STUPEFACIENTS. – Toxic substances with a selective action on the cerebral cortex which, by inhibiting the higher nervous centres, are capable of modifying perceptual, imaginative and intellectual faculties so as to induce (according to the dosage) states of simple euphoria, drowsiness, stuporous intoxication, hallucinations and generally pleasant kinesthetic sensations.
Prolonged use of these substances produces in the organism a condition of habituation, increasing tolerance and, on the other hand, a progressive decrease in specific reaction, so that the doses may be increased without incurring the symptoms of acute poisoning that would be observed if the same quantity were used in an unaccustomed organism.
Stupefacients, although they may dull consciousness, are distinguished from narcotics (v.) and hypnotics (v.), for which they have neither the indications nor the effects. The latter facilitate or induce forced sleep without causing intoxication or loss of reflexes as in the categories mentioned above.
I. VOLUPTUARY ACTION
The pleasurable action of stupefacients has been known since ancient times among the peoples of the native countries of the various drugs; however, they are used there in their crude state and generally sparingly, so as not to incur the extreme states of irreversible psychic and organic degeneration incompatible with the continuation of the species, which are reached by drug addicts in white countries. The spread among the latter has assumed alarming proportions, especially through the use of pure extractive or synthetic preparations, and therefore much more active and toxic. This spread has been facilitated by their valuable use in medicine as sedatives, analgesics and anesthetics. When taken in excessive quantities concentrated over a short period, stupefacients cause acute poisoning, generally characterized by a brief initial period of psychic and psychomotor exaltation, followed by drowsiness, then depression of vegetative functions leading to coma and death from paralysis of the bulbular respiratory and cardiac nerve centres. Treatment is aimed at eliminating the poison from the organism and counteracting its effects with drugs having an antagonistic action. Chronic poisoning is of great moral and social interest. It is established by prolonged use in necessarily increasing doses due to the intervening habituation: as a result, one distinguishes toxicophilia (a tendency towards the drug that is not absolutely coercive and determining, a tendency that allows the consciousness of a volitional strength capable of abstinence) or toxicomania (the phase of habituation in which the need for the drug is irresistible). Mania, a phenomenon in the abuse of stupefacients correlated with habituation, although having an organic basis, is in itself an impulsive tendency that is essentially psychic. In general, toxicomanias place their victims among individuals and races predisposed by particular weakness in moral restraint and the sense of self-preservation.The principal stupefacients and their related toxicomanias are:
a) Opium (meconism): a drug consisting of the dried latex of Papaver somniferum (a papaveraceous plant native to Asia Minor). It contains various substances, including certain alkaloids with stupefying action such as morphine and narcotine. Known as the “alcohol of the yellow races,” it may be smoked (China, India) or eaten (India, Persia, Turkey, America); it has a milder action than morphine and, even when used for a long time, generally does not lead to cachexia.
b) Morphine (morphinomania): an alkaloid of opium that paralyzes the higher nervous functions. The starting point for the development of morphinomania is not only painful diseases—neuralgia, shooting pains of tabetics, rheumatism, dental pain, etc.—but also general nervous disorders of a neurasthenic or hysterical type: intractable insomnia, reactive depressive states, professional psychic tensions are not rarely the motive for the first injection, which is sometimes resorted to even out of simple curiosity. All these factors suggest that there is some psychic disposition, an abnormally low capacity for resistance that predisposes to the onset of morphinomania. Sometimes, though very rarely (Antheauche and Leroy), morphinomania may occur in attacks, in a manner analogous to epilepsy; Kraepelin had already spoken of epileptic attacks or hysterical anxiety.
The effects of chronic morphine use are divided into physical and psychic. Among the former: severe weight loss, earthy-yellow skin tone, loss of appetite, difficult digestion, constipation sometimes interrupted by diarrheal discharges, oliguria, dysuria, hypotension, tachycardia, marked vasomotor disturbances, impotence, azoospermia, amenorrhea; neurologically, one may observe: muscular hypotonia, tremor (with characteristics intermediate between that of the elderly and that of alcoholics), dysarthria, hyperreflexia, miosis; sensory disturbances (hypoaesthesia for all modalities, paresthesias, sometimes with a neuralgic character) are always present and have particular significance. The psychic effects are much more characteristic and important, especially for their social significance, so that they can only be compared with the disturbances of the most severe alcoholics. All qualities of the psychic person are affected, particularly the ethical ones; severe hypochondriacal states and marked psycho-sensory disturbances (hallucinations, illusions) are observed; memory disturbances are constant, both in the activity of fixation and in that of recall, without ever occurring a definitive loss of mnemonic material; irreversible defects of judgment belong to the picture of morphinism; the lack of initiative is very evident, although mechanical fulfilment of usual work duties may remain possible even for years.
Chronic morphine poisoning is characterized by habituation to the drug, which is established very early and leads to the taking of ever higher doses; by manifestations of abstinence, i.e., severe disturbances that appear when the administration is suddenly suspended in a habituated individual. The “thirst” for morphine is such that it drives the intoxicated person even to crime, merely to procure the alkaloid and thus satisfy the irresistible need. The cure is by no means easy: compulsory admission to specialized treatment centres with the strictest supervision is indispensable; relapses, however, are very frequent. Toxicomanias from other derivatives of opium and morphine (heroin) are also known.
c) Coca: a drug to be chewed, prepared from the leaves of certain erythroxylaceous plants (especially Erythroxylon coca L.), native to the Andean zone of South America, where the indigenous people have used it since ancient times to dull hunger and fatigue. This is evidenced by Inca vessels (11th century) on which coqueros are depicted, recognizable by the characteristic bulge in the cheek (a sign of the coca quid placed between the teeth and the buccal wall).
d) Cocaine: an alkaloid of coca, also prepared synthetically. It has an anesthetic action at the point of introduction, and after absorption and passage into the blood it also acts on the central nervous system. Prolonged use of the substance occurs solely for voluntary purposes with an erotic tone and is determined by the search for pleasure: the “path of pleasure” (v. COCAINISM).
Other stupefacients little diffused in white countries are:
e) Indian hemp (Cannabis sativa var. indica): of the family Moraceae, whose drugs are used especially by Moslem peoples in Asia and Africa (under the name of haisis) and in Mexico (marijuana). It contains an essential oil (cannabinol) that partially affects the brain. It produces intoxication and sometimes delirium, while leaving a glimmer of consciousness.
f) Peyote: a drug obtained from Anhalonium lewinii (a cactus), used in Mexico. Its stupefying alkaloid (mescaline) provokes visual hallucinations with the eyes closed.
II. ON THE LICITNESS OF THE USE OF NARCOTICS
It is clear that with regard to the abuse of narcotics the moral judgment cannot but be one of condemnation: the pursuit of pleasure obtained through the impairment of higher faculties and the bio-physiological degeneration is contrary to human nature. The pursuit of pleasure (v.) as the ultimate and exclusive end represents an inversion of values and is therefore essentially immoral. The moral condemnation is further grounded in the physical-biological condemnation (degenerate offspring, organic breakdown, asociality, neuro-psychic abnormality) with which nature burdens the drug addict.
There is no dispute even over the use of narcotics in the field of anesthesia and as analgesics for surgical interventions: their use is humane, reasonable, and dangerous (v. NARCOTICS).
But moral questions may arise regarding the use of narcotics when, beyond their effect of alleviating pain, they have other negative effects. If these substances, in a given case, diminish the organism's resistance so as to facilitate the destructive action of morbid factors and hasten death, one may ask whether their use as analgesics is moral. Here we are faced with two effects, one good and one bad; hence the principle of the double effect applies. Therefore, the use of such substances will be licit if: a) the analgesic effect cannot be obtained with other substances that avoid the bad effect, whether because they do not exist or because they produce other, more serious drawbacks; b) if the patient requesting such narcotics and the physician prescribing their use do not intend the hastening of death; for otherwise this bad effect would be nothing more than a means to obtain the good effect, thus falling back into the immoral principle that the end justifies the means; c) if, finally, there exists a certain just proportion between the bad effect and the good one, so that it is reasonable to perform the action despite the bad effect (v. EUTHANASIA).
Often the alleviation of pain can be achieved only through the deprivation of consciousness. The loss of consciousness is undoubtedly an evil, because it reduces man to a state of dehumanization; to deprive a person of consciousness against his will is illicit, and even if a dying person were to desire it, it would still be illicit if the patient were not prepared for death, either because he must settle important temporal affairs or because he must put his soul in order; it would be a crime to remove the still-present possibility of gaining eternal life. However, the administration of hypnotics to provide necessary rest for a certain period is not illicit.
Moreover, it should be noted that although death and pain are in themselves evils, they can be occasions for the exercise of many virtues such as patience and penitence, especially in the final stages of life, when man, freed from passions that might lead him astray, more easily turns his soul toward God. Therefore, even within the limits of what is licit, the use of narcotics is not considered advisable.
III. LEGAL REGULATION
The social and individual danger posed by narcotics has led the governments of the most advanced countries to enact legislation aimed at limiting their recreational use, first by determining the world's supply for scientific and therapeutic purposes, then by apportioning production among cultivated countries and regulating distribution. This was done from 1931 to 1936 by the Opium Commission attached to the League of Nations, and subsequently by the Commission on Narcotic Drugs under the United Nations' Economic and Social Council.
In Italy, the regulations governing the trade and expressing the abuse of narcotics are found in the Consolidated Law on Health (Royal Decree 27 July 1934, no. 1265), articles 148-60; various aspects are also addressed in the Penal Code, articles 445, 446, 447, 613, 729.
For timely prevention of the spread of abuse, the physician has the duty to report to the Public Security authorities within two days any patient found to be suffering from chronic narcotic intoxication. The pharmacist, for these substances, is required to demand a medical prescription, complete with the patient's full name and address, the reasons for the prescription, and the circumstances and limits of use. The quantity of circulating narcotic substances is subject to control by the Revenue Agency.
Costante Scarpellini
IV. THE STRUGGLE AGAINST OPIUM
The abuse of opium was introduced into China by Europeans; in the so-called Opium War (1840-42) its importation was imposed by force on the defeated country. In 1929, 1796, and 1800, the Chinese emperors issued the severest edicts prohibiting its cultivation and use. In the Kingdom of Siam, the death penalty was established for offenders. The Church has always supported the government's struggle against this abuse. In response to a query from the Apostolic Vicar of Siam, the Sacred Congregation for the Propagation of the Faith ruled on 3 June 1830 that these laws were not merely penal but, on account of the common good, obligatory for Christians in conscience (*Collectanea S. Congregationis de Propaganda Fide*, Rome 1907, no. 815).
It appears that some Apostolic Vicars were too inclined to punish opium smokers with excommunication, for on 30 October 1843 the Sacred Congregation advised the Apostolic Vicar of Malacca to apply this most severe penalty with discretion (*ibid.*, no. 1035). The Church's stance did not change, as clearly demonstrated by the reply given by the Holy Office on 10 March 1852 to the Apostolic Vicar of Shensi, stating that the cultivation, trade, and use of opium remained forbidden to Christians under very severe penalties (*ibid.*, no. 1071). On 20 September 1850, the same Holy Office, in instructions to the Apostolic Vicars, decreed that opium smokers could be baptized only if there was moral certainty that they would abandon the vice (*ibid.*, no. 1103).
After the Opium War, civil laws prohibiting the cultivation of the poppy were abolished, and this cultivation became the source of prosperity for several provinces. For Christians, nearly all of whom were in dire material straits, it was difficult to abstain from poppy cultivation without grave harm. Moreover, it was observed that men habituated to opium use put their lives at risk by abstaining completely. Therefore, on 23 March 1878, at the request of the Apostolic Vicar of Kuy-Tschoeu, the Holy Office permitted the cultivation of the poppy with certain precautions, as well as its medicinal use (*ibid.*, II, no. 1489).
On July 4, 1883, the Sacred Congregation of Propaganda Fide suggested to the Apostolic Vicars in China that they establish a temperance movement against the use of opium, similar to those that had been created in Europe and America against alcoholism (ibid., no. 1599). Since the response of the Holy Office in 1878 had been interpreted too broadly, the same Holy Office declared on December 29, 1891, that the cultivation of the poppy remained licit only for medicinal purposes; however, due to the grave dangers arising from it, the cultivation, trade, and use of opium were generally prohibited to Christians. For recidivists and habitual users, the most severe ecclesiastical penalties were threatened (ibid., no. 1776).
At the request of the Apostolic Vicariate of Shensi, the Holy Office declared on April 25, 1894, that Christians could neither lease land with the obligation to cultivate poppies nor accept opium as payment for rent; however, they were not obliged to forbid the tenant from cultivating it (ibid., no. 1867).
On October 2, 1931, the Apostolic Delegate, Msgr. C. Costantini, reaffirmed the ecclesiastical legislation on the matter, namely: 1) Christians could not be admitted to the Sacraments, nor catechumens to Baptism, if they cultivated or engaged in the trade of opium; 2) the cultivation of the poppy in itself was not illicit, but in China it constituted an immoral act due to its harmful consequences; 3) missionaries, in collaboration with the government, were to combat opium abuse through preaching, schools, and newspapers (Coll. Commissionis Synod., 4 [1931], pp. 923-25).
In 1934, the first National Council of the Catholic Church in China, held in Shanghai, drew attention to the opium issue.