Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
Narcotics research, rehabilitation, and treatment. Hearings, Ninety ... Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
276So that at the end of the week this person is detoxicized from hisaddiction.Chairman Pepped. You mean if anybody had been taking heroin fora protracted period of time and had that course of injections whichyou just described, all in 1 week, that at the end of that week thatperson would not have any further craving for heroin ?Dr. Casriel. Wliile he is on Perse, no further physiological craving,but if he stops taking Perse and takes heroin, he will get his old habitback, his old euphoria.The first injection of Perse immediately cuts down the amount ofheroin they need to sustain their addiction. I have seen people go fromiiO bags a day to one bag until they came to me the next clay and gotanother shot of Perse.Now, how does Perse work? Dr. Revici stated that heroin is analkaloid. iVn alkaloid is a building block of protein. Those chemicalswhich are addictive are basically alkaloids building blocks of proteins.Now, if you put a specific protein into your body like milk, you willget a specific reaction to that milk, you will get a marked inflammedarea and you will develop certain antibodies to counteract the proteinsin the milk.But an alkaloid is only a small portion of a protein and it doesn'tdevelop a specific antibody when it is injected. Instead, the body devellopsa generalized defensive substance which is a steroid, which combineswith the alkaloid, be it heroin, or methadone, or morphine. Butbecause it is not specific there is an overproduction of this steroid.For instance, if one unit of heroin got into the body, the body miglitmanufacture in an analogous two units of steroids, one which combineswith the heroin and neutralizes the effect of the heroin.The other one is free in the body. It is this free steroid which is notattached to the heroin which causes the addictive phenomena, it causesthe craving phenomenon.Now, when a person who has never used a narcotic injects a smallportion of narcotics into his body or takes it orally, the body's defensesystem is activated. The injectable route is the quickest route. If youdigest it, it take a little longer to get into the bloodstream. The eftectsof the narcotics will be felt by the body, it goes to the brain centers.It diminished the body's awareness of pain and it is a basic depressant.One dies of an overdose because one's respiration stops and then theindividual stops breathing. That is how one dies of an overdose.One of the lifesaving measures is to give artificial respiration imtilthe effect of the narcotic is passed out of the body.Now, the body removes heroin in about 4 to 6 hours. It takes the bodyabout 36 hours to remove methadone. That is why one injection orone pill of methadone can last at least 24 hours, Avhereas one injectionor one pill of heroin would only last 4 to 6 hours.But when this heroin is detoxicized it is removed by the body, thesteroid whicli the body has developed previously to defend itselfagainst the hei-oin is free and it gradually develops an attraction to thebody tissue, sotting up a type of ])ulling or craving sensation. It sets upin tile body what Dr. Eevici calls an anoxicbiosis, which when ti-anslatedinto English means a negative oxygen metabolism. It is ver}'similar to the type of pain and feelings you would get if a tourniquet
277were tied around your hand. You get a negative oxygen metabolismAvith an increase of lactic acid. The oxygen isn't present to break downthe carbohydrates in the body."Wliat we have then, after the injection of heroin after 4 hours, theheroin goes through the body, we have this steroid which turns uponthe body which produced it, causing an anoxicbiosis. This is perceivedby the addict as a craving, as a yearning. As this anoxicbiosis buildsup greatei- and greater, depending on the amount of steroids, there islocalized acidosis that develops in the body and the body attempts tocompensate for this localized acidosis by a generalized alkaline reaction.This is manifest clinically as the so-called cold turkey phenomenon.It is very uncomfortable for the addict to experience. It is seenwith high amounts of steroid—not high amounts of heroin—but ahigh amount of steroid developed over a long period of addiction ordue to methadone maintenance. The blockading effect of methadone,by the way, is just the overwhelming of the body's ability to producemore steroids and the body then develops a tolerance for methadone,just as some people who start to become heavy alcoholic drinkers canshow heavy tolerance for alcohol before they become drunk. I haveseen people drink 10 ounces of alcohol and look like they are sober.But tlie steroid which has been produced in response to this foreignalkaloid, remains in the body about 7 days. It takes about 7 days forthis steroid to break down. This is why it takes 7 days to detoxify somebodyfrom addiction. It takes 7 days to maintain a state of oxygenationin the body while the steroid is being broken down.Dr. Revici has developed other pharmacological tools to go alongwith this basic tool called Perse. For instance, when a person has beenon methadone maintenance, for instance, he has so much steroid in himthat all the Perse that you give him still causes some side effects, youjust can't get enough of this oxygenizing substance into the tissue andthat is all that Perse is.Mr. Perito. Doctor, excuse me.Are you saying it is more difficult to detoxify a methadone addictthan a heroin addict ?Dr. Casriel. Yes, because a person on methadone maintenance, hastremendous quantities of defensive substance built up in them. Dr.Revici has developed a substance which will temporarily combine andneutralize the steroid in the blood and this is called trichlorbutinol.It is an alcohol, but the interesting thing about this alcohol, it doesn'tdevelop more steroid.For instance, if I have given a person who is really under tremendouscraving, and you know he has a large steroid component becausehe has been on, say, methadone maintenance, I would give him, togetherwith the Perse, some trichlorbutinol. Within 7 to 15 seconds hefeels better because that alcohol combines with the steroids in thebloodstream. It takes about 7 to 15 minutes for the Perse to get intothe tissue to counteract the anoxiobiosis. If the person is already insecondary stages of withdrawal, the cold turkey phenomenon, you cangive him a little hydrochloric acid to counteract the generalized alkalinecondition that he has.If we know the degree of his steroid developed, we can detoxify aperson without any side effects. If we don't know the amount of
- Page 238 and 239: -—I have presented one generic ki
- Page 240 and 241: ,clinic;?,>•
- Page 242 and 243: 230I realize we are running late.Do
- Page 244 and 245: ''232'']Vir. Winn. Tiien you mentio
- Page 246 and 247: 234So having put it in the area, ha
- Page 248 and 249: ,Memberships'—i236privilege of co
- Page 250 and 251: ;238A central hypothermic response
- Page 252 and 253: ;240South Bronx, Bedford-Stuyvesant
- Page 254 and 255: 242€are of patient addicts. We ha
- Page 256 and 257: 244hospitals in the city, came into
- Page 258 and 259: 246that came into my office, and I
- Page 260 and 261: 'Mr.;>•/nmo'.i,,;248deputy commis
- Page 262 and 263: :250two Rockefeller Institute physi
- Page 264 and 265: :252during pliase II that serious e
- Page 266 and 267: 254well-structured methadone mainte
- Page 268 and 269: ;:256nonsense and serves only to ad
- Page 270 and 271: :258you best complete your statemen
- Page 272 and 273: 260Mr. Pertto. Based upon your expe
- Page 274 and 275: 262A a'reat case in point was a con
- Page 276 and 277: «264Mr. Steiger. Did you discuss w
- Page 278 and 279: —:266Mr. HoRAN. We don't support
- Page 280 and 281: 268Mr. Horan, let's back up a littl
- Page 282 and 283: 270It is not up to heroin or morphi
- Page 284 and 285: 272nesses yesterday who brought out
- Page 286 and 287: 274;Mr. Perito. It is my understand
- Page 290 and 291: 278steroid he lias in him we might
- Page 292 and 293: 280Mr. Perito. You are referriii"'
- Page 294 and 295: 282not drug free. I can say approxi
- Page 296 and 297: 28 A$2-a-day habit these individual
- Page 298 and 299: •As286I got to the point once in
- Page 300 and 301: 288Mr. Steiger. You mentioned anoxi
- Page 302 and 303: 290Mr. Eangel. I could see then tha
- Page 304 and 305: 292Dr. Casriel. Mr. Keating, I have
- Page 306 and 307: j294What period of time are ^ve tal
- Page 308 and 309: 296was March of 1970—he was admit
- Page 310 and 311: 298"The paper by Dole and Nyswander
- Page 312 and 313: :300vent them from coming to New Yo
- Page 314 and 315: 302[Exhibit No.14(b)]Casriel Instit
- Page 316 and 317: 304to result from the insuflScient
- Page 318 and 319: 306It is this role of the intervent
- Page 320 and 321: 308EESULTSStudies concerning tlie p
- Page 322 and 323: 310The method derives from a specia
- Page 324 and 325: 312Why is this happening? What need
- Page 326 and 327: m)effective with uncured alcoholics
- Page 328 and 329: I316Casriel, who is medical-psychia
- Page 330 and 331: 318resort to heroin. One must not f
- Page 332 and 333: .320in Permanent Cure of Narcotic A
- Page 334 and 335: 322!(4) '-Modification of Adaptatio
- Page 336 and 337: 324sections of the country, all sor
277were tied around your h<strong>and</strong>. You get a negative oxygen metabolismAvith an increase of lactic acid. The oxygen isn't present to break downthe carbohydrates in the body."Wliat we have then, after the injection of heroin after 4 hours, theheroin goes through the body, we have this steroid which turns uponthe body which produced it, causing an anoxicbiosis. This is perceivedby the addict as a craving, as a yearning. As this anoxicbiosis buildsup greatei- <strong>and</strong> greater, depending on the amount of steroids, there islocalized acidosis that develops in the body <strong>and</strong> the body attempts tocompensate for this localized acidosis by a generalized alkaline reaction.This is manifest clinically as the so-called cold turkey phenomenon.It is very uncomfortable for the addict to experience. It is seenwith high amounts of steroid—not high amounts of heroin—but ahigh amount of steroid developed over a long period of addiction ordue to methadone maintenance. The blockading effect of methadone,by the way, is just the overwhelming of the body's ability to producemore steroids <strong>and</strong> the body then develops a tolerance for methadone,just as some people who start to become heavy alcoholic drinkers canshow heavy tolerance for alcohol before they become drunk. I haveseen people drink 10 ounces of alcohol <strong>and</strong> look like they are sober.But tlie steroid which has been produced in response to this foreignalkaloid, remains in the body about 7 days. It takes about 7 days forthis steroid to break down. This is why it takes 7 days to detoxify somebodyfrom addiction. It takes 7 days to maintain a state of oxygenationin the body while the steroid is being broken down.Dr. Revici has developed other pharmacological tools to go alongwith this basic tool called Perse. For instance, when a person has beenon methadone maintenance, for instance, he has so much steroid in himthat all the Perse that you give him still causes some side effects, youjust can't get enough of this oxygenizing substance into the tissue <strong>and</strong>that is all that Perse is.Mr. Perito. Doctor, excuse me.Are you saying it is more difficult to detoxify a methadone addictthan a heroin addict ?Dr. Casriel. Yes, because a person on methadone maintenance, hastremendous quantities of defensive substance built up in them. Dr.Revici has developed a substance which will temporarily combine <strong>and</strong>neutralize the steroid in the blood <strong>and</strong> this is called trichlorbutinol.It is an alcohol, but the interesting thing about this alcohol, it doesn'tdevelop more steroid.For instance, if I have given a person who is really under tremendouscraving, <strong>and</strong> you know he has a large steroid component becausehe has been on, say, methadone maintenance, I would give him, togetherwith the Perse, some trichlorbutinol. Within 7 to 15 seconds hefeels better because that alcohol combines with the steroids in thebloodstream. It takes about 7 to 15 minutes for the Perse to get intothe tissue to counteract the anoxiobiosis. If the person is already insecondary stages of withdrawal, the cold turkey phenomenon, you cangive him a little hydrochloric acid to counteract the generalized alkalinecondition that he has.If we know the degree of his steroid developed, we can detoxify aperson without any side effects. If we don't know the amount of
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