Romancing Opiates, Revised Paperback Edition: Pharmacological Lies and the Addiction Bureaucracy

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Editorial Reviews:

Product Description
For hundreds of years, addiction to drugs has seemed dangerous but with a hint of glamour. Addicts are a mystery to those who have never been one. They are presumed to be in touch with profound enlightenments of which non-addicts are ignorant. Theodore Dalrymple shows that doctors, psychologists, and social workers have always known these drug addictions to be false! They have created these myths to build lucrative method of expensive quasi-treatment.

Customer Reviews: Read 21 more reviews...

4 out of 5 stars

read one of his other books first May 26, 2006
47 out of 57 found this review helpful

This is my third Dalrymple book, so needless to say I like his work. I'm giving it four stars because I like his writing style and I think he makes an interesting point, but this is a weaker effort than "Life at the Bottom" and "Our Culture". That said, here's a synopsis of the plot, and what I found to be strengths and weaknesses.

To start with the bad- it's a bit repetitive. It relies for its major premise, that we have romanticized opiate addiction, on a couple of books written a hundred years ago by obscure authors. I think his point is still true, but other than "Trainspotting" and one or two other examples, he built a rather elaborate structure on a rather slender foundation. I also had a lot of problem with his treatment of the addiction itself. A major point, which I thought he demonstrated admirably, was that opiates are not physically addicting and more than that, the physical withdrawal even from heroin is trivial. This is a salient point, and one that if true (and he makes a strong case for it) should be far more widely disseminated. On the other hand I don't think giving up much of any drug is like swearing off broccoli, and a kind word or two of praise to those endeavoring to beat their addiction would've make the book better for me.

His writing style is dry and witty and persuasive. His research is thorough, and his personal opinions are usually not left to stand on their own, but are buttressed with facts. As I said in the title, if you haven't read one of his other books- read one of them first. If you have and you like his style, you'll probably like this as well- just maybe not quite as much.

4 out of 5 stars

Provocative and Informative May 17, 2006
31 out of 40 found this review helpful

I've been a fan of Dalrymple's writing for years, and looked forward to his latest book. It doesn't disappoint. Dalrymple demonstrates, both with examples from his practice and citations to medical literature, that withdrawal symptoms from opiates such as heroin are comparable to the flu, and are actually far less medically serious than the DTs experienced by alcoholics (which can actually be life-threatening). Our society is nevertheless far more sympathetic to heroin addicts than alcoholics, seeing them as tragic figures in need of medical treatment who have little if any responsibility for becoming addicted in the first place. Dalrymple traces the tendency to romanticize opiate addiction from the Romantic poets up through the recent "heroin chic." Required reading for anyone interested in addiction.

1 out of 5 stars

Why not ask the horse what he thinks . . . June 18, 2006
30 out of 64 found this review helpful

Let me first say that I agree with Mr Dalrymple about how Opiates have been overly, and, at times, harmfully romanticized by artists. An artist creates a great work of art, this artist's drug usage becomes common knowledge, and faster than you can say Post Hoc Ergo Propter Hoc, some idiot makes the assumption that drugs are a major ingredient in the creative process. It is a dangerous assumption--the legend of Charlie Parker's heroin use probably destroyed more aspiring musicians then anyone will ever know. And, for the record, any artist working under the burden of an addiction is creating in-spite of it and not because of it.

Now that that part is over . . . how about Mr Dalrymple's assertion that opiate addicts over-play their withdrawal symptoms so that they can get free drugs from the government? I'm NOT an expert in the physiology of the brain, but doesn't it stand to reason that if opiates can trick the neuro-receptors in one's brain into something as drastic as shutting down the respiratory system, then doesn't it also stand that there could also be drastic physical changes associated with the altered brain chemistry of withdrawal? That SEEMS logical doesn't it? (Then again maybe addicts not only fake withdrawals but also fake the effects of taking the drug to begin with.) But since I can't prove this theory one way or the other, I guess I'll have to stick to the other part of his theory: the supposed reward that addicts get for their little pantomime . . . While it may be the case that Mr Dalrymple's government--the British Government--gives away free Heroin or Methadone, this is not the case in the good-ole USA where opiate maintenance treatment is definitely NOT free. (Oh, and by the way, if the "sympathy" method worked so well then why don't people addicted to other drugs use this trick to get the British government to give them THEIR drug of choice for free?) The thought that withdrawing gains you sympathy from anyone is just wrong, most people prefer to think that the addict brought it upon themselves and that this is, at the very least, what they deserve. This surely appears to be Mr Dalrymple's opinion, as well as the opinion of one of the other reviewers who claims to be a doctor in the field. I assure you as one who has been on the other side of that stethoscope that your lucky to get a doctor who is only chronically apathetic. More likely you'll get someone like Mr. Dalrymple who is contemptuous if not openly hostile. And certainly wouldn't be inclined to give you free drugs. Try as he might to paint drug programs as being populated by bleeding-heart pushovers, this is not the case. Most people--in the clinics and everywhere else--attach a huge stigma to Heroin usage, and the Heroin user. The first thing most people do when they find out you are an addict isn't to shower you with understanding and loving concern, but rather to hide their valuables. And when it comes to maintenance treatment in the United States, withdrawing or not, you have to pay.
So if maintenance programs, as used to treat opiate addiction, aren't based on misguided altruism, saintly charity, or even sentimental socialism, and if the system isn't universally populated by the most caring of people--Mr. Dalrymple being an example--then why do we have this system . . . aside from the fact that Methadone clinics are a profitable business. Well, the main reason that our government here in the US (and the British government as well) really allow these type of maintenance programs to exist is because it can be statistically proven that they reduce crime, and also allow for a stability of life that the street drug lifestyle can never provide--meaning that the addict has a chance to hold down a job and become a productive member of society. (Though the "stability" part certainly is the less important of the two from a politician's standpoint.) Does anyone really think that the present conservative climate in our country would tolerate Methadone clinics for one second if the only reason for their being was to help out drug addicts?

So I guess by now you've figured out that I've had some experience with opiates . . . Yes, I was a Heroin addict and am now on Methodone. I've tried to kick cold-turkey and I can assure you that it truly sucked. So was it all in my mind? Well let me bring my own bit of proof to the table: to offer up a little bit of anecdotal evidence to the contrary and in opposition to what the "medical experts" would have you believe. (Should my anecdotal evidence be any less valid then that of a jaded doctor?) It is a common experience for people who buy drugs on the street to occasionally get ripped-off. On more then one occasion I've been stuck (no pun intended) with something that was indistinguishable from Heroin only to realize a little while after using it that it wasn't. So, if it seemed to be Heroin--if I believed it was Heroin--why didn't the placebo effect cure my withdrawals? On second thought, maybe it did . . . maybe I am just telling you that it didn't so you'll feel sorry for me and maybe send me some money for drugs. Seriously, If I included my address and asked you to send me money to keep me from withdrawing, would you?

While correct in suggesting that people's assumptions and prejudices about opiate addiction and opiate addicts are mostly wrong-- Mr. Dalrymple fails to mention that this dearth of knowledge also extends to what medical experts know. The field of addiction treatment is studded with far too much bad science; and let's not forget all of those charlatans--every one with a new and miraculous cure--playing on the hopes of the addicted. And ultimately, who can the addict turn to--they're only a bunch of junkies after all . . . who would listen?
With a system populated by the likes of Mr. Dalrymple, it's no mystery why the political will-power to make a concerted and methodologically sound study of the physical and psychological effects of opium addiction and withdrawal is non-existent. (Especially when it's so much easier to just throw maintenance and a course of canned psycho-babble administered by unenthusiastic councilors at the addict . . . and to then blame the addict when the treatment fails, and not the system.) For example, while the symptoms of opiate withdrawals might appear flu-like to the observer, this is not what the experience feels like to the person withdrawling; It is difficult to relate the experience because there is no frame of referance at this time. And while some of the physical symptoms ARE best described as flu-like, there are many additional physical symptoms that are not . . . and then there's the psychological anguish that is in no way like any flu that I or anyone else has ever had. But since these are not easily quantifiable, and because no one really cares that much about it, doctors tend to fall back of the old flu-like symptoms description. Which brings me to Mr. Dalrymple's disdainful assertion that withdrawals can't be worse than the flu because the flu kills people and withdrawals rarely do--yet another mean-spirited logical fallacy. Besides, while by themeselves withdrawals don't often kill, they DO however drive the addict back into drug use, and that is what kills them.
So what does it all mean? I think it's about preconceived notions. Prejudice is a strange thing; the more you look at people's beliefs the more you come to realize that more often then not the prejudice come first and the justification come afterwards. Like the way that a knee-jerk racist will turn to Social Darwinism, Eugenics or even the Bible to prop up their claim to superiority. It's funny too--in a sad way--how the flawed logic of prejudice is often mirrored by flawed science; starting with a conclusion and then cherry pick statistics to prove it.
I suspect that Mr. Dalrymple has grown to dislike the people that he sees in his system everyday. So much so that he professes to admiring Chairman Mao's solution for opiate addiction . . . can you guess what that might be? So he brought out his broad brush and painted this book-form tirade asserting that every single opium addict is fundamentally weak-minded and deceitful. And thus they are truly worthy of his scorn.
And it seems that now, more then ever, there's a huge audience for this type of thing. It appeals to the easy-answer-to-a-difficult-question crowd, who just love to have their prejudices reinforced by "experts." Imagine how it assuages their conscious to read that they where correct all along for hating drug addicts, after all, a doctor says it's the right thing to do.

4 out of 5 stars

Been there - and wish I'd had this book. June 4, 2006
27 out of 33 found this review helpful

Theodore Dalrymple has made an inestimable contribution toward productive discourse on western social ills by insisting first on clarity of language beginning with the critical distinction between `the poor' and `the underclass', a distinction that will ultimately improve our efforts to help both groups. Thus, I recommend reading his prior books `Life at the Bottom' and `Our Culture' first, unless you have a special interest in the subject of opiate addiction, which I do. Like Dalrymple, I am a physician. My experience is also with an almost exclusively white, Anglo-Saxon population; his reference group being British, and mine being a decade spent working in a rural section of the southern Appalachian mountains. The similar ethnic factor we share in patient demographics is helpful in demonstrating how substance abuse, like other underclass behaviors, is a cultural rather than a racial issue - important in that race issue mischaracterization has been a smokescreen often blown over reality by both white and minority activists for reasons other than a desire to help the needy. Here again I thank Dalrymple for bringing the core issue into focus, as we are unlikely to solve any problem we do not correctly understand.
In rural Appalachia intravenous heroin use is relatively rare. But the past decade has seen an explosion in the abuse of what is sometimes termed `hillbilly heroin', which is prescription diversion of oral synthetic opiates such as hydrocodone, oxycodone, and morphine. Of seven national hotspots of per capita hydrocodone use, four are in eastern Kentucky, and between 1998 and 2001 annual grams of hydrocodone consumed per capita increased in some Appalachian counties more than five fold. These drugs get to the streets and hollows and into the high schools not by way of international crime cartels, but straight from the signatures on physician's prescription pads.
I was there, as a primary care doctor to the poor and underclass, and I can say that every conceptual and practical mistake made in American and British attempts to address heroin abuse in the urban environment are mirrored in drug saturated rural communities in the USA. I can also attest that the big city drug seeker's country cousins are every bit as flagrantly dishonest, manipulative, self-centered, and lazy at any enterprise other than acquiring their drugs as are their urban counterparts.
It is intentional that I use the words 'abuser' and 'seeker', rather than 'addict' in regards to the misuse epidemic of synthetic opiates in rural America. The term 'addict' incorrectly conjures up images of someone with a hellish physiological dependancy upon opiates who could not possibly face more than a few hours without their drugs before decending into horrific and life threatening withdrawl. This is pure nonsense. What one typically sees instead is the sporadic though habitual turning back to opiates as life's preferred alternative, involvment in the underground pill trade as supplemental income, or both.
One important factor overlooked in Dalrymple's analysis is that of the vulnerabilities often inherent to the physician personality, vulnerabilities heightened by the commission of the medical enterprise to be empathetic and to help, and the training process to listen and to believe what the patient tells you - all good things, to be sure. Yes, I'm now jaded, but these factors, positive as they are, set us up as suckers for the historical myths about opiates, the drug seeker's mastery of the victim role and of manipulation, and the more recent general myths about contemporary underclass American. This book should be required reading for all fourth year medical students. Read it if you interface with opiate abuse in any way. Read Dalrymple's other books as well if you want the full picture.

1 out of 5 stars

Adds very little to the undestanding of opiate addiction June 10, 2006
20 out of 49 found this review helpful

I found Dalrymple's book to trivialize a complex medical/psychological/moral and spiritual problem. Published in 2006, most of his references were not very current and largely opinions cited from general medical texts. I was surprised at Dr. Dalrymple's lack of appreciation for the recent developments in his own field of addiction psychiatry. I have no doubt that Dr. Dalrymple's contact with opiate addicts and the recovery industry is extensive and clearly qualifies him to an opinion, however, I found the few useful points (e.g. the popular myths surrounding the nature of opiate withdrawal, the codependence of the recovery industry and the recoveree, naive withdrawal versus experienced or anticipatory withdrawal) he makes are lost in his rhetoric and the disdain he appears to hold for opiate addicts (as opposed to the compassion he expresses for acutely abstinent alcoholics who show more objective physical signs of withdrawal).
On the whole, the suffering of opiate addicts is more similar to the suffering of alcoholics (or any "addiction") than Dr. Dalrymple would have us believe. While in the settings of chronic use and acute abstinence, opiates are less toxic than alcohol, as many addicts or alcoholics with 6 months to a year or more of recovery can tell you, the physical sequelae are often times only a small part of their ongoing suffering. It would appear that Dr. Dalrymple's disdain towards opiate addicts may be in part due to the ineffectiveness of his use of the medical model alone in conceptualizing and treating opiate addiction, his failure to recognize the complex nature of addiction and his understandably jaded experience with the sociopathy of institutionalized addicts who are perhaps incapable of feeling any remorse and to grow morally and spiritually from the recognition of their role in the pain they cause themselves and others.

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