Lies and Myths About Opiates

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Romancing
Opiates: Pharmacological Lies and the Addiction Bureaucracy

by Theodore Dalrymple (New York: Encounter Books, 2006); 146 pages;
$21.95.

This is a
hugely important book. If it gets sufficient attention, it could
be a major landmark in the ongoing campaign to introduce truth into
the honesty-challenged issue of recreational drugs. Although written
very much from a conservative point of view, the content of the
book is important to libertarians for the way it shakes two key
foundations of conservative and socialist support for drug prohibition.

The first
of these is the idea that drug addiction is a threat to ordinary
people – a force so powerful that mere experimental or occasional
exposure would turn even healthy and well-balanced people into helpless
victims of a raging compulsion that is beyond their power to resist.

The second
is the generally misplaced trust conservatives (especially) tend
to have in the medical and drug-treatment establishments’ pronouncements
on the subject.

The book deals
with these issues in the particular context of heroin and other
opiates, but the principles probably have wider application to most
recreational drugs.

If you are
generally conservative in outlook, you must read this book, because
it is written with unimpeachable authority by one of your own, and
because you will learn some important facts about the reality of
heroin use, as opposed to the myths. If you are of a generally libertarian
outlook, you should read this book for the same reason. Although
you may be less inclined to accept the authority of the author,
and will undoubtedly find many of his strongly conservative assumptions
and assertions irritating, you will find it especially useful as
ammunition in debates with conservatives.

“Theodore
Dalrymple” is a pen name used by a British medical doctor (a
psychiatrist). In the book under review, he states,

During the past fourteen years, I have worked as a doctor in a large
general hospital in a British slum, and in the even larger prison
next door.

His long experience
of working in and around medical and corrective institutions has
clearly given him a profound insight both into the British underclass
and its mentality and also into the consequences of drug abuse.
This experience, however, should be kept in mind, when assessing
his conclusions, as I shall discuss in due course.

Addiction or
choice?

Dalrymple’s
case is that there is an almost universally held, conventional view
about heroin addiction that is wrong in almost every particular
but nevertheless is maintained in the face of countervailing evidence
for various self-serving reasons.

His heretical
position is as follows: It is not actually particularly easy to
become an addict by using heroin – it takes some effort over
a period of time. Being an addict is not primarily a medical issue,
but rather a spiritual or psychological one, because withdrawal
is actually not a particularly hard, drawn-out, or hazardous, process.
(It is equivalent in terms of physical discomfort to a mild case
of flu, at most, and holds no physical dangers.)

Those who
want to stop taking heroin simply do so (and many do), and if they
continue to want not to take heroin they have no difficulty in abstaining
from its use. Those who relapse are simply the ones who seek its
recreational (or escapist) benefits. The received opinion that heroin
withdrawal is a nightmarish process, impossible for most without
assistance, is simply a lie, perpetrated by addicts themselves,
who seek justification for their own lack of willpower and dramatization
of their condition, or to inveigle people in authority into supplying
them with the drugs they want.

The lie is
willfully maintained by those whose employment and status depend
on the fiction that addiction is a medical condition and by those
who don’t wish to appear unempathetic to people society designates
as “victims.” The false view of heroin addiction rests
on a long and highly influential Western literary tradition, stretching
from Thomas De Quincey and Samuel Taylor Coleridge down to Irvine
Welsh and Melvin Burgess today. In addition to the false view of
addiction, this tradition carries the equally false and equally
self-serving romantic nonsense that drug use leads to artistic inspiration
or insight. Heroin addiction does not “cause crime.” Rather,
the kind of people who are addicts (at any rate, the ones Dalrymple
has encountered) are predisposed to criminality anyway.

In this short
book, Dalrymple effectively deploys the authority of his personal
experience together with analysis of the literature and some medical
references, to make his case for the above. In doing so, he manages
to place responsibility for the consequences of heroin use squarely
where it properly belongs – on the shoulders of the user himself
– without losing his underlying human sympathy for the person
concerned. Referring to an addict who hospitalized himself after
overdosing following his release from prison, despite having been
warned by Dalrymple that his tolerance would be reduced, Dalrymple
writes, “All of us know what it is like to give in to temptation,
and to that extent the man was deserving of our compassion.”
He also quotes one Dr. Chambard approvingly, suggesting that he
“sympathizes with the predicament of people who poison their
intelligence, without thereby absolving them from their responsibility
for doing so, and without accepting uncritically their views of
themselves.”

I suspect
that Dalrymple probably somewhat understates the unpleasantness
of withdrawal from heroin addiction because of his concentration
on the limited physical effects and his general lack of concern
for the psychological effects. The comments of addicts themselves
suggest that it is likely there is a very large depressive element
to the unpleasantness of the experience. This does not, of course,
particularly detract from Dalrymple’s main point. For the vast
majority of people – possessed of a minimum of willpower and
a real reason to quit – withdrawal would not be an insurmountable
problem, as Dalrymple soundly demonstrates.

On occasion,
Dalrymple can be oversimplistic in his treatment of an example that
suits his case and perhaps his underlying philosophy. He raises
the much-cited example of Mao’s treatment of the problem of
opiate addiction by shooting drug addicts and dealers and suggests
that within three years from 1949 Mao produced “more cures
than all the drug clinics in the world before or since.” One
wonders whether Dalrymple is in the habit of treating communist
claims of superlative production achievements in other areas with
such credulity. However, given that heroin addiction is largely
a moral and spiritual matter, it should not be a surprise to anyone
that it would decline dramatically following the reestablishment
of civil authority after a long period of catastrophic war, foreign
occupation, and civil war.

Dalrymple’s
book also highlights a classic example of what every libertarian
and paleoconservative knows is the inevitable consequence of state
involvement in social problems – the self-justifying, ever-expanding
but generally utterly ineffective bureaucracy. The mechanisms of
self-deception and mass delusion by which this is maintained in
the case of drug treatment would certainly bear generalizing to
other areas of government, and perhaps a few readers of Dalrymple’s
book will be inspired to do just that.

Drawbacks of
the book

There is one
obvious weakness in an argument resting so strongly (though by no
means exclusively) on the author’s personal experience. That
is the possibility that his perception has been skewed by the self-selecting
nature of the sample he has observed. In this case, it is obvious
that Dalrymple’s experience of heroin addicts has been heavily
biased towards the underclass (concerning which, see Dalrymple’s
excellent book Life at the Bottom) and those who have failed
to successfully manage their use of heroin. By definition, those
in prison will be largely of the underclass. Similarly by definition,
those who end up in a hospital will be largely those who have overdosed
on heroin or suffered other medical complications resulting, mainly,
from failure to take adequate precautions.

There is no
apparent reason why this should be fatal to the main thrust of Dalrymple’s
case. While members of the underclass may well be much less reluctant
to lie than the broader population, there is no reason to suppose
nonunderclass addicts might suffer genuinely agonizing withdrawal
symptoms when under-class addicts do not. It is, however, likely
to color his broader conclusions, and I suspect it does. Dalrymple
almost completely ignores the existence of a huge class of people
who use heroin in a controlled manner for recreation while maintaining
apparently “normal” lives, perhaps because he has presumably
never, or very rarely, encountered them in prison or in the hospital.
Because heroin use and possession are illegal, the people concerned
will obviously not have engaged him in dinner party discussion on
the subject.

For this reason,
I would recommend that readers of this book also read carefully
another indispensable book on heroin: Heroin Century by Tom
Carnwath and Ian Smith (Routledge, 2002). If, in the light of Dalrymple’s
observations, the authors, who are just as qualified by experience
to talk about heroin use and effects as Dalrymple, are maybe a little
too ready to sympathize with claims of the agonies of withdrawal
or the inspirational possibilities of heroin use, they are certainly
not taken in completely.

Sad to say,
Dalrymple’s concluding section concerning the wider implications
of his argument is disappointingly superficial. It is perhaps unsurprising
that he comes down against the (in my opinion) incontestably correct
solution of relegalization of drugs, but it is a pity that his arguments
for doing so are so unconsidered.

On the immediate
policy consequences of his views, he is admirably direct and forceful:

As a first step … I would suggest the closure of all clinics claiming
to treat drug addicts, the modern bureaucratic institutionalisation
of Romantic ideas…. Henceforth, instead, doctors should treat
addicts only for the serious physical complications of drug addiction:
abscesses, viral infections and the like.

It is when
he comes to the inevitable issue of whether to maintain prohibition
or relegalize these drugs that he falls, in my view.

All Dalrymple’s
arguments in favor of continued prohibition of heroin are unsophisticated
and easily rebutted. But this is not a book written about prohibition
versus relegalization. The benefit of Dalrymple’s continued
advocacy of prohibition is that his credibility with the authoritarians
will be undiminished, and the weak conclusion of this book does
not significantly undermine the power and significance of the basic
case that he makes.

Dalrymple
is a highly accomplished writer, who can get his point across very
effectively. I find his witty, competent, and blunt prose very readable.
He has the knack for producing pithy phrases and sentences that
uncompromisingly encapsulate his position in ways that will certainly
delight those who share his outlook, although inevitably sometimes
this can stray towards the crassness of the American conservative
“shock jock” style.

The evident
decision not to use notes means that, where the writer occasionally
quotes from published texts, he is forced to include the full reference
in parentheses within the text, and this can somewhat break the
flow. In one section, he quotes from no fewer than nine such texts
over the course of four pages. This also means that there are occasions
when he quotes from studies without proper attribution, which means
the reader has no way of checking whether his interpretation of
the results is correct.

Unfortunately,
this particular edition appears to have been poorly proofed, with
an uncomfortably large number of minor typographical errors, particularly
later in the text.

These are
minor irritants in what is otherwise a smooth read.

Buy Romancing
Opiates, read it, and use Dalrymple’s authority and arguments
in discussions on this hugely important issue.

January
13, 2007

Randal
Cousins lives in Yorkshire, England, and is the father of four children.
His educational background is in mathematics, but he devotes his
intellectual energies largely to trying to reconcile conservative
instincts with libertarian reason.

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