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Author Topic: Social And Ethical Issues of the Abuse of Opium, Morphine, Heroin and Synthetics  (Read 177 times)

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source: https://www.britannica.com/topic/drug-use/Opiate-addiction

Social And Ethical Issues Of Drug Abuse

There are many social and ethical issues surrounding the use and abuse of drugs. These issues are made complex particularly because of conflicting values concerning drug use within modern societies. Values may be influenced by multiple factors including social, religious, and personal views. Within a single society, values and opinions can diverge substantially, resulting in conflicts over various issues involving drug abuse.

Since the 1960s, drug abuse has occupied a significant place in the public consciousness. This heightened awareness of drugs and their consequences has been influenced largely by campaigns and programs oriented toward educating the public about the dangers of drug abuse and about how individuals and societies can overcome drug-related problems. One of the most hotly contested issues concerning contemporary drug abuse centres on whether currently illicit drugs should be legalized. Another major area of concern involves the abuse of drugs in sports, which can send conflicting messages to young generations whose idols are professional athletes.

Conflicting values in drug use

Modern industrialized societies are certainly not neutral with regard to the voluntary nonmedical use of psychotropic drugs. Whether one simply takes the position of American psychologist Erich Fromm, that people are brought up to desire and value the kinds of behaviour required by their economic and social system, or whether one goes further and speaks of the Protestant ethic, in the sense that German sociologist Max Weber used it to delineate the industrialist’s quest for salvation through worldly work alone, it is simply judged not “right,” “good,” or “proper” for people to achieve pleasure or salvation chemically. It is accepted that the only legitimate earthly rewards are those that have been “earned” through striving, hard work, personal sacrifice, and an overriding sense of duty to one’s country, the existing social order, and family. This orientation is believed to be fairly coincident with the requirements of industrialization.

But the social and economic requirements of many modern societies have undergone radical change in the last few decades, even though traditional values are still felt. In some places, current drug controversies are a reflection of cultural lag, with the consequent conflict of values being a reflection of the absence of correspondence between traditional teachings and the view of the world as it is now being perceived by large numbers within society. Thus, modern societies in a state of rapid transition often experience periods of instability with regard to prevailing views on drugs and drug use.

Cultural transitions notwithstanding, the dominant social order has strong negative feelings about any nonsanctioned use of drugs that contradicts its existing value system. Can society succeed if individuals are allowed unrestrained self-indulgence? Is it right to dwell in one’s inner experience and glorify it at the expense of the necessary ordinary daily pursuits? Is it bad to rely on something so much that one cannot exist without it? Is it legitimate to take drugs if one is not sick? Does one have the right to decide for oneself what one needs?

Does society have the right to punish someone who has done no harm to himself or herself or to others? These are difficult questions that do not admit to ready answers. One can guess what the answers would be to the nonsanctioned use of drugs. The traditional ethic dictates harsh responses to conduct that is “self-indulgent” or “abusive of pleasure.” But how does one account for the quantities of the drugs being manufactured and consumed today by the general public? It is one thing to talk of the “hard” narcotic users who are principally addicted to the opiates. One might still feel comfortable in disparaging the widespread illicit use of hallucinogenic substances.

But the sedatives and stimulants are complications that trap the advocate in some glaring inconsistencies. It may be asked by partisans whether the cosmetic use of stimulants for weight control is any more legitimate than the use of stimulants to “get with it,” whether the conflict-ridden adult is any more entitled to relax chemically (alcohol, tranquilizers, sleeping aids, sedatives) than the conflict-ridden adolescent, and whether physical pain is any less bearable than mental pain or anguish.

Billions of pills and capsules of a nonnarcotic type are manufactured and consumed yearly. Sedatives and tranquilizers account for somewhere around 12 to 20 percent of all doctor’s prescriptions. In addition there are many different sleeping aids that are available for sale without a prescription. The alcoholic beverage industry produces countless millions of gallons of wine and spirits and countless millions of barrels of beer each year.

One might conclude that there is a whole drug culture; that the problem is not confined to the young, the poor, the disadvantaged, or even to the criminal; that existing attitudes are at least inconsistent, possibly hypocritical. One always justifies one’s own drug use, but one tends to view the other fellow who uses the same drugs as an abuser who is weak and undesirable. It must be recognized that the social consensus in regard to drug use and abuse is limited, conflict ridden, and often glaringly inconsistent. The problem is not one of insufficient facts but one of multiple objectives that at the present moment appear unreconcilable.

Youth and drugs

Young people seem to find great solace in the fact that adults often use drugs to cope with stress and other life factors. One cannot deny that many countries today are drug-oriented societies, but the implications of drug use are not necessarily the same for the adult as they are for the adolescent. The adult has already acquired some sense of identity and purpose in life.

He or she has come to grips with the problems of love and sex, has some degree of economic and social skill, and has been integrated or at least assimilated into some dominant social order. Whereas the adult may turn to drugs and alcohol for many of the same reasons as the adolescent, drug use does not necessarily prevent the adult from remaining productive, discharging obligations, maintaining emotional and occupational ties, acknowledging the rights and authority of others, accepting restrictions, and planning for the future.

The adolescent, in contrast, is apt to become ethnocentric and egocentric with drug usage. The individual withdraws within a narrow drug culture and within himself or herself. Drug usage for many adolescents represents a neglect of responsibilities at a time when more important developmental experiences are required. To quote one observer:

It all seemed really quite benign in an earlier time of more moderate drug use, except for the three percent who became crazy and the ten percent we described as socially disabled. Since then, however, more and more disturbed kids have been attracted to the drug world, resulting in more unhappy and dangerous behavior. Increasingly younger kids have come into the scene. Individuals who, in psychoanalytic terms, are simply lesser people, with less structure, less ego, less integration, and hence, are less likely to be able to cope with the drugs. Adolescents are at a crisis period in their lives, and when you intrude regularly at this point with powerful chemicals, the potential to solve these problems of growing up by living them through, working them out, is stopped.

Adults being drug users has important implications in terms of the expectations, roles, values, and rewards of the social order, but society as a whole does not accept drug use as an escape from responsibility, and this is a fact of fundamental importance in terms of youth. Drugs may be physiologically “safe,” but the drug experience can be very nonproductive and costly in terms of the individual’s chances of becoming a fully participating adult.

Psychotropic Drugs

Opium, morphine, heroin, and related synthetics

The opiates are unrivalled in their ability to relieve pain. Opium is the dried milky exudate obtained from the unripe seed pods of the opium poppy plant (Papaver somniferum), which grows naturally throughout most of Turkey. Of the 20 or more alkaloids found in opium, only a few are pharmacologically active. The important constituents of opium are morphine (10 percent), papaverine (1 percent), codeine (0.5 percent), and thebaine (0.2 percent). (Papaverine is pharmacologically distinct from the narcotic agents and is essentially devoid of effects on the central nervous system.) About 1804 a young German apothecary’s assistant named F.W.A. Sertürner isolated crystalline morphine as the active analgesic principle of opium.

Codeine is considerably less potent (one-sixth) and is obtained from morphine. Diacetylmorphine—or heroin—was developed from morphine by the Bayer Company of Germany in 1898 and is 5 to 10 times as potent as morphine itself. Opiates are not medically ideal. Tolerance is developed quite rapidly and completely in the more important members of the group, morphine and heroin, and they are highly addictive. In addition, they produce respiratory depression and frequently cause nausea and emesis.

As a result, there has been a constant search for synthetic substitutes: meperidine (Demerol), first synthesized in Germany in 1939, is a significant addition to the group of analgesics, being one-tenth as potent as morphine; alphaprodineWiki (Nisentil) is one-fifth as potent as morphine but is rapid-acting; methadone, synthesized in Germany during World War II, is comparable to morphine in potency; levorphanolWiki (Levo-Dromoran) is an important synthetic with five times the potency of morphine. These synthetics exhibit a more favourable tolerance factor than the more potent of the opiates, but in being addictive they fall short of an ideal analgesic. Of this entire series, codeine has the least addiction potential and heroin has the greatest.

History of opiates

The narcotic and sleep-producing qualities of the poppy have been known to humankind throughout recorded history. Sumerian records from ancient Mesopotamia (5000 to 4000 BCE) refer to the poppy, and medicinal reference to opium is contained in Assyrian medical tablets. Homer’s writings indicate Greek usage of the substance at least by 900 BCE. Hippocrates (c. 400 BCE) made extensive use of medicinal herbs including opium.

The Romans probably learned of opium during their conquest of the eastern Mediterranean. Galen (130–200 CE) was an enthusiastic advocate of the virtues of opium, and his books became the supreme authority on the subject for hundreds of years.

The art of medicinals was preserved by the Islamic civilization following the decline of the Roman Empire. Opium was introduced by the Arabs to Persia, China, and India. Paracelsus (1493–1541), professor at the University of Basel, introduced laudanum, a tincture of opium. Le Mort, a professor of chemistry at the University of Leyden (1702–18), discovered paregoric, useful for the control of diarrhea, by combining camphor with tincture of opium.

There is no adequate comprehensive history of the addictive aspects of opium use in spite of the fact that it has been known since antiquity. Because there were few alternative therapeutics or painkillers until the 19th century, opium was somewhat of a medical panacea. Thus, although at least one account, in 1701 by a London physician named Jones, spoke of an excessive use of opium, there appears to have been no real history of concern until recent times, and opiates were easily available in the West in the 19th century—for instance, in a variety of patent medicines.

Physicians prescribed them freely, they were easy to obtain without prescription, and they were used by all social classes. At one time the extensive use of these medicines for various gynecological difficulties probably accounted for high addiction rates among women (three times the rate among men). The invention of the hypodermic needle in the mid-19th century and its subsequent use to administer opiates during wartime produced large numbers of addicted soldiers (about 400,000 during the U.S. Civil War alone); it was thought mistakenly that if opiates were administered by vein, no hunger or addiction would develop, since the narcotic did not reach the stomach.


Toward the end of the 19th century, various “undesirables” such as gamblers and prostitutes began to be associated with the use of opiates, and narcotics became identified more with the so-called criminal element than with medical therapy. By the turn of the 20th century, narcotic use had become a worldwide problem, and various national and international regulatory bodies sought to control opium traffic in China and Southeast Asia. In the 20th century, narcotic use was largely associated with metropolitan slums, principally among the poor and culturally deprived. Narcotic use eventually spread to middle-class youth.

Physiological effects of opiates

The various opiates and related synthetics produce similar physiological effects. All are qualitatively similar to morphine in action and differ from each other mainly in degree. The most long-lasting and conspicuous physiological responses are obtained from the central nervous system and the smooth muscle of the gastrointestinal tract. These effects, while restricted, are complex and vary with the dosage and the route of administration (intravenous, subcutaneous, oral). Both depressant and stimulant effects are elicited.

The depressant action involves the cerebral cortex, with a consequent narcosis, general depression, and reduction in pain perception; it also involves the hypothalamus and brain stem, inducing sedation, the medulla, with associated effects on respiration, the cough reflex, and the vomiting centre (late effect). The stimulant action involves the spinal cord and its reflexes, the vomiting centre (early effect), the tenth cranial nerve with a consequent slowing of the heart, and the third cranial nerve resulting in pupil constriction. Associated effects of these various actions include nausea, vomiting, constipation, itchiness of the facial region, yawning, sweating, flushing of skin, a warm sensation in the stomach, fall in body temperature, diminished respiration, and heaviness in the limbs.

Opiate addiction

There is no single narcotic addict personality type; addiction is not a unitary phenomenon occurring in a single type. The great variation in addiction rates and classes of addicts in various countries caution against placing too great an emphasis on personality variables as major causative factors. Even within the United States, there is great danger in generalizing from the cases of the patients found at the public health service hospitals. Such individuals are a highly select group of adults who have spent previous time in correctional institutions. They are not representative of the adolescent addict or the adult addict who has not had continual difficulty with the law.

Another type of user is the addict who is a member of a closely knit adolescent gang. This subculture is highly tolerant of drug abuse, and the members have ready access to narcotic drugs. They do not actively seek the opportunity to try heroin. Neither are they deliberately “hooked” on heroin by adult drug peddlers. They are initiated to narcotic use by friends, gang members, or neighbourhood acquaintances, and the opportunity for such use is almost always casual but ever present. This “kicks” user is apt to abandon narcotics when gang membership is abandoned.

The chronic user is more likely to be the immature adolescent at the periphery of gang activities who uses narcotics for their adjustive value in terms of deep-seated personality problems. Such individuals do not abandon drug use for the more conventional pursuits when entering adulthood. Instead, old ties are severed; interest in previous friendships is withdrawn; athletic and scholastic strivings are abandoned; competitive, sexual, and aggressive behaviour becomes markedly reduced, and the individual retreats further into a drug-induced state. Identification is now with the addict group: a special culture with a special language. The addict’s world revolves around obtaining drugs.

Means of administration

Most persistent users follow a classic progression from sniffing (similar to the oral route) to “skin popping” (subcutaneous route) to “mainlining” (intravenous route), each step bringing a more intense experience and a higher addiction liability. With mainlining, the initial thrill is more immediate. Within seconds a warm glowing sensation spreads over the body, most intense in the stomach and intestines, comparable to sexual release. This intense “rush” is then followed by a deep sense of relaxation and contentment.

The user is “high” and momentarily free. It is this initial state of intense pleasure that presumably brings the novice to repeat the experience, and it is this mode of administration that hastens a user on the way to drug tolerance and physical dependence. Soon the user finds that the effects are not quite there. Instead, his or her body is beginning to experience new miseries. At this juncture, the user “shoots” to avoid discomfort. The euphoria is gone. The individual now spends every waking moment in obtaining further supplies to prevent the inevitable withdrawal symptoms should supplies run out.

Habits are expensive. If indigent, the addict must spend all his or her time “hustling” for drugs—which means that the person must steal or raise money by other means such as prostitution, procuring, or small-time narcotics peddling. The addict always faces the danger of withdrawal, the danger of arrest, the danger of loss of available supply, and the danger of infection, of collapsed veins, or of death from overdosage. Very few individuals are still addicted by age 40. They have either died, somehow freed themselves from their addiction, or sought treatment.

Therapy for opiate addiction

Drug dependence can be viewed as an ethical problem: Is it right and permissible to need a narcotic agent? How one answers this question dictates the position one will take in regard to addiction therapy. In general, the addict can be given the drug or can be placed on a substitute drug, or drugs can be barred altogether. Narcotic maintenance, which gives the addict the drug, is the system employed in the management of opiate dependence in some institutions. Methadone treatment is a drug-substitution therapy that replaces opiate addiction with methadone addiction in order that the addict might become a socially useful citizen. Some drug therapy groups involve an intensive program of family-like resocialization, with total abstinence as the goal. Psychological approaches to total abstinence through reeducation involve psychotherapy, hypnosis, and various conditioning techniques that attempt to attach unpleasant or aversive associations to the thoughts and actions accompanying drug use. Each of these approaches has had successes and has limitations.

Great Britain began to control the use of narcotics in 1950, embracing the principle of drug maintenance. Supporters of the approach insisted that narcotic addiction in Great Britain remained a very minor problem because addiction was considered an illness rather than a crime. (Later, however, addiction became more widespread.) The British physician was allowed to prescribe maintenance doses of a narcotic if, in his or her professional judgment, the addict was unable to lead a useful life without the drug. But in 1967 the British government took the right to prescribe for maintenance addiction away from the general practitioner and placed it in the hands of drug treatment clinics. Although some addicts must obtain legal supplies from the clinic, others are allowed to obtain supplies from a neighbourhood pharmacy and medicate themselves. These clinics also provide social and re-educative services such as psychotherapy for the addict. The general experience among these clinics has been that a large proportion of the addicts are becoming productive, socially useful members of the community.

There are two major drawbacks to the maintenance use of narcotic drugs. Both the physical and the social health of the user remains unsatisfactory. A high incidence of hepatitis, bacterial endocarditis, abcesses, and, on occasion, fatal overdosage accompanies the self-administration of opiates. Socially, the addict on self-administration also tends to remain less productive than his or her peers—the reason apparently being that the individual on narcotic maintenance is still very preoccupied with certain aspects of narcotic use. Narcotic addiction is a two-faceted problem: the yearning for the “high” and the felt sense of not being physiologically normal. The addict on narcotic maintenance often attempts to obtain or retain both drug effects: frequent intravenous use prevents the feeling of drug hunger and maximizes the attempt to experience euphoria.

Methadone therapy aims to block the abnormal reactions associated with narcotic addiction while permitting the addict to live a normal, useful life as a fully participating member of the community. Methadone provides a “narcotic blockade” in that it is possible to increase methadone medication to a point at which large oral doses will induce a state of cross-tolerance in which the euphoric effects of other narcotics cannot be felt even in very high doses.

Additionally methadone has the ability to allay the feeling of not being right physically, which the addict finds he or she can correct only by repeated narcotic use. Methadone treatment, then, rests on these two pharmacological actions: the blockade of euphoric effects and the relief of “narcotic hunger.”

Methadone is not successful in every case, but results have been dramatic in some cases. In various studies conducted on addicts who entered a methadone treatment program, most remained in the program, and virtually none returned to daily use of heroin. The majority either accepted employment or started school, and previous patterns of antisocial behaviour were either eliminated or significantly reduced. Methadone is a drug of addiction in its own right, but it does not have some of the more serious undesirable consequences associated with heroin.

There are various types of drug counseling units that advocate complete abstinence from drug dependency. Such drug therapy, usually involving a group of addicts, tries to promote personal growth and teach self-reliance. Individual counseling and psychotherapy may or may not be provided for the members of the group, but generally it is believed that moral support is derived from the experiences of fellow addicts and former addicts who have or are trying to become chemically independent. Success rates for various drug therapy groups vary widely.

In countries where the addict is treated as a criminal, physicians may be prevented from administering opiates for the maintenance of addiction. Acceptable treatment includes enforced institutionalization for several months, strict regulation against ambulatory care until the person is drug-free, and the total prohibition of self-administration of drugs even under a physician’s care. Estimates of cures based upon decades of such government-regulated procedures range from 1 to 15 percent.

The most outstanding effect of the opiates is one of analgesia. All types of pain perception are affected, but the best analgesic response is obtained in relieving dull pain. The analgesic effects increase with increasing doses until a limit is reached beyond which no further improvement is obtained. This point may fall just short of complete relief.

Depression of cortical function results in a euphoric response involving a reduction of fear and apprehension, a lessening of inhibitions, an expansion of ego, and an elevation of mood that combine to enhance the general sense of well-being. Occasionally in pain-free individuals the opposite effect, dysphoria, occurs, and there is anxiety, fear, and some depression. In addition to analgesia and associated euphoria, there is drowsiness, mental and physical impairment, a clouding of consciousness, poor concentration and attention, reduced hunger or sex drive, and sometimes apathy.

Apart from their addiction liability, respiratory depression leading to respiratory failure and death is the chief hazard of these drugs. All of the more potent opiates and synthetics produce rapid tolerance, and tolerance to one member of this group always is associated with tolerance to the other members of the group (cross-tolerance). The more potent members of the group have a very great addiction liability with the associated physical dependence and abstinence syndrome.

Hallucinogenic drugs

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