treatment of narcotic addicts at Fort Worth, Tex., and Lexington, Ky., prevent addiction so far as they cure persons who would otherwise become foci of "infection." The hospital at Lexington alone has treated slightly more than 11,000 patients since 1935. Follow-up reports indicate that over 16 per cent of these patients have remained abstinent over a seven year period, and probably at least an additional 20 per cent have remained abstinent for extended periods of time. Physicians should keep the danger of addiction to analgesic drugs in mind and should exercise caution in prescribing them. These drugs should never be used when other drugs or other measures will suffice. The dosage should be held to the minimum compatible with adequate pain relief, and the interval between doses should be as great as possible. The drugs should be discontinued as soon as the need for pain relief has passed. They should never be used primarily for their sedative actions. In chronic cases, they should be administered orally whenever possible. Self medication with a hypodermic should not be allowed. The drugs should not be given intravenously unless the need for rapid pain relief is great, since this method produces maximum euphoria and carries an increased risk of addiction. The drugs should not be administered to persons with known neurotic personalities unless definite indications for the use of a potent analgesic are present. Narcotic drugs should never be used for the relief of symptoms due to alcoholic excess, since alcoholic persons are very addiction-prone. Analgesic drugs should rarely, or never, be used in the treatment of asthma, since asthmatic persons are very susceptible to addiction. It is significant that in many cases of morphine addiction and several of the cases of primary addiction to meperidine hydrochloride observed at Lexington addiction resulted from its use for the relief of asthma. . Suggestions are made from time to time that clinics should be established where known addicts would be given drugs free, or sold drugs at minimum cost, for the continued support of their addiction. The proponents of this plan believe that addiction is incurable or that treatment is inhumane and that if addicts are given the minimum amounts of drugs necessary to maintain their addiction lawlessness attendant on contraband traffic in narcotic drugs would be eliminated. This reasoning is unrealistic, as has been shown by several attempts in this country and abroad that have failed. Addicts on such "rations" connive to get more than their allotted amount of drugs, so that they can increase their dosage and continue to obtain a euphoric effect. They may sell, or give away, part of the extra supply so obtained to persons who are not addicted. This creates new addicts who are potential customers for the contraband market and thus increases the problem which the ration plan is supposed to abolish. Furthermore, many addicts can be treated and learn to live. a useful effective life instead of one of personal neglect, indolence and semisomnolence which is so typical of the addict. Addiction is 'infectious," and treatment, rather than support of addiction, is necessary to minimize its spread. SUMMARY Because of vigorous enforcement of the Harrison Narcotic Act and to treatment of addicts in federal facilities the total number of narcotic drug addicts in the United States has declined from 150,000 to 200,000 in 1914 to approximately 48,000 at the present time. Drug addiction is a state in which a person has lost the power of self control with reference to a drug and abuses the use of the drug to such an extent that the person or society is harmed. The drugs to which addiction commonly occurs in the United States are opium and the opium alkaloids, the synthetic morphinelike analgesics, the barbiturates, bromides, alcohol, marihuana, cocaine, amphetamine and, rarely, peyote. The characteristics of addiction to these drugs are discussed. Drug addiction is primarily a psychiatric problem and should be regarded as a symptom of a basic underlying personality maladjustment. The common personality types of drug addicts are described. The diagnosis of narcotic addiction is usually easy, but may be difficult. Isolation of the patient and observation for signs of abstinence is, at times, the only conclusive means of diagnosis. Withdrawal of drugs is the first and the least important step in the treatment of narcotic addiction. Withdrawal of morphine is best achieved by a ten day reduction of morphine or by substitution and reduction of methadon. Institutional therapy is necessary for the successful treatment of addiction. A minimum period of treatment of four to six months is essential. The patient's entire personality must be reoriented by appropriate psychotherapeutic technics. The pharmacologic characteristics, the advantages and disadvantages, and the comparative addiction liabilities of the older and newer analgesic drugs are discussed. The prevention of drug addiction involves the development of an emotionally sound people through the program of the National Mental Health Act, the reduction of the illegitimate use of narcotics by the control measures provided for under the Harrison Narcotic Act, the isolation and treatment of addicts. which prevents them from spreading addiction, and proper cautious use of addicting drugs by physicians. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE REPRINTED WITH PERMISSION FROM THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION HEW-LEX., KỲỶ. 1955 THE SENATE OF CANADA PROCEEDINGS OF THE SPECIAL COMMITTEE ON THE TRAFFIC IN NARCOTIC DRUGS IN CANADA No. 11 WEDNESDAY, MAY 25, 1955 The Honourable TOM REID, Chairman WITNESS Dr. Harris Isbell, Director of Research, U.S. Public Health Hospital, Lexington, Kentucky. EDMOND CLOUTIER, C.M.G., O.A., D.S.P. QUEEN'S PRINTER AND CONTROLLER OF STATIONERY OTTAWA, 1955 |