Apomorphine Versus Addiction

Chapter Six

“Society cares for the individual only so far as he’s profitable”
— Simone de Beauvoir

In late 1955 Dent was obviously pleased that “The medical profession has beaten the Government’s proposed ban on the legal production of heroin” but he didn’t desist from emphasising where the next danger lay:

          “Now it is the turn for the government to beat the profession and induce it to prescribe less of the addictive drugs, especially the barbiturates. Doctors must learn that an anaesthetic is not a hypnotic. Dulling the cerebrum is not the same as producing sleep. Sleep is an activity of the hypothalamus and even when we are soundly asleep we are still acutely aware of our surroundings and remain responsive to the slightest stimuli. The word “hypnotic” has become nothing more than a euphemism for a “deadener”; “lethic” would be a better term.”

This plea would fall on deaf ears. Barbiturates and amphetamines were already in widespread use and Big Pharma was about to release the Benzodiazapines that include Colnazepam, Diazepam or valium, Lorazepam, Chlordiazepoxide or librium, Alprazolam, Temazepam, and so on. These were less toxic than the Barbiturates they would supersede but are still “lethics” and invariably lead to dependency with severe side-effects including the pain of withdrawal. For the pharmaceutical corporations, with increasing influence over which drugs were available for prescription, this was win/win, an undoubted triumph for the “free” market economy, but of dubious benefit to the anxious, depressed or addicted patient who may have preferred any route that offered an abstinence based model. Predictably on 16/5/70 twenty British doctors reflected on the inevitable when, having noticed a further deterioration in the drug problem, they corresponded in the BMJ;

“The increasing number of methadone (physeptone) addicts a proportion of whom are receiving their supplies from G.P’s. and in addition the ease with which young persons are still obtaining from doctors preparations containing such drugs as amphetamines, barbiturates, opiates, and other stimulants of the Central Nervous System.”

(The emergent “pill a day” culture that ensued illustrates just how easily the NHS and its doctors have been manipulated by Big BRAIN-LETTER_400Pharma and how governments have played their part in facilitating the excesses typified by Renton in Irving Welsh’s 1993 novel “Trainspotting”; “Swanney taught us to adore and support the National Health Service, for it was the source of much of our gear. We stole drugs, we stole prescriptions, or bought them, sold them, swapped them, forged them, photocopied them or traded them with cancer victims, alcoholics, old age pensioners, AIDS patients, epileptics and bored housewives. We took morphine, diamorphine, cyclone, codeine, temazepam, nitrezepam, phenobarbitone,, sodium amytal, dextropropoxyphene, methadone, nalbuphine, pethidene, pentaxocine, buprenorphine, dextromoramide chlormethiazole.” The hedonism of drug taking is constantly emphasised by Welsh as is the “psychic defense” of a generation shorn of traditional values and identity. The irony, however, of the NHS providing the wherewithal for this hedonistic defiance was only lost  on those who enabled it.)

Despite these concerns, Britain was moving inexorably towards becoming an off shore drugstore for corporate America. Any notion of medical independence was by now the illusory preserve of a dwindling medical fraternity, for whom the Hippocratic Oath was becoming increasingly subsumed by vested interests and sadly eroded by a spineless government. But craven British hypocrisy knows no bounds, there is no cause it cannot insidiously dismantle, no commercial interest it cannot throw its supine weight behind and no expedient tactic it will not embrace to enforce its own or another’s toxic will. Despite all evidence to the contrary the emerging NHS bureaucracy would attempt to seize even the moral high ground in order to get its way. In the same year as Dent waged his moral assault on Anslinger this correspondence (on right) with five signatories appeared in the Telegraph:

             “the decision” (to ban heroin) “involves a choice of social values which cannot be made by doctors alone, but only by Government.”

British doctors were now to receive moral guidance from those only too happy to be the mouthpiece for Whitehall, WHO and the Narcotics Bureau in Washington rather than listen to their own specialists working at the sharp end. The lunatics were taking over the asylum, this was the thin end of of a very long and divisive wedge that would ultimately erode the self same “social values” that the British government, with bewildering sanctimony, purported to uphold. (Interestingly, one of the signatories to the above quote was Russell Brain and it would be Brain, a neurologist and a practising Quaker who subsequently delivered the reports into the Misuse of Dangerous Drugs in 1961 and 1964. An ideal man for the job; all he lacked was a halo though he was rewarded with a peerage.)

Unbelievably, despite this demoralisingly self-righteous atmosphere, Dent would not give up on Apo’! In the same year, 1955, at the same time that the Heroin Bill was debated, Dent wrote to America requesting support for his initiative which by now he had developed and was using in pill form with sub-emetic doses, dissolved under the tongue. He had realised that Apo’ taken in this way (also nasally) was effective as the blood brain barrier was more easily bridged than by swallowing, when a large proportion of Apo’s effectiveness is destroyed through the stomach. Dent wanted to share this information with anybody who would listen but the reply dated 22/2/1955, from the American Medical Association and the “Land of the Free” suggested that America had already made up its mind:

“In sub-emetic doses apomorphine produces a hypnotic or narcotic effect. As such it is potentially habit forming. If it actually satisfies the compulsion of the alcoholic or the narcotic addict to escape from reality, it accomplishes this through the same fundamental depressant or euphoric effect as alcohol, barbiturates or narcotics. In my opinion apomorphine would be most unsatisfactory and potentially dangerous for the treatment of alcoholics or other forms of addiction.”

Dent replied to the doctor at A.M.A. pointing out;

The Second Letter to Dent from AMA which clearly states that his request for research should be addressed to the Committee on Narcotics and Drug Addiction in Washington.

The Second Letter to Dent from AMA which clearly states that his request for research should be addressed to the Committee on Narcotics and Drug Addiction in Washington.

“There is a fundamental difference between the action of apomorphine and that of the central depressants. Apomorphine has little if any action on the cerebrum but owes its calming effect to stimulation of the hypothalamus.”

And continued:

“No addiction to it has been produced in over 4000 cases during the past 35 years during which I and others have been using it for compulsive alcohol and drug takers and cases of mental disturbance.”

Dent was also fascinated to know from AMA just what the “lethal dose” of oral Apo’ could possibly be? He had been trying to find out for years (ha,ha!) and had never been able to discover what it was (HA,HA!). He once had a female patient who honestly wanted to kill herself with Apo’ and Dent had “obliged” with 500 pills but alas, to no avail. (LOL!) Of course, as any increase in oral Apo’ will eventually remove itself due to its emetic property you have to say of the two doctors Dent probably knew more about what he was talking about though it is equally clear that this American was not going to take kindly to another of Dent’s anecdotes laden with ridicule.

The question remains however, why would an American doctor and one presumably representing the position of A.M.A., be so flatly hostile to correspondence concerning an appeal for more research? If he really was so sure that Apo’ was “dangerous” you would also expect him to know where in the brain Apo’ performs its action and what its properties are. Clearly there was more than a little confusion.  Was he confused by the suffix “morphine” (?) or perhaps he thought he was describing methadone which, unlike Apo’, is indeed potentially “dangerous” and “addictive”(?) or, maybe, the answer lay in his follow up letter to Dent dated 22/2/1955 which tersely stated;

 “ I would suggest that you take this matter up with the Committee on Narcotics and Drug Addiction of the National Research Council, 2101 Constitutional Ave., Washington, D.C.”

It is extremely doubtful that Dent would have taken up this invitation. He may have been naïve to enquire in the first place but not so deluded as to fail to realise that whenever drugs policy,  profitability and ethics became intertwined that all roads are a dead end and finish in Washington.

"Oh America!" by Gee Vaucher

“Oh America!” by Gee Vaucher

By the early 1960s, still in London and still working Dent was running out of steam. His TB, bouts of double pneumonia and sixty cigarettes a day was beginning to take its toll. He decided to reel in his doses of  “charisma” by treating people by correspondence only and confusingly for his detractors the sub-emetic pills were still therapeutic.  Nevertheless it was still not regarded as worthy of any detailed research by any medical body or association in America or in the U.K. Dent battled on giving lectures in Europe and at home and in his last SSA editorial expressed his enduring regret at the “aversion” label that Apo’ could not shake off:

         “I made many bad mistakes in that first paper, the worst being the stressing of the aversion factor in the action of apomorphine which is slight and often non existent and does not contribute to the success of the treatment. I have never been able to correct this mistake and to my shame it is the only factor used by some doctors who have followed me, notably in Czechoslovakia, U.S.A. and France.”

Dent had several profound interests throughout his life. Three of these; cartography, palaeontology and geology combined to give his holidays purpose. He’d often return with a boulder or rock, rolled off some mountainside to be analysed and added to the rockery at the end of the garden. Naturally, whenever he moved house, the rockery had to come too which by the end of his life was a huge undertaking. He was not well but still working and to help out after his latest move one of his three daughters offered to “sort out his rocks.” It took her all day but finally, with the last one wedged into position, she stood back in admiration of her accomplishment. At that moment Dent emerged to join her. For a few moments there was silence.

Well?” she said, getting her breath back, “What do you think?”

The strata’s all wrong!” he said.

John Yerbury Dent died at work on 8th January 1962. He was seventy-three.

Dent's obituary in the British Medical Journal exhibits a clear understanding of Dent's holistic approach to treating of addiction. By the late 80s this had been reinterpreted by the historian Virginia Berridge to be a purely "biological" interpretation and a treatment that derived from "social context". This only goes to prove that while no history isn't good bad history is worse.

Dent’s obituary in the British Medical Journal exhibits a clear appreciation that Dent’s approach to overcoming addiction was both holistic and egalitarian. By the late 80s this had been reinterpreted by the historian Virginia Berridge to be purely “biological” and derived from “social context”. This only goes to prove that while ‘no history’ isn’t good, ‘bad history’ is worse.

© Warwick Sweeney, © October 2013. All rights reserved.

3 Responses

  1. Amazon.fr – The Cannabis Health Index: How to Achieve …

  2. Chronic Fatigue Syndrome Forum, Chronic Fatigue Syndrome …

  3. It’s about time that addiction was tackled constructively.

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