by Martin Booth
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 thi
s 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: