[MENTION=360]prplchknz[/MENTION] to answer your questions, check out my latest blog posts:
http://www.typologycentral.com/forums/private-blogs/79175-sultanate-3.html
But here's a basic summary of everything: I'm not saying addicts didn't exist. What's important though is... What is addiction? How does it occur, when, why, to what extent... Why are there such differneces between time periods, geographic locations, different populations of users, based on everything from social context, their personality, etc... Basically, historically, moderate opioid use has been the rule. That is, the majority of users, whether "medical" or "non-medical" (this distinguishing between medical and nonmedica, legitimate and nonlegitimate is highly arbitrary, by the way) used moderately. We can also see geographic differences, difference between different time periods, we also see differences in method (there's an interesting case in the Netherlands, and you can read about it in the article on drugtext.org: when heroin users who shot up changed to vaporizing, their health and safety drastically increased), etc...
Either way, some things need to be said about the concepts we're using:
Above all it demonstrates that the concepts, the reactions, the structures of control which are now taken for granted are not fixed and immutable. The division between 'medical' and 'non-medical' use, the categorization of what is 'legitimate' or 'illegitimate' drug use, addiction as a sickness, or even as an exclusive condition, are not timeless concepts, but historically specific and laden with implicit assumptions. Contemporary attitudes towards narcotics are not simply an arbitrary figment of man's unreason for which history proveds some whiggishly relevant insights. They are the product of a social structure and the social tensions of that time. Michael Ignatieff has commented in a recent study of the establishment of the prison in the early nineteenth century that no proper discussion of reform or change can take place as long as the participants still use concepts and perceptions which arise out of a past which they ostensibly deny. Discussions of the historical relevance of opium and its contemporary implications have suffered from much the same deficiency. But through an awareness of the dynamics of the 'problem' of opium use, of the social roots of medical ideas, of the developing links between medicine and the state, can come a questioning of our present-day assumptions and contemporary pretensions to control.
As far as moderation...
Speculations on the nature and pattern of opium smoking
John C. Kramer, M.D., Associate Professor in the Department of Psychiatry and the Department of Pharmacology at the University of California, Irvine.
'...most evidence suggests that moderation in the consumption of smoking opium was the rule both in China and elsewhere...This is not an argument favoring moderate use of opium. It is rather an indication that social and perhaps psychophysiological forces work toward limiting the liabilities of drug use within society.'
'...We have assumed, evidently erroneously, that opiates including smoking opium are so seductive and tolerance to it is so profound that moderation is impossible.'
'...While testimony varied widely, it appears likely that most opium smokers were not disabled by their practice. This appears to be the case today, too, among those people in southeast Asia who have continued to smoke opium. There appear to be social and perhaps psychophysiological forces which work toward limiting the liabilities of drug use.'
'...estimates of average consumption are available. Kane (1992:64) reported one survey of the daily consumption of 1000 smokers:
646 smokers used between 1 and 8.5 Gm.
250 smokers used between 11 and 21 Gm.
104 smokers used between 32 and 107 Gm.
Thus, about two thirds of the smokers surveyed used substantially less than 12 Gm. daily and probably few of the heaviest smokers approached the maximum consumption listed.'
'...One survey about 1880 of 1000 opium smokers suggests that the heaviest using 10 percent of the group consumed 50 percent of the opium....'
'...Geddes (1976:221-2) reviewed the Thai government's 1965-6 survey on addiction: The Miao were reported to have a 9.55 percent addiction rate, the Lahu 11.17 percent and the Yao, 15.9 percent. The overall rate for the tribes studied was 3.6 to 6.1 percent among males and 1.2 percent among females. He says that though addiction is recognized as a social problem among the Miao, it is not severe in most Mao communities. In one village he noted "a number" of occasional and moderate smokers, one of whom had retired as headman, and was still vigorous for his age. Four to 5 percent of the village were "seriously" addicted.'
SPECULATIONS ON THE NATURE AND PATTERN OF OPIUM SMOKING | Opiates, heroin & methadone
As far as physical withdrawal...unpleasant, sometimes very (in extreme cases, and extreme situations, combined with malnutrition, and unhygienic conditions even deadly:
The Worst Place to Die: How Jail Practices Are Killing People Going Through Opioid Withdrawals | TheInfluence ), but unlike delirium tremens from GABA drug - benzos, barbs, booze.. - which can be lethal in and of itself:
https://en.wikipedia.org/wiki/Delirium_tremens
Delirium tremens (DTs) is a rapid onset of confusion usually caused by withdrawal from alcohol. When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days. People may also see or hear things other people do not.[1] Physical effects may include shaking, shivering, irregular heart rate, and sweating.[2] Occasionally, a very high body temperature or seizures may result in death.[1]
Alcohol is one of the most dangerous drugs to withdraw from
An alcoholic man with delirium tremens on his deathbed, surrounded by his terrified family.
Prevention is by treating withdrawal symptoms. If delirium tremens occurs, aggressive treatment improves outcomes ... Mortality without treatment is between 15% and 40%.[7] Currently death occurs in about 1% to 4% of cases.[1]
)
..and yet..
.. the opiates, barbiturates, and amphetamines incude tolerance, so that increasingly large doses are needed, and barbiturate users, especially, suffer severe withdrawal symptoms when the drug is stopped. But even with these drugs the personality of the user and the situation in which use occurs - set and setting - have to be taken into account. It is a myth that one shot of heroin makes an addict. Addiction occurs much later, often after a long period of "chipping" or a weekend habit. It has been demonstrated that a number of doctors who were taking as many as four shots of morphine a day were able to stop without discomfort when they were on vacation. It appears that even the problem of severe withdrawal symptoms has been exaggerated...
... medical authorities now widely agree that even heroin and the opiates cause no physiological damage. An addict may suffer from chronic constipation and reduced sexual potency, but assured of a drug supply he will live to a ripe old age. It is true that addicts risk collapsed or abscessed veins, and even death, but these result from unregulated doses and unsterile equipment. The addict who is a "walking death" has been brought to that condition by the present state of the law...'
We can also see just how arbitrary the whole concept of addiction itself is...as well as the difference between "medical" and "non-medical", legitimate and illegitimate...
The legal status of opium in England in the 19th century:
...Laudanum and the other preparations were to be found not just in high-street pharmacies but on show in back-street shops crowded with food, clothing, materials and other drugs.... those selling drugs in Preston included a basket maker, shoe maker, smallware dealer, factory operative, tailor, rubbing stone maker and baker, and a rent collector, who, as he pointedly noted, was `connected with a burying club'... Many of the people engaged in selling drugs and chemicals would sell opium with complete freedom, and their number was estimated in the 1850s to be between 16,000 and 26,000, although even this number probably
did not include small `general' stores dealing in all manner of goods as well as opiates.
19th century England, at a time where the "medical" explanation of addiction was being formulated (especially towards the end of the century):
In essence, the nineteenth century evolved the treatment of addiction as a method of dealing with the individual who in some way offended society's idea of what was decent and orderly. It was not as if anyone could put forward evidence that the condition was particularly life-threatening or damaging to the health of the individual himself, nor was there much evidence that the social demand for treatment was generated in any large measure by the belief that the addict caused great trouble to family and friends, or to other members of society. In the late nineteenth century the leading image of the addict was of the middle-class patient (often a woman) indulging in a self-regarding act which was mildly damaging to health and perhaps a little bit of a nuisance. The historical evidence given in Chapter 12 suggests that this image of the class and sex characteristics of the addict was badly out of focus, while even at the height of concern about morphine addiction, remarkably few addicts were actually being admitted to hospitals or nursing homes. The extent of learned debates on therapeutic methods which were conducted in the medical journals was out of balance with the actual treatment demands...
n so far as treatment had a manifest clinical purpose it was therefore to save the individual from his own behaviour, although the latent social purpose of correcting unacceptable deviance must have been of equal or greater importance. If opiates had produced compulsive drug-seeking without physical withdrawal symptoms, the medical profession might not have had such a ready opening for promulgation of disease theories, while if alcoholism treatment had not provided a contemporary parallel and a base for medicalization, treatment of opiate addiction might not have become such a socially accepted idea. Without alcoholism, there would certainly have been no Society for the Study of Inebriety.
The hint is though that incapacity from use of opium was not seen as a problem of such frequency and severity as to be a leading cause for social anxiety. The prime image of the opium user was dissimilar to that of the wastrel and disruptive drunkard. Opium users were not lying about in the streets, or filling the workhouses, or beating their wives. It seems fair to conclude that at the saturation level which the plateau represented, opium was not a vastly malign or problematic drug in terms of its impact on social functioning. But the conclusion must at the same time also be accepted that opium when freely available was, indeed, a drug which could at the population level give rise to certain definite health risks. The impact on infant mortality cannot be quantified, and as has already been argued in Chapter 9 opium would often have interacted with disease and malnutrition to produce an unhappy result, when no single factor could be held solely to blame..
So much then for a tentative set of conclusions. In a particular historical period and in the social context of a particular country, and with opium as a drug available only in oral form, we can begin to see the outline nature of the equilibrium reached between the society and the drug - a plateau at a high general level of usage and with regional variation, no persuasive evidence of large-scale social incapacity, but with associated mortality levels which, though not too disastrous when matched against certain modem drug experiences, were nonetheless cause for concern..
And this taking into account that if you look at the amount of opium used at the time, you reach a figure of 127 normal doses per person per year:
The second conclusion relates to the actual level of the plateau. Three pounds avoirdupois amount approximately to 1.36 kg. The average consumption per person at alb. per 1,000 population would therefore have been 1,360 mg. of opium annually. A recommended single-dose level for opium is today 6o mg. (containing about 6 mg. of morphine). This would imply that between 1830 and 1860 the average user - man, woman and child - was consuming in terms of today's judgements roughly 127 therapeutic doses of opium each year. It is fair to conclude therefore that the plateau represented a very high level of population experience with this drug.
There has recently, as regards population alcohol consumption, been much interest among epidemiologists in how use levels are distributed within the population, with the prediction that the distribution curve will usually be skewed and with a long low upper tail, rather than being represented by the familiar inverted U of the normal distribution curve.32 The data are not available to reconstruct how opium consumption would have been distributed, but obviously the average alone does not tell us all we want to know - many people would have been consuming less than the average, and equally certainly a proportion would here have been consuming much more, and some people very much more.
Moving on to a harder opioid, there's the well-known Vietnam case:
..the contention that heroin irreversibly enslaves the user has not been confirmed by any large-scale study of drug use. In Vietnam, for example, the U.S. Army found by testing urine specimens that more than 250,000 American soldiers had used heroin, and that of these, some 80,000 could be classified as addicts (in that they used it every day for long periods and suffered withdrawal symptoms). Yet, more than 90 percent of these users and addicts were able voluntarily to withdraw from the use of heroin without any medical assistance or without any permanent aftereffects. Follow-up studies showed that less than 1 percent of the total number - and less than 6 percent of the addicts - used heroin again in a two-year period after they were discharged from the Army. Doctors and scientists studying this massive data were compelled to conclude that heroin use did not necessarily lead to addiction, and that addiction was not necessarily irreversible...
Agency of Fear | Table
A study on opium users in Asia:
...The authors sum up the question of opium's impact on social functioning by saying that there are `two extremes with many in-between'. As ever, there is need to underline the point that different contexts will mean different consequences. ...
Chinese immigrants in the US (when opium was still legal): most used moderately...
and even those who used heavily were by and large functional - in fact so functional...
The work incentives of opiate users, as reported by hostile parties, have changed radically with the politics of their times. According to a contemporary authority, an addict "characteristically becomes lethargic, slovenly, undependable, and devoid of ambition." By contrast, at the turn of the century opium became illegal in the United States, in large part due to the efforts of Samuel Gompers. He claimed that its use by Chinese immigrants so increased their productivity that whites were at a disadvantage in the labor market. Additionally, it increased their risk-taking proclivity, as virtually all Chinese were alleged to be heavy gamblers. In reality, the period between the Civil War and World War I was the period of America's greatest sustained proportional economic growth. It was characterized by low unemployment rates, legal opium, and a large population of habitual users. The same was true of Victorian England.
8 THE MARKET FOR HEROIN BEFORE AND AFTER LEGALIZATION | Dealing with Drugs
Also, this is important: now that in the US you have a serious situation, where you have whites, mostly less-well educated ones, killing themselves, directly or indirectly, with suicide, booze, drugs... While the same is not happening in any other developed country. Why is this happening?
Krugman has some explanations (but not necessarily solutions):
http://www.typologycentral.com/foru...rent-events/82662-despair-american-style.html
oh and here's the Dutch case:
...We believe that this Dutch example demonstrates that less repression of heroin use most likely results in less risky modes of heroin use and that fiercer repression leads to riskier methods. At the same time less repression has not resulted in higher numbers of consumers. On the contrary, heroin consumption has mostly become an issue in geriatric care in the Dutch context.
Now, although we by no means support moral judgements over heroin self-administration by injection or injecting as such, for example calling it a form of auto- mutilation, we do believe chasing heroin to be a generally safer method of heroin use than injecting. We believe the Dutch epidemiological data[24] as well as the general condition of the average Dutch heroin user, support this argument but are obviously open to debate.
We may also conclude from this example that peer, fashion and culture driven processes are far stronger than any policy, legislation or prevention program. There is nothing any policy or prevention program has done initially to drive heroin users from the needle to chasing the dragon. We had no clue and a lot of Dutch luck. Which by no means implies we can do nothing. On the contrary, we believe that, proper, non-stigmatized information and low threshold care services combined with decriminalization of use are vital for a healthier drug policy reducing substance use related risks.
Promoting chasing as a harm reduction campaign in our view is potentially a useful strategy but strongly depends on the availability of chaseable heroin, relatively low prices and low repression. Furthermore changing drug administration rituals by means of drug service programs is a substantial challenge not to be underestimated.[25]
A design for a functional regulation of heroin is not in the scope of this article but we may conclude that also in the relation of heroin and criminal law, it is difficult to distinguish between remedy and disease. In our view, administrative/medicinal legislation/regulation is by nature better suited for public health issues such as substance use and the Dutch policy is but an example of damage control under self inflicted hazardous conditions.
Finally as heroin is now generally seen as unfashionable, uncool and a even a loser’s drug in Dutch youth culture and we almost haven’t seen any new, young heroin users for many years now, what does this mean for the future? Very little or nothing. If heroin would suddenly become hip, fashionable and sexy again tomorrow, we believe there is not much that any policy can do about it.
Also, this is important:
Occasional and controlled heroin use: Not a problem?
Hamish Warburton, Paul J. Turnbull and Mike Houg
JRF Drugs and alcohol research programme
This series of publications examines the social dimensions of drug and alcohol use. It focuses on sensitive issues which are difficult for government-funded research to address, and on the implications for policy and practice
...The report deconstructs some of the myths surrounding heroin use and heroin dependence. It is relevant to policy-makers, those working in the drug treatment field, academics and drug researchers.
...Some people will argue that it is irresponsible to draw attention to groups of heroin users who manage to control their heroin use. The argument is that downplaying the risks will inevitably result in more widespread use and greater suffering. We would argue that in drugs prevention honesty is always the best policy. Those who are the target of drugs education are highly sensitive to exaggerated messages, and will discount these. We also think that sustaining a popular belief in the inherent uncontrollability of heroin dependence could itself have perverse consequences. Drug dependence is to some extent socially constructed - in the sense that public beliefs about drugs such as heroin determine how people actually experience them. It is possible - but not provable - that the way that public stereotypes of heroin use are deployed may help create the highly destructive role of 'junkie' that many heroin users occupy. In a world in which heroin is increasingly available, policy should do all that it can to undermine this stereotype.
...Heroin careers can be fluid, varied and hard to define. Patterns of heroin use described to us are at odds with popular beliefs about heroin use...These findings show that some people can use heroin for prolonged periods of time without becoming dependent. They show that some people can use heroin dependently, but in a stable and controlled way that causes few of the problems typically associated with the drug. Some interviewees had also switched from problematic patterns of use to stable, controlled or non-dependent patterns of heroin use. Contrary to popular assumptions about heroin use, the findings suggest that heroin use does not lead inexorably to dependence and that chaotic use is not an inevitable outcome of dependence. Importantly, it also shows that some people can bring their heroin use back under control after periods of uncontrolled or highly problematic use. Interviewees were careful about where they used heroin and whom they used with. This allowed them to use heroin in a safe, comfortable and relaxing environment.
...
To finish..I'm not saying that the drug itself is not important at all. But it is just one of many things that together combine into a nuanced, complex picture of the whole phenomenon:
Far from the physical attributes of the drugs in question being a side-issue or something quite separate from the main business, an understanding of the extraordinary subtlety and potency of the actions of these substances on the human mind and body helps not only to make intelligible the social processes which were the game evolved around them, but re-inforces one's sense also of the astonishing subtlety and potency of accidental and informal, or formal and purposive social processes, which allow society at different phases in history to live on terms with these strange mindacting chemicals.
http://www.drugtext.org/Opium-and-the-People/appendix.html