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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Wednesday 19th June 2013

My feeble brain tries, and completely fails, to keep up with the flow of new information on topics that interest me. Generally, I skim through trying to get the essence of what has been written.

But this steady stream, or raging torrent, occasionally contains a tidal surge as a very large amount of information gets released in one go. When that happens twice in one week, it really becomes problematic.

Such large scale appearances are generally the result of someone taking an entire archive and making it available online. That just happened twice in a week. The second was the release of 140 years of ‘Popular Science’ magazine. ‘Popular Science’ is an American magazine and it looks very like an American version of ‘New Scientist’. By that I mean it conveys science to the general reader but does it with much more pizzazz, and many more adverts, than the UK publication.

The archive is fully searchable and what little time I’ve spent with it, so far, suggests that it may prove to be very enlightening as much because of what it doesn’t include. But I’ll leave further consideration of ‘PopSci’, as it refers to itself these days, for another time.

Because today I want to look at the other new release – the complete archive of the US ‘Journal of Inebriety’. This pdf explains what the project is about.

Making sure one has taken account of every piece in the new issue of a journal is hard enough. When 141 issues become simultaneously available the choice is between telling the world you will be unavailable for a month or dipping in at random in the hope of finding something of interest.

According to the explanation linked to, above;

‘“All of the issues can now be accessed electronically, making it easy to look for specific topics within the 35-volume collection,” said Hazelden Library Manager Barbara Weiner, who spearheaded the project along with Mr. White.’

That’s over-stating it somewhat because the files are not electronically searchable and one has to pore through the index to find an item that, from its title, seems worthy of further study and then scroll through the pdf of the issue to find it.

But, if my first serendipitous exploration is anything to go by, that could prove to be a worthwhile, if somewhat laborious, process.

Issue No.4 from Volume 5 published in October 1883 contains an article be Dr. J B Mattison (who was described in 1902 as ‘medical director of the Brooklyn Home for Narcotic
inebriants’ with over thirty years’ experience with addiction treatment) entitled ‘The Curability of Opium Addiction’. (Page 44 of this very large pdf.)

When the current UK government adopted its new ‘drugs strategy’, it said it was making treatment a much higher priority. That sounds laudable and in line with the general shift towards harm reduction measures for problem drug users. Unfortunately, whether because of dogmatic adherence to the notion of success equalling profit or because of a fear that it would be open to press abuse for wasting money on ‘junkies’ at a time when ‘hard-working families’  were suffering austerity measures, it also introduced a system of payment by results for treatment providers.

That in itself might not have been so bad had it not decided that a ‘result’ in treatment terms meant achieving total abstinence. Simply getting an injecting drug user onto a maintenance programme enabling them to bring their life into control, avoiding high-risk needle-sharing and criminal activity to fund street purchases, is viewed as a failure.

In the simplistic world of politics, the individual represents the population so the fact that there are those who have been able to achieve complete abstinence after long periods of addiction is taken to mean that this outcome is available to all and, for many politicians, it is also proof that those who do not achieve complete abstinence are simply not trying hard enough.

It was that present day issue that made Dr Mattison’s thoughts so interesting. Mattison had been asked whether ‘opiomania’ could be cured – whether he knew of any well-authenticated cases of people being abstinent for ten years or more. His answer was a most emphatic ‘Yes’.

But he then looked at what was meant by ‘cured’. Straightaway he notes that in both ‘professional and lay circles’ there are those who say that ‘unless recovery be never followed by relapse it is a failure’. This approach he says is a mistake and he says that a recovered addict may well relapse if exposed to the same conditions that brought about the original addiction. As an example, Mattison says that a patient who has become addicted to morphia as the result of chronic pain is unlikely to achieve abstinence if the pain continues and suggests that such people are ‘ineligible for treatment’.

Most of his paper relates brief case histories from his own and other doctors’ experiences though they are all of successful treatment producing complete abstinence.

His concluding paragraph says that opium addiction is curable in the sense that other diseases are. But, just as with other diseases, it is essential to ensure that the same conditions that produced the original addiction are avoided in the future. He also says that abstinence from alcohol is essential to ensure that one addiction is not simply replaced by another.

Dr Mattison is in no doubt that addiction is a disease and that removing the cause of the original incentive to use opium or morphine is as essential to recovery as removing the source of a cholera outbreak is to preventing its re-appearance.

It is slightly depressing to find that 130 years on there are still those who say that addiction should be dealt with by criminal sanction and that, even where treatment is recognised as the proper way to deal with it, the system still behaves as though you can cure addiction without dealing with its underlying causes.

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