CIRCUMSTANCES IN WHICH IT MAY BE MEDICALLY ADVISABLE TO ADMINISTER MORPHINE OR HEROIN TO PERSONS KNOWN TO BE SUFFERING FROM ADDICTION TO THESE DRUGS.
45. This Section of our Report may conveniently be prefaced by some observations as to the use of morphine or heroin for the relief of pain. etc., due to organic disease, an, such as inoperable cancer. In such cases, the adrninistration of the drug for prolonged periods may, no doubt, produce a cravicng which might persist and develop into an addiction if the disease were cured. .But there can be no question of the propriety of continuing to administer the drug in quantities necessary for relief of the disease, so long as it persists, ignoring for the time being the question, of possible production of addiction. No questions such as are discussed later in this Report would therefore arise in these cases unless and until the conditions calling primarily for administration of the drug were removed. In that event, the addiction remaining would require consideration and treatment in the same way as in any other case of addiction.
46. It is, of course, also necessary for a time to administer morphine or heroin to persons suffering from addiction to these drugs who are under treatment by the gradual reduction method. In such circumstances no question can arise as to the legitimacy of giving the drugs, in pursuit of a definite plan of treatment, in such doses as may be dictated by the experience of the physician. The precautions which it is considered desirable to observe in dealing with such patients are set out in the next Section of this Report.
47. Apart from the cases dealt with in the two preceding paragraphs, we are satisfied that any recommendations for dealing with the problem of addiction at the present time must take account of and make provision for the continued existence of two classes of persons, to whom the indefinitely prolonged administration of morphine or heroin may be necessary :---
(a) Those in whom a complete withdrawal of morphine or heroin produces serious symptoms which cannot be treated satisfactorily under the ordinary conditions of private practice; and .
(b) Those who are capable of leading a fairly normal and useful life so long as they take a certain quantity, usually small. of their drug of addiction, but not otherwise.
48. Most of the witnesses admitted the existence of these two classes of cases, though in some instances with reluctance. Some physicians of great experience believed that if thorough treatment could be carried out in all cases, it would very rarely, if ever, be found necessary to provide any addict with even a minimum ration of drug for an indefinite period. It was recognised, however, even by these witnesses, that under present e conditions it was not possible, for reasons already stated (see, paragraph 44), thoroughly to treat all cases. There must, consequently, remain persons in whom a complete cure cannot be expected.
49. Further, many of the witnesses were of the opinion that, even were it possible to treat thoroughly all cases, there would still exist a certain number of persons who could be grouped in one or other of the two classes above enumerated. When therefore, every effort possible in the circumstances has been made; and made unsuccesfully, to bring the patient to a condition in which he is independent of the drug, it may in the opinion of the majority of the witnesses examined become justifiable in certain cases to order regularly the minimum dose which has been found necessary, either in order to avoid any withdrawal symptoms, or to keep the patient in a condition in which he can lead a useful life. It should not, however, be too lightly assumed in any case, however unpromising it may appear to be at first sight, that an irreducible minimum of the drug has been reached which cannot be withdrawn and which, therefore, must be continued indefintely.
Though the first attempt eritirely, to free a patient from his drug may be a failure, a subsequent one may be succesful. In this connection a paragraph may be usefully quoted from the précis of evidence furnished to us by one of the general practitioner witnesses who has successfully treated several cases of addiction: "I have encountered cases where for a time administration had to be continued on account of physical and mental distress when withdrawal was attempted. In every case as soon as possible, further attempts to get the patient to give up the habit were made. In two cases, for a period of several months, it was necessary to continue administration of small doses of morphine to allow the patient to lead a useful life. In both cases it was finally given up"
The conclusion stated in paragraph 48 has an obviously important bearing on the consideration of the administrative measures discussed in Section V.