duties, evasion of
new ones, extraordinary resourcefulness in the discovery of the line of
least resistance, and finally amazing cunning and treachery--this is the
inevitable history.
The drug habit is no respecter of persons. I have had under my care
exemplary mothers and wives who became indifferent to their families;
clergymen of known sincerity and fervor who became shoplifters and
forgers; shrewd, successful business men who became paupers, because the
habit left them at the mercy of sharpers after mental deterioration had
set in. But the immediate action of morphine by no means paralyzes the
mental faculties. Though when once a man becomes addicted to the drug he
is incapacitated to deal with himself, yet while he is under its brief
influence his mind is sharpened and alert. Under the sway of opium a man
does venturesome or immoderate things that he would never think of doing
otherwise, simply because he has lost the sense of responsibility. I have
had patients who took as much as sixty grains of morphine in a single
dose, an overdose for about one hundred and fifty people, and about fifty
grains more than the takers could possibly assimilate or needed to produce
the required result--an excellent illustration of how the habit destroys
all judgment and all sense of proportion.
Against this appalling habit, which can be acquired easily and naturally
and the result of which is always complete demoralization, there is at
present no effective safeguard except that provided by nature itself, and
this is effective only in certain cases. It happens that in many people
opium produces nausea, and this one thing alone has saved some from the
habit; for this type of user never experiences any of the temporarily
soothing sensations commonly attributed to the drug. Yet this pitiful
natural safeguard, while rarely operative, is more efficacious than any
other that up to the present has been provided by man in his
heedlessness, indifference, and greed.
DANGERS OF THE HYPODERMIC SYRINGE
I have seen over six thousand cases of drug habit in various countries of
the world. Ninety-five per cent. of the patients who have come to me
taking morphine or other alkaloids of opium have taken the drug
hypodermically. With few exceptions, I have found that the first knowledge
of it came through the administration of a hypodermic by a physician. It
is the instrument used that has shown the sufferer what was easing his
pain. I consider that among those who have acquired the habit through
sickness or injury this has been the chief creator of the drug habit. This
statement does not apply to those who have acquired the habit through the
taking of drugs otherwise. My work has been carried out almost entirely in
cooperation with the physician, and I have not come in contact with the
under-world drug-takers. I consider that the syringe has been the chief
creator of the drug habit in this country. In 1911 I made this statement
before the Ways and Means Committee of the United States Congress, then
occupied with the matter of regulating the sale of habit-forming drugs,
and I personally secured the act which was passed by the New York
legislature in February, 1911, to restrict the sale of this instrument to
buyers on a physician's prescription. Before that time all drug stores and
most department stores sold hypodermic instruments to any one who had the
money. A boy of fifteen could buy a syringe as easily as he could buy a
jack-knife. If a physician refused to give an injection, the patient could
get an instrument anywhere and use it on himself. This bill has passed
only a single legislature, but I am arranging to introduce a similar bill
before all the others, and hope to have the State action confirmed by a
Federal bill. At present in Jersey City, or anywhere out of New York, any
one may still buy the instrument. It is inconceivable that the syringe
should have gone so long without being considered the chief factor in the
promotion of a habit which now alarms the world, and that as yet only one
state legislature should have seen fit to regulate its sale. Restricting
the sale of the syringe to physicians, or to buyers on a physician's
prescription, is the first step toward placing the grave responsibility
for the drug habit on the shoulders of those to whom it belongs.
HABIT-FORMING DRUGS IN PATENT MEDICINES
The second step to be taken is to prevent by law the use of habit-forming
drugs in patent and proprietary medicines which can be bought without a
physician's prescription. Prior to the Pure Food and Drugs Act, created
and promoted by Dr. H. W. Wiley, druggists and patent-medicine venders
were able, without announcing the fact, to sell vast quantities of
habit-forming drugs in compounds prepared for physical ailments. When that
act came into effect, these men were obliged to specify on the label the
quantities of such drugs used in these compounds, and thus the purchaser
was at least enabled to know that he was handling a dangerous tool. Except
in a few States, however, the sale of these compounds was in no way
restricted, and hence the act cannot be said to have done much toward
checking the formation of the drug habit. Indeed, it has probably worked
the other way, for there is perhaps not an adult living who does not know
that certain drugs will alleviate pain, and people who have pains and
aches are likely to resort to an accessible and generally accredited means
of alleviation. Yet the difficulties in the way of passing the Pure Food
and Drugs Act are a matter of scandalous history. What, then, would be the
difficulties in passing a Federal bill to restrict the sale of patent
medicines containing habit-forming drugs? It is of course to the interest
of every druggist to create a lasting demand for his article. There is
obviously not so much profit in a medicine that cures as in one that
becomes indispensable. Hence arises the great inducement, from the
druggist's point of view, in soothing-syrups and the like. In this country
all druggists, wholesale and retail, are organized, and the moment a bill
is brought up anywhere to correct the evil in question, there is enormous
pressure of business interests to secure its dismissal or satisfactory
amendment.
To show the essential selfishness of their position, it is only necessary
to quote a few of the arguments used against me before the Congressional
Ways and Means Committee when I was making a plea for the regulation of
the traffic in habit-forming drugs. They claimed that registration of the
quantities of opiates in proprietary medicines would entail great bother
and added expense, that these drugs are usually combined with others in
such a way as to result in altering their effect on the user, and that,
anyway, so small an amount of these drugs is used that it cannot create a
habit. Now, as a matter of fact, the combination of medicines in these
remedies makes not the slightest difference in the physiological action of
the drug; further, it is found that, just as with the drug itself, the
dose of these compounds must be constantly increased in order to confer
the same apparent benefit as in the beginning; and finally, it is well
known that what creates the craving is not the quantity of the drug, but
the regularity with which it is taken. A taker of one eighth of a grain of
morphine three times a day would acquire the habit just as surely as a man
who took three grains three times a day, provided the latter could
tolerate that quantity.
The average opium-smoker consuming twenty-five pills a day gets only the
equivalent of about a quarter grain of morphine taken hypodermically or of
a half grain taken by the mouth. A beginner could not smoke a quarter of
that quantity, but still he acquires the habit. Any amount of the drug
which is sufficient to alleviate pain or make the taker feel easier is
sufficient to create a habit. A habit-forming drug having no curative
properties whatever is put into a medicine merely for the purpose of
making the taker feel easier. One wholesale house alone prepares and
sells six hundred remedies containing some form of opiate. Most of the
cases of the cocaine habit have been admittedly created by so-called
catarrh cures, and these contain only from two to four per cent. of
cocaine. In the end, the snuffer of catarrh powders comes to demand
undiluted cocaine; the taker of morphine in patent medicines, once the
habit is formed, must inevitably demand undiluted morphine.
This easy accessibility of drugs in medicinal form is more dangerous than
moralists care to admit. The reason why opium-smoking has been, up to the
present, less prevalent in the United States than in China and some other
countries is probably that the preparation of it and the machinery for
taking it are not convenient. If opium-smoking had been generally
countenanced in America, if the sale of the pure drug had been for
generations permitted here, as it has been in China, if houses for its
sale and preparation had been found everywhere, if its social aspects had
been considered agreeable, if society had put the stamp of approval upon
it, opium-smoking would be as prevalent here as it has been in China. Our
human nature is essentially little different from that of the Chinese, but
lack of opportunity is everywhere recognized as a great preservative of
virtue. Due allowance being made for the difference of moral concepts, our
standards of morality and honesty and virtue are certainly no higher than
those of the Chinese. Thus, were the conditions the same in both cases,
there is no reason to suppose that opium would not be smoked here as much
as there; but fortunately it has not yet become thus easy, convenient, and
agreeable, and consequently that particular phase of the evil has not yet
reached overwhelming proportions. On the other hand, the alkaloids of
opium administered hypodermically or as ingredients in many patent
medicines _are_ thus convenient, and as a result this phase of the evil
_has_ reached overwhelming proportions. Nor have we any cause for
congratulation upon our particular form of the vice, for opium-smoking is
vastly less vicious than morphine-taking.
THE TRAFFIC IN OPIUM
Something more is needed, however, than mere restriction of the sale of
hypodermic syringes and patent medicines by any one legislature or
country. All persons who handle habit-forming drugs should be made to give
a strict accounting for them, otherwise the traffic can never be properly
regulated. Four years ago, by special act of Congress, all importation of
prepared opium and of crude opium designed for smoking purposes was
prohibited. In the ample interval between the passage of the bill and its
going into effect the importation of opium was simply phenomenal. By the
time it went into effect the American dealers had learned the secret
process of preparing opium for smoking, which had hitherto been known only
in the Orient. Thereafter it was found that since responsible importing
houses were still at liberty to import crude opium in any quantity for
general medicinal use, the retailers could buy and were buying from
importers all the crude opium they wished and preparing it themselves
without having in any way to account for the use they meant to make of it,
although that use had now become illegal. The result was that the smoker
could get opium more easily than before, since the secret process of
preparing it had become known; and having no longer to pay the enormous
tax on prepared opium, he got it much cheaper. In short, the only
difference was that the Government lost about one million five hundred
thousand dollars a year in revenue, while the vice was greatly increased.
Thus the act had worked in precisely the opposite way from the intention
of the framers, and all because men are permitted to handle opium without
accounting for it. Until there is such an accounting, there can be no real
regulation of the opium trade.
Congress has just passed a bill aiming to regulate the traffic in
habit-forming drugs. I wish to go on record here as saying that this bill
will not accomplish its purpose, and should be further amended to prove
effective. But it will be only a matter of time when there will be
amendments proposed, which, if adopted, will create legislation on this
subject worth while.
The history of the Opium Commission appointed by Mr. Taft is sufficient to
show how any less comprehensive regulation would act. When Mr. Taft was
Governor-General of the Philippines, he found that an enormous quantity of
opium was being smoked by the natives and the large Chinese settlement, of
whom it was estimated that fifty-five thousand were smokers. He appointed
a commission headed by Bishop Brent, now stationed at Manila, who has
since headed two international opium conferences, at Shanghai in 1909 and
at The Hague in 1911. Mr. Taft sent the commission into the most important
opium-producing countries to find out how they were dealing with the
problem and what progress was being made toward decreasing the use of the
drug. The nearest approach they found to a reform was the method of the
Japanese in their newly acquired island of Formosa. Japan, with the most
stringent regulation of the sale of opium in the world, had made it a
government monopoly in Formosa, had compelled the registration of all
smokers, and was gradually lessening the amount which each smoker could
buy. After the exhaustive report of the commission, our Government adopted
the same tactics in the Philippines. To the surprise of the officials,
they found that out of the fifty-five thousand opium-smokers they could
obtain a registration of only from ten to twelve thousand, which meant
that the great majority were getting smuggled opium. By special act of
Congress the authorities at Manila were allowed to stop the importation of
opium entirely. But this, while it meant a great loss of revenue to the
local government, apparently did not lessen the amount smoked. After the
sale was stopped, there were virtually no voluntary applications for
opium treatment, as there must have been if anybody's supply had been cut
off, which conclusively showed that nobody had discontinued the habit
merely because importation had been discontinued. Stopping importation,
then, is a farce, unless at the same time there is rigid governmental
control in those countries that produce or import the drug. And,
therefore, unless there should be a cooperation of all governments, it is
futile to try to regulate the traffic. As long as people can get opium,
they will smuggle it.
It has been demonstrated to be quite practicable for all the
opium-producing countries to make the drug a government monopoly; it would
be equally practicable for them to sell directly to those governments that
use it for governmental distribution. The only obstacle to an
international understanding is that the producing countries know very well
that government regulation would materially lessen the sale of the drug.
Within the borders of our own country such a system would simplify rather
than complicate present conditions. We have to-day along our frontier and
in our ports inspectors trying to stop the illicit traffic in opium, and
the money thus spent by our Government would be more than sufficient to
handle and distribute all of the drug that is needed for legitimate
purposes. Any druggist could of course continue to buy all that he wished,
but he would have to account for what he bought. The drug would serve only
its legitimate purpose, because the druggist could sell it only on
prescription. This would at once eliminate the gravest feature of the
case, the indiscriminate sale of proprietary and patent medicines
containing small quantities of opium. The physician would thus have to
shoulder the entire responsibility for the use of any habit-forming drug.
With the Government as the first distributor and the physician as the
last, the whole condition of affairs would assume a brighter aspect, for
it would be a simple matter to get from the physician a proper accounting
for what he had dispensed. Thus the new crop of users would be small, and
less than ten per cent. of the opium at present brought into this country
would be sufficient to meet every legitimate need.
THE HABIT-FORMING DRUGS
The important habit-forming drugs are opium, cocaine, and the small, but
dangerous, group of hypnotics. These last--trional, veronal, sulphonal,
medinal, etc.--are chiefly coal-tar products, and are not always
classified as habit-forming drugs, but they are such, and there are many
reasons why the sale of them should be scrupulously regulated. The opium
derivatives go under the general head of narcotics. Morphine is the chief
active principle, and codeine and heroin are the chief derivatives of
morphine. Codeine is one eighth the strength of morphine; heroin is three
times as strong as morphine.
Though the general impression is otherwise, the users of heroin acquire
the habit as quickly and as easily as if they took morphine. Many cough
and asthma preparations contain heroin, simply for temporary alleviation,
since, like opium, it has no curative power whatever. From time to time I
have had to treat cases of heroin-taking in which the victims had thought
to satisfy their need for an opiate without forming a habit. In the cases
where it was given by prescription, it was so given by the physician in
the sincere belief that it would not create a habit. All this despite the
fact that heroin is three times stronger than morphine, and despite the
fact that physicians know that anything which will do the work of an
opiate is an opiate. Codeine, notwithstanding the fact that it is weaker
than morphine, is likewise habit-forming; yet doctors prescribe it on
account of its relative mildness, even though they know that it is the
cumulative effect of continued doses, and not the quantity of morphine in
the dose, which results in habit. As with morphine, to use either of these
drugs effectively means in the long run the necessary increase of the dose
up to the limit of physical tolerance.
The most harmful of all habit-forming drugs is cocaine. Nothing so quickly
undermines its victim or provides so short a cut to the insane asylum. It
differs from opium in two important ways. A man does not acquire a habit
from cocaine in the sense that it is virtually impossible for him to leave
it off without medical treatment. He can do so, although he rarely does.
On withdrawal, he experiences only an intense and horrible depression,
together with a physical languor which results in a sleepiness that cannot
be shaken off. Opium withdrawal, on the other hand, results in
sleeplessness and extreme nervous and physical disorder. In action, too,
cocaine is exactly the opposite of opium, for cocaine is an extreme
stimulant. Its stimulus wears off quickly and leaves a corresponding
depression, but it confers half an hour of capability of intense effort.
That is why bicycle-riders, prize-fighters, and race-horses are often
doctored, or "doped," with cocaine. When cocaine gives out, its victim
invariably resorts to alcohol for stimulus; alcoholics, however, when
deprived of alcohol, generally drift into the use of morphine.
The widespread use of cocaine in the comparatively short period of time
since its discovery has been brought about among laymen entirely by
patent-medicine preparations containing small quantities of it. These have
been chiefly the so-called catarrh cures, which of course cure nothing.
With only a two or four per cent. solution, they have created a craving,
and in the end those who could do so have procured either stronger
solutions or the plain crystal. As with the other drugs, in order to
maintain the desired result the dose must be increased in proportion as
tolerance increases. Wherever the sale of patent medicines has been
restricted to those presenting a physician's prescription, the consumption
of cocaine has at once been lessened. A man cannot afford to get a
physician's prescription for a patent medicine; and even if he could, the
reputable physician refuses to prescribe one that contains cocaine. When
an overseer in the South will deliberately put cocaine into the rations of
his negro laborers in order to get more work out of them to meet a sudden
emergency, it is time to have some policy of accounting for the sale of a
drug like cocaine.
It is also extremely important to regulate the sale of the hypnotic
coal-tar derivatives. All the group of hypnotics should be buyable only on
a physician's prescription. They all disturb heart action and impoverish
the blood, thereby producing neurotics. No physician, without making a
careful examination, will assume the responsibility of prescribing for a
man who comes to him in pain, yet a druggist does so constantly. He knows
nothing of the customer's idiosyncrasy; that, for instance, an amount of
veronal which would not ordinarily affect a child may create an intense
nervous disorder in a particular type of adult. To the average druggist a
headache is only a headache; he does not know that what will alleviate one
kind of headache is exceedingly bad for another kind, and furthermore it
is not his business to warn the customer that a particular means of
headache alleviation may perhaps make him a nervous wreck. The patient
usually has the same ignorance. In a case which was once brought to my
attention, a girl swallowed nine headache powders within one hour. Had
there been ten minutes' delay in summoning a doctor, she would have died;
as it was, she was seriously ill for a long time.
These, then, the narcotics, cocaine, and the hypnotics, are the chief
habit-forming drugs. They form habits because it is necessary to increase
the dose in order to continue to derive the apparent benefit obtained from
them in the beginning, and because, when once the habit is set up, it
cannot be terminated without such acute discomfort that virtually no one
is ever cured without medical help. In drug addictions the condition of
the patient is not mental, as is generally supposed, but physical.
Definite medical treatment to remove the effects of the drug itself is
imperative, whether the victim be suffering from the drug habit alone or
from that habit in a body otherwise physically disordered. With regard to
the cure of the habit, as in the case of the conditions which permit of
its being acquired, it may justly be said that the victims have been
unfairly treated.
THE NEED OF CONTROL BY THE GOVERNMENT AND BY PHYSICIANS
The prevalence of the drug habit, the magnitude of which is now startling
the whole civilized and uncivilized world, can be checked only in one
way--by controlling the distribution of habit-forming drugs. With the
Government as the first distributor and a physician as the last,
drug-taking merely as a habit would cease to be. If physicians were made
accountable, they would use narcotics, hypnotics, and cocaine only when
absolutely necessary. Nobody should be permitted to procure these drugs or
the means of using them or any medicines containing them without a
doctor's prescription. By such restriction the intense misery due to the
drug habit would be decreased by nine tenths, indeed, by much more than
this; for when a physician dares no longer to be content with the mere
alleviation of pain, which is only nature's way of announcing the presence
of some diseased condition, he will seek the more zealously to discover
and remove its cause.