THE ADDICTION EPIDEMIC

169 different batches of the drug, and it may be that variations the Law. Whether, in this instance, the Law is not an ass in the results of treatment between different series and both Dr. Glatt and Dr. Bewley question. The prescription even individuals in the same group of patients are due of drugs for recognised addicts has been approved to in as of variation as well the because it represents addiction as a medical rather than a toxicity largely potency It is worth that drug. remembering, however, nephro- criminal matter. The addict is not driven to consort with was in of Howard’s earlier society’s outcasts, and large-scale traffic in drugs is blastoma almost 90% fatal series of children, and that much higher doses are prob- prevented. On the other hand, the general practitioner ably needed than have commonly been given in the past can never be sure that he is not over-prescribing. He has if results are to be improved. only his patient’s word for the dose required and cannot Howard also discusses the management of pulmonary know how many of his colleagues besides are being asked to supply it. The addict has any excess he may obtain for metastases. When these first appear after a course of are new or potential addicts. "If ", actinomycin they are usually resistant to further treatment sale, and the buyers with this drug and may best be dealt with by irradiation says Dr. Bewley, " potential addicts had less contact with or excision. Metastases which appear in the lungs before addicts and less ease of access to narcotics, there would be been has should be treated full with a less addiction." given actinomycin course of the antibiotic and irradiated if regression is not Dr. Glatt suggests that addicts should have to get their complete. Metastases which are resistant to actinomycin supplies from recognised centres and from them alone. or irradiation do not usually respond well to excision. Prescription would then be preceded by objective assessMetastases in liver and bone resisted actinomycin and ment of the amount required. Each writer pleads for responded only temporarily to irradiation. compulsory notification of addiction by practitioners so that the size of the problem may at least be accurately known. (Collation of information by the Ministry of Health rather than the Home Office we have suggested THE ADDICTION EPIDEMIC before) Dr. Bewley recommends besides that a body be OFFICIAL figures1 indicate that opiate addiction in this set up to keep the situation under continual review; at country is on the increase and that its pattern is changing. present, the Interdepartmental Committee on Drug Dr. Bewley2 confirmed this from his own experience, and Addiction meets only periodically. Where prevention is so greatly preferable to treatment, on p. 171 Dr. Glatt has the same tale to tell. The middlea policy of wait-and-see is not justifiable. Sterner pretreatment addict from medical is whose habit stems aged ventive measures will have to be taken and, whether or not no longer typical. Today’s addict is under 25 years of age and has progressed, under the tutelage of addicts like they prove effective, proper provision will have to be made himself, from amphetamines and marihuana to the for the treatment of the young addicts already with us. A intravenous injections of heroin and cocaine. Thus, the few special units in mental hospitals, properly staffed, and modern habit is contagious and, as Dr. Bewley points out, run, as Dr. Bewley suggests, in conjunction with the the more addicts there are the more quickly will their teaching hospitals is one possibility. With this " chronic number increase. It is thought to be currently of the order relapsing disorder " on the increase and the results of of two thousand (no accurate information is available), treatment still unsatisfactory they should have plenty to do. but the situation stands to get worse before it improves. Reviews of treatment and prevention is therefore urgent. IN THE PINK Treatment involves many difficulties. In the first place, addicts are not always prepared to submit to it. Most of THBRE are old pilots and bold pilots : but no old, bold Dr. Glatt’s patients had been faced with a stay either in pilots." This venerable paradox on the value of fear now hospital or in some sort of penal institution and had receives official support from the Ministry of Aviation. In " chosen the former only as the lesser of two evils. Not only an information circular " printed on pink paper, airmen the addict, however, is unwilling. Inpatient treatment is are advised that " fear is normal and provides a very essential and hospitals are, in general, reluctant to under- effective alerting system. Tranquillisers and sedatives take it. The addict, as Dr. Bewley says, makes a poor depress this alerting system and have been a contributory patient, unmanageable in the psychiatric units of teaching cause of fatal aircraft accidents." or general hospitals. His admission therefore devolves on Though fear is the emotional spring, it is the enhanced the mental hospitals which are often too busy and underawareness which flows from fear that aids the airman-or staffed to do more than see to the initial withdrawal phase. any other who must keep his wits about him in a potenThe addict is then discharged having, perhaps, resolved to tially dangerous situation-to anticipate and react. The maintain his independence. He is likely to have neither successful pilot never allows experience and ability to dull job, training, guidance, nor moral support: he returns to the subtle apprehension which stimulates the constant his old friends, his old environment, and, before long, search for signs of the unusual: he scans the sky, the visible his old ways. The longest abstention achieved among parts of the aircraft, and the instruments in a ceaseless Dr. Bewley’s patients after discharge was 22 weeks. One watch. If he stops worrying, sooner or later he may be of Dr. Glatt’s patients was still off drugs after 2 years. lost. Controlled anxiety is the best shield against disaster. Dr. Glatt believes that one factor encouraging the On the other hand, uncontrolled anxiety clouds judgaddict’s early relapse is the ease with which he can law- ment and inhibits action. It is unusual among airmen, fully obtain fresh supplies of drugs from a general except as an acute emotion in some extraordinary situation, practitioner. If a practitioner proves " difficult " he or as a result of fatigue: and symptomatic treatment by moves on to another until he finds one agreeable to the sedatives or tranquillisers is dangerous, since the fine regular prescription of dangerous drugs countenanced by control which would abolish the inhibiting excess without 1. Reports to the United Nations by Her Majesty’s Government on the cancelling the protective sufficiency is lacking in drug "

2.

Working of the International Treaties Bewley, T. Lancet, 1965, i, 808.

on

Narcotic Drugs, 1957-1962.

3. ibid. 1964, i, 649.