by Lucy Inglis
Cocteau, an extraordinary Parisian socialite, quickly fell into ‘the abyss of divine enjoyment’.2 He maintained his habit for twenty-five years, after which he decided to become sober, and in 1929, during his most wretched hours, his most remembered works were written. Louche, attractive and absurdly charismatic, Cocteau was a poster boy for addiction, and recovery. His experiences encompassed a new understanding of what it meant to be an addict, and the accompanying sense of isolation, and salvation: ‘Everything one does in life, even love, occurs in an express train racing toward death. To smoke opium is to get out of the train while it is still moving. It is to concern oneself with something other than life or death.’3
Jean Cocteau’s experience of opium, which he ate, smoked and drank, as laudanum, encapsulates the upper-middle-class European model of addiction. He remained in control of his life and faculties, yet he yearned to be free.
During the time Cocteau was writing, the world was undergoing a shift in how opium, principally heroin, was marketed. The period between the wars was a particularly difficult time in drug legislature, and also in terms of illicit global supply routes, which had been significantly disrupted by the First World War. Still painfully aware of their commitment to the Hague Convention, European countries were realizing not only the extent of their legitimate medicinal opiate needs, both in wartime and peace, but also the scale of their internal narcotics problems. Whiffens, one of the major British opiate exporters, had its licence revoked in 1923 after a smuggling scandal. La Société Roessler et Compagnie in Mulhouse, France took over as chief producer in western Europe, and in 1928 produced 4.35 tons of heroin, enough to satisfy the medical needs of the world population more than three times over.4 French pharmaceutical companies completed meticulous export papers for 346 kilos of morphine to the United States, 440 kilos to Germany and sixty-two kilos to Jakarta, all of which were countries where morphine was now illegal. Yet those countries showed no evidence of morphine’s arrival, and the French firms refused to supply the names and details of the importers to the governments of the countries receiving the drugs.5 At the same time, Switzerland showed exports to France, which went unrecorded on import papers, and Germany and Finland supplied Estonia.
British and Dutch pharmaceutical companies in particular were finding ways to subvert their Hague Convention agreements to supply drug racketeers by importing poppy straw as raw material and processing it through an ever-widening net of company names. Also, in 1928, Estonia made a desperate plea to the League of Nations, asking that governments take over the factories producing heroin and cocaine ‘on an enormous scale’.6 Finland, outside of the League and where tuberculosis was rife, refused to give up heroin-based cough medications throughout the 1930s, such as the charmingly named Pulmo, and they continued to import vast quantities of morphine and heroin to be made into pills for a small army facing up to Stalin, which hit a peak in the Winter War of 1939–40.
Yet even as the modern commercialization of heroin spread, Cocteau’s eloquent writing on opium influenced another generation of users, where all drugs, including heroin, were part of the creative, fashionable experience. Cocteau was writing in a new era of psychoactive drugs, but as an established member of the Parisian bourgeoisie, he favoured the old methods of smoking, eating or drinking opiates. He abhorred morphinists, and routinely took his opium in the morning, afternoon and evening. Yet, in the end, he knew he needed to stop, and recorded his experience as Opium: Diary of a Cure. Cocteau, writing in the late 1920s, along with the works of De Quincey, established drug addiction as a noble artistic undertaking for two generations of the twentieth century.
Like De Quincey, Cocteau marks the divide between addiction as a noble, mind-altering pursuit and the realities of the street trade. Coupled with the continuing American clampdown on delivery of pharmaceutical diamorphine, the Second World War disrupted the supply of heroin to the US, and official addiction figures fell to the lowest levels on record. A heroin epidemic in the young poor black community of Chicago in the late 1940s indicated that international suppliers were finding a new route into the USA, selling daily hits for pocket money in order to secure a fresh market. The problems amongst the ‘Chicago Negro youth’ between 1949 and 1953 were closely recorded, and demonstrated the failure of the police and judiciary to get to grips with the epidemic as it happened, with a lag of up to two years in terms of investigations and arrests, leading analysts to conclude that ‘failure to respond effectively during the early stages of disease spread may be a characteristic feature of heroin epidemics, and should be considered in the design of addiction control programs’.7
In western Europe, the children born at the end of the Second World War were exposed to a host of new intoxicants in the form of psychoactives such as LSD. In the United States, marijuana had become a staple recreational narcotic in the 1950s and 60s, rapidly overtaken by barbiturates such as Quaaludes, benzodiazepines, and heroin smoking in the 1960s and 70s.
Jean Cocteau’s articulate experience of addiction was co-opted by the American beat poets, who used all of the drugs available to expand their minds and empty their pockets. They were preoccupied by notions of personal and sexual freedom, and the ills of what they saw as a repressive, capitalist society. The ancient story of the poor writer assumed a new nobility when coupled to an existential hunger that ate up any experience narcotics had to offer.
William Burroughs, along with Jack Kerouac and Allen Ginsberg, was one of the defining figures of the Beat Generation. Burroughs was born in 1914 and was a committed drug user. He became a heroin addict in his late twenties after he was turned down for the navy during the Second World War, and he became a dealer in 1950s New York, writing later that ‘Junk is not, like alcohol or weed, a means to increased enjoyment of life. Junk is not a kick. It is a way of life.’8 His novels Junkie (1953) and Naked Lunch (1959) are testament to the debasement heroin addiction can bring, and were banned in the United States not for their narcotic-related content but for violations of sodomy laws, namely paedophilia. Widely lauded as an artistic genius, Burroughs also shot his common-law wife, Joan Vollmer, in the head during a delirious game of William Tell. They had one son, William Jr., who died aged thirty-three, soon after he was found in a ditch, suffering acute symptoms of liver failure owing to chronic drug and alcohol abuse.
Burroughs’ depiction of his experiences of opiate addiction is particularly powerful, and his account of using morphine will be familiar to any user. He writes that it ‘hits the backs of the legs first, then the back of the neck, a spreading wave of relaxation slackening the muscles away from the bones so that you seem to float without outlines, like lying in warm salt water.’9 Burroughs, despite his gentlemanly exterior, had, like Kerouac and Ginsberg, spent time in a mental institution by the time he was thirty, although Kerouac’s drug of choice was alcohol, while Ginsberg opted for LSD and cannabis. But like Cocteau and Thomas De Quincey, Burroughs was committed to opiates.
And like De Quincey, Burroughs, unlike those around him, lived a long life and died aged eighty-three. His legacy to a new creative generation was coupled with his staunchly traditional American upbringing and Harvard education, things that many of those who so slavishly read his works could not hope to experience.
In later editions of Naked Lunch, Burroughs wrote that the only successful cure for heroin addiction that he had come across was apomorphine, stating that it ‘is qualitatively different from other methods of cure. I have tried them all. Short reduction, slow reduction, cortisone, antihistamines, tranquilizers, sleeping cures, Tolserol, reserpine. None of these cures lasted beyond the first opportunity to relapse.’10
Apomorphine occurs naturally in blue lotus flowers and white water lilies of the species Nymphaea. The Mayans of Central America used Nymphaea in rituals, as a hallucinogenic and aphrodisiac, as also indicated in ancient Egyptian tomb artwork. Apomorphine can also be synthesized from morphine and sulphuric acid, and was produced as early as 1845 by the German chemist A. E
. Arppe. It was used originally to treat aggressive behaviour in farmyard animals and by 1884 it had been used in trials for the treatment of Parkinson’s disease, trials that recommenced only as late as 1951, with considerable success.11 It became part of the treatment programmes for alcohol in London in 1931 under radical addiction doctor John Yerbury Dent, who also used it to treat drug addiction. It was later restricted as a dangerous drug in its own right, with actions too similar to morphine to be of significant use when weighed against the side effects, which can include convulsions, but are mainly associated with violent vomiting. Owing to the vomiting, many medical professionals have labelled apomorphine a form of aversion therapy, in which the patient comes to connect the vomiting with the heroin or morphine habit. However, the average heroin addict is accustomed to vomiting and purging to the point where this is unlikely. Apomorphine is used now for veterinary purposes when dogs swallow poisons. Professor Andrew Lees of London’s National Hospital for Neurology and Neurosurgery, and the world’s leading Parkinson’s specialist, remains convinced of apomorphine as an effective treatment for Parkinson’s, and says that it should also be trialled again for heroin addiction, ‘but we are up against punitive and draconian legislation. The heroic era of neuropharmacological research has now vanished.’12
Lees points to Burroughs as one of the successful examples of the apomorphine cure, and Burroughs himself remained convinced of its efficacy, writing that before he took apomorphine at the hands of Dr John Dent, ‘I had no claims to call myself a writer and my creativity was limited to filling a hypodermic. The entire body of work on which my present reputation is based was produced after the apomorphine treatment, and would never have been produced if I had not taken the cure and stayed off junk.’13 Apomorphine kept Burroughs clean for two creatively productive years before subsequent relapse, but his belief in apomorphine for breaking down the metabolic actions of addiction didn’t waver, and he became a sage to other artists struggling under the burden of their own habits.
In 1974, Rolling Stone magazine recorded a conversation between the British musician David Bowie and William Burroughs. Whilst it is hard to have much sympathy for Burroughs, one can only feel for him agreeing to a grim simulation of a Jamaican meal ‘prepared by a Jamaican in the Bowie entourage’, with Bowie dressed in ‘a three tone NASA jumpsuit’ and whose most memorable contribution to the exchange was ‘I change my mind a lot. I usually don’t agree with what I say very much. I’m an awful liar’. Bowie was then in the grip of an overwhelming cocaine addiction, and eighteen months later had to change his life entirely in order to recover, moving to Berlin and living in a cheap apartment above a Turkish cafe where he ate all his meals: ‘I had approached the brink of drug-induced calamity one too many times, and it was essential to take some kind of positive action.’14
Their interview, however, highlights the divides in popular culture, something of which the sixty-year-old Burroughs had only scant knowledge and from which the twenty-seven-year-old Bowie had fashioned an existence. As Burroughs remarked, wonderingly, ‘The escalating rate of change. The media are really responsible for most of this. Which produces an incalculable effect.’15
For many, management of their habit had become the new reality. Bowie, like Burroughs, would not be clean for decades, but they both went on to enjoy long and productive lives. For others, it was not so easy, and in 1964, despite the United States having allegedly reduced its legal morphine consumption to negligible levels, the market for heroin on both coasts was booming, particularly in New York City. Intravenous heroin use was becoming the norm amongst users, but the series of wars and particularly Korea, with its advanced blood-banking facilities in the MASH tents, had revealed that transfusions weren’t simply a matter of giving the blood from one to another. Hepatitis was rife in the donations.
Intravenous heroin use emerged simultaneously in Alexandria, Egypt and Indiana, USA, as a widespread problem in 1925. There is still no evidence why this happened in both places at the same time, although Indiana has acted historically as a conduit to the south for contraband coming into Chicago. Egypt went from negligible heroin use in the First World War to a full-blown intravenous heroin epidemic by 1925. In 1926 one Armenian chemist sold 600 kg of heroin, quite legally as there were still no restrictions. By 1929, almost one in four Egyptian males aged between twenty and forty were addicted to heroin, and only an outbreak of subtertian malaria, from needle-sharing, seemed to slow it down.16 From Indiana intravenous heroin use spread across the United States as the quickest mode of consumption. By the 1960s, to be ‘on the spike’ was nothing remarkable.
In 1964, America announced that it had a medical solution to the problem of heroin addiction: methadone, a treatment pioneered by doctors Vincent Dole, Mary Jeanne Kreek and Marie Nyswander at the Rockefeller University in New York. Although it had been synthesized in the winter of 1937–8 by Gustav Ehrhart and Max Bockmuhl for Hoechst AG near Frankfurt, the Second World War had put development on hold and it only went into experimental use in the late 1940s, when methadone required the backing of private funding to achieve mainstream recognition. Administered in a controlled environment, methadone maintenance treatment (MMT) ‘eliminates the drug craving which drives many detoxified addicts to resume heroin addiction’.17 Methadone produced neither ‘euphoria nor other distortion of behaviour’, and ‘frees the heroin addict from the exigencies of the street life’, but it also robbed them of the will to get out of bed and take a shower.18 Addiction doctors treating inpatients in rehabilitation units knew that they were battling a gargantuan problem, and that management might be the best they could hope for, because ‘Almost without exception, these units merely separate the addict from heroin for a brief period.’19
For many, MMT was ‘a system of chemical parole’, and there remains substantial evidence that treatment programmes do not dispense adequate doses to keep patients from the discomfort associated with heroin withdrawal.20 Hence, many in MMT continue to use street heroin or other drugs outside of their programme. MMT also robbed the user of the routine that surrounded their habit: a supervised dose administered by or in front of a physician in clinical surroundings bore little resemblance to the score many users were accustomed to. For Burroughs, methadone was ‘completely satisfying to the addict, an excellent painkiller, and at least as addicting as morphine’.21 Owing to the 1971 initiation of the War on Drugs, there was a disruption in the supply of street heroin to the East Coast of America at the same time as there was a surge in the number of methadone patient places, with New York City Council making 40,000 available by 1973, of which 34,000 were taken up.22 This is in contrast to Dole’s original 1969 clinic, which had places for only 1,000 carefully screened addicts. For health services, MMT had the distinct advantage over the early twentieth century Public Health Service clinic programmes because it was an outpatient service, making it significantly more cost-effective.
Outpatient care had the disadvantage of not removing the addict from their street surroundings, and in a changing market, where the quality of street heroin was dropping as it was cut further and further to make up for reduced supply, addicts began to turn to pharmaceutically produced methadone for a reliable high, and the market on the street for methadone began in earnest. To enrol in a treatment programme had significant advantages too, not least the 100-mg daily maintenance dose: those in a programme were issued with a methadone identity card, to be presented in clinic. However, these cards were extremely useful for those also scoring on the street, as they could be shown to any arresting officer as proof of the need to carry methadone. So within two years of the beginning of the War on Drugs, street demand in New York City had moved towards methadone liquid. MMT remained controversial, because, unlike in China, the USA had refused to maintain addicts when it passed the Harrison Act, and ‘According to the Bureau of Narcotics, any doctor who uses methadone maintenance as treatment for heroin addicts violates federal law’.23 Challenges to Harrison, demanding that addicts be ma
intained, had been rebuffed definitively by Webb v. United States in 1919. The cases of Linder (1925) and Boyd (1926), occurring less than seven years later – when doctors had been entrapped by federal agents for prescribing more than one morphine dose – allowed the Supreme Court to fudge the issue by declaring that if a doctor acted ‘for the purpose of curing disease or relieving suffering’, then an acquittal was in order.24
These fudges allowed MMT to become part of the official governmental rehabilitation of addicts in the early 1970s. Private clinics used other drugs, such as apomorphine, and also ibogaine, throughout the 1960s and 70s, when those who could afford it sought cures in comfortable surroundings. Ibogaine remains controversial. Derived from iboga root bark or the plant Tabernanthe iboga, ibogaine is a psychedelic that some claim breaks the metabolic chain of addiction in as little as forty-eight hours. The promotion of ibogaine as a cure for addiction was mainly the work of one man, Howard Lotsof, who as a nineteen-year-old heroin addict in 1962, took ibogaine and claimed to be cured instantly. His life’s work was to bring ibogaine to the attention of governments and major pharmaceutical companies, in which he had a measure of success. Various offshore ibogaine treatment centres still exist around the world, and in most Hague Convention nations, it is either unregulated or illegal. Lotsof died in 2010, still a committed proponent of both ibogaine and methadone, and ibogaine remains a persistent presence on the fringe of addiction treatment. Trials in the 1990s proved that it is effective in mitigating the early effects of withdrawal, but like most heroin cures, ibogaine’s success depends largely upon the commitment of the patient, as Keith Richards said of his attempt with apomorphine in 1971: ‘I once took that apomorphine cure that Burroughs swears by. Dr Dent was dead but his assistant whom he trained, this lovely old dear call Smitty, who’s like a mother hen, still runs the clinic . . . But it’s a pretty medieval cure. You just vomit all the time. In 72 hours, if you can get through it, you’re clean. But that’s never the problem. The problem is when you go back to your social circle – who are all drug pushers and junkies. In five minutes you can be on the stuff again.’25