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

519The Deceptive Communication and the Narcotic Abuser: Kurland, A. A.Rutgers Symposium on Comnnmication and Drug Abuse, Sept. 3-5, 1969.Rutgers University, The State University of New Jersey, New Brunswick,N.J.The Out-Patient Management of the Narcotic Addict: Kurland, A. A. InPerry Bhick (Ed.) Drugs and the Brain. Baltimore, Md.: The JohnsHopkins Press, 1969, pp. 363-370.The Daily Testing of Urine for Opiates as a Deterrent to Opiate Usage. TheResults of a .VYear Study: Kurland, A. A., Kokoski, R., Kerman, F., andBass, G. A. Presented at 32d annual meeting of the Committee on Problemsof Drug Dependence, NAS-NRC, Washington, D.C., Feb. 16-18,1970. (Published in 1970 Report, pp. 6719-6730.)N-allyl-14-hydroxydihydronormorphinone (Naloxone) in the Management ofthe Narcotic Abuser. A Pilot Study: Kurland, A. A., and Kermai, F.Presented at the 33d annual meeting of the Committee on Problems ofDrug Dependence, NAS-NRC, Toronto, Ontario, Canada, Feb. 16-17,1971.Attachment No. 2[Reprinted Froui the American Journal of P.sychiatr.v. vol. 122. No. 7, January 1966]Urine Detection Tests in the Man.\gement of the Narcotic Addict(By Albert A. Kurland, M.D., Leon Wurmser, M.D., Frances Kerman, R.N.,and Robert Kokoski, Ph. D.)The focus of this study was the data originating from the daily analysis of urineof narcotic users being treated in an inpatient and outpatient setting. This informationhas provided impressions suggesting certain treatment approaches whichmay provide for their more effectiv-e management. The inpatient group was madeup of court-referred narcotic addicts and patients seeking voluntary admission tothe Spring Grove State Hospital because of narcotic addiction. The outpatientgroup was made up of parolees from the correctional institutions of Maryland whohad been penalized for their use of narcotics.The background and history of the role of laboratory control in the supervision ofthe narcotic addict are relatively brief. Until 10 years ago the only means availableto the clinician for ascertaining the addict's use of narcotics were his clinicalobservations and complex, time-consuming laboratory procedures for analyzingurine for narcotics.The introduction in California of nalorphine testing (the measurement of apupillary response following the administration of a single dose of this drug) inI9r)~) as a medicolegal procedure in testing convicted narcotic users on parole orprobation to determine their abstinence from narcotics opened up a new approachin the attempts to control the ingestion of narcotic drugs (5, 6, 7). By 1962, over6,000 nalorphine injections were being administered per month (9, 10). The testwill yield a negative result if it has been preceded by a drug-free period of 24 to 48hours, or if a drug that produces a dilatation of the pupil has been administeredprior to the test procedure. Also, the test is not as accurate or sensitive as chemicaltests for narcotics in urine (•?, 4). Nevertheless, nalorphine testing was thought tobe useful by the parole and probation officers (.9, 10). It was their impression thatalthough the potential for addiction remains, the problem is contained. However,Terry and Teixeira {10) were not able to make a conclusive statement on thiswhen they summarized their impressions in 1962 after having observed the use ofthe test in California for several years.METHODOur own experience with the management of the narcotic addict began in 1960with court-referred narcotic addicts who came to the hospital for diagnostic studyand treatment. In an effort to determine the patient's receptivity toward treatment,we attempted to determine his freedom from narcotics on a daily basis.For this purpose nalorphine testing was not feasible, but a spot test for narcoticsin urine was employed. This procedure, the Motley spot test {8), was accepted asbeing neither sensitive nor specifically reliable. However, the test was helpful inalerting the hospital staff to possible breaches of abstinence and emphasized theusefulness of this type of assessment. In January 1964, the Motley test was