by Kawal Deep Kour (PhD, Indian Institute of Technology)
The phenomenon of the “opium habit” was attracting worldwide attention by the 1920s. Most addiction historiography research has focused on the United States, where researchers including Arthur Light and Edward Torrance of the Philadelphia Committee for the Clinical Study of Opium Addiction Research, and Charles Terry and Mildred Pellens of the Bureau of Social Hygiene’s Committee on Drug Addictions, whose 1928 classic The Opium Problem is recognized as a seminal primary source of contemporary addiction study. But it was also an object of concern internationally: In January 1923, a joint sub-committee of the League of Nations Health Committee and the Advisory Committee on Traffic in Opium, consisting of Dr H. Carriere (Vice President, Director of the Swiss Federal Public Health Department, Berne), Dr W. Chodzko (delegate of the Polish government to the Office of International Hygiene), Dr. O.Anselimo (German Minister of Health) and J. Campbell (representative of the Indian government) presented a massive report on the illegitimacy of nonmedical opiate use.
India was no exception. In 1928, Lieutenant Colonel Ram Nath Chopra and his team at the School of Tropical Medicine, Calcutta (now Kolkata) carried out similar pioneering studies on the opium habit there. Chopra (1882-1973) is regarded as the father of Indian pharmacology. He is respected as a great teacher, keen researcher in Indian indigenous drugs, toxicologist, clinical pharmacologist, and above all a visionary theoretical pharmacologist. A series of papers by Colonel Chopra and Colonel R. Knowles contained an analytical study of the opium habit. Their findings had great relevance to understanding the progression of opium habit in India. Already in 1926, the report of the Rolleston Committee chaired by Humphrey Rolleston, the then President of the Royal College of Physicians in Britain, had outlined a system of adopting a medico-legal and health approach to the enunciation of drug policies in Britain. This served as the foundation for the British system of treating addiction. It affirmed that addiction is the “manifestation of a disease and not a mere form of vicious indulgence.” In the first three decades of the twentieth century, medical treatments for narcotic addiction continued to focus on managing the mechanics of withdrawal from narcotics.
In the course of research on opium addicts and the etiology of addiction in India, Chopra and his team had divided addicts they observed into three main groups: (i) moderate users, who used the drug for its medicinal properties rather than for its euphoria inducing effects, (ii) those who indulged deliberately for the sake of euphoria-inducing and aphrodisiac effects, and (iii) those accustomed to using the drug following fatigue and hard work.
Chopra was convinced that, considering the absence of specialized treatment facilities, such as the “abstinence sanatoria” in the West, and ignorance of a majority of the medical fraternity in India about the advances in the field of addiction, the treatment of addicts would have to be individualized per the specific needs of the patient. He decided to adopt a gradual as opposed to the sudden withdrawal method which had been adopted in institutions across Europe and America, where specialized treatment facilities were available. A gradual withdrawal method involved a detoxification regimen of gradual decrease in dosage of drugs in the initial phase, later progressing to a more rapid cessation supplemented with dosages of biochemic preparations including nux vomica and gentian and black pepper, which were administered over a period of three to six weeks. Chopra cited minimal discomfort as the major advantage of the gradual withdrawal method. Another advantage was that the post-withdrawal insomnia, an extremely distressing condition, was much less frequent. It was believed that this would encourage other addicts to seek treatment and help prevent relapse.
The observations made by Lt. Colonel Chopra in the studies mentioned above were a harbinger of an emerging politico-medical discourse that emphasized state and medical collaboration in effectively tackling a public health menace. Scientific investigations and studies had demonstrated that opium addiction could be treated effectively – with medical involvement. It was expected that the involvement of the medical community would combine the twin objectives of scientific expertise and rational administration, designed to promote social welfare by safeguarding public health.
Chopra and his team conducted their first ever experiment of a proposed mass treatment scheme in 1939 in Assam – a province which had earned notoriety as “black spot on the face of India.” (The rate of opium consumption in Assam was much higher than the standard established by the League of Nations of 6 per 10,000 population per annum. In Assam, it was 267 per annum per 10,000.) The experiment was a three-phased intervention of detoxification, withdrawal management, and recovery. Considering the financial constraints and the nature and extent of the scheme, the mode of treatment was confined to the treatment of withdrawal symptoms – meaning, relieving those symptoms and counteracting the effects of opium on the system. Most substitution treatments were rejected as being too costly, but the use of Lecithin and Glucose, a “Vitamin Cure,” was deemed to be best suited towards treating the Indian drug addict.
This mass treatment scheme experiment made Assam a pioneer of sorts in prevention and cessation of opiate addiction in India – a model later emulated by other provincial governments, as Orissa (now Odisha) which had also reported a sizeable number of people addicted to opium. The experiment was designed as a six-week program beginning with registration, which enabled classification according to the intensity of addiction, based on factors as daily dosage, age, duration of use, and so on. The addicts reporting at the detoxification clinics were to undergo a process of registration, which was organized under two overarching categories: (i) total number of addicts with legitimate opium passes and (ii) total number of addicts without opium passes.
(Discover the sources of these “opium passes,” the administration of the program, and more in Part II… Coming soon!)