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 Robert Newman
MD, M.P.H.
Thanks! for the new

Injecting drugs can be a risky business in prohibitionist society. This is because hygiene is difficult, education is minimal, and fluctuations in quality can lead to accidental overdose. US opposition to needle-exchange programs at home and abroad  has  massively  promoted  the spread of HIV and hepatitis in users - and non-users - alike. Noxious tobacco-smoking aside, the Supreme Court of the United States has never been sympathetic to a drug-based lifestyle.... "

To be a confirmed drug addict is to be one of the walking dead....The teeth have rotted out, the appetite is lost, and the stomach and intestines don't function properly.

The gall bladder becomes inflamed; eyes and skin turn a bilious yellow; in some cases membranes of the nose turn a flaming red; the partition separating the nostrils is eaten away-breathing is difficult.

Oxygen in the blood decreases; bronchitis and tuberculosis develop.

Good traits of character disappear and bad ones emerge. Sex organs become affected.

Veins collapse and livid purplish scars remain. Boils and abscesses plague the skin; gnawing pain racks the body.

Nerves snap; vicious twitching develops. Imaginary and fantastic fears blight the mind and sometimes complete insanity results.

Often times, too, death comes-much too early in life....Such is the torment of being   a  drug addict;  such  is  the  plague  of  being  one  of  the  walking dead..." (1962)                 

Redefining Addiction
Abstract: The Need to Redefine Addiction, R.G. Newman MD, M.P.H.

Newman examines the debate that surrounds how narcotic addiction should be defined.   He argues  that  the traditional  definition  of narcotic addiction found in most medical textbooks, emphasizing physical dependency and tolerance associated with the patient’s  current drug use,  does  not present  an  accurate or meaningful picture of the disorder. He  suggests  that any  definition  must  account for   the conflicting evidence related to the ability to maintain abstinence following repeated exposure to narcotics.

The medical literature is consistent in reporting a high rate of recidivism among those with opiate addictions following completion of even the most respected treatment programs. The greatest challenge that physicians (and patients) face is not achieving abstinence, but maintaining it. And yet, other studies over the last 25 years have  demonstrated  convincingly that  many individuals  that use narcotic drugs, even when  the  use  is over  long periods  of time  and at very  high dosage  and frequency, experience little if any difficulty both in achieving and maintaining abstinence.

Based upon his review of these conflicting findings Newman concludes that the widespread belief in  the inevitability and  irreversibility of addiction is  based upon the limited experience of clinicians who treat a self-selected subgroup of users.

Dr. Newman ends his discussion by arguing that a definition of addiction, to be useful, must take into account the seemingly conflicting results that have been reported. He suggests that narcotic addiction be defined as an atypical response to  exposure  to  opiates  that  is  characterized  by  progressive  by  increasing consumption  of  the  drug  and  a  persistent  disposition  to relapse even after abstinence has been  achieved  and  acute  physical   dependence   has   been reversed.

R.G., Newman. The Need to Redefine Addiction in Tagliamonte, A., and Maremmani I. (eds), Drug Addiction and Related Clinical Problems, (1995) Springer-Verlag Wien Publishing Company, New York.

The Natural History of Opiate Dependence
Abstract – Effective Medical Treatment of Opiate Addiction, National Institute of Health Consensus Statement 1997

Scientific  evidence   reviewed    for  the  NIH  report   indicates   that     opiate dependence  stems  from a physiological  medical   disorder  in   the    human  brain that  causes  the  addicted   individual to crave and   continue to use the substance despite the risk of physical or psychological harm. There is consistent evidence   that  medical treatment can  be  utilized  to effectively manage this disorder and that treatment can provide substantial positive benefits to the addicted patient and society.

Investigators  that  have examined  the biological,  psychological  and   social factors that contribute to opiate abuse argue that most individuals that become dependent on opiates begin their cycle of addictive behavior early, generally in their twenties, and continue to use illicit drugs  intermittently  throughout  their lifetime.   They argue that repeated exposure to drugs  such as  opiates  causes substance use to increase despite the adverse effects and harmful consequences that the individual may experience. The  majority of  individuals  that   become addicted  to    opiates    develop  a physiological  dependence  that  gradually escalates as the body concomitantly builds up tolerance to the physical effects of the drug.

Once a pattern of physical dependence is firmly established the addicted patient enters  repeated  cycles  of  drug  cessation  and    relapse   that  can  continue throughout his or her lifespan. This pattern of dependence on opiates leads  to what  the  experts  call  an  addiction  career  that  is usually accompanied by decades of legal problems and incarceration in public correctional facilities.

The Neurobiology, Pathology and Genetic Risk Factors Associated with Opioid Addiction and Dependence
Abstract – Effective Medical Treatment of Opiate Addiction, National Institute of Health Consensus Statement 1997

Decades of clinical research on the neurobiology and pathology of opiate dependence have revealed that individual vulnerability to drug abuse is partially inherited and the pattern and degree of severity of this disorder are strongly influenced by environmental factors.

This conclusion is supported by evidence gathered in government-funded family, twin, and adoption studies that indicate that the children of opiate dependent parents have a higher predisposition and susceptibility to abuse and dependence after their initial use of opioids compared with children whose parents do not use drugs.

Neurobiological studies suggest that there are a number of opioid receptor pathways in the human cerebral cortex that play an important role in the development of drug dependence and the intensity of symptoms of physical withdrawal experienced by opiate addicted patients.

Definition of Opioid Dependence as a Medical Disorder
Abstract – Effective Medical Treatment of Opiate Addiction, National Institute of Health Consensus Statement 1997

The   Consensus  panel  at  the  National  Institutes  of  Health  defines  opioid dependence as a cluster of cognitive, behavioral, and physiological symptoms in which an individual continues to use opiates despite significant physiological and psychological harm caused by the ingestion of the drugs.

The condition  is characterized by the patient’s repeated self-administration of  an opiate drug over an extended period of time resulting in the development of opioid tolerance, compulsive drug taking behavior, and withdrawal symptoms upon cessation of use. Patients may develop a dependence on opioids with or without symptoms of physiological tolerance and withdrawal; these patients usually have a long history of opioid self-administration either through intravenous drug injection, intranasal ingestion or smoking

Health care providers in the United States agree that although the factors that contribute to opiate dependency are poorly understood,  one thing is certain: once physical dependence on opiates develops,  it  can constitute a medical disorder   that  requires  treatment     intervention.   Methadone  maintenance treatment in conjunction with medical attention and psychiatric counseling can do a great deal to alter the course of the natural history of opiate dependence and help prolong periods of abstinence from illicit drug use in addicted patients.

Modified: July 2, 2005