Opium

by Martin Booth

  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.

  Complex substances, such as cyclazocine or naloxone, which were classed as chemical antagonists, were tried to counter relapses into addiction by blocking the effects of heroin. They failed, the former having significant side-effects and the latter requiring huge dosages. In the early 1970s, at the Addiction Research Center at Lexington, Kentucky, a substance known as N-methylcyclopropylnorxymorphone was tested without success.

  The sad truth is, to this day, no effective remedy for opiate addiction has been found and no other drugs have been so extensively researched with so little positive result: for most addicts, what keeps them habituated is a justifiable fear of withdrawal, to avoid which they are pr
epared to go to great lengths to ensure a continued supply.

  One of the best and most graphic descriptions of the terrors of withdrawal was included by Dr Robert S. de Ropp in his study Drugs and the Mind, published in 1958:

  About twelve hours after the last dose of morphine or heroin the addict begins to grow uneasy. A sense of weakness overcomes him, he yawns, shivers, and sweats all at the same time while a watery discharge pours from the eyes and inside the nose which he compares to ‘hot water running up into the mouth.’ For a few hours he falls into an abnormal tossing, restless sleep known among addicts as the yen sleep. On awakening, eighteen to twenty-four hours after his last dose of the drug, the addict begins to enter the lower depths of his personal hell. The yawning may be so violent as to dislocate the jaw, watery mucus pours from the nose and copious tears from the eyes. The pupils are widely dilated, the hair on the skin stands up and the skin itself is cold and shows that typical goose flesh which in the parlance of the addict is called ‘cold turkey,’ a name also applied to the treatment of addiction by means of abrupt withdrawal.

  Now to add further to the addict’s miseries his bowels begin to act with fantastic violence; great waves of contraction pass over the walls of the stomach, causing explosive vomiting, the vomit being frequently stained with blood. So extreme are the contractions of the intestines that the surface of the abdomen appears corrugated and knotted as if a tangle of snakes were fighting beneath the skin. The abdominal pain is severe and rapidly increases. Constant purging takes place and as many as sixty large watery stools may be passed in a day.

  Thirty-six hours after his last dose of the drug the addict presents a truly dreadful spectacle. In a desperate effort to gain comfort from the chills that rack his body he covers himself with every blanket he can find. His whole body is shaken by twitchings and his feet kick involuntarily, the origin of the addict’s term, ‘kicking the habit.’

  Throughout this period of the withdrawal the unfortunate addict obtains neither sleep not rest. His painful muscular cramps keep him ceaselessly tossing on his bed. Now he rises and walks about. Now he lies down on the floor. Unless he is an exceptionally stoical individual (few addicts are, for stoics do not normally indulge in opiates) he fills the air with cries of misery. The quantity of watery secretion from eyes and nose is enormous, the amount of fluid expelled from stomach and intestines unbelievable. Profuse sweating alone is enough to keep both bedding and mattress soaked. Filthy, unshaven, dishevelled, befouled with his own vomit and faeces, the addict at this stage presents an almost subhuman appearance. As he neither eats nor drinks he rapidly becomes emaciated and may lose as much as ten pounds in twenty-four hours. His weakness may become so great that he literally cannot raise his head. No wonder many physicians fear for the very lives of their patients at this stage and give them an injection of the drug which almost at once removes the dreadful symptoms … If no additional drug is given the symptoms begin to subside of themselves by the sixth or seventh day, but the patient is left desperately weak, nervous, restless, and often suffers from stubborn colitis.

  The rigours of cold turkey are no longer a necessary or inevitable part of overcoming addiction. Nowadays, tranquillisers and synthetic-opiate analgesics are used, the best known being methadone.

  Methadone hydrochloride, a white crystalline powder which behaves like morphine or heroin, was discovered by German scientists during the Second World War. They were eager to invent a synthetic opiate to replace morphine which was in short supply due to the Allied blockade. Developed in the Mallinckrodt Laboratories, it was originally called dolophine hydrochloride. There is some argument as to how this name was arrived at: one suggests dolophine was named after Adolph Hitler whilst another states it was later invented by an American chemical company and derived from the Latin dolor, meaning pain. Knowledge of the drug remained dormant until around 1970 when two New York doctors, Marie Nyswander and Vincent Dole, started treating hard-line addicts with 150-milligram injections.

  A powerful analgesic, methadone cancels out the euphoria of heroin and eases withdrawal, its effects lasting up to thirty-five hours as opposed to heroin’s eight-hour span: it also prevents other substances, such as heroin, from working. At first, an injected dose equivalent to the addict’s usual heroin dose is given but this is slowly reduced until injections are replaced by an orally administered methadone mixture or physeptone pills, then a weaker linctus. The aim is that, after stabilising on methadone, addicts will then gradually reduce their dose until they are finally able to do without it.

  As methadone is also addictive, an addict may have to be weaned from it after the heroin craving is dead. In essence, methadone detoxification is not so much a curing of heroin addiction as a replacing of it by another addictive substance which is more readily overcome: but addicts on methadone say although it brings some order into their lives, they remain addicted to a drug and are trapped. They add that, in some ways, withdrawing from methadone is worse than from heroin because the withdrawal period is longer and similar symptoms may occur. In many cases, addicts spend years on methadone.

  A potentially less harmful cure is acupuncture. Dr H.L. Wen, an eminent neurosurgeon working in Hong Kong in the 1970s, operated upon chronic addicts by destroying a section of their brain’s frontal lobes under local anaesthetic. Worried about aspects of the anaesthesia, he decided to try acupuncture as an anaesthetic during his lobectomy. To his surprise, no sooner had he started placing and manipulating the acupuncture needles than his patient claimed his withdrawal symptoms ceased. Not convinced, Wen carried out a series of trials, since which a large number of addicts have been treated, a significant number successfully. At about the same time, a Hong Kong clinic claimed success with electro-stimulation, passing a 5-volt current through addicts’ ear lobes. The drawback with both systems is that, to be effective, they have to be undergone over a long period, making them impractical and giving the addict opportunities to rehabituate.

  Another approach to addiction lies in herbal or traditional medicine. In Malaysia, traditional Muslim doctors called bomoh treat addiction with herbal teas and the recitation of Koranic texts, regardless of the addict’s religious leanings. Most bomoh quarantine their patients to avoid contact with drugs and to enhance their concentration on the teachings of Allah whilst others employ the use of pembenci (hatred charms) in a process of sympathetic magic which psychologically aids the patient. In neighbouring Thailand, addicts could attend Buddhist wats (temples) for herbal treatment, prayer and moral support which lasted for up to ten days. Such regimes were harsh but effective, involving herbal teas, potions which caused vomiting, herbal purgation baths and the strict vigilance of monks, or purifiers. As with Western techniques, the underlying idea was denial allied with moral assistance. Mass detoxification took place with all the addicts making a religious vow together: frequently, cured addicts stayed to help others. Sadly, this traditional approach has declined somewhat in the last twenty years as Thailand has ‘modernised’ and the population has become increasingly urban, relying more upon Western methods.

  Other alternatives are also coming on to the market. Buprenorphine, a synthetic opiate, is proving a possible agent. In the USA a new substance, levomethadyl acetate, is being studied with clinical trials in both North America and Europe but it is not yet passed for general usage.

  There is one other method of curing addiction which has nothing to do with substitute drugs, drug therapies, acupuncture needles or extract of prickly ash bark: it is not even part of a doctor’s techniques.

  In 1966, an English music teacher in her early twenties arrived in Hong Kong with just HK$100 and a desire to be a Christian missionary, although in what field she had no idea. Her name was Jackie Pullinger.

  Armed with her love of young people and children, and the love of Christ, she established a youth club in one of the most feared and lawless barrios in the world, Kowloon Walled City. By a quirk of the 1898 Convention of Peking a tiny area of Hong Kong, about t
he size of a New York City block, which had once been a small walled village, became a disputed territory theoretically owned by China, ruled by the British but governed in fact by Chinese criminal fraternities whose members used it as a safe haven. By the 1960s it was a dense wedge of buildings bisected by narrow dark alleys into which the sun seldom penetrated, noxious cellars, warrens of apartments, staircases, tunnels and one-room factories making anything from fish-balls and boiled sweets to plastic sex toys.

  Without a concerted police presence and aided by police corruption, Kowloon Walled City was by the late 1950s one of the world’s primary heroin manufacturing centres. The presence of so much heroin not only made Hong Kong of primary importance to international drug traffickers, it produced an horrendous number of domestic heroin addicts. So prevalent was the drug in the Walled City the main thoroughfare through it, a fetid alley wider than most, was colloquially known as Pak Fan Gai, or White Rice Street: pak fan was also local slang for heroin which could be purchased openly there by the kilogram. It was in this exceptionally dangerous milieu the petite Jackie Pullinger was to find her calling. This was to cure heroin addicts. But methadone or substitute drugs had no place in Jackie Pullinger’s armoury which consisted solely of the love of God and prayer.

  Addicts came to a series of evangelical prayer meetings over a period of weeks. Each meeting began with a prayer and then a sermon by Jackie, followed by the singing of evangelical hymns to a guitar. All the proceedings were carried out in Cantonese which Jackie speaks like a local. Very gradually, the atmosphere grew tense, with everyone coming under a spell. Within ten minutes, the entire gathering was chanting and praying in tongues. The addicts stood up. Jackie and her acolytes, who numbered not only foreign helpers but also former addicts, encircled them singly, laying on their hands. The addicts then passed into a semi-trance, swaying and muttering, sometimes falling, to be caught, at other times keeping upright by the presence but not the contact of outstretched palms.