Heroin Treatment
Supreme court interpretations of the 1914 Harrison Narcotics Tax Act had criminalized opioid dependency as well as the use of any opioid "for the sole purpose of maintenance." Thus began the saddest chapter of America's longest war: the stigmatizing and criminalizing of dependent individuals as well as the physician who prescribe them drugs. This directly led to the under utilization of opiates such as morphine in terminally ill patients out of a fear of becoming addicted - oftentimes expressed by the patients to the doctors. Medical schools provided almost no instruction on addiction; making Dr. Dole's research program a courageous act.
In 1964, at Rockefeller Institute (now known as Rockefeller University), Dole and Nyswander initially treated six addicts during the first year, but the results of this work "were sufficiently impressive to justify the trial of maintenance treatment of heroin addicts admitted to open medical wards of general hospitals in the city." By 1967 over 300 patients were receiving daily doses of methadone, a potent synthetic opioid with an especially long half-life. "After the patients had reached the stabilization level (80 to 120 mg/day methadone) it was possible to maintain them with a single, daily, oral ration, without further increase in dose." The rate of successful retention in the program was close to 90%, more than double anything previously demonstrated by abstinence-only programs which up to then had been the only alternative to incarceration. Dole's patients not only largely stopped heroin use, they expressed an interest in family, friends, work, and becoming fully engaged members of society once more. Though psychiatrists were available counseling was not mandatory. Dole found that the shift of priorities from daily drug-cravings and the endless quest to keep the abstinence syndrome at bay restored to these individuals an inherent sense of self-worth; resumed family responsibilities as well as employment. The doctors noted that although methadone satisfied the physical cravings of heroin addiction, patients soon became completely tolerant to its effects. Patients would remain "dependent" on methadone but could otherwise continue their lives normally...choosing when to gradually withdraw themselves by a graduated lowering of the dose over several months.
Habituation results from exposure to any stimulus for long enough. The body always strives for homeostasis or balance, which is why the sudden withdrawal of methadone, morphine, alcohol, cigarettes, precipitates what is called the withdrawal abstinence syndrome.
Read more about this topic: Vincent Dole
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