6

God’s Own Medicine

Writing at the end of the nineteenth century, Sir William Osier called opium ‘God’s Own Medicine’ because it was a naturally occurring substance which could perform miracles and be used straight from the poppy, its active ingredients, like those of most plant-derived medicines, being its alkaloids which may be classed in two main groups. One, the pyridine–phenanthrene group, contains morphine and codeine, whilst the other, the isoquinoline group, includes papaverine and noscapine.

As well as the main alkaloid constituents of morphine, noscapine, papaverine, codeine and thebaine, trace alkaloids include narceine, meconidine, codamine, laudanine, laudanosine, lanthopine, protopine, cryptopine, rhoeadine, oxynarcotine, pseudo-morphine, gnoscopine, xanthaline, tritopine and hydrocotarnine. In all, they account for only 20 per cent of opium by weight. The morphine content of opium is not standard and can range between 4 and 21 per cent according to country of origin with noscapine being the next most plentiful at 4–8 per cent.

Today, only a very small quantity of opium is used medicinally, for example as an analgesic for patients suffering from cancer of the stomach, its main medicinal use being obtained from its alkaloids and derivatives. Morphine kills pain and euphorically relaxes the patient, although the majority of morphine is nowadays converted into codeine because the natural supply of that alkaloid is minute. Codeine is a less powerful analgesic and not as likely to cause addiction. Its usage includes the treatment of minor aches, pains and coughs. For years, it was available over druggists’ counters as an alternative to aspirin, but is now strictly controlled although it is still available. Noscapine is used to counteract coughing and papaverine has dramatic effects on increasing blood flow. Thebaine is a dangerous poison, causing severe convulsions, but its importance is that it can be converted into codeine and chemically altered to form other drugs. Heroin is a strong pain suppressive but it is not widely used in medicine outside Britain.

Opiate is the generic term given to the group of drugs derived from natural opium or an alkaloid of it whilst semi-synthetic opiates are those produced by starting with a natural alkaloid then chemically modifying it: heroin may be classed as a semi-synthetic. Although synthesised, there are parts of the semi-synthetics’ chemical construction which mirror or echo that of their base alkaloid. Synthetic opiates – sometimes confusingly referred to as opioids – are drugs which act in the same way as natural opiates and semi-synthetics but they are entirely man-made: their chemical structure bears little or no relation to opium alkaloids. These include pethidine, often used to relieve pain in childbirth, dextropropoxyphene and methadone.

Morphine, codeine and thebaine can all be used as the basis for a variety of semi-synthetic opiates which have become increasingly important in recent decades. Some are incredibly powerful. In the 1960s, a team working on thebaine under the prominent natural products chemist, Professor Bentley, in the Edinburgh laboratories of Macfarlan Smith & Co., made a literally unconscious discovery when someone accidentally stirred cups of mid-morning tea with a contaminated glass rod: within minutes several of the scientists were lying flat out on the floor. The company physician, Dr Simpson, was called. He monitored the comatose scientists, noting their heart rates, breathing patterns and behaviour before they revived. The drug they had unwittingly drunk was later developed into etorphine. Approximately 10,000 times as powerful as morphine, it is also known as M99 or Immobilon, and is used in dart guns to capture elephants and rhinos. Less than 2 millilitres will knock a full-grown white rhino senseless: a mere scratch from a contaminated needle can kill a man. Fortunately, there is an antidote called M50/50 or Revivon.

The problem with opiates in general is that they are addictive and although the risk of dependence varies greatly from one to another, a frequent user will become habituated.

Addiction is the compulsive taking of drugs which have such a hold over the addict he or she cannot stop using them without suffering severe symptoms and even death. Opiates are not unique. Cocaine, alcohol, caffeine and nicotine are also addictive, but they are nothing like as powerful as opiates in their hold over their victims. Nowadays, the term addiction is replaced by that of physical dependence, which is a more accurate definition, for addicts are frequently physically dependent upon their drug: this is certainly the case with opiates.

The idea of dependence was defined in 1964 by the World Health Organisation as ‘a state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterised by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects and sometimes to avoid the discomfort of its absence.’ It is today considered an illness.

Opiate dependence is not a habit, nor is it a simple drive for some emotional craving. It is as fundamental to an addict’s existence as food and water, a physio-chemical fact: an addict’s body is chemically reliant upon its drug for opiates actually alter the body’s chemistry so it cannot function properly without being periodically primed. A hunger for the drug forms when the quantity in the bloodstream falls below a certain level, the addict becoming anxious and irritable. Fail to feed the body and it deteriorates and may die from drug starvation.

This chemical relationship is easily proven. Not only humans can be addicted: so can other mammals. In Laos, where opium is commonly smoked, domestic pets such as cats and dogs become addicts by passively smoking their master’s pipes. Tame macaques in India may also become passive addicts and, in the past, became addicted by licking out cold opium pipes. Today, drug-sniffing dogs employed by customs authorities are sometimes trained on synthetic opium-smelling substances because they are liable to addiction. Addicts give birth to on average smaller babies which, after the umbilical cord is severed, may exhibit symptoms of opium withdrawal having been literally cut off from a supply they have known since conception.

For the non-addict, one of the greatest mysteries is why someone takes to drug use knowing the terrible dangers. Philip K. Dick, the American science-fiction author, spoke for many people when he wrote in 1977: ‘Drug misuse is not a disease, it is a decision, like the decision to step out in front of a moving car. You would call that not a disease but an error of judgement.’ Clearly peer pressure, poverty and other social factors are likely to play their part in this decision-making process but the fact remains – why ‘hard’, very addictive drugs, such as opiates, instead of alcohol or ‘soft’ drugs such as marijuana? It may be that some, especially the very young, are unaware of what they are taking: this might account for the present-day world-wide trend towards younger and younger addicts. A young British addict who first took heroin at thirteen, not realising it was addictive, recently stated, ‘I was feeling left out. My mates were having a better laugh, so I tried it.’ A recent British survey has found Ecstasy users smoking ‘skag’ to ease the fading effects of an Ecstasy dose, in ignorance of what it is: skag is a street name for heroin.

Perhaps some users are hoping to find an alternative existence as summed up by Aldous Huxley in 1949:

If we could sniff or swallow something that would, for five or six hours each day, abolish our solitude as individuals, atone us with our fellows in a glowing exaltation of affection and make life in all its aspects seem not only worth living, but divinely beautiful and significant, and if this heavenly, world-transfiguring drug were of such a kind that we could wake up next morning with a clear head and an undamaged constitution – then, it seems to me, all our problems (and not merely the one small problem of discovering a novel pleasure) would be wholly solved and earth would become paradise.

One assumption, which holds good for heroin and morphine, is the ‘kick’ or ‘rush’, the orgasmic sensuality of an injection which is particularly prevalent with heroin. For some heroin addicts, the effect is a warming of the stomach and an erotic tingling in the crotch: for others, this is heightened to a considerable erotic thrill. Perhaps the reason is summed up best by the comedian Lenny Bruce, who stated of his fatal addiction, ‘I’ll die young, but it’s like kissing God.’ The erotic pleasure can, however, be offset by a characteristic vomiting which the first shots of heroin or morphine produce.

For many addicts, heroin is favoured because, whilst allowing them to maintain full consciousness, they can withdraw into a secure, cocoon-like state of physical and emotional painlessness. Heroin is seen as an escape to tranquillity, a liberation from anxiety and stress: for the poor, it is a way out of the drudgery of life, just as laudanum was for their forebears two centuries ago.

For a long while it was believed – as an offshoot from the eugenics debate – that only certain types of people might turn to drugs and become addicted. Orientals, it was suggested, were more resistant to opium than Occidentals, the assumption based on the supposition poisons were less dangerous to an indigenous population living where the substances were naturally occurring. This, of course, was bunkum for the poppy is not native to Asia. Victorian moralists and social observers claimed the lower classes showed a greater predilection for, and were worse affected by, opium than the middle and upper classes. This too was claptrap.

Everyone, regardless of social, economic or racial background or type of physique, is a potential addict although today some doctors opine that certain people are genetically predisposed towards addiction. Opinions, such as those of the nineteenth-century American doctor, R. Batholow, are discounted: his ideal candidate for addiction was ‘a delicate female, having light blue eyes and flaxen hair, [who] possesses, according to my observations the maximum susceptibility.’ His opinion was not unique. Many of his contemporaries thought women particularly at risk: with hindsight, this conclusion may have been caused by the fact that morphine was so widely used to treat menstrual problems, diseases of a ‘nervous character’ from which women were believed to suffer and was also administered as an analgesic in pregnancy and labour. Furthermore, prostitutes used opiates not only to sustain them in their long and arduous work but also as a crude form of contraception because continued dosage disrupted ovulation.

It was also suggested that addiction was related to psychological disorders or types. As recently as the 1920s, Dr Lawrence Kolb of the United States Public Health Service expressed the belief that ‘normal’ people gained no pleasure from morphine except the release of pain and that pleasure was only felt by mentally unstable people. The addict, he claimed, was of psychopathic tendency. His theory is dismissed now but it is accepted that specific mental attributes may lead to drug use: these include a restless curiosity about unknown experiences and a desire to share visions with others. This may account for the quasi-religious attitudes of some addicts who see themselves in the initial phases of addiction as joining with others in a cosmic experience. For many, addiction is an entry to a special fellowship with its own mores, rules and even language. Morphine addicts in the USA spoke in an esoteric jargon – the act of injection was erroneously known as ‘Chinese needlework’ whilst to smoke heroin or opium was to have the ‘lamp habit’.

Addicts today have their own argot – to ‘shoot up’ is to inject intravenously, to ‘chase the dragon’ is to smoke opium or heroin whilst heroin itself has a wide variety of slang names such as ‘horse’, ‘H’, ‘Big Harry’, ‘elephant’, ‘stuff’, ‘candy’, ‘smack’ and (ironically) ‘shit’. To be addicted is to have ‘a monkey on your back’ or to be ‘strung out’ whilst a dealer is a ‘pusher’, ‘candyman’ or ‘connection’. Heroin is sold by the ‘deal’ (a single dose in a tiny paper packet), the ‘deck’ (a small bagful), the ‘piece’ (approximately 1 ounce), the ‘half-lo’ (15 bags’-worth) and the ‘key’ (short for kilogram). The act of adulteration or diluting is known as ‘cutting’ because the measures of powder are traditionally mixed and separated with a sharp edge like a razor blade. Heavily cut heroin is known as ‘six and four’. To be asked if one ‘wants a boy’ does not imply a homosexual relationship: ‘boy’ is a metaphor for heroin and the reply is ‘no way’ if one is ‘anywhere’ – that is, in possession. One expression, seldom associated with opium today but derived from drug-taking, is ‘hip’. Meaning to be one of the in-crowd, it comes from nineteenth-century American addict slang when a ‘hip’ was an experienced drug taker: its root lay in the fact addicts gained sore hips from reclining on their sides on hard, opium den bed-boards. Despite such an extensive vocabulary of opiate slang, heroin users do not today have their own specific culture, as is sometimes implied by the media, unlike, for example, Ecstasy which has an accompanying culture of rave parties and its own style of neo-pop music.

So what is taking opium like? The first effect is relaxation although a few may experience a transitory, sudden rush of excitement like the erotic heroin kick. Cares, concerns and inhibitions are dispelled, to be followed by a calmness, although there may be some nausea in the early stages. The calmness grows to a serene self-assurance then a listless complacency. Nothing worries nor concerns opium takers: they often feel light, as if floating, and many describe themselves as levitating whilst under the influence. Early in addiction, mental power may be enhanced or increased and addicts believe they are having radical and unique ideas and thoughts.

As many addicted writers and artists vouchsafe, opium may stimulate visions in those with considerable imagination but, of itself, opium is not a fantasy-promoting substance. In latter stages of addiction, all opiates actually suppress imaginative creation, just as they can suppress the ability to be creative in other art forms. As Billie Holliday, the famous blues singer, said in 1956: ‘If you think dope is for kicks and for thrills, you’re out of your mind … If you think you need stuff to play music or sing, you’re crazy. It can fix you so you can’t play nothing or sing nothing.’

The exciting stage of drug experience does not last long: it may be sustained for a matter of months but it is more likely to begin to disappear after a few weeks, depending upon the addict’s metabolism. With raw opium it may survive for quite a while although Eric Detzer, in his autobiography Monkey on my Back, put modern opium-eating into context:

There’s nothing classy or poetic about opium. It has the same effect as morphine or heroin. You get relaxed and energetic at the same time. Problems become unimportant. You feel sleepy, but if you go to bed you lie awake. You itch all over. You get constipated. You get hungry, particularly for sweets. You get patient and understanding. You get nice … An opium high can be described in one word: comfortable. It’s weird that people get to where they’ll give up their souls for stuff that just makes them comfortable.

With heroin, the kick reduces as tolerance rises, addicts taking larger and larger amounts, which would be fatally poisonous to unaccustomed individuals, just to feel normal. The ‘high’ – the plateau of experience to which all heroin addicts aspire, where reality is suborned – disappears and excitement rapidly deteriorates as dependency increases. The sought-after euphoria becomes more difficult to achieve and is then lost: by this stage dependency is firmly established and if it is not sustained, the addict slips into a state of first restless distress then excruciating physical pain. This is known as withdrawal sickness or abstinence syndrome – or, in the slang of the modern addict, ‘cold turkey’ or ‘bogue’.

While most addicts, having lost the euphoria, build up their doses in order to try to regain it, others, desperate to feel the rush or peace again, start taking drug cocktails, such as ‘speedballs’ (heroin and cocaine) or “Frisco speedballs’ (heroin, cocaine and the hallucinogen, LSD) or other similarly dangerous concoctions of heroin with ‘uppers’ (amphetamines), ‘downers’ (barbiturates), ‘jacket’ (Nembutal) or ‘crystal’ (Methedrine). Inevitably, many die from an ‘OD’ – an overdose.

Popular belief labels all addicts as desperate characters but they are not. A minority maintain their habit at a steady dose rate, just keeping themselves above the threshold of withdrawal. They may live conventional lives, even hold down responsible jobs without detection by even close friends and family. George Crabbe was an example of such a ‘secret’ addict. Another was William Wilberforce: a noted evangelist, statesman, philanthropist and reformer, he succeeded against considerable vested interests in abolishing the slave trade and yet he was himself in thrall to opium, the one slavery he could do nothing to end.

Opiates in themselves are relatively safe drugs and even today addicts in receipt of opiates on prescription, and who maintain a stable, hygienic life-style, can be virtually indistinguishable from non-drug users and suffer no serious damage. A present-day consultant psychiatrist running a British drug-dependency unit has stated he knows of an 85-year-old woman from the Scottish Hebrides who has been injecting heroin for sixty years.

For those who do not control their addiction, physical deterioration is inevitable. The first symptoms of physical decline are inflammation of the mouth and throat, gastric illnesses and circulatory disorders which can weaken limbs so far as to paralyse them. At the same time, addicts become demoralised, insensitive to their surroundings and self-centred. They feel, often with justification, outcast and yet value their drug-imposed insularity. Quite often, because of their constant physical lassitude and moral turpitude, they do not bother to take any interest in personal hygiene: against such a condition, it is no wonder it is so difficult to press home the need not to share needles which leads to the transmission of the AIDS virus.

As addiction deepens, the addict grows even more mentally and physically lethargic, lacking concentration and becoming forgetful. The body debilitates and becomes emaciated as appetite for food is lost: the voice grows hoarse, constipation develops with amenorrhoea and sterility in women or impotence in men. Medical complications include hepatitis and liver damage, blood poisoning, venereal diseases, skin infections and fungal diseases, swelling and collapsing of veins too frequently used for injections, respiratory diseases, tuberculosis, psychosomatic disorders, advanced tooth decay and nervous tremors. The memory is impaired to such an extent even everyday practicalities are overlooked and the addict withdraws into an inner world. Hearing and sight, however, become acute: tiny noises are amplified and bright lights are painful. Waking hours may be filled with hallucinations with sleep bedevilled by nightmares.

This developing pattern of addiction, essentially the same for opium as for morphine or heroin, has long been known. The April 1837 edition of the quarterly journal The Chinese Repository, published in Canton and Macau, contained an article on a series of paintings by a Chinese artist called Sun Qua which illustrated the downfall of an opium smoker from health and wealth to pain and poverty. The subject was the son of a wealthy businessman who inherited his father’s business, the pictures described as follows:

1. This picture represents the young man at home, richly attired, in perfect health and vigour of youth. An elegant foreign clock stands on a marble table behind. On his right is a chest of treasure, gold and silver; and on the left, close by his side, is his personal servant, and, at a little distance, a man whom he keeps constantly in his employ, preparing the drug for use from the crude article, purchased and brought to the house.

2. In this he is reclining on a superb sofa with a pipe in his mouth, surrounded by courtesans, two of whom are young in the character of musicians. His money now goes without any regard to its amount.

3. After no very long period of indulgence, his appetite for the drug is insatiable, and his countenance sallow and haggard. Emaciated, shoulders high, teeth naked, face black, dozing from morning to night, he becomes utterly inactive. In this state he sits moping, on a very ordinary couch, with his pipe and other apparatus for smoking lying by his side. At this moment, his wives – or a wife and a concubine – come in; the first finding the chest emptied of its treasures, stands frowning with astonishment, while the second gazes with wonder at what she sees spread upon the couch.

4. His lands and his houses are now all gone; his couch exchanged for some rough boards and a ragged mattress; his shoes are off his feet, and his face half awry, as he sits bending forwards, breathing with great difficulty. His wife and child stand before him, poverty stricken, suffering with hunger, the one in anger, having dashed on the floor all his apparatus for smoking, while the little son, unconscious of any harm, is clapping his hands and laughing at their sport! But he heeds not either the one or the other.

5. His poverty and distress are now extreme, though his appetite grows stronger than ever; he is as a dead man. In this plight, he scrapes together a few coppers cash, and hurries away to one of the smoking-houses, to buy a little of the scrapings from the pipe of another smoker, to allay his insatiable cravings.

6. Here his character is fixed; a sot. Seated on a bamboo chair, he is continually swallowing the fæces of the drug, so foul, that tea is required to wash them down his throat. His wife and child are seated near him, with skeins of silk stretched on bamboo reels, from which they are winding it off into balls; thus earning a mere pittance for his and their own support, and dragging out from day to day a miserable existence.

Just as the way drugs are taken affects the speed and intensity with which they have an effect, the means of taking them also affects the rate with which addiction develops and may affect the ease of withdrawal. Addiction from opium smoking takes the longest, followed by opium-eating. Orally administered morphine or heroin results in quicker addiction but the greatest impact comes by intradermal, intramuscular or intravenous injection. Organic factors, such as an individual’s metabolism, also play an important role in the addiction syndrome.

Morphine and heroin addiction develop much more quickly than that of opium because they are far more concentrated. It therefore follows that police narcotics officers do not – as they frequently seem to do in films such as Lethal Weapon and Beverly Hills Cop – stick their finger into a suspected drugs haul and lick it to see what they have: such behaviour is a sure-fire way to attain an addiction.

A morphine addict is not usually hooked by the first injection. It may take several weeks of daily doses, or it may take months, before signs of chronic morphine habituation occur: but with continued use addiction is a certainty. Chronic addicts rarely survive to old age and may succumb to a relatively mild disease, or they become so weak as to die from simple infirmity. Death may come within weeks or they may linger on for years: there is no set pattern.

Of all the opium-based drugs, heroin is the most addictive and addiction can start with the very first dose. Curiously, heroin itself appears to have little adverse physical effect upon the body, much of the addict’s considerable health problems deriving from his or her life-style and the fact that today many simultaneously use cocaine to counteract heroin’s numbing effect.

Opium and its derivatives have posed problems for decades. Even now, although doctors and scientists understand the chemical make-up of opiates, they still have little idea how the various parts operate and there is still no guaranteed antidote.

Without an assured remedy, doctors have over the years devised scores of ways to try to fight addiction. Addicts were purged to eradicate toxins, given other opiates or opiate-like drugs as a substitute or an antagonist for certain withdrawal symptoms, and all methods tried to reduce the pain of withdrawal. Some doctors believed withdrawal was psychological or psychosomatic. Others believed it was life-threatening, yet others did not. Until well into the twentieth century, most doctors regarded addiction as they did disease: treating the symptoms but not the cause. The only common denominator was that no addiction could be reversed without the dedicated co-operation of the addicts themselves, but few fought their habit by themselves.

Thomas De Quincey was one who did. His addiction was abhorrent and he tackled it himself, yet never managed a complete cure. Of his attempt, he wrote: ‘I triumphed. But infer not, reader, from this word … triumphed, a condition of joy and exultation. Think of me as one, even after four months had passed, still agitated, writhing, throbbing, palpitation, shattered…’

When morphine was discovered it was promoted as a cure for opium addiction: then, when heroin arrived it was claimed to cure morphinism. Professor Louis Lewin, in his book Phantastica, tells of a Chinese opium smoker who offered a reward to anyone who could rid him of his craving. One man succeeded who, with his success behind him, promptly went to Hong Kong and set up a thriving clinical business: his ‘cure’ was morphine injections.

Such quackery was noted by Dr D.W. Osgood of the Foochow (now Fuzhou) Medical Missionary Hospital in 1878, who observed:

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 prepared 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 the 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.

After fifteen minutes or so, the tension relaxed and the addicts were helped to seats. They appeared completely exhausted, some exhibiting early withdrawal symptoms. No criticism was made of the addicts’ problem. It was put in the context of being an evil which only goodness might overcome.

Having undergone a number of prayer meetings, addicts were then taken to a rest centre where they were put to bed and continually attended by someone who prayed for or with them. In this respect, the process was similar to that of the Malaysian bomoh and the Buddhist regimes in the Thai wats: psychological support was vital. What was missing were the bowls of noxious teas.

In a relatively short space of time, the addiction was eradicated without pain. Furthermore, comparatively few addicts re-addicted: prayer gave them the psychological strength to maintain their liberty.

Jackie Pullinger has run her mission for thirty years, although latterly not in Kowloon Walled City which has been demolished in collaboration with the Chinese government: in that time, she has saved well over 500 addicts and has extended her mission to Macau and the Philippines.

In the face of such success even the most dedicated atheist has to admit to the possibility of there being a god for, if miracles do exist, then Jackie Pullinger is surely a conduit for them: to use the addict’s parlance, she scores where the marvels of medicine have not. It is almost as if God, feeling guilty at having made his own medicine, is offering his own relief from it and it is perhaps not just divine inspiration but also divine irony he should exercise his love in China, for China has been at the core of the opium story for centuries.