Romancing Opiates

 Posted by on 24 August 2007 at 2:12 pm  Uncategorized
Aug 242007

I just began reading Theodore Dalrymple’s recent book Romancing Opiates. So far, it’s excellent. Most surprising is the fact that — contrary to all popular belief, fictional portrayals, and media reports — the symptoms of physical withdrawal from heroin are extremely mild. The addict is not in any danger of dying whatsoever, as with serious alcohol withdrawal. He’s not even in any real physical distress.

The distress that addicts do feel is based solely on their beliefs about the withdrawal of the drug: it’s purely psychological. Studies have shown that addicts aren’t able to tell whether they’ve been given morphine or placebo, such that symptoms like nervousness and restlessness came and went based on what they were told about the contents of their injection (28).

However, addicts are extremely adept at faking such distress in the hopes of wheedling a prescription from the often-gullible doctor. Most doctors accept the standard view that withdrawal from opiates is a terrible ordeal, despite substantial evidence to the contrary, such as the addicts displaying no great signs of distress when secretly watched by the doctor. So the doctors routinely prescribe the addict drugs like methadone.

In contrast, when the addict is confronted with a doctor like Dalrymple, who refuses such prescriptions and clearly explains his reasons why, some will not only cease their performance of distress, but even “smile and admit with a laugh that anyone who says that cold turkey is a terrible ordeal is lying and more than likely trying to bluff his way to a prescription” (25). Once that is done, other addicts in the ward don’t even bother with the attempted deception.

In recent years, doctors have tried to alleviate the non-existent horror of opiate withdrawal by “ultra-short opiate detoxification.” (If I recall correctly, this method was featured on House.) Basically, the addict is administered “an opiate antagonist, naloxone, under general anesthesia, followed by continued administration of naloxone for a further forty-eight hours. This [method] … turns a trivial medical condition, namely ‘natural’ withdrawal from opiates, into a potentially fatal one, since quite a number of deaths are known to have occurred as a result of it, some clinics that use it having recorded as many as ten deaths” (29). Yikes!

The failure to consider the obvious implications of perceptual observations can have serious consequences in any area of life. In this case, that failure on the part of those in the business of addiction treatment means that a voluntary psychological dysfunction is treated with ineffective, counterproductive, and even life-threatening methods. Lovely, no?

Suffusion theme by Sayontan Sinha