Our Love Affair with Drugs: The History, the Science, the Politics vwv
Jerrold Winter, PhD Professor of Pharmacology and Toxicology
Jacobs School of Medicine and Biomedical Sciences University at Buffalo
1
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Library of Congress Cataloging-in-Publication Data
Names: Winter, Jerrold, author.
Title: Our love affair with drugs: the history, the science, the politics / Jerrold Winter. Description: New York, NY : Oxford University Press, [2020] | Includes bibliographical references and index.
Identifiers: LCCN 2019014952| ISBN 9780190051464 (hardback) | ISBN 9780190051471 (updf) | ISBN 9780190051488 (epub)
Subjects: | MESH: Psychotropic Drugs | Central Nervous System Agents | Substance-Related Disorders—prevention & control | Public Policy | Drug and Narcotic Control
9. Pharmacological Puritanism and the War on Drugs: All the King’s Horses and All the King’s Men . . . 162
Index 185
PREFACE
This book is about psychoactive drugs. For me, the adjective psychoactive has a touch of pretention about it. We might better say that these are simply drugs that in various ways influence the way our brains function. Manifestations of their influence on the brain are quite varied. There may be the comfort provided by opioids to those who are dying or in pain or, in everyday life, the surge of contentment for the users of caffeine, nicotine, heroin, alcohol, or marijuana upon the taking of their drug of choice. Turning to the more exotic, a drug such as LSD may alter the way the world looks to us; it may even inspire thoughts of God. All of this and more is encompassed by psychoactive; the term, I must admit, has the virtue of brevity and I will use it often, but we should ever keep in mind the enormous complexity of our brains and the actions of drugs upon them. Adding to the purely scientific questions which confront us are the ways in which our society chooses to respond to the presence of psychoactive drugs. Should they be banned and their users sent to prison, tolerated as a reflection of man’s eternal search for an escape from anxiety, pain, and the monotony of daily life, or celebrated as therapeutically useful agents?
This book is an attempt to bring order and genuine understanding to the thousands of bits of information which swirl about us concerning psychoactive drugs. These come to us from newspapers, magazines, television, social media, the Internet, and in everyday conversation with family and friends. To accomplish this end, we must strive to attain total perspective. The rise of the Internet has made achieving such perspective both easier and more difficult. Easier because an enormous store of information is readily at hand; a Google search today will turn up 462 million hits for LSD, including offers to sell us the drug. But our striving for total perspective is made more difficult because, as we are inundated with information from all sides, we may become, not informed, but more confused.
In commenting on those who write for the general reader about psychoactive drugs, Daniel Kunitz, a noted editor and author, said that “the
grail is a comprehensive tome that would reveal the secrets of all drugs and would stand as the last, totalizing word on the subject.” Alas, Our Love Affair with Drugs: The History, the Science, the Politics is not that book. Indeed, the Kunitz goal has never been reached nor is it ever to be reached, for there can be no last word on an ever- changing subject. There is no place for dogma in writing of these drugs. What we believe today is only the best approximation of truth based on what has come before. We must ever be prepared to alter our beliefs as Nature’s secrets are revealed by the methods of science.
This book is divided into nine chapters, the middle seven of which are concerned with individual drugs or drug classes. It is my hope that these chapters are made intelligible by the contents of chapter 1, in which I introduce the reader to that branch of medical science called pharmacology. Central to that introduction is the concept of the drug receptor and the phenomena of drug tolerance, physical dependence, and addiction. The middle seven chapters can be read pretty much in any order. A reader with a particular interest in hallucinogens may wish to start with chapter 7. However, I do recommend that chapter 1 be read first as it will provide a basis of understanding for all that follows.
The contents of this book are largely factual, for example, the consequences of an overdose with heroin or a heart attack following the use of cocaine or methamphetamine or evidence of benefit provided to epileptic children by derivatives of marijuana or by ecstasy (MDMA) for a veteran suffering from posttraumatic stress disorder. I will, however, insert my personal opinions from time to time but, in all instances, will strive to identify them as such. These personal opinions are most evident in the final chapter, which deals with our war on drugs and the tools with which we have chosen to fight it.
I welcome the reader to join me on what I hope is an informative and even sometimes an enjoyable trip.
ACKNOWLEDGMENTS
There are many to whom I owe thanks. Among those who will remain nameless are the staff of the Health Sciences Library (HSL) of the University at Buffalo. The superb holdings of the HSL have provided me with many pleasurable hours and form the backbone of this book. The conversion of their journal collection to electronic form has saved me many trips to the HSL but unfortunately has diminished my personal contact with the staff. The medical literature is, of course, entirely the work of countless scientists, physicians, and scholars; some have been named, many more have not. To each I am indebted.
I thank the students who for a time shared my laboratory and who are now my mentors. From them I have learned far more than I taught. It was a privilege to know them all. In the writing of the present book, I am particularly indebted to Katherine R. Bonson, PhD, Scott Helsley, MD, PhD, David J. McCann, PhD, and Chad J. Reissig, PhD. Special thanks go to Mireille M. Meyerhoefer, MD, PhD, who read each chapter as it was completed and offered valuable criticism.
My colleagues in the Department of Pharmacology and Toxicology of the Jacobs School of Medicine and Biomedical Sciences of the University at Buffalo have been unstinting in sharing with me their profound knowledge of drugs. Thanks go to Margarita Dubocovich, PhD, and David Dietz, PhD, who chaired the Department during the time that this book was in progress. David Nichols, PhD, and Rick Strassman, MD, both of whom have been major contributors to our understanding of psychoactive drugs, offered helpful comments regarding my chapter on hallucinogens. Rick Doblin, PhD, kindly corrected my account of his crusade to bring MDMA into clinical use. Daphne Lloyd- Alders, MD, PhD, and Howard Chambers, MD, PhD, provided support whenever it was needed.
This project would not have been completed without the superb professionalism of Jeremy Lewis and Bronwyn Geyer of the Oxford University Press. The assistance of Raj Suthan and Leslie Anglin is much appreciated.
Finally, I will be forever grateful to Andy Ross of the Andy Ross Literary Agency for being the first to have had faith in this undertaking.
My children, Anne, Jerrold, Jr., Kurt, and Jessica, have endured decades of my talk about drugs, and I thank them for their forbearance. The book is dedicated to Barbara, my wife of 59 years and a constant source of encouragement.
Our Love Affair with Drugs
CHAPTER 1
Pharmacology
The Science
of Drugs
Aldous Huxley once said that man was a pharmacologist before he was a farmer.1 Although written records rarely go back more than 5,000 or 6,000 years, there is reason to believe that humans did indeed experience the effects of a variety of drugs much earlier, perhaps even before the rise of agriculture some 12,000 years ago in the Nile Valley. Likely drugs available to the ancients include opiates, cocaine, tetrahydrocannabinol, cathinone, and numerous hallucinogens. But these were drugs in their crude natural forms: the opium poppy, coca leaves, hemp, khat, and a variety of other plant sources. Identification of pure chemicals and a science of drugs was much slower in coming.
Pharmacology had to wait for the rise early in the 19th century of organic chemistry, largely in Germany, and physiology, chiefly in France and England.2 Pharmacology was born of the marriage of these two disciplines. Signifying its maturation in this country, the first department of pharmacology was established at Johns Hopkins University School of Medicine in 1893. Today, pharmacology is taught as a basic medical science, along with anatomy, pathology, physiology, biochemistry, and microbiology, to every medical student.
Each of the drugs I mentioned earlier will be discussed in detail in the chapters that follow, but before we do this we need a basic pharmacological vocabulary and a little knowledge of how drugs act. Pharmacology deals with the interaction of chemicals with a living system: the human body.
Although drugs act on every element of the body, we will be most interested in that most complex of organs, the brain.
DRUG MOLECULES AND OUR BRAINS
We are aware that a drug has acted upon our brains by the effects that it produces. These effects may be as direct and unequivocal as vomiting after apomorphine or convulsing after strychnine. These effects may be of such subtlety as to inspire poetry or to stimulate thoughts of God. Diffuse, relaxed pleasure or orgasmic high; tranquility or terror: Drugs can produce any of these reactions and more. Some drugs may even inspire us to love our fellow man. And in every instance the effects of a drug are colored and made still more complex by the structure and past experience and current state of the brain upon which it acts. No wonder that humans throughout their history have been fascinated by such chemicals. Most readers of this book have had ample opportunity to experience the effects of numerous drugs over their lifetime. For example, I daily ingest what I like to call a “geriatric cocktail” aimed at staving off cardiovascular problems. This consists of metoprolol (Lopressor), atorvastatin (Lipitor), ramipril (Altace), aspirin, and hydrochlorothiazide. When it comes to drugs acting on my brain, I have caffeine in the form of Coke or Pepsi or chocolate, alcohol in beer and wine or, on a good day, a margarita or two, and, if my sciatica is acting up, a modest dose of hydrocodone, an opioid, in combination with acetaminophen (Vicodin). In listing these drugs, you may have noticed that I said metoprolol (Lopressor), atorvastatin (Lipitor), ramipril (Altace), and hydrocodone in combination with acetaminophen (Vicodin). The capitalized name is a trade or proprietary name; the other is the generic name. The trade name is the one most often heard by patients, at least until the patent on the drug runs out and a generic form is available. Most of the drugs we will be talking about will be addressed by their generic name, but if a drug such as fluoxetine is well known by its trade name Prozac, I will use that as well.
The basic unit of every drug is the molecule, the smallest particle of the drug that retains all of the drug’s properties. There are lots of them. The modest doses of the five drugs in my daily geriatric cocktail alone contain about 5 x 1020 molecules; that’s 5 followed by 20 zeros. How in the world do they know where to go? I know where I want them to go: metoprolol, atorvastatin, ramipril, and aspirin to one or another element of my circulatory system; hydrochlorothiazide to my kidneys; caffeine, alcohol, and hydrocodone to my brain. But the fact is that they don’t know where to
go—once in the bloodstream, my drugs, with few exceptions, bathe virtually every cell and organ in my body. This does not mean that they act everywhere in my body.
DRUG RECEPTORS
In most instances a drug produces its desired effects by attaching itself to a structure of the cell called the receptor; receptors can be very selective, responding only to certain drugs and ignoring the rest. For example, opiates, about which much more will be said in chapter 2, reach receptors in the brain and spinal cord to dampen our experience of pain. But there are other opiate receptors. Some are in the gut and, when acted upon, can cause constipation.
Although the slowing of bowel activity by opiates does not strike fear as does addiction, constipation can be a major problem, especially in the elderly. After being treated with an opiate for postsurgical pain, the late comedian Robin Williams said he felt the need for a turd exorcism. More ominously, there are opiate receptors in a primitive area of the brain, the medulla oblongata. When opiates act on these receptors, the activity of the medulla is suppressed; breathing is slowed and may stop entirely. Death is the endpoint. Hardly a day goes by that we are not made aware by the media of this pharmacological fact. The death of Prince in 2016 at the hands of fentanyl, an especially potent opiate, was a much publicized and lamented but not unusual example.3
The concept of the receptor is fundamental to an understanding of drugs, and I will invoke it repeatedly in the chapters to follow. However, in preparing to talk about a variety of drugs with disparate mechanisms of action, I want to provide three additional definitions that are particularly relevant to the drugs acting on my brain and to which I will make frequent reference. These are for drug tolerance, physical dependence, and addiction. Morphine, the drug that remains the gold standard for the relief of severe pain, nicely illustrates the phenomena.
DRUG TOLERANCE AND PHYSICAL DEPENDENCE
Let us imagine that I suffer from metastatic cancer. My physician prescribes morphine, and the pain-relieving effects are wonderful. But, over time, in order to maintain analgesia, it is necessary to increase the amount of morphine that I receive. It is now said that I have become tolerant to morphine.
Blessedly, that tolerance can be overcome with increasing doses of the drug. I may, after a few months, receive on a daily basis a quantity of morphine that would have killed me prior to my development of tolerance.
Tolerance, in and of itself, is benign. On the other hand, if I am a user of illicit cocaine or heroin, other drugs to which a high degree of tolerance develops, tolerance presents a problem. To acquire larger doses requires more money. For those not blessed with wealth, available sources of more money may involve theft, robbery, or prostitution.
During the period that I am treated with increasing doses of morphine for my cancer pain, my brain is undergoing adaptive changes in addition to tolerance. Surprisingly, I am totally unaware that these adaptations have taken place. Only upon abruptly stopping my morphine are they manifest. Taken together, the constellation of signs and symptoms that results is called the withdrawal syndrome or abstinence syndrome. I am now said to be physically dependent on morphine.
In the physically dependent state, so long as the direct effects of the drug and the compensatory changes in my brain are in rough balance, nothing very remarkable happens. If I upset that balance by suddenly depriving myself of morphine, the fact my brain has been altered by the drug will quickly be evident. Put another way, after physical dependence has developed, the continued present of morphine is required for normal function. But, so long as the drug of dependence is provided, I will not experience withdrawal. As we will see later, avoidance of the abstinence syndrome can become a powerful motivator for the continued use of a drug. A full discussion of the morphine abstinence syndrome will be given in chapter 2.
Tolerance and physical dependence are invariable pharmacological phenomena. They have nothing to do with willpower or your moral character. They certainly have nothing to do with the law. Every human, indeed every living animal going far down the evolutionary scale, will develop physical dependence when exposed to an appropriate drug for an appropriate period of time. In treating my hypothetical cancer pain in a perfectly acceptable medical fashion, it is quite likely that I will become physically dependent upon morphine. Addiction is another matter.
ADDICTION
Before I provide you with the definition of addiction which I favor and which I will use throughout this book, we need to understand that there is
no universally accepted definition. The situation is such that 40 years ago a committee of experts suggested that we get rid of the term as being illdefined and unhelpful. Well, it didn’t go away, and it will not go away, and we must face the fact that ambiguity and misunderstanding concerning addiction prevail at all levels of society. For this reason, any time we encounter anyone trying to tell us something about “addiction,” whether it be labeling a person as an “addict,” speaking of a drug said to induce addiction, or suggesting a means to treat addiction, we need first to establish what they mean by the word. Humpty Dumpty’s dictum to Alice, “When I use a word—it means just what I choose it to mean—neither more nor less,” will not satisfy us.
Let us begin with two authoritative definitions of addiction. The first comes to us from the Federation of State Medical Boards of the United States: “Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include impaired control over drug use, craving, compulsive use, and continued use despite harm.”4
The second definition is provided by the American Association for Addiction Medicine (AAAM): “Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”5 The Society provides an alphabetic mnemonic: inability to Abstain, impairment in Behavioral control, Craving for drugs or rewarding experiences, Diminished recognition of significant problems, and a dysfunctional Emotional response.
This concept of addiction as a chronic disease of the brain,6 and thus possibly amenable to medical treatment, is antithetical to many who regard addiction as a moral failure, a condition we bring voluntarily upon ourselves. Given these uncertainties, I prefer a purely operational definition such as that provided by Alan Leshner, a former director of the National Institute on Drug Abuse, the primary funding agency for addiction research in the United States: Addiction is the behavioral state of compulsive, uncontrollable drug craving and seeking.7
I would amend Dr. Leshner’s definition only to add that the drug of addiction must do harm to the individual. For example, caffeine is a drug that induces physical dependence; the abstinence syndrome is characterized by anxiety, insomnia, and headache. Most of us have known some who surely
do compulsively crave and seek the drug but, because caffeine does no harm except in massive doses, we do not label the users, habitual coffee drinkers for example, as drug addicts. Alcoholism, on the other hand, completely fits our definition of addiction. Not only is there compulsive drug craving and seeking, but the drug harms the individual in multiple ways, including physical damage to the liver and other organs as well as inducing recurrent social or interpersonal problems.
DRUG- INDUCED PLEASURE/ AVOIDANCE OF WITHDRAWAL
As we will see in discussing the drugs we love in the chapters that follow, there are two major factors in the continued use of a drug of addiction. The first, often overlooked by those who oppose the use of any psychoactive drugs, is the fact that these drugs can bring us pleasure. This can take the form of the euphoria induced by a drug such as cocaine, the relaxation following an alcoholic drink or a deep drag on a nicotine or marijuana cigarette, the mystical state induced by a hallucinogen, or the relief of pain in our lives, whether that pain be psychic or physical.
The second major factor influencing the compulsive use of an addictive drug is avoidance of a withdrawal syndrome. Just as drug tolerance has different implications for the patient chronically treated for pain compared with the illicit user, so too does physical dependence. A cancer or postsurgical patient physically dependent on morphine and no longer in need of the drug can slowly be weaned off of the drug with minimal discomfort and no risk of addiction. In contrast, the morphine or alcohol addict must each day face the prospect of desperate illness; for him the avoidance of the abstinence syndrome provides a powerful incentive for continued use of the drug. To paraphrase Thomas Hardy, once you have been tormented by the withdrawal syndrome, mere relief becomes delight.
Past thinking about physical dependence and its role in addiction was based almost exclusively on the abstinence syndromes peculiar to opiates, drugs such as morphine and heroin, as will be discussed in chapter 2, and the depressant drugs of chapter 5, especially alcohol and the barbiturates. The syndromes differ in detail, but both are quite dramatic; abrupt withdrawal of alcohol can even be life- threatening. Then along came cocaine.
PHYSICAL VERSUS PSYCHOLOGICAL DEPENDENCE
Fifty years ago it was said that there was no abstinence syndrome, that is, no physical dependence, following chronic cocaine use, and as a result, cocaine would be a negligible factor in drug misuse. Indeed, one writer opined that there is no such thing as cocaine addiction.8 Yet, in 2014, it was estimated that there were 1.5 million regular users of cocaine in the United States, with nearly a million meeting accepted psychiatric criteria for dependence or abuse. In 2017, there were more than 14,000 deaths involving cocaine.9 The drug cartels are well aware of cocaine’s appeal for many Americans; in 2017, Colombia alone produced 1,500 tons of the drug with most destined for the United States.10
How are we to rationalize this behavioral state of compulsive, uncontrollable cocaine craving and seeking which does harm to the individual, thus fully meeting our definition of addiction, but in the absence of physical dependence of the classical type? The explanation offered was the notion of psychological dependence. For example, smokers of cigarettes and users of cocaine were said to be merely psychologically dependent and not really addicted to nicotine and cocaine; these were soft drugs and not to be compared with hard drugs able to induce physical dependence of the kind seen in heroin addicts or alcoholics. American tobacco companies were particularly emphatic in their denial that nicotine is a drug that leads to both physical dependence and addiction.
What has changed is that we are now willing to accept as a withdrawal syndrome the irritability of the smoker denied his nicotine and the depression of a cokehead without a line to snort and the craving of both for a fix. 11 And this is as it should be; the notion that compulsion to use a drug is “just in your mind” forgets the wise remark of Susanna Kaysen that “a lot of mind is brain.” 12 Put more formally, the rebound of compensatory homeostatic adjustments that manifest as anxiety, irritability, depression, or craving for a drug such as nicotine or cocaine are as real and as compelling for the nicotine or cocaine addict as are the aches, gooseflesh, and nausea of heroin withdrawal for the junkie. With the acceptance of the hypothesis that all human subjective states have a neurochemical basis, the notion of psychological dependence and artificial distinctions between hard and soft drugs may be discarded; addiction and its ability to control human behavior should be our focus. Smokers of nicotine cigarettes are as addicted as any heroin addict. Indeed, on a statistical basis, the heroin addict is more likely to escape his addiction.
In the chapters that follow, we will repeatedly revisit the concept of the drug receptor and our definitions of drug tolerance, physical dependence, and addiction as they apply to the drugs we love.
NOTES
1. Huxley A (1958) Collected Essays. New York: Harper & Brothers.
2. Holmstedt B, Liljestrand G (1963) Readings in Pharmacology. London: Pergamon Press.
3. Winter JC (2016) What addiction really means. www.slate.com/articles/health_ and_science/medical/examiner/2016/05/prince
4. Federation of State Medical Boards of the United States (2005) Model policy for the use of controlled substances for the treatment of pain. J Pain Palliat Care Pharmacother 19(2):73–78.
5. American Society of Addiction Medicine (2011) Definition of addiction. www.asam.irg/resources/definition-of-addiction
6. Volkow ND, Goob GF, McLellan AT (2016) Neurobiological advances from the brain disease model of addiction. N Eng J Med 374(4):363–371.
7. Leshner AI (1997) Addiction is a brain disease, and it matters. Science 278:45–47.
8. Ashley A (1975) Cocaine: Its History, Use, and Effects. New York: St. Martin’s Press.
9. National Institute on Drug Abuse (2018) Overdose death rates. https:// www.drugabuse.gov/related- topics/trends- statistics/overdose-death-rates
10. United Nations Office on Drugs and Crime (2018) Coca crops in Colombia at alltime high. https://www.unodc.org/unodc/en/frontpage/2018/September/cocacrops-in- colombia-at-all- time-high--unodc-report- finds.html
11. Winter JC (1998) The re-demonizing of marijuana. Pharm News 5(3):22–27.
12. Kaysen S (1993) Girl Interrupted. New York: Vintage Books.
CHAPTER 2
Opioids
God’s Own Medicine
Albert Schweitzer called pain “a more terrible lord of mankind than even death.” Thus, it is not surprising that humans have from the earliest times attempted to identify plants which might provide pain relief. The Odyssey by Homer provides a mythic account of the use of one such agent.
Then Helen, daughter of Zeus, took other counsel. Straightaway she cast into the wine of which they were drinking a drug to quit all pain and strife, and bring forgetfulness of every ill. Whoso should drink this down, when it is mingled in the bowl, would not in the course of that day let a tear fall down over his cheeks, no, not though his mother and father should lie there dead . . . Such cunning drugs had the daughter of Zeus, drugs of healing, which Polydamna, the wife of Thor, had given her, a woman of Egypt, for there the earth, the giver of grain, bears the greatest store of drugs . . .1
More than a century ago, it was suggested by Oswald Schmiedeberg, a German scientist regarded by many as the father of modern pharmacology, that the drug to which Homer refers is opium for “no other natural product on the whole earth calls forth in man such a psychical blunting as the one described.”2 When today, in the fields of Afghanistan or Turkey or India, the seed capsule of the opium poppy, Papaver somniferum, is pierced, a milky fluid oozes from it which, when dried, is opium.
Virginia Berridge, in her elegant history of opium in England, tells us that the effects of opium on the human mind have probably been known for about 6,000 years and that opium had an honored place in Greek, Roman, and Arabic medicine.3 I will not dwell on that ancient history but will instead jump ahead to the 17th century by which time opium had gained wide use in European medicine.
Writing in 1680, Thomas Sydenham, a British physician, said this: “Among the remedies it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious.”4 Sydenham’s favored form of opium was a solution in alcohol, a combination which came to be called laudanum. In addition to the relief of pain, opium was employed against dysentery, asthma, uncontrollable cough, fever, and a variety of other ailments; even diabetes was an indication for its use. Today opium remains in American medicine only in the form of paregoric, camphorated tincture of opium. Many a parent has witnessed relief of their child’s diarrhea by paregoric without knowing the origins of this remedy. In the past, babies born of heroin or methadone-dependent mothers, and thus themselves physically dependent, have had their withdrawal syndrome eased by paregoric.5
CONFESSIONS OF AN OPIUM EATER AND OTHER PLEASURES
But, as was suggested by Homer, there is more to opium than its ability to relieve pain, fever, cough, and diarrhea. John Jones, a British physician, published a book in 1700 called The Mysteries of Opium Reveal’d. 6 In it he said that opium also causes “a most delicious and extraordinary refreshment of the spirits” as upon receiving “very good news or any other great cause of joy.” In language bold for his day, Jones went on to say that “It has been compared not without good cause to a permanent gentle degree of that pleasure which modesty forbids the name of . . .” Modern film-makers show no such modesty. Speaking of heroin, an opioid we soon will consider, Rent-Boy, an opioid addict in the film adaptation of Irvine Welsh’s novel Trainspotting, says this: “People think it’s about misery and deprivation and death and all that shit, which is not to be ignored, but what they forget is the pleasure of it all. Otherwise we wouldn’t do it. . . . Take your best orgasm, multiply by a thousand, and you’re still nowhere near . . . ”7
The smoking and eating of opium in the Orient has a long history. Indeed, so lucrative was the Chinese opium trade for the English in the 19th century that the British East India Company conducted the so- called
opium wars to keep open the import of Indian opium into China.8 In the West, the opium habit in China was generally viewed as no more than a vice among the lower levels of society, and it was little recognized that opium had become an increasingly popular drug among the working class of England as well. In any event, opium was of little interest to European intellectuals. This changed with the publication in 1821 of The Confessions of an English Opium Eater. 9
The Confessor was Thomas De Quincey, who would go on to be one of England’s most prolific and admired authors. De Quincey was introduced to opium at the age of 19 to relieve the pain of a toothache but soon became a regular user for reasons which he described in The Confessions: “For it seemed to me as if then I stood at a distance, aloof from the uproar of life; as if the tumult, the fever and the strife were suspended; a respite were granted from the secret burdens of the heart. . . . Here was the panacea for all human woes; here was the secret of happiness. . . . Thou hast the keys of paradise, O just, subtle and mighty opium.”
De Quincey was not alone in his admiration for opium. Its use was a regular feature of romantic writers of the time: George Crabbe, Wilkie Collins, Francis Thompson, and John Keats in England, Charles Baudelaire in France, and Edgar Allan Poe in America were all devotees. (Some scholars have suggested that Poe was more regular in the use of opium in his writings than in person.) Samuel Taylor Coleridge wrote that his epic poem Kubla Khan was inspired by an opium dream. For many of these men, laudanum was the vehicle of choice, thus raising the issue of concurrent alcoholism.10
Despite lavishly praising the virtues of opium, De Quincey as well as medical writers of the time were aware of its more sinister aspects. In the mid-19th century, an American textbook of pharmacology noted that the use of opium was a vice, “very often pernicious in its effects,” and the source of much abuse.11 However, the author went on to say that “it does little apparent injury even through a long course of years . . . is less injurious to the individual and society than alcohol and that this evil may be corrected without great difficulty if the patient is in earnest . . .” De Quincey’s view of the ease of “correction” of the opium habit, or as we would term it, opiuminduced physical dependence, was less sanguine.
In The Confessions, De Quincey wrote that “I have struggled against this fascinating enthrallment with a religious zeal and have accomplished what I never heard attributed to any other man—have untwisted almost to its final links, the accursed chain which fettered me.” We should note the inclusion of “almost” in that sentence. In fact, De Quincey soon relapsed and used opium on and off for the remaining 55 years of his life.12 I am
