CLASSIFICATION OF HABIT-FORMING DRUGS
Opium is the basis of almost all the habit-forming drugs. There is no
other drug known to the pharmacist that has a similar action or can be
used as a substitute when a definite tolerance of it has been established.
The chemists have given us more than twenty different salts or alkaloids
of opium in various forms and under as many different trade names, and I
regret to say that they are busy working in their laboratories to put upon
the market injurious drugs under various supposedly harmless disguises,
but intended in the end only to deceive.
MORPHINE
Morphine is the active principle of opium, and until a few years ago only
crude opium or morphine was used for medical requirements. Morphine is
intrinsically far worse than opium itself, for opium has certain
properties which partly counteract the effect of the morphine that it
contains. But morphine is not only the active principle, but the actively
evil principle, of the drug.
The user of morphine always retains his faculties. He is usually capable
of intelligent conversation. Unlike the alcoholic's brain, his is not
inflamed. It is impossible for the physician intelligently to discuss his
symptoms with an alcoholic; with a victim of drugs, on the other hand, he
can thresh out every detail of the case.
Later codeine was placed upon the market, supposedly an innocent alkaloid
of opium, non-habit-forming, but still capable of eliminating pain and
suffering due to illness or injury. After taking up this work, my
investigations soon led me to realize that it was not the quantity of the
drug taken which produced the drug habit, but the regularity of the
dosage. I also found from my clinical comparisons that codeine has only
one eighth the strength of morphine, yet in the end just as surely a
producer of the drug habit similar to that of morphine itself.
HEROIN
At this writing the most harmful form of opiate with which we have to deal
is heroin. This preparation of morphine was first put upon the market by
German chemists about fifteen years ago, the word "heroin" being nothing
more than a trade name. It was first used in cough mixtures, and was
widely discussed in the medical and pharmaceutical press, where it was
claimed that all the harm of morphine had virtually been eliminated in
this product, which, without having the depressing effect of morphine, at
the same time preserved its stimulating effect. A great number of
physicians themselves have acquired the habit of taking opiates in this
form, believing at the outset that they were not harmful drugs.
My investigations soon showed me that heroin is three times as strong as
morphine in its action, and for that reason its use sets up definite
tolerance more quickly than any other form of opiate. For the same reason
it shows more quickly a deleterious effect upon the human system, the
mental, moral and physical deterioration of its takers being more marked
than in the case of any other form of opiate.
Until the Federal Pure Food Law was passed we did not know that many of
the well-known, advertised medical preparations contained quantities of
various salts or alkaloids of opium. The unsuspecting users of patent
medicine were making themselves confirmed drug-users unwittingly, and did
not realize how necessary the habit had become to them until for one
reason or another they had been deprived of their usual daily dosage.
The reader may imagine my surprise when, although a layman, I found that
the physician, to whom we had looked for guidance in administering and
prescribing these drugs, knew nothing about them beyond their
physiological action; that their medical training both in college and in
clinics had left them in virtual ignorance of the whole question. The
physician freely prescribed or administered these various drugs, while
laymen were able to buy over the counters of druggists prescriptions
containing definite quantities of them. Unknowingly, the doctor and the
druggist were creating great numbers of drug-fiends.
Physicians do not yet know over how long a period such drugs can be
administered in regular daily dosage without setting up a tolerance, after
which the patient cannot be deprived of the drug. If the public had been
better advised on this subject, it would have been able to protect
itself, and would have been more careful about what it took.
COCAINE
Outside the opium group, there is at present only one other drug that must
be considered as habit-forming, and that is cocaine. The prostitution of
this drug from its proper uses is absolutely inexcusable. It was first
used medicinally about thirty years ago, and as an anesthetic only. Its
administration upon the nose by specialists in that field of surgery soon
established the fact that it not only deadened tissue, but set up a
certain stimulation which for the time being made one feel abnormally
strong or mentally active. This was the beginning of its common use in the
shape of so-called catarrh cures. Only a small quantity--from five to ten
per cent.--was used. The tissue of the nose is very susceptible to the
action of drugs. When it is applied in this way, the circulation takes up
the drug as quickly as if taken hypodermically. Unscrupulous chemists and
physicians have unloaded upon the world a drug which is beneficial when
taken medicinally, but one that has reaped a harvest of irresponsible
victims, in which murder, all forms of crime, and mental and moral
degeneracy have conspicuously figured, and all for financial gain.
The habit was first generally spread through the medium of catarrh-cures.
Cocaine contracts and deadens the tissue with which it comes in contact,
and thus, as in the case of catarrh, relieves the patient from discomfort,
making him feel, indeed, as if there were no nose on his face. Its effect,
however, lasts only from twenty to thirty minutes.
This is one of the reasons why the cocaine habit is so easily formed. A
man taking any powerful stimulant is sure to feel a corresponding
depression when the effect of that stimulant has died away, and it then
becomes necessary for him to take more of the drug in order to buoy
himself up and restore himself to the point of normality. It is among
cocaine-users, therefore, not a yearning for any abnormally pleasurable
sensation which sends them back again and again to their dosage, but
merely their desire to be measurably restored to the comfort which is
natural to the normal state. It must be apparent, however, that as soon as
it has become necessary for any one to resort to the use of a drug in
order to rise to the normal there has been a marked depreciation, physical
or mental, and probably both. This explains the fact that many criminals
are found to be cocaine-users. No drug so quickly brings about a mental
and physical deterioration. It is virtually certain to be a short cut to
one of two public institutions, the prison or the madhouse. It will send
the average person to the prison first because it is an expensive drug,
and the craving for it is more than likely to exhaust his financial
resources and then drive him to theft. It is the most expensive of all
drug habits. I have known victims who habitually used one hundred and
twenty grains a day, at a cost of about seventy dollars a week. This
undoubtedly explains the great number who have been made criminals by
using cocaine. One who uses it thereby diminishes his earning capacity;
while, on the other hand, one who must have it must have money, and much
of it.
It may be that this matter of cost explains why the under-world has
suddenly taken up heroin instead of cocaine. The former is much cheaper.
HYPNOTICS
While I have only touched upon the opium group and cocaine, I wish to put
myself on record now as saying that there is no class of drugs so sure in
the end to bring about a deterioration of the physical being as the
frequent use of the hypnotic group, or coal-tar products, the
sleep-producers. I have never seen more pitiable cases than those who have
come to me after they had been taking regularly, during a considerable
period, some cure for sleeplessness. This habit not only produces an
extreme neurotic condition, but changes the entire temperament of a
person. It will turn the most beautiful character into an extreme case of
moral degeneracy.
Insomnia, headaches, and such ailments spring from a disorganized physical
condition. Trying to alleviate them by the use of powerful drugs does not
remove the cause, but compounds the physical disabilities which produce
these unfortunate physical results. Some day I hope to see as stringent a
legal regulation of the sale of these drugs, used for this common purpose,
as there now is of opium and its products and cocaine.
SLEEPING-POWDERS, OR HYPNOTICS
The time cannot be far distant when both Federal and State governments
will recognize the danger that lies in the unrestricted sale by druggists
and the uncurbed administration by physicians of sleeping-powders, or
hypnotics. It cannot be denied by any one who is thoroughly familiar with
the subject of habit-forming drugs that in such substances may lie a peril
comparable to that inherent in cocaine and opium compounds. Hypnotics of
many varieties can be obtained at any drug store in the United States
without a doctor's certificate. The sale of bromides is absolutely
unrestricted. The many and varied coal-tar products, of which veronal is
the leader, with trional, suphonal, medinal, as close followers, and the
numerous proprietary remedies, such as somnose, neuronidia, bromidia,
Peacock's bromides, etc., may be mentioned as preparations which are
widely advertised and openly and energetically sold, and all of which are
definitely dangerous.
COAL-TAR PRODUCTS
Preparations for headaches and neuralgia are notably dangerous. There can
be no doubt of the necessity for legal restriction of the sale of
anti-kamnia, phenalgin, orangeine, Koehler's headache remedy, shac, all
coal-tar products notable for their production of anemia and depression,
and undoubtedly responsible for the presence of many men and women in the
mad-houses of the land. The chemist whose genius is responsible for the
introduction of caffeine to overcome the depressing effect of some of the
other component parts of these preparations has put hundreds of thousands
of dollars into the pockets of the manufacturing druggists and has saddled
the world with a great and unnecessary weight of physical and mental
degeneration.
THE PERIL OF THE DRUG-STORE
Not least among these preparations that have most importantly contributed
to the tragic army of drug-users in the United States have been various
diarrhea remedies and other bowel correctives containing a large amount of
straight opium. Morphine, opium, and heroin appear in many cough-mixtures
in habit-forming quantities and are offered for sale everywhere save in
New York State, where recent legislation somewhat restricts the traffic.
Indeed, in every State except New York there are few druggists who do not
make up and sell preparations of their own containing codeine, morphine,
heroin, or some of the derivatives of opium.
No druggist has a right to prescribe any of these powerful drugs. The
American public has fallen into the bad habit of trusting the druggist
when it should go to the physician. A dozen times every day in the
experience of the average American druggist a customer enters who says, "I
want something to make me sleep," or, "I want something to cure my
headache." Without hesitation, and without blame, for with him the custom
has probably been unconsciously built up, the druggist reaches to his
shelf and dispenses preparations in which the utmost peril
lurks--preparations containing ingredients which should be sold only on
the prescription of a physician. Under the present law, as I think it
exists in every State, druggists cannot prescribe, but they can advise
customers to purchase advertised preparations and those which they
themselves compound.
Only a very powerful drug can stop a headache as quickly and completely as
Americans have come to demand. The preparation must be strong enough to
deaden disordered nerves, and being chosen because it will be generally
effective, not selectively effective, as in the case of a remedy chosen
after an intelligent diagnosis has revealed the nature of the trouble to
be treated, it is virtually certain to have no curative qualities
whatever. Hundreds of deaths have resulted from unwisely experimenting
with such preparations. Most of us have peculiar idiosyncrasies with
regard to certain drugs. I have seen patients who could not take so much
as two grains of veronal or trional without flushing, itching, and similar
symptoms. With such people large doses might bring about serious results
and even death.