The abstinence syndrome in long-term, high-dosage narcotic addiction.

Abstract

SummaryTwenty‐six adult Chinese male volunteers with informed consent were studied to assess the syndrome of narcotic withdrawal in the presence of intermittent nalorphine administration. All the subjects were long‐term addicts with remarkably high tolerance to narcotics. After a 3‐day control period of drug administration tailored to each man's habits, withdrawal was commenced and studies were extended into the succeeding 72 hr.The abstinence scoring system was applied to gauge the severity of the syndrome as a function of the mode of self‐administration of narcotics. Generally the scores followed an upward trend with each day of withdrawal heavily influenced, especially on day 3, by vomiting. Emesis was found to increase from 15–4 per cent on day 1 to 38–5 per cent by day 3. Yawning, lacrimation and mydriasis occurred most frequently. In a few instances spontaneous penile erection and ejaculation were noted during withdrawal. Clinically, peak intensity was reached approximately 36 hr into withdrawal. Heroin needle‐users were the most severely affected, followed by heroin inhalers and then those who smoked opium. On the basis of these findings a redistribution of the point values in the scoring system used to assess the intensity of the syndrome is recommended. Small doses of nalorphine precipitated abrupt, short‐lived, but occasionally violent exacerbations of the basic absinence pattern.Aside from these episodes, however, nalorphine apparently does not materially affect the fundamental course of withdrawal symptoms in the doses and method used.