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Reports - American Bar and Medical Association

Appendix A

Some Basic Problems in Drug Addiction and Suggestions for Research*

by MORRIS PLOSCOWE

V. THE EFFECTS OF DRUG ADDICTION

The compulsion to take the drug is one of the components of the "drug fiend" myth which has been propagated by irresponsible journalism and irresponsible law enforcement. Another vital aspect to this myth is the misconception concerning what narcotic drugs do to human beings and the kind of behavior that such drugs foster. It is alleged that drugs like heroin and morphine have devastating effects on the persons who use them. Murder on the installment plan is a phrase frequently used to describe heroin addiction. It is charged, moreover, that the use of narcotic drugs leads to the commission of all kinds of serious crime, particularly crimes of violence. The printed proceedings of the House and the Senate Committees are full of such charges concerning the use of narcotic drugs. The pernicious effects of narcotic drugs on human beings were the justification for the severe penalties that were recommended as a means of dealing with the drug traffic and problems of drug addiction.

Unfortunately, the facts concerning the effects of such drugs as morphine and heroin on human beings differ considerably from these misconceptions. The facts tend to indicate that the use of drugs like heroin and morphine is consistent both with a reasonable state of health and with a reasonable degree of efficiency on the part of the individual user.

Over thirty years ago, Dr. Kolb pointed out that there was no evidence that the use of a narcotic drug made one less efficient. It was lack of the drug and the constant pre-occupation with obtaining it which led to a loss of efficiency on the part of the individual. Thus, the drug addict is not, by virtue of the fact that he takes a drug, necessarily a parasite, who is unable to function in any productive capacity. Nor is he necessarily a degenerate human being who, because he takes drugs is sliding rapidly towards the grave. This is apparent from the comments of Dr. Nathan B. Eddy, who analyzed the world literature on morphine in 1940 and who observed: "Given an addict who is receiving morphine in amount and at intervals adequate to keep the withdrawal symptoms completely in abeyance, the deviations from normal physiological behavior are minor for the most part within the range of normal variations."34 Professor W. G. Karr, a biochemist of the University of Pennsylvania, wrote in a similar vein: "The addict under his normal tolerance of morphine is medically a well man. Careful studies of all known medical tests for pathological variation indicated, with a few minor exceptions, that the addict is a well individual when receiving satisfying quantities of a drug. He responds to work in the normal manner. He is as agreeable a patient, even more so, than other hospital cases. When he is abruptly withdrawn from the drug he is most decidedly a sick individual."35 The feeling of normality and well being which an addict has, when he is using the drug was observable by Dr. Marie Nyswander, when she tested a group of patients at Lexington by means of Rorschach tests, both before and after using morphine. She writes: "With the administration of morphine a striking change is observed in the Rorschach-a change which corresponds to the addict's subjective feeling that he has attained normalcy. The responses begin to fall into more normal categories; the constriction is lessened, and movement response and fantasy appear."36 Dr. Lawrence Kolb noted that many prominent people who led socially useful lives have been addicted to narcotic drugs, yet were able to function effectively in their business and profession.37 As a matter of fact some who at one time were gutter alcoholics have improved themselves and their social functioning by shifting to morphine. This notion that the use of an opiate drug may actually improve the functioning of a particular individual is clearly presented by Wikler and Rasor: "On further interrogation, the majority of such individuals explain that in ordinary life situations opiates (usually heroin or morphine) reduce appetite, pain and erotic urges of all sorts, heterosexual, homosexual or autoerotic. In addition, intravenous injection of these agents produces a transient 'thrill' akin to sexual orgasm, except that it is centered in the abdomen. After these effects have developed a sense of gratification or satisfaction is achieved and they feel more 'at ease' and free to do what they 'want to do.' In some situations they may 'want' to doze peacefully and enjoy daydreams of wealth, power or social prestige. In other situations they may want to socialize, and they feel more comfortable to the presence of women. Furthermore, some opiate users state that these agents do not impair, others state that they actually improve, their ability to do useful work and that under the influence of opiates, they are less aggressive and 'keep out of trouble.' "It is difficult, of course, to verify statements such as these relative to the contrasting effects of drugs in actual life situations. However, observations made under experimental conditions are in substantial agreement with them. Thus, as long as adequate amounts of opiates are administered, aggressive, antisocial behavior is practically never observed, personal hygiene is maintained, assigned responsibilities are discharged satisfactorily, psychologic tests of performance reveal little or no impairment, and the sensorium remains quite clear, while anxiety associated with anticipation of pain is reduced."38 Opiate drugs like morphine do have certain effects upon the individual. The use of the drug causes a loss of appetite. Thus there may be a failure to maintain a proper intake of foods. This may affect health. However, as Maurer and Vogel point out: "... it has not been possible to demonstrate that opiate drugs in themselves actually destroy tissue or are directly the cause of tissue deterioration."39 The existence of emaciation and anemia in drug addicts, "...may be due to the unhygienic and impoverished life of the addict rather than to the direct effect of the drug."40 The drug addict simply does not eat enough, because on the one hand the drug he uses reduces appetite and on the other hand, costs so much that he has no money left over for food. Another effect of drug addiction is in reducing the urge to sex.

"The reproductive system generally tends to become inactive. ... In both males and females, opiates have a general tendency to reduce or obliterate sexual desire, although there may be individual exceptions to this."41 This lowering of sexual desire resulting from narcotic drugs would cause one to be skeptical of the claim that heroin and morphine incite to violent sexual crimes. Drug addiction may result in moral and character deterioration. But here the legal and social policy concerning drug addiction may be at fault rather than the use of the drug. An addict can only obtain the drug from underworld sources. He is cut off from any legitimate supply. The underworld will supply him at a price. The price is high and most addicts do not have the kind of money necessary to feed a habit. The obvious alternative is to raise the money by theft or if the addict is a woman, by prostitution.

Once the addict is started on a criminal or prostitutional career, his moral deterioration becomes almost inevitable. But the question may well be raised whether it is the drug or the short sighted social policy which utterly fails to take into account the desperate need of the addict for his drugs which causes the breakdown in character.

As Lindesmith notes: "Addicts escape most of the alleged degenerate results of the drug if they are sufficiently well-to-do, and many addicts suffer serious 'character deterioration' only after the narcotic agents catch up with them. In other countries ... addicts do not suffer evil effects ... forced upon the American users. They do not steal, lie, engage in prostitution, or become derelicts to the extent that our addicts do. If the toxic effect of the drug on the central nervous system promotes degeneration, or if addiction is a bio-chemical affair,... why do not similar conditions result in other countries or in our own upper class."42