A 50-year-old woman addicted to heroin: review of treatment of heroin addiction

Heroin addiction is a complicated medical and psychiatric issue, with well-established as well as newer modes of treatment. The case of Ms W, a 50-year-old woman with a long history of opiate addiction who has been treated successfully with methadone for 9 years and who now would like to consider newer alternatives, illustrates the complex issues of heroin addiction. The treatment of heroin addiction as a chronic disease is reviewed, including social, medical, and cultural issues and pharmacologic treatment with methadone and the more experimental medication options of buprenorphine and naltrexone.

[Eradication of opium smoking in Taiwan during the Japanese colonial period (1895-1945)]

Eradication of opium smoking during the Japanese colonial period is one of the most proud medical accomplishments in Taiwan. The mission was accomplished mainly due to a governmental policy of gradual prohibition in 1897 and the establishment of the Government Center Hospital for Opium Addicts in 1930. Professor Tsungming Tu, medical director of the Government Center Hospital, was responsible for the unique medical treatment of opium addiction there. The latter consisted of an immediate withdrawal of opium smoking which was partly substituted by small amounts of morphine in gradual reduction, and at the same time special pills were given to enhance the sympathetic activity also to lessen the withdrawal symptoms. By such treatment, the habit of opium smoking could often be eliminated in a few weeks. The success rate was 46%. Shortly after the World War II, the number of opium smokers in Taiwan became negligible. In early colonial period, however, there were grass roots movements as well as private efforts by physicians of Western medicine to treat opium addiction. In 1898, the Flying Phoenix Society which was a laymen organization worshipping deities began to use supernatural power to force the addicts to stop opium smoking. More than thirty thousand were enlisted and the success rate was 58%. In 1908, the enthabitual treatment in a private correction infirmary called 'Newmatou' consisted of a substitute treatment using morphine to replace opium and a gradual reduction in morphine dosage afterwards. All addicts were hospitalized until treatment goal was achieved. Among 55 addicts thus treated, 53 (96%) were ridded of opium smoking habit. The treatment method was almost identical to that employed by Professor Tu. Another physician, Dr. Ching-yue Lin, who worked at the Red Cross Hospital in Taipei, also used substitute treatment, replacing opium by heroine, and obtained a success rate of 80%. Dr. Lin published his comprehensive study on opium addiction and treatment in the Journal of the Formosan Medical Association in 1908. Therefore, Dr. Tu's enthabitual treatment seemed to be not so unique. Previous treatments employed by physicians at 'Newmatou' infirmary and by Dr. Lin at the Red Cross Hospital were strikingly similar or nearly the same. This review may help us reassess the prevailing opinion regarding the history of eliminating opium smoking in Taiwan.

Francis Thompson (1859-1907): a medical truant and his troubled heart

Francis Thompson was born in 1859 in Preston and grew to manhood in Ashton-under-Lyne in Lancashire. After six years registered as a medical student at Owens College, Manchester, he set off for London to retrace the footsteps of Thomas De Quincey (1785-1859). His early experience in London followed closely that of the earlier English Opium Eater until he was rescued by Wilfrid Meynell (1852-1948) who recognized his nascent literary flair. Thompson's poetry earned him respect and reputation and his prose brought him a reasonable income, but he never weaned himself from laudanum and he died of tuberculosis in 1907. Not every truant is honoured by a lapidary inscription in his alma mater, even though he may be overlooked in an arbitrary census.

Economic manifestations of opiate addiction: evidence from historical data from colonial Indonesia

The aim of this paper is to demonstrate, using an example, the utility of historical data to illuminate important questions in the field of drug dependence research. The literature on the consumption of addictive substances often characterizes users as being one of two types: "addicts" and "casual users." An econometric characterization of the responses of opium consumers in the late-colonial Netherlands Indies to changes in the price of opium and other important variables is provided, which explicitly acknowledges the existence of different types of opium smokers, as modeled in the underlying theory. The results reveal systematic differences between the behavior of groups of high-intensity consumers and groups of low-intensity consumers. While the findings show that both groups showed similar total price elasticities, the high-intensity consumers were affected predominantly via changes in the number of users rather than in per capita consumption. In the course of the analysis, various analytic methods that are new to the field of drug dependence research are introduced.

Milk of Paradise?

One cannot have an idea of this multifaceted theme without its medical and cultural-historical background. After a history of several thousand years as a remedy and consumer good, around 1800 this poppy drug was in the focus of public attention due to Brownianism, at first as an often self-prescribed unspecific remedy against physical and mental pain. Many representatives of the early Romanticism knew it from personal experience. However, it was the publication of Thomas de Quincey's Confessions of an English Opium-Eater (1821/1822) which made it a subject of international debate in accordance with the programmatic statements of writers of that epoque and corresponding to the antibourgeois attitude of these men. It became a motif of a counter-world experience and a subject and cause of lyric-subjective reflection as well as a possible premise of poetic creativity.

Heinrich Heine and syphilis

Though Heinrich Heine died 151 years ago, the underlying illness responsible for his suffering of many years has never been fully clarified. The diagnosis put forward most frequently in retrospect was that of a venereal disease. However, this diagnosis was the result of an interpretation in disregard of the historical context. Only by evaluating and interpreting the entire source material in its historical context (Heine's complete works, his correspondence, records of conversations kept by contemporaries and prescriptions) can this diagnosis be confirmed on a reliable basis. Above all, medical records dated 1848 and their interpretation in the context of contemporary syphilis nosology and therapy show that Heinrich Heine was treated for syphilis from 1848 onward. After 8 years confinement to the proverbial 'mattress grave', Heine's death can ultimately be explained by his long-standing and well-documented abuse of opium.

75 years of opioid research: the exciting but vain quest for the Holy Grail

Over the 75-year lifetime of the British Pharmacological Society there has been an enormous expansion in our understanding of how opioid drugs act on the nervous system, with much of this effort aimed at developing powerful analgesic drugs devoid of the side effects associated with morphine--the Holy Grail of opioid research. At the molecular and cellular level multiple opioid receptors have been cloned and characterised, their potential for oligomerisation determined, a large family of endogenous opioid agonists has been discovered, multiple second messengers identified and our understanding of the adaptive changes to prolonged exposure to opioid drugs (tolerance and physical dependence) enhanced. In addition, we now have greater understanding of the processes by which opioids produce the euphoria that gives rise to the intense craving for these drugs in opioid addicts. In this article, we review the historical pathway of opioid research that has led to our current state of knowledge.

Damaged goods: return to sender. A review of the historical medical records of repatriated Chinese miners

After the Anglo-Boer (South African) War (1899-1902), there was a shortage of unskilled labor on the South African gold mines. Chinese men were imported to make up for the deficit. This article reviews the records of indentured Chinese mine workers examined for repatriation in 1905. The records tell of high proportions of social disorders, respiratory diseases, musculoskeletal disorders, opium addiction, and injury. These reflect the social and physical conditions to which these men were exposed in the mines.

History of Addiction: A UK Perspective

The level of substance misuse in Britain has fluctuated over recent centuries, reaching its nadir in the early twentieth century. Since then, the trends for alcohol and drug abuse (though not for tobacco consumption) have risen steadily. British physicians have played a major role in the emergence of the addiction concept, from the initial challenge to Galen's theories to the now widely adopted Alcohol Dependence Syndrome. While treatment has been influenced by contemporary attitudes, it has been generally underpinned by pragmatism and has avoided the punitive responses seen in other parts of the world.

Opiate addiction and the entanglements of imperialism and patriarchy in Manchukuo, 1932-45

In the Japanese colonial state of Manchukuo, opiate addiction was condemned by officials and critics alike. But the state-sponsored creation of a monopoly, opium laws, and rehabilitation programs failed to reduce rates of addiction. Further, official media condemnation of opiate addiction melded with local Chinese-language literature to stigmatise addiction, casing a negative light over the state's failure to realise its own anti-opiate agenda. Chinese writers were thus transfixed in a complex colonial environment in which they applauded measures to reduce harm to the local population while levelling critiques of Japanese colonial rule. This paper demonstrates how the Chinese-language literature of Manchukuo did not simply parrot official politics. It also delegitimised Japanese rule through opiate narratives that are gendered, consistently negative, and more critical of the state than might be expected in a colonial literature.

Historical review: Molecular and cellular mechanisms of opiate and cocaine addiction

The National Institute on Drug Abuse was founded in 1974, and since that time there have been significant advances in understanding the processes by which drugs of abuse cause addiction. The initial protein targets for almost all drugs of abuse are now known. Animal models that replicate key features of addiction are available, and these models have made it possible to characterize the brain regions that are important for addiction and other drug effects, such as physical dependence. A large number of drug-induced changes at the molecular and cellular levels have been identified in these brain areas and rapid progress is being made in relating individual changes to specific behavioral abnormalities in animal models of addiction. The current challenges are to translate this increasingly impressive knowledge of the basic neurobiology of addiction to human addicts, and to identify the specific genes that make some individuals either particularly vulnerable or resistant to addiction. In this article, I present a historical review of basic research on opiate and cocaine addiction.

Coleridge's choleras: cholera morbus, Asiatic cholera, and dysentery in early nineteenth-century England

Samuel Taylor Coleridge suffered from a variety of bowel disorders throughout his life; though a large part of his ailment was caused by his famous opium habit, he continuously sought an organic origin, and on at least two separate occasions, in 1804 and 1831-32, he ascribed his disorders to attacks of "cholera." With Asiatic cholera apparently first reaching England in late 1831, there was considerable argument among both physicians and the general public as to whether it was a distinctly new disease, or merely a severer variation of traditional English cholera, known as "cholera morbus." Coleridge took a particular interest in these discussions. In this paper, we attempt to establish the exact nature of his attacks of illness, and point to the complexities of describing and framing new diseases and bowel disorders in the early nineteenth century.

A tale of two policies: the French connection, methadone, and heroin epidemics

The law enforcement and treatment policies of the Nixon administration are often credited with ending the epidemic of heroin addiction that rose in America's cities in the 1960s. In this article it is argued that although the interventions did in fact cause a major change in heroin distribution and use, the epidemic did not end in any simple way. The decline in heroin and increase in methadone that resulted from the Nixon policies lead to a shift for many addicts in both clinical and street settings from one narcotic to another. The temporary shortage of heroin that resulted from law enforcement was quickly compensated for with methadone, as well as with new distribution systems from Southeast Asia and Mexico. In the end, the interventions caused a change in an enduring "heroin system," a change that left that system in a stronger form in terms of supply and in a situation of continuing growth in terms of the number of addicts.

History and current status of opioid maintenance treatments: blending conference session

Opiate addiction is a chronic, relapsing disorder. Left untreated, high morbidity and mortality rates are seen. Pharmacotherapies for this disorder using mu opiate agonists (methadone and levomethadyl acetate) and partial agonists have been developed in the last 40 years. Agonist pharmacotherapy with oral methadone for the treatment of opiate dependence was developed in clinical pharmacology studies at Rockefeller University by Dole, Nyswander, and Kreek. Further studies by this laboratory and others established that moderate to high dose treatment with methadone (80-120 mg) reduced or eliminated opiate use in outpatient settings with consequent reductions in morbidity and up to 4-fold reductions in mortality. Levomethadyl acetate (LAAM), a congener of methadone, is biotransformed to active metabolites responsible for its longer duration of action. The Federal Regulations regarding the dispensation of methadone and LAAM have recently been revised to facilitate the treatment of patients under a "medical maintenance" model. Future regulatory reform will likely involve the establishment of rules for "office based opioid treatment."