in American Society, 5th, 6th, 7th, and 8th editions, Erich Goode, McGraw-Hill,
1999/2005/2008/2012. Chapter 11 and 10
and Drugs, Society, and Human Behavior, Ray and Ksir, Mosby,
1993 (and 2004). Chapter 14; statistics gathered from sources indicated, especially: especially: Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.)
anybody lend me a dime?"
The HARD Drugs!
From the Indiana University
- Street level competition:
- The "stuff"
of social images about drugs and drug users
on the streets
are considered to be some of the most important pharmaceuticals worldwide,
and their use is considered to constitute the most serious problem, too.
- Origin: Several millennia
ago- Middle East
plant, after petals drop off- 7-10 day period prior to seed pod maturing-
pod is sliced vertically. Overnight a white substance oozes out, oxidizes
and turns reddish-brown and gummy. This gum is scraped off with a special
curved blade==> Raw opium. (See: Opium Growing in India) (Opium
- Early Egyptians (1500
B.C.): used for pain relief and to soothe the crying of babies.
- Greece (100 B.C.): Homer's
Odyssey: Despair over Ulysses' loss and death of friends alleviated
by the daughter of Zeus serving a drink containing opium.
- Galen, last of the great
Greek physicians: "Cure-all"
- Also sold in cakes and
candies throughout Greece: Recreational use.
- Knowledge of the uses
of opium lost throughout the "Dark Ages"
- Arabic world: Koran forbade
alcohol=> Opium and Hashish became the primary social drugs
- Traders, Fighters,
and Explorers: spread use of opium.
- Used opium as a
trade product- sold seeds to Chinese (by 900 A.D. mentioned in Chinese Medical
- Arabic physicians
make substantial contributions to medicine and develop insights about opium:
first description of addiction circa 1000 A.D.
- Early 1500, European
medicine- Paracelsus: Laudanum; called opium the "stone of immortality"
- Dr. Thomas Sydenham (English
"Hippocrates", circa 1700's): reinvented laudanum: 2 oz. Opium,
1 oz. saffron, a dram of cinnamon and cloves- all dissolved in 1 pint of Canary
- 1644 Chinese Emperor
outlawed tobacco use: partly responsible for spread of opium use. Prior use
of tobacco with opium led to development of opium smoking- this spread rapidly
- 1729: non-medicinal use
of opium outlawed: Smuggled in from India. Highly profitable enterprise (especially
for the British)
- Britain and the Dutch
had been attempting to get trade set up with China since before 1500. (Opium
- By 1700: limited trade
began through the port of Canton: English took tea, and began smuggling in
opium (Chinese apparently weren't interested in any of the legitimate goods
the English had.
- In India, opium was legal-
the government was the British East India Company- held monopoly on opium.
Auctioned chests of opium to private merchants, given to selected British
firms, who sold to Chinese merchants in Canton.
- Each chest=> 120 pounds
of opium. 1729- 200 smuggled in, 1838- 25,000
- 1839: Emperor sent honest
man to end the practice. He was successful, and destroyed 20,000 chests ($6
- After incident involving
alcohol and the death of a Chinese civilian, war was declared
- 2 years of fighting-
Britain won. Got Hong Kong and $6 million. "Trade" in opium continued,
but declined. 1893: moral protest and by 1906 bill passed- ending the process
19th Century Use and Patterns
- 1803: Frederick Sertürner
(Hannover, Germany) conducts experiments and isolates the primary active ingredient
in opium, names it- Morphium after Morpheus, the god of dreams.
- Use grows slowly, but
by 1831, Sertuener is given the French version of the Nobel Prize.
- Further work reveals
over 30 alkaloids, with codeine isolated in 1832 (Greek word for poppy head
- These drugs were viewed
as major medical breakthroughs, effective in treating a variety of human ailments.
- 1853 marks another breakthrough,
in technology- the perfection of the hypodermic syringe, making the administration
of morphine more efficient and effective. It was thought that IV injection
would not be as addicting as oral use!!
- Wars: Civil War (1861-1865),
Prussian-Austrian (1866), and Franco-Prussian (1870) led to the widespread
use of morphine in injectable form- "Soldier's Disease" (this terminology
is suspect. Although still cited in Ray and Ksir, 2004, and repeated in Mosher
and Akins, Drugs and Drug Policy, Sage, 2007, page 95, it appears that
the reference to "soldier's disease" or "army disease"
may have originated in the 20th century as part of campaign to prohibit narcotics.
Mythical Roots of US Drug Policy: Soldier's Disease and Addiction in the Civil
War," by Jerry Mandel (local
copy). Mandel's argument makes sense since the idea of addiction, especially
as a "disease," did not become commonly accepted until the 20th
- Throughout the 19th Century
the use of opiates spread quite rapidly. Most use was instrumental. The drugs
could be bought openly, Sears
carried syringe kits in their catalogs, by the end of the century the number
of addicts is estimated at being well over 100,000-- some suggest, millions
(probably an overestimate).
- The typical addict was
characterized as being: respectable, older (middle-aged), female, middle class,
rural/suburban and white.
- Opium and its various
extracts and preparations were widely used by creative individuals: writers,
artists, etc. Thomas De Quincy, perhaps most importantly known for his attempts
to explore the effects of the drug laudanum on consciousness: "The
confessions of an Opium Eater."
in San Francisco
- Samuel Taylor Coleridge:
"Kubla Khan" and Elizabeth Barrett Browning were also well known
- Heroin was synthesized
in 1874 (2 acetyl groups were added to the morphine molecule- increasing the
lipid solubility- leading to more rapid transferal to the brain. Heroin is
3-6x as potent as morphine, although the pharmacology of the drugs is identical.
- Heroin was originally
marketed in 1898 as a Non-addicting substitute for codeine- a cough suppressant.
It was viewed as a "perfect" drug, and was thought to hold potential
as a cure for "Morphinism" It's addictive potential did not become
understood until well into the 20th Century.
Opioids, and Narcotics
Library on Opiates (see especially the online chapters from "licit
and Illicit Drugs)
by weight of opium)
Laudanum (10% opium and alcohol) (erowid image)
Paregoric (4% opium and alcohol) (wikipedia)
(Hydromophone) (semi-synthetic) (erowid)
(Percodan) (semi-synthetic, from Thebaine) (wikipedia) (erowid)
Hydrocodone (Vicodin) (erowid)
Fentanyl (Sublimaze) (80x
as potent as morphine) (wikipedia)
LD50-- 10-15x ED50
- Outlaws sale and distribution:
Heavy tax penalty.
- Leads to creation of
the Bureau of Narcotics (tax collection agency) and a variety of federally
run heroin clinics (all closed during the 1920 due to negative publicity and
shifting attitudes concerning heroin and medicine.
- Other rulings effectively
eliminate the medical use and prescription of heroin.
provision protecting physicians, however, contained a joker hidden in the
phrase, "in the course of his professional practice only. "After
passage of the law, this clause was interpreted by law-enforcement officers
to mean that a doctor could not prescribe opiates to an addict to maintain
his addiction. Since addiction was not a disease, the argument went, an
addict was not a patient, and opiates dispensed to or prescribed for him
by a physician were therefore not being supplied "in the course of
his professional practice." Thus a law apparently intended to ensure
the orderly marketing of narcotics was converted into a law prohibiting
the supplying of narcotics to addicts, even on a physician's prescription."
(The Consumers Union Report on Licit and
Illicit Drugs by Edward M. Brecher and the Editors of Consumer Reports Magazine,
1972. Chapter 8. The Harrison Narcotic Act (1914))
- By 1920, distinctive
shift in the addict population, the image of the drug, and use patterns.
The creation of the "addict sub-culture."
- 1925: Linder Case successfully
challenges the regulations prohibiting doctors from "maintaining"
an addict. Due to the recent history of harassment (as many as 25,000 physicians
were arrested over a total of 25 years, 3,000 served prison sentences and
thousands had their licenses suspended), few doctors would.
- 1962 ruling: Robinson
v. California, reaffirms ruling in "Linder" and suggests present
legal policies concerning the use of opiates in medical settings is unconstitutional
- Even during the 1920's
a number of publicly funded "heroin clinics" were opened, but administrative
problems and public stereotypes led to their closing.
- The Harrison Act of 1914
is seen by many (Alfred Lindesmith) as being the source of our modern problems,
- Created a criminal
class that had not existed previously (being an addict was criminal, by
definition by 1920; and their involvement led to a variety of criminal
behaviors- Economic/Compulsive, increasing price of heroin.
- Was essential in
the development of the "addict subculture" (Lindesmith, one
of the first to study its formation and suggest the link to our social
and legal policies, was attacked by Anslinger who attempted to have Lindesmith
fired from his university position)
- The number of addicts
remained rather small and non-problematic through the 1940's (approximately
- Throughout the 1950's
and 1960's there was dramatic growth;
- Preble and Casey: The
recruitment power of the Subculture of Addicts
- The significance of
the "career" and the group interaction.
- Addiction as
a socio-cultural rather than a pharmacological reality
for remaining in the subculture: It's a Meaningful life!
and satisfaction of accomplishment: Meeting the challenge- survival and
Norman Zinberg: Euphoria
seekers (compulsive) and Maintainers
Goal is not getting
a fix so much as it is succeeding in getting the money, and maintaining the
"structure of the group."
or the "chipper"-- Controlled use patterns
All in study used
heroin, IV, used for extended period of time, some with periods of compulsive
different in that:
- Rarely used more than
once a day
- Were able to keep a "stash"
- Avoided associating with
- Used the drug recreationally
rather than to treat depression
- Knew their dealer
- Did not use to "escape"
- Rituals and sanctions
control use patterns.
- Compare to Alcohol use:
Most who use alcohol are not compulsive or addicted
- Group Norms and Values:
- Define moderate
use, condemn compulsive
- Limit use
to physical, psychological, and social settings conducive to positive or
- Develop means
of identifying untoward drug effects: test drugs to avoid OD
drug use and support non-drug related obligations and relationships.
as I contend, the use of opiates and other illicit drugs is indeed an evolving
social process, the recognition that the social setting strongly influences
the capacity for control offers an alternative to prohibition. Elements of
potential control are active in all groups of opiate users, even among addicts.
Many opiate users representing many different styles of use have precepts,
however punitive, that dictate how they can use their drug without becoming
addicted or suffering physical and psychological damage, or, at least, how
they can use the drug in order to get what they desire from it. Is it not
possible that using groups will gradually develop these ideas into social
sanctions and rituals similar to those that govern acceptable alcohol use
(Zinberg et al. 1975)? Although the sample studied in my NIDA project is small,
the fact that many of those who fulfilled the project's stringent criteria
for controlled use had formerly been addicted suggests the need to consider
approaches other than abstinence. For example, assisting the maintenance of
controlled use could be a practical means of preventing drug abuse with the
least social cost; and experimenting with this alternative in a careful and
gradual way would not obstruct the effort to discourage the use of the opiates
generally." (Norman E. Zinberg, "Nonaddictive Opiate Use
in Robert 1. DuPont, Avram Goldstein, and John O'Donnel (eds.), Handbook on
Drug Abuse (Rockville, MD: National Institute on Drug Abuse, 1979), pp. 303-313.)
Drug Effects and the Heroin
- The dangers of heroin
use are most intimately related to the social context of use, and especially
the illegal status of the drug
- 1% of all heroin addicts
die each year: very high rate for their age group. Overdose
- Subcultural norms- especially
route of administration and needle sharing: quite problematic. AIDS, the "taste
face," etc. A structure for developing a sense of self.
- Quality control: potency,
market competition, adulterants. Yet the daily pursuit is for the highest
potency: If one OD's it's "Righteous Dope" and the rush is on to
- Rosenbaum: Difficulties
in Taking Care of Business
Yet, in other contexts:
not so problematic
- Use by "respectable"
people-- especially doctors and other medical professionals
- 3-4,000 heavy
users (usually narcotics)
- Pure and standardized
- Good, clean needles
- Awareness of nutritional
- Not a money problem
- Recorded instance
of individuals in this type of setting using morphine for 30-40 years
with no debilitating effects
- Other Effects:
Alcohol worse than
heroin and cocaine?
Why Use Heroin?
- Waldorf: Immersion
in a social world. Many background factors, but the subculture, its networks,
friends and peers: group behavior and acceptance are important elements in
understanding the process.
- The individual's identity
becomes determined by these association, prestige, respect and excitement.
- Preble and Casey: "The
career of the heroin users serves a dual purpose for the slum inhabitant;
it enables him to escape, not from purposeful activity, but from the monotony
of an existence severely limited by social constraints, and, at the same time,
it provides a way for him to gain revenge on society for the injustices and
deprivation he has experienced."
- The subculture of the
addict is a distorted mirror of dominant values: Success, Competition, Personal
Ambition and Initiative
- Creates a world far removed
from the banality of the straight world: here is something different, exciting.
- Significant element of
learning, coming to appreciate the drug's effect: Pleasure and Pain as the
most intense life has to offer. Sexual overtones, as well.
Kicking the Habit
- The world of heroin use
is different from that of other drugs: Pot smoker- "straight" means
no drug effect. Heroin: "getting straight"-- injected and back to
- The drug is viewed with
magical powers, a certain religious quality to the behavior pattern
- Abstention==> Stupid.
The world is filled with pain and misery. Why face that?
- Relevance of other things
and people: Insofar as they relate to getting and using dope.
- Heroin valued more than
money, better than money: "It's a commodity"
- Love/hate relationship
with the dealer (vs. Pusher)
- Quitting=> giving
up far more than the drug. Lifestyle and networks. Turning on and kicking
are both group phenomenon
- Being addicted is perhaps
of little consequence: Viet Nam veterans, most had signs of physical dependence.
50% just stopped. 14% maintained. Rest: used sporadically.
- Treatment: Variety. Multiple
and the Future
- Psychiatric Image: Weak,
- Sociologists: Retreatist/
- Addict: Reject societal
definition of responsibility
- Prestige, Status,
and Responsibility: Habit
- Preble and Casey:
"Their behavior is anything but an escape from life. They are actively
engaged in meaningful activities and relationships seven days a week.
The brief moments of euphoria....a small fraction of their daily lives....They
are always on the move and must be alert, flexible, and resourceful. The
surest way to identify heroin users in a slum neighborhood is to observe
the way people walk. The heroin user walks with a fast purposeful stride,
as if he is late for an important appointment--indeed, he is....He is,
in short, taking care of business."
- AIDS: For white males--homosexual
behavior. For the rest of our society: AIDS is a disease of addicts, their
sex partners and their children.
- Quantity and quality
increasing: 14-80% pure depending on type (Columbian/Mexican) and location
(DEA Pluse Check: Mid Year 2000)
- Current NSDUH Data
- Due to social image:
unlikely to become as popular as cocaine.
- But, new forms of
use: "Chasing the
Dragon" and a new smokable "speedball"--heroin and crack.
- Alternating between
heroin and crack or cocaine, some areas: MDMA and Ketamine are popular.
(DEA Pluse Check: Mid Year 2000)
- Combination with
- Alcohol use remains
Owner: Robert O. Keel firstname.lastname@example.org
Credits for this Page of Notes
Tuesday, November 5, 2013 11:52 AM