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[Editors' note: Our recent symposium, Sex, Drugs and Psychological Warfare, received such a tremendous response from readers that Frontpage's editors have decided to rerun a highly controversial symposium that also touched on the issue of drugs. While dealing with different themes, this symposium dealt with numerous important questions and phenomena that readers raised in their responses to Sex, Drugs and Psychological Warfare. The symposium below, which also triggered a heated debate at Frontpage, is reprinted from our October 13, 2006 issue.]
Symposium: Romancing Opiates
Theodore Dalrymple has sparked a heated controversy with his new book Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy. His argument that the official doctrine concerning drug addiction is mistaken and self-serving has provoked much criticism from various quarters. Today we invite Dr. Dalrymple to face some of his critics and we also invite a supporter of his views. We are joined by:
Theodore Dalrymple, a contributing editor to City Journal and the author of his collection of essays Our Culture, What’s Left of It: The Mandarins and the Masses. He is the author of the new book that serves as the topic for this discussion: Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy.
Chris Rutenfrans, a criminologist who formerly worked at the University of Nijmegen and the Department of Justice in the Netherlands. Since 1998 he was one of the two editors of the famous supplement Letter & Geest (Letter and Spirit) of the daily newspaper Trouw.
Ron Fisher: an active illicit opiate user since 1994. After several attempts at detox, meetings and rehabilitation, like so many other opiate abusers, he kept on relapsing. To find any type of stable life without the chase for the drugs and the depression caused by its withdrawal or abstinence, he found it through long-term methadone maintenance. He is currently on a 150 mg a day dose. Having been off illicit (non-prescribed) drugs for 5 years, he maintains he enjoys the maximum benefit of getting a month’s worth of take home-medication at a time.
Percy Menzies, Director of Assisted Recovery Centers of America. He has a master’s degree in pharmacy and worked for DuPont Pharmaceuticals that developed naltrexone for the treatment of heroin addiction. His special responsibility was training physicians and counselors on the rationale for the development of naltrexone.
FP: Theodore Dalrymple, Chris Rutenfrans, Percy Menzies and Ron Fisher, welcome to Frontpage Symposium.
Theodore Dalrymple, let’s begin with you. Illuminate for us your general thesis and argument.
Dalrymple: My general thesis is simple: that addiction is not an illness and treatment is therefore metaphorical rather than real. Mao Tse Tung threatened addicts with dire consequences if they did not stop, and they did stop. This suggests that there is a category difference between addiction and, say, cancer of the bowel.
Addiction is one answer to perennial existential problems – in my view not a very good answer, but I don’t claim to have a perfect one – and so-called medical treatment is beside the point. It often does tangible harm, and in my view does harm in an intangible way as well by persuading addicts that they ‘need’ the help of professionals to stop. This, of course, is all to the advantage of a group of professionals.
FP: Percy Menzies, Theodore Dalrymple appears to be just stating a basic given, so what exactly is the problem? Humans are all plagued by a spiritual human hunger that cannot be filled by the physical world, yet the obsessive attempt to do just that often leads to addiction. So addiction is not necessarily an “illness” that can necessarily be cured by professionals’ medication for it. And the assumption that they do have a cure can obviously make things worse. Right?
Menzies: Heroin use may begin as a voluntary action, but over a period of time the use becomes involuntary primarily through negative reinforcement. The withdrawal symptoms are not life-threatening but they are so uncomfortable that few patients stop voluntarily. The addiction is further sustained through Pavlovian Conditioning. Patients who are off opiates for a period of time will experience all the symptoms of acute withdrawal (conditioned abstinence) when they are exposed to the sights, sounds, people, places etc. of past drug use. At my clinic detoxed patients are required to ingest naltrexone under supervision every other day and attend counseling sessions and the results are amazing. Naltrexone debunks the theory that opiate addicts need replacement medications for the rest of their lives. I am surprised that Theodore Dalrymple makes no mention of naltrexone in his book.
Rutenfrans: In favor of Dalrymple’s thesis are the experiences in the US when the Harrison Act made the use of opiates illegal in 1914. Before 1914 opiates, often in the form of laudanum, were used mainly by women, especially to ease the discomfort of menstruation. As the Harrison Act made these practices illegal, most women who, even less than men, don’t like to be regarded as criminals, stopped the use of opiates immediately, without any medical or psychiatric or psychological support. How could this happen, when opiates are indeed as addictive as much people think?
Fisher: I do believe addiction is a disease. I do not think it is comparable to a standard disease like bowl cancer or a brain tumor, but than again, not all illnesses are apples to apples comparison.
Having suffered first-hand from addiction, what I find similar to addiction and any other disease is that addiction is insidious, progressive, and fatal if ignored. I beg to differ with Dr. Dalrymple’s statement: “Mao Tse Tung threatened addicts with dire consequences if they did not stop, and they did stop.” Where are the statistics of how many addicts there were at the beginning? How many stopped as a result? How many were killed? How many suffered in silence? How many stopped for a period of time only later to relapse? If they did stop because of this threat, does that negate completely that addiction is a problem? Using Mao’s example of how he addressed addicts is not valid since the communist regime of the time probably did not keep statistics of how many people were dealt with under the threat of dire consequences.
The same lack of statistics also applies to the reference Mr. Rutenfrans made of the Harrison 1914 Act making opiates illegal resulted in users quitting. Both examples with their inherent flaws and lack of statistics make part of the argument that addiction is not a disease, baseless.
Addiction is not an answer to perennial existential problems, it is in itself a perennial existential problem — one that has endured throughout the ages. The two main methods of dealing with opiate addiction for long term clean time recently have been 12 Step meetings and methadone maintenance treatment. Many addicts are helped without the so called medical treatment at all. That is the basis of 12 step programs – addicts helping addicts. However, there are many addicts that have repeatedly failed with 12 step programs as I have.
Not knowing of any other way to deal with addiction effectively, I felt I was really running out of options and was suggested methadone maintenance treatment. It was not much of a choice since it was either that or ending up in a jail, psychiatric ward, or even dead. Surprisingly methadone gave me the breathing room I needed to begin to think clearly. My obsession to use was removed. Methadone itself does not make one high but somehow blocks chemically the hunger one has for opiates. I began to be able to think clearly again. I was able to finally deal with the wreckage of my past and look forward to a future.
Dalrymple: I do not agree that conditioning makes people automata. If it were true that addicts really cannot help themselves, that they lose all volition in the matter, it would justify the most illiberal measures to help them, to prevent them from destroying themselves and so forth.
But the fact that millions of addicts, not just of opiates, have given up, merely by taking thought, suggests that conditioning is not very important.
As to various drug treatments, they all suffer from very similar drawbacks. Readers will be interested to know that in a recent edition of the Lancet, the ‘epidemic’ of fentanyl injection in the mid-west of America, which is claimed to have taken the lives of ‘hundreds’ was explained by the fact that fentanyl gives a stronger ‘rush’ of pleasure than other drugs – suggesting that the search for pleasure is at the root of the problem.
In a Lancet just two weeks previously, it was reported that buprenorphine has become the drug of abuse favoured by tens of thousands in the Republic of Georgia – all in the last 3 years, since addicts in France started selling their treatment to dealers to export it to Georgia (the drug was already the favourite opiate of abuse in Finland, thanks to the same source). At the very least, this suggests how deeply addicts value their treatment.
At the same time, in the New England Journal of Medicine, a trial was reported with a clever drug which combined buprenorphine with naloxone, so that, if injected, it precipitated withdrawal symptoms. A very clever drug combination, if I may say so.
Of 497 subjects (heroin addicts) recruited, 296 were excluded immediately because of their antisocial behaviour or use of other drugs, and 35 refused to take part. Of the rest, only 44 per cent completed the study (75 subjects) which lasted only 24 weeks, and whose criteria of success included not failing to obtain the prescription for longer than a week, and not missing more than 3 appointments. Given the fact that trials are more successful than treatment in ‘natural’ conditions, and the fact that addicts are well able and willing to fool doctors with urine samples and self-reports, this was hardly a therapeutic triumph, and is absolutely typical of the whole methodology of the treatment model, whichever pharmacological ‘treatment’ is used. It depends on the willingness of the so-called patients to take it, and according to the theory on which treatment is necessary, they have no will.
As to China, the figure I have taken is a commonly quoted one, though higher numbers are sometimes quoted. In any case, it doesn’t matter for the sake of the argument whether the real figure is 1, 5, 10 or 100 million.
The methods used by the new regime are in many books on China.
As to personal experience, it is of very limited evidential value in a field in which the subjects are so given to deceit and self-deceit.
Menzies: I am surprised that Dr. Dalrymple dismisses conditioning as a contributing factor to addiction. All the drive states involved in the survival of the species, i.e. food, sex, shelter etc. are a function of conditioning. Schools are trying to reduce near epidemic levels of obesity by removing or limiting access to fatty and high-sugar food and thus extinguish the conditioning caused by the easy access to these foods.
Mao eliminated opium addiction through extreme coercion of both the users and the suppliers. Would Mao have succeeded if the flow of opium was unimpeded? Heroin addiction is back big time in China due to the heroin coming from Laos and Burma. Just yesterday, China announced that it is going to open 100 new methadone clinics to treat the addicts. I once again contend that price and access are the two biggest contributing factors to the spread of addiction. We can see this in countries like Georgia, Pakistan, Iran etc.
Addiction by its very nature will lead to neuroadaptation and tolerance. The addicts will make futile attempts to reach new ‘highs’ by increasing the dose, frequency and when that does not work – poly drug use. Addicts learn very quickly to boost the effects by mixing other substances. ‘Speedball’ is a popular combination of heroin and cocaine that has killed tens of hundreds. The newest ‘supercharger’ is fentanyl and addicts will discover newer combinations to feed the narcissistic behavior.
Scientists learned many years ago that drugs that have even a mild addiction potential can cause havoc. This quest is on for drugs that have no addiction potential whatsoever. The best example is the treatment of alcoholism. The three drugs approved by the FDA – Antabuse, naltrexone and acamprosate are all non-addicting. We learnt this from the disastrous results of the past of treating alcoholism with addictive drugs like Laudanum, beer and yes Valium (Mother’s Little Helper).
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