Busting a Drug Myth

Theodore Dalrymple, author of Romancing Opiates, calls commonly held beliefs about opiate addiction and withdrawal poppycock:

Heroin doesn't hook people; rather, people hook heroin. It is quite untrue that withdrawal from heroin or other opiates is a serious business, so serious that it would justify or at least mitigate the commission of crimes such as mugging. Withdrawal effects from opiates are trivial, medically speaking (unlike those from alcohol, barbiturates or even, on occasion, benzodiazepines such as valium), and experiment demonstrates that they are largely, though not entirely, psychological in origin. Lurid descriptions in books and depictions in films exaggerate them à la De Quincey (and also Coleridge, who was a chronic self-dramatizer).

I have witnessed thousands of addicts withdraw; and, notwithstanding the histrionic displays of suffering, provoked by the presence of someone in a position to prescribe substitute opiates, and which cease when that person is no longer present, I have never had any reason to fear for their safety from the effects of withdrawal. It is well known that addicts present themselves differently according to whether they are speaking to doctors or fellow addicts. In front of doctors, they will emphasize their suffering; but among themselves, they will talk about where to get the best and cheapest heroin.

When, unbeknown to them, I have observed addicts before they entered my office, they were cheerful; in my office, they doubled up in pain and claimed never to have experienced suffering like it, threatening suicide unless I gave them what they wanted. When refused, they often turned abusive, but a few laughed and confessed that it had been worth a try. Somehow, doctors—most of whom have had similar experiences— never draw the appropriate conclusion from all of this. Insofar as there is a causative relation between criminality and opiate addiction, it is more likely that a criminal tendency causes addiction than that addiction causes criminality.

Dalrymple offers the following explanations for the perpetuity of what has become the "orthodox view" about opiate addiction:

First, the literary tradition sustains it: Works that deal with the subject continue to disregard pharmacological reality, from De Quincey and Coleridge through Baudelaire, Aleister Crowley, Bulgakov, Cocteau, Nelson Algren, Burroughs and others. Second, addicts and therapists have a vested interest in the orthodox view. Addicts want to place the responsibility for their plight elsewhere, and the orthodox view is the very raison d'être of the therapists. Finally, as a society, we are always on the lookout for a category of victims upon whom to expend our virtuous, which is to say conspicuous, compassion. Contrary to the orthodoxy, drug addiction is a matter of morals, which is why threats such as Mao's, and experiences such as religious conversion, are so often effective in "curing" addicts.