Treatment of Morphine Addiction.
The time is rapidly approaching when every physician must treat morphine and alcohol habits as scientifically and successfully as he treats other diseases. The Medical World for August presents a short symposium on the treatment of this condition. Our friend Dr. Waugh has some very excellent things to say about the use of strychnine. Another writer is definite about the withdrawing of morphine and the use of auxiliary measures. One whose name is withheld says the following course was adopted by his father in the successful treatment of hundreds of cases in private and sanatarium practice. The method requires as follows:
A reliable nurse, preferably of the same sex as the patient.
A physician to cope with the various emergencies as they may arise, and to apply such symptomatic treatment as may be indicated.
Begin at night with two ounces of castor oil, or other active cathartic if there be any decided objection to the oil.
The following morning early, one ounce of epsom or Rochelle salts, followed in two hours with high rectal flushing.
When the intestinal tract seems to be about empty, start with the treatment proper, viz: two-drop doses of Norwood's tincture of veratrum every two hours for forty-eight hours, taking care before the administration of each dose that the pulse does not run below 60 or over 100 (in which case defer the dose till the pulse rate comes within the limits given).
Morphin may be given, in the usual doses taken, up to the time the veratrum is begun, when it will not be asked for till the second day, with the appearance of neuralgic or neuritic pains in the forearms or legs, lead the patient to think of something for the relief thereof. For the relief of these pains, the physician may use such means as seem best to him; my own preference is for anti-phlogistine locally, and macrotys and gelsemium (in good size doses) internally.
During the forty-eight hours of the administration of veratrum the diet is water, malted milk, beef extract, eggnog or milk as preferred.
Subsequent to the 48 hours of active treatment the patient will gradually develop an appetite the indulgence of which is proper, but with which the digestive system is apt to be severely taxed; the physician again uses such medication as may seem best to him. My preference is for some of the paw paw preparations. These patients do better in this stage if they refrain from the use of coffee, tea, tobacco, and alcoholics, although it is not essential. During the convalescent period a good general tonic is very desirable. About the fourth day the bowels will need attention, cascara sagrada filling the requirements better than any other drug.
It is necessary that the physician be within fairly close call for 48 to 72 hours, and that the nurse be retained for 10 to 14 days— although the patient will think differently after 4 or 5 days.
The patient should be warned after the treatment that he is as susceptible to the action of morphin as he was before he first began its use, and that if he wishes to again become a morphin fiend, he will have to start as gradually as he did the first time.
A quotation is made by The World from The Medical Record in which Langsdorf gives the following prescriptions, with the instructions as to their use;
|Compound extract of colocynth||gr. 1|
|Extract of hyoscyamus||gr. 1/4|
|Extract of nux vomica||gr. 1/2|
|Extract of jalap||gr. 1/2|
|Oleoresin of ginger||gr. 1/8|
Mix and make one pill.
|Pilocarpin hydrochlorid||gr. 1|
|Fluid extract of hyoscyamus||drs. 2|
|Fluid extract of prickly ash||drs.2|
|Tincture of belladonna root||drs. 4|
Dose: Seven to twenty drops every hour.
Tincture of gelsemium.
Dose: Five to twenty drops every two hours.
|Tincture of strophanthus||dr. 1/2|
|Tincture of nux vomica||dr. 1|
|Tincture of convallaria||drs. 2|
|Tincture of cactus grandiflora||drs. 2|
|Tincture of digitalis||drs. 3|
Dose: Seven to eight drops every four or five hours.
Langsdorf lays stress on careful observance of details in administration. The usual dose of the accustomed drug (the addiction) is to be given at bedtime, along with three pills. (Formula No. I.) In the morning, after free movement of the bowels, give another dose of the accustomed drug. If the bowels have failed to move, give a hot water enema or a saline laxative. Within one hour after the morning dose of the accustomed drug, give ten to fifteen drops of the formula No. 2 and continue giving No. 2 every hour. Twelve hours after commencing No. 2 start giving Formula No. 3, about twelve drops every two hours. When No. 2 has been given for fourteen hours give three pills (Formula No. i) continue No. 2 and No. 3.
After No. 1 has acted freely, give a moderate dose of the accustomed drug. Continue No. 2, but stop No. 3, for eight hours after the last dose of the accustomed drug then resume No. 3 as before. Twelve hours after the last dose of the accustomed drug give three pills (Formula No. 1) and when these have acted freely and show greenish or yellowish discharges, discontinue Nos. 1, 2 and 3 and start with formula No. 4 about eight drops every four or five hours. Continue for this several days.
When greenish or yellowish discharges appear the cure is effected. Should the patient become nervous or restless, give 25 drops of Formula No. 3. If the bowels are slow, assist with a saline, hot water enema, or castor oil. If about the time for the last dose of Formula No. 1 to act, the patient becomes nauseated, give plenty of warm water and induce vomiting; it will give relief. If aching of the bones occurs, give a hot bath. If sleep does not come by the second night, give bromides. Watch the pulse throughout the treatment.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.