NARCOTICS. - Toxic substances with an elective action on the cerebral cortex which, by inhibiting the higher nerve centers, are capable of modifying the perceptive, imaginative and intellectual faculties so as to induce (according to the doses) states of simple euphoria, of drowsiness, of stuporous intoxication, of hallucinations and of generally pleasant kinesthetic sensations.
Their prolonged use brings about in the organism a condition of habit, of increasing resistance and, on the other hand, a progressive diminution of specific reaction, so that the doses can be increased without incurring the symptoms of acute poisoning, such as would be encountered by employing the same quantity in an organism not accustomed to it.
Stupefacenti, although they can dull the consciousness, are distinguished from narcotics (v.) and from hypnotics (v.), of which they do not have the indications and the effects. The latter facilitate or induce a forced sleep without provoking intoxication or absence of reflexes as in the categories mentioned above.
I. VOLUNTARY ACTION
The pleasurable action of stupefacenti has been known since the most ancient times by the peoples of the countries of origin of the individual drugs; nevertheless, they use them in their raw state and generally sparingly, so as not to incur the extreme states of psychic and organic degeneration that are irreversible and incompatible with the continuation of the species, which are reached by drug addicts of the white countries. Among the latter, their diffusion has assumed worrying proportions, especially through the use of extractive or pure synthetic preparations, and therefore much more active and toxic. It has been facilitated by their valuable employment in medicine as sedatives, analgesics and anesthetics. Stupefacenti, taken in excessive quantities concentrated over time, produce acute poisonings, characterized in general by a brief initial period of psychic and psychomotor exaltation, followed by drowsiness, then by depression of the vegetative functions down to coma and death from paralysis of the nervous, bulbar, respiratory and cardiac centers. The therapy is aimed at eliminating the poison from the organism and at combating its effects with drugs having an antagonistic action. Chronic poisonings are of great moral and social interest. They become established through prolonged use in necessarily increasing doses because of the intervening habituation: consequently, a distinction is made between toxicophilia (a tendency toward the toxic substance that is not absolutely coercive and determining, a tendency that allows the coexistence of a volitional force capable of abstinence) and toxicomania (the phase of habituation in which the need for toxic satisfaction is irresistible). Mania, a phenomenon in the abuse of stupefacenti correlated with habituation, although having an organic basis, is in itself a determining impulsive tendency, essentially psychic. In general, the toxicomanias reap their victims among individuals and races predisposed by a particular weakness in moral restraints and in the sense of self-preservation.
The principal stupefacenti and the 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, among them certain alkaloids with a stupefying action such as morphine and narcotine. Called "the alcohol of the yellow races," it can be smoked (China, India) or eaten (India, Persia, Turkey, America); it exerts a milder action than morphine, and generally its use, even prolonged, does not lead to cachexia.
b) Morphine (morphinomania): an alkaloid of opium that paralyzes the highest nervous functions. The starting point for the development of morphinomania is constituted not only by painful diseases: neuralgias, lancinating pains of tabetics, rheumatism, toothaches, etc., but also by general nervous disturbances of a neurasthenic or hysterical type: rebellious insomnia, reactive depressive states, professional psychic tensions not rarely constitute the reason for the first injection, which is sometimes arrived at even out of simple curiosity. All these factors suggest that there is some psychic disposition, an abnormally scanty capacity for resistance that predisposes to the onset of morphinomania. Sometimes, but very rarely (Antheaume and Leroy), morphinomania can arise in attacks, in a manner analogous to dipsomania; already Kraepelin had spoken of epileptic attacks or of hysterical anxiety.
The effects of the chronic intake of morphine are distinguished into physical and psychic. Among the former: severe weight loss, a yellow-earthy skin color, loss of appetite, difficult digestion, constipation sometimes interrupted by diarrheal discharges, oliguria, dysuria, hypotension, tachycardia, marked vasomotor disturbances, impotentia coeundi, azoospermia, amenorrhea; neurologically one may observe: muscular hypotonia, tremor (with characteristics intermediate between that of the senile and that of alcoholics), dysarthria, hyporeflexia, miosis; disturbances of sensation (hypoesthesia for all modalities, paresthesias, sometimes with a neuralgiform character) are always present and have a particular value. The psychic effects are much more characteristic and important, above all for their social significance, for which reason they can be compared only with the disturbances of the most severe alcoholics. All the qualities of the psychic person are affected, especially the ethical ones; severe hypochondriacal states and marked psycho-sensory disturbances (hallucinations, illusions) are observed; mnemonic disturbances are constant, both of the activity of fixation and of that of recall, without a definitive loss of mnemonic material ever occurring; irreversible defects of judgment belong to the picture of morphinism; the lack of initiative is very evident, although a mechanical fulfillment of the usual duties of work remains possible even for years.
Chronic morphine poisoning is characterized by addiction to the drug, which becomes established very early and leads to the intake of ever higher doses; by the manifestations of abstinence, that is, severe disturbances that appear when the administration is abruptly suspended in a habituated individual. The "thirst" for morphine is such as to drive the intoxicated person even to crime, merely in order to procure the alkaloid and thus satisfy the irresistible need. The cure is anything but easy: admission to specialized nursing homes, with the strictest surveillance, is indispensable; relapses, however, are quite frequent. Toxicomanias from other derivatives of opium and of morphine (heroin) are known.
c) Coca: a chewing drug prepared from the leaves of certain erythroxylaceous plants (especially in Erythroxylon coca L.), native to the Andean region of South America, where the natives have used it since remote times to dull hunger and fatigue. Evidence of this is given by Inca vessels (11th century) on which the coguérus are depicted, recognizable by the characteristic bulge in the cheek (the sign of the cocaine bolus placed between the teeth and the wall of the mouth).
d) Cocaine: an alkaloid of coca, also prepared synthetically. It possesses an anesthetic action at the point of introduction; following absorption and passage into the blood, it also acts on the central nervous system. The prolonged use of the substance occurs for purely pleasurable purposes with an erotic tonality and is determined by the pursuit of pleasure: "the path of pleasure" (v. COCAINISMO).
Other stupefacenti little diffused in the white countries are: e) Indian hemp (Cannabis sativa var. Indica): of the family of the moraceae, whose drugs are used especially by the Mohammedan peoples of Asia and Africa (under the name of halil) and in Mexico (Marijuana). It contains an essential oil (cannabinol) that paralyzes the brain. It produces intoxication and sometimes delirium, while nevertheless leaving a glimmer of consciousness. f) Peyotl: a drug obtained from Anhalonium lewini (a cactaceous plant), used in Mexico. Its stupefying alkaloid (mescaline) provokes visual hallucinations with the eyes closed.
II. ON THE LAWFULNESS OF THE USE OF NARCOTICS
It is clear that with regard to the abuse of s. the moral judgment can only be one of condemnation: indeed the pursuit of pleasure obtained by the clouding of the higher faculties and by bio-physiological degeneration is contrary to human nature. The pursuit of pleasure (v.) as an exclusive ultimate end represents an inversion of values and is therefore essentially immoral. The moral condemnation is founded also on the physical-biological condemnation (degenerate offspring, organic decay, asociality, neuro-psychic abnormality), with which nature burdens the drug addict.
Nor is there any discussion of the use of s. and of narcotics in the field of anesthesia and as analgesics for surgical interventions: their employment is humane, reasonable and therefore moral (v. NARCOTICI).
But moral questions can arise regarding the use of s. when they, beyond their effect of soothing pain, have other negative effects. If these substances in the concrete case diminished the resistance of the organism in such a way as to facilitate the destructive work of morbid factors and accelerate death, one may ask whether their use as analgesics is moral. One finds oneself in the presence of two effects, one good and the other bad; for which reason it is appropriate to apply the principle of the double effect. Therefore the use of such substances will be lawful if: a) the analgesic effect cannot be obtained with other substances that avoid the bad effect, whether because these do not exist, or because they produce other more serious drawbacks; b) if the patient who requests such s. and the physician who orders their use do not intend the acceleration of death; and this because otherwise this bad effect would be nothing other than a means of obtaining the good effect; one would thus fall 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, such that it is reasonable to perform the action, notwithstanding the bad effect (v. RUTANASIA).
Often the alleviation of pain can be obtained only through the deprivation of consciousness. The loss of consciousness is without doubt an evil, because it places man in a state of dehumanization; to deprive a person of consciousness against his will is unlawful and, even if a dying person desired it, it would likewise be unlawful, should the patient not be prepared for death, whether because he must settle temporal affairs of notable importance, or because he must order the state of his soul; it would be a crime to take away the possibility, still present, of gaining eternal life. However, the administration of hypnotics to give the rest necessary for a determined time is not unlawful.
Furthermore it is to be observed that, although death and pain are in themselves evil, they can be an occasion for the exercise of many virtues such as patience and penance, and this especially in the last periods of life, in which man, once the passions that could lead him astray have ceased, more easily orients his soul toward God. It is therefore not considered appropriate to abound, even within the limits of what is lawful, in the use of s.
III. LEGAL REGULATION
The social and individual danger of narcotics has led the governments of the most advanced countries to issue legislative measures aimed at limiting their recreational use, first of all determining the world requirement for scientific and therapeutic use, allocating production among the cultivating countries and regulating its distribution. This was done from 1931 to 1936 by the Opium Commission attached to the League of Nations, then by the Commission on Narcotic Drugs dependent on the "Economic and Social Council" of the United Nations.
In Italy the rules governing trade in and suppressing the abuse of narcotics are found in the Consolidated Text of the health laws (Royal Decree of 27 July 1934 no. 1265) arts. 148-60: the Penal Code also deals with them under various aspects, arts. 445, 446, 447, 613, 729.
For timely prevention of the spread of abuses, the health officer has the duty to report within two days to the public security authority the person under his care who proves to be suffering from chronic narcotic intoxication. The pharmacist is required, for these substances, to demand the medical prescription, accompanied by the complete particulars of the name, surname and address of the patient, the reasons for the prescription, and the circumstances and limits of use. The quantity of narcotic substances in circulation is subject to the control of the Finance Police.
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Costante Scarpellini
IV. STRUGGLE AGAINST OPIUM
The abuse of opium was introduced into China by Europeans; in the so-called Opium War (1840-42) importation was imposed by force on the defeated country. In the years 1729, 1796 and 1800 the Chinese Emperors, by very severe edicts, prohibited its cultivation and use. In the kingdom of Siam the death penalty was established against transgressors. The Church has always supported the government's struggle against this abuse. To the question of the vicar apostolic of Siam, Propaganda replied on 3 June 1830 that those laws were not purely penal, but on account of the common good bound Christians in conscience (Coll. S. Congr. de Prop. Fide., Rome 1907, n. 815).
It appears that some vicars apostolic were too inclined to punish opium smokers with excommunication, because on 30 Oct. 1843 Propaganda advised the vicar apostolic of Malacca to apply this most severe penalty with discretion (ibid., n. 1035). However, the attitude of the Church did not change, as is well demonstrated by the reply given by the Holy Office on 10 March 1852 to the vicar apostolic of Chensi, in which it is stated that the cultivation, commerce and use of opium remained forbidden to Christians under most grave penalties (ibid., n. 1071). On 20 Sept. 1850 the same Holy Office, in an instruction to the vicars apostolic, decreed that opium smokers could be baptized only if there was moral certainty that they would abandon this vice (ibid., n. 1103). After the Opium War the civil laws that prohibited the cultivation of the poppy were abolished and this cultivation became the source of prosperity for several provinces. For Christians, almost all of them in material hardship, it was difficult to abstain from poppy cultivation without most grave harm. Moreover, it was observed that men accustomed to the use of opium put their lives in danger by abstaining completely. Therefore the Holy Office on 23 March 1878, following a request from the vicar apostolic of Kuy-Tschou, permitted the cultivation of the poppy with certain precautions, and also its medicinal use (ibid., II, n. 1489).
On 4 July 1883 Propaganda suggested to the vicars apostolic that they create in China a temperance movement against the use of opium, as had been done in Europe and America against alcoholism (ibid., n. 1599). Since too broad an interpretation had been given to the reply of the Holy Office of 1878, the same Holy Office declared on 29 Dec. 1891 that the cultivation of the poppy remained lawful only for medicinal purposes; on the other hand, because of the great dangers deriving from it, its cultivation, commerce and use remained in general forbidden to Christians. Against recidivists and habitual users the most severe ecclesiastical penalties were threatened (ibid., n. 1776). Following a request from the apostolic vicariate of Chensi, the Holy Office declared on 25 Apr. 1894 that Christians could not lease land with the obligation of cultivating the poppy on it, nor could they accept opium as payment of the rent itself; however, it was not their obligation to forbid the tenant to cultivate it (ibid., n. 1867). On 2 Oct. 1931 the apostolic delegate, Msgr. C. Costantini, reaffirmed the ecclesiastical legislation on the matter, namely: 1) Christians cannot be admitted to the Sacraments, nor catechumens to Baptism, if they cultivate or engage in the commerce of opium; 2) the cultivation of the poppy in itself is not unlawful, but in China it constitutes an immoral action because of its nefarious consequences; 3) missionaries, in collaboration with the government, must fight against the abuse of opium through preaching, schools and newspapers (Coll. Commissionis Synod., 4 [1931], pp. 923-25).
In 1934 the first Chinese national Council at Shanghai drew attention to the opium question.
Bibliography2 works
Nicola Kowalsky