Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

298"The paper by Dole and Nyswander on the treatment of heroin afldiction bymethadone does not come np to expectations pjenerated by prior publicity in thepublic press and two feature articles in the New Yorker."The authors seem to be unaware of the tragic consequences of the introductionof heroin as a cure for morphine addiction at the turn of the century andthe later introduction of Demerol as a harmless narcotic. Although the authorsstate at the beginning of the paper that it is only a progress report, an unwarrantedconclusion is made, 'Maintenance of patients with methadone is no moredifficult than maintaining diabetics with oral hypoglycemic agents, and in mostcases the patient should be able to live a normal life' : The authors are silent onthe problem of treating methadone addiction."Although 22 cases are presented as evidence of success of the treatment, twohad been followed less than 1 month and 10 cases for less than 2 months :Perusalof the paper shows that four of the cases were still in the hospital, four othershad used 'Unscheduled' narcotics, two others had been discharged after tolerancetests only, and one left the program against advice."A common pitfall for investigators studying new cures for narcotic addictionis the difficulty of determining the degree of addiction at the beginning of theexperiment. liimmelsbach and others have shown that narcotic dependencecan be determined only by objective observations during withdrawal, afterwhich the subject may be restabilized and experimental testing with the newdrug begin."The evidence presented in this paper that the substitution of the narcoticmethadone for the narcotic heroin is superior to withdrawal from all narcotics,is not impressive. In spite of what the authors say. successful treatment bywithdrawal is not rare, particularly over a period of less than 2 months whichis the time reported by Dole and Nyswander in 10 of the 22 cases."The following statements might be useful in counteracting some of the misleadingreports that are becoming more numerous daily.Victor H. Vogel, Harris Isbell and Kenneth W. Chapman, wrote in the Journalof the American Medical Association. December 4, 1948, in an article called ThePresent Status of Narcotic Addiction: "The total addiction liability to methadoneis almost equal to that of morphine, although its physical liability is less.The euphoric effect of methadone on the addict (and undoubtedly in the addictionprone person) is equal to that of morphine, so that its habituation liabilityis high."Harris Isbell wrote in his article "Methods and Results of Studying ExperimentalHuman Addiction to the Newer Synthetic Analgesics," published in theannals of the New York Academy of Science, October 1, 1948: "The behaviorof men addicted to methadone was similar to the behavior seen during morphineaddiction. The patients ceased all productive activity, neglected their personsand their quarters, and spent most of their time in bed in a semi-somnolentstate which they regarded as very pleasurable. Psychological changes seen duringaddiction to methadone were similar to those seen during morphine addiction.During addiction to methadone patients continually requested increases indosage."Harris Isbell, Abraham "Wikler, Anna J. Eiseman, Mary Daingerfield and KarlFrank, in their article "Liability of Addiction to 6-dimethylamino-4-diphenyl-?.-heptanone (methadone amidone or 10820) in Man: Experimental Addiction tomethadone" published in the Archives of Internal Medicine, October 1948:"When the dosage was increased to 40-60 mg. daily in the second week of addiction,definite evidence of sedation appeared after the third or fourth iniection,and the men began to express satisfatcion with the effects of the drug. Their behaviorbecame strikingly similar to that seen during addiction to morphine. . . .The degree of somnolence and lack of activity was greater than that seen duringmorphine addiction. The men complained about this, and said that whileaddicted to methadone they could do little but stay in bed. They stated thatmethadone lacked a peculiar quality possessed by morphine, which was termed'drive' and which they described as a sense of ambition to work and play games.When it was pointed out that their behavior while addicted to moriihine wasinconsistent with these observations, the patients were puzzled and stated thatwhen they were receiving morphine at least they thought they were ambitious,but when they were taking methadone they knew that they were lazy."Last December Dole and Nyswander wirh Alan Warner reported on further,and more extensive, studies (750 cases) in the Journal of the American Medical