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

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

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32We can, I think, most helpfully go back to the source, the opiumsource, and try to do more than we have done about the overproduction,especially the illicit production, of opium to reduce the availabilityof compounds for abuse.Chairman Pepper. Doctor, did I understand you to say tliat youthought we could now scientifically develop an antagonistic drug toheroin which would give, as Dr. Seevers indicated, a relative immunityof sensation to tlie addict in the taking of heroin ?Dr. Eddy. We already have such compounds.Chairman Pepper. If that could be put into mass use, then that wouldto a large degree remove the desire for the taking of heroin, I ])resume,from the addict ?Dr. Eddy. Well, the answer isn't quite as simple as that. We canantagonize the effects of heroin. We can prevent the individual fromgetting a response to his taking of heroin. We don't necessarily, bythe same token, remove his desire to take heroin. We can prevent theheroin from having any effect upon him, but we don't necessarily, atthe same time, prevent him from wanting to have that effect.Chairman Pepper. ]SIr. Wiggins wishes to ask a question.Mr, Wiggins. Doctor, I am confused. Why would a person take twodrugs that would have the net effect of taking none? I gather thatthere are antnironists that neutralize heroin?Dr. Eddy. That is right.Mr. WiGGixs. Which has the effect of not taking heroin.Dr. Eddy. That is right.IVIr. WiGGixs. So why not, just in terms of the logic of it, avoid takingheroin in the first instance?Dr. Eddy. Well, they generally do. If you can persuade them to takethe antagonist even though they want the subjective effects of thehei^oin or another opiate. The problem is to s:ei: them to take somethingv/hich they know is going to prevent them from getting the kick theywant. The people who have been put on the antagonists, they don'tnecessarily take your word for it that they are not going to get anykick out of their heroin, and they may go back and try heroin untilthey find that this is futile. If they have got any sense they are goingto say, "Well, I am throwing mj^ money away." And as long as you cankeep them on the antagonist they cannot get an effect out of heroin andhence have no reason to abuse heroin or to go out on the street andsteal televisions and cars and the rest of it to buy heroin.So you have improved the situation from that standpoint for themand yourself. But you have to persuade them to take the antagonist.Chairman Pepper. Excuse me. Could you add something to thatantag'onistic drug to cause the patient to get an unfavorable reactionif, after taking the antagonistic dnig, he took heroin ?Dr. Eddy. Well, you can do it the other way around. If he is takingheroin and you give him the antagonist you certainly give him an mipleasantreaction. I don't know any instance wheie he necessarily getsan unpleasant i-eaction from the heroin he attempts to take after hehas taken the antagonist. He may get an unpleasant reaction from theantagonist itself until you stabilize him on it.Mr. Wiggins. Does the antagonist have any effect ?Dr. Eddy. For a person dependent on an opiate, the antagonist pvecipitateswithdrawal symptoms, very markedly so. It is the same as if

33you had taken all of the heroin or opiate away from the addict, just'like that. He goes into withdrawal when you give him an antagonist ifhe is taking an opiate.Mr. WiGGixs. How much success are you having in getting people todo this voluntarily ?Dr. Eddy. Well, it hasn't been tried too widely. There are two difficulties,at least. One is that the most potent antagonist we have, whichhas been tried, cyclazocine, is likely to produce unpleasant reactionswhen you start to administer it. Dr. Seevers referred to these. Theyare quite disagreeable. You have to proceed rather cautiously withmost people to stabilize them on the cyclazocine. They, too, become tolerant,accustomed to the drug so that these unpleasant reactions disappearand you can stabilize them, keep them in a state where they cantake cyclazocine day by day and be free from any adverse symptoms.You have got to completeh' withdraAv them from their heroin, discontinuetheir hei'oin administration completely for several days beforeyou start the antagonist.That is one drawback for that particular antagonist. The other onewhich has ]:)een used to the greatest extent is naloxone, which does notproduce any unpleasant reactions at all. It is as nearly as we know, apure antagonist. It has no morphine-like eifects whatsoever. Cyclazocinedoes have morphine-like effects under certain circumstances. It is apowerful analgesic. It is on the order of 40 times more potent as ananalgesic than morphine itself. But to attain its analgesia you are liableto produce, with a great many people, these unpleasant side reactions.So it is not a practicable analgesic.Xaloxone is not an analgesic at all. It only produces antagonism.It is quite effective when injected, but it is very poorly effective bymouth and the doses required to stabilize the individual to a statewhere he would not get a reaction from taking heroin requires verylarge oral doses, and the duration of action is short.But we have other antagonists in the offering, which we ho[)e to beable to develop, of longer duration and hopefully as effective as cyclazocine,without the unpleasant reactions. This is the field in which agreat deal of effort is being put at the present time. Ideally, it wouldseem to me the way to go about it. Practically, as I say, the difficulty isto 2:)ersuade the patient to begin and to continue the administration ofthe antagonist; but he must, initially, give up his opiate entirely and hemust take a compound which he knows is going to prevent him fromgetting any of the reactions that he has been wanting. So far as thiscan be done, the program is successful.Chairman Pepper. Doctor, Mr. Perito has a question.Mr. Perito. Dr. Eddy, do these antagonists have an opiate base?Dr. Eddy. No.Mr. Perito. They do not ?Dr. Eddy. No; not necessarily.The original, tlie first antagonist that we are familiar with, nalorphine,is a modified morphine. You can make similar modificationsin various of the synthetic bases which are used as analgesics, in levorphanol,for example. You can make a similar substitution in levorphanoland get a more potent antagonist than nalorphine. You cansimilarly substitute in the synthetic phenazocine the same group andget a very powerful antagonist with very intense subjective reactions,

32We can, I think, most helpfully go back to the source, the opiumsource, <strong>and</strong> try to do more than we have done about the overproduction,especially the illicit production, of opium to reduce the availabilityof compounds for abuse.Chairman Pepper. Doctor, did I underst<strong>and</strong> you to say tliat youthought we could now scientifically develop an antagonistic drug toheroin which would give, as Dr. Seevers indicated, a relative immunityof sensation to tlie addict in the taking of heroin ?Dr. Eddy. We already have such compounds.Chairman Pepper. If that could be put into mass use, then that wouldto a large degree remove the desire for the taking of heroin, I ])resume,from the addict ?Dr. Eddy. Well, the answer isn't quite as simple as that. We canantagonize the effects of heroin. We can prevent the individual fromgetting a response to his taking of heroin. We don't necessarily, bythe same token, remove his desire to take heroin. We can prevent theheroin from having any effect upon him, but we don't necessarily, atthe same time, prevent him from wanting to have that effect.Chairman Pepper. ]SIr. Wiggins wishes to ask a question.Mr, Wiggins. Doctor, I am confused. Why would a person take twodrugs that would have the net effect of taking none? I gather thatthere are antnironists that neutralize heroin?Dr. Eddy. That is right.Mr. WiGGixs. Which has the effect of not taking heroin.Dr. Eddy. That is right.IVIr. WiGGixs. So why not, just in terms of the logic of it, avoid takingheroin in the first instance?Dr. Eddy. Well, they generally do. If you can persuade them to takethe antagonist even though they want the subjective effects of thehei^oin or another opiate. The problem is to s:ei: them to take somethingv/hich they know is going to prevent them from getting the kick theywant. The people who have been put on the antagonists, they don'tnecessarily take your word for it that they are not going to get anykick out of their heroin, <strong>and</strong> they may go back <strong>and</strong> try heroin untilthey find that this is futile. If they have got any sense they are goingto say, "Well, I am throwing mj^ money away." And as long as you cankeep them on the antagonist they cannot get an effect out of heroin <strong>and</strong>hence have no reason to abuse heroin or to go out on the street <strong>and</strong>steal televisions <strong>and</strong> cars <strong>and</strong> the rest of it to buy heroin.So you have improved the situation from that st<strong>and</strong>point for them<strong>and</strong> yourself. But you have to persuade them to take the antagonist.Chairman Pepper. Excuse me. Could you add something to thatantag'onistic drug to cause the patient to get an unfavorable reactionif, after taking the antagonistic dnig, he took heroin ?Dr. Eddy. Well, you can do it the other way around. If he is takingheroin <strong>and</strong> you give him the antagonist you certainly give him an mipleasantreaction. I don't know any instance wheie he necessarily getsan unpleasant i-eaction from the heroin he attempts to take after hehas taken the antagonist. He may get an unpleasant reaction from theantagonist itself until you stabilize him on it.Mr. Wiggins. Does the antagonist have any effect ?Dr. Eddy. For a person dependent on an opiate, the antagonist pvecipitateswithdrawal symptoms, very markedly so. It is the same as if

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