Authors: Martin Booth
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 âhot 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 âcold 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, âkicking 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 âmodernised' 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.
7
The Fantasy Traders
Opium, which has been virtually synonymous with China for hundreds of years, is often thought to have been introduced by Arabs in the seventh century
AD
but this is debatable. There exist earlier references to opium in China so the Chinese were clearly acquainted with it before the Arabs arrived yet the fact remains the Arabs did bring it in substantial quantities, the Chinese adapting the Arabic name of
af-yum
to
a-fu-yong.
Arab dhows reached as far as Chinese waters in the sixth century and, by 900, there were substantial Arab communities in most Chinese ports. In later centuries, after Arab influence had faded in China, they took their cargoes to Malacca to trade with Chinese merchants there, bartering silks and silver in exchange for, as Duarte Barbosa recorded in 1516, âdrugs of cambray, afiam, which we call opium, wormwood and saffron'.
The likelihood is opium was either brought home by Chinese seafarers who were sailing as far as Africa in the first century
BC
, or introduced by Buddhist priests from Tibet around the first century
AD
who used it solely as an anodyne, the knowledge having reached Tibet with traders from Persia and India: or, just as likely, it arrived from India via Burma, where Chinese merchants were trading in jade and gemstones as early as the third century
BC
, or from Bactria (central Asia) whence the famous Chinese explorer, Chang Chien, travelled in 139
BC
, meeting the remnants of the Greek civilisation of Alexander the Great there.