STUPEFACENTI. — Toxic substances with a selective action on the cerebral cortex which, by inhibiting the higher nervous centers, are capable of modifying perceptive, imaginative, and intellectual faculties so as to induce (depending on the dosage) states of simple euphoria, drowsiness, stuporous intoxication, hallucinations, and generally pleasurable kinesthetic sensations.
Their prolonged use produces in the organism a condition of habituation and increasing resistance, and, on the other hand, a progressive diminution of specific reaction, so that their doses may be increased without incurring the symptoms of acute poisoning that would be observed if the same quantity were administered to an unaccustomed organism.
Stupefacenti, although they may dull consciousness, narcotics (v.) hypnotics (v.), whose indications and effects they do not share. The latter facilitate or induce forced sleep without producing intoxication or absence of reflexes, as occurs in the categories mentioned above.
I. VOLUNTARY USE. - The pleasurable use of stupefacients has been known since the most ancient times among the peoples of the countries where the individual drugs originate; nevertheless, they use them in their crude state and generally sparingly, so as not to fall into the extreme irreversible and mutually incompatible psychical and organic degenerative states that preclude the continuation of the species, as reached by drug addicts in the white countries. Among the latter, their spread has assumed worrying proportions, especially because of the use of pure extractive or synthetic preparations, and therefore much more active and toxic ones. This has been facilitated by their valuable use in medicine as sedatives, analgesics, and anaesthetics. Stupefacients, taken in excessive quantities concentrated over a short period, cause acute poisoning, generally characterized by a brief initial period of psychic and psychomotor exaltation, followed by drowsiness,
then depression of the vegetative functions, progressing to coma and death through paralysis of the nervous, medullary, respiratory, and cardiac 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 importance. It develops through prolonged use in necessarily increasing doses because of the intervening habituation; consequently, one distinguishes toxicophilia (a tendency toward the toxic substance that is not absolutely coercive and determining, a tendency permitting the coexistence of volitional strength capable of abstinence) from drug addiction (the stage of habituation in which the need for toxic gratification is irresistible). Mania, a phenomenon associated with habituation in the abuse of stupefacients, although having an organic basis, is in itself a determining impulsive tendency that is essentially psychic. In general, drug addictions claim their victims among individuals and races predisposed by particular weakness in moral restraints and in the instinct of self-preservation.
The principal stupefacients and corresponding drug addictions are: a) Opium (meconism): a drug consisting of the dried latex of Papaver somniferum (a poppy native to Asia Minor). It contains various substances, including certain alkaloids with a stupefying action, such as morphine and narcotine. Called the “alcohol of the yellow races,” it may be smoked (China, India) or eaten (India, Persia, Turkey, America); it exerts a milder action than morphine, and generally even prolonged use does not lead to cachexia.
b) Morphine (morphinomania): an alkaloid of opium that paralyses the higher nervous functions. The starting point for the development of morphinomania consists not only in painful illnesses—neuralgia, lancinating pains in patients with tabes, rheumatism, dental pain, etc.—but also in general nervous disorders of a neurasthenic or hysterical type: intractable insomnia, reactive depressive states, and professional psychic tensions not infrequently constitute the reason for the first injection, which is sometimes undertaken out of simple curiosity. All these circumstances suggest that some psychic disposition exists, an abnormally low capacity for resistance that predisposes to the onset of morphinomania. Sometimes, but very rarely (Antheaume and Leroy), morphinomania may arise in attacks, analogously to dipsomania; Kraepelin had already spoken of epileptic attacks or hysterical anxiety.
The effects of chronic morphine use are distinguished as physical and psychic. Among the former are severe weight loss, a yellowish-earthy complexion, loss of appetite, difficult digestion, constipation sometimes interrupted by diarrhoeal discharges, oliguria, dysuria, hypotension, tachycardia, marked vasomotor disturbances, impotentia coeundi, azoospermia, and amenorrhoea; neurologically, the following may be observed: muscular hypotonia, tremor (with features intermediate between that of the elderly and that of alcoholics), dysarthria, hyporeflexia, and miosis; disturbances of sensation (hypoaesthesia in all modalities, paraesthesias, sometimes neuralgiform in character) are always present and have particular significance. The psychic effects are much more characteristic and important, especially because of their social significance, and can be compared only with the disorders of the most severe alcoholics. All the qualities of the psychic personality are affected, particularly the ethical ones; severe hypochondriacal states and marked psychosensory disturbances (hallucinations, illusions) are observed; mnemonic disturbances are constant, affecting both the activity of fixation and that of recall, without any definitive loss of mnemonic material ever occurring; irreversible defects of judgment belong to the clinical picture of morphinism; the lack of initiative is very evident, although the mechanical performance of ordinary 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; and by withdrawal manifestations, that is, severe disorders appearing when administration is abruptly suspended in an habituated individual. The “thirst” for morphine is such as to drive the intoxicated person even to crime in order to procure the alkaloid and thereby satisfy the irresistible need. Treatment is far from easy: admission to specialized sanatoria, under the strictest supervision, is indispensable; relapses, however, are very frequent. Drug addictions to other derivatives of opium and morphine (heroin) are also known.
c) Coca: a chewing drug prepared from the leaves of certain erythroxylaceous plants (especially Erythroxylon coca L.), native to the Andean region of South America, where the indigenous peoples have used it since remote times to dull hunger and fatigue. This is attested by Inca vessels (11th century) depicting the coguérus, recognizable by the characteristic protuberance on 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 has an anaesthetic action at the point of introduction; following absorption and passage into the blood, it also acts on the central nervous system. Prolonged use of the substance occurs solely for pleasurable purposes, with an erotic colouring, and is motivated by the pursuit of pleasure: the “path of pleasure” (v. COCAINISMO).
Other stupefacients that are little widespread in the white countries are: e) Indian hemp (Cannabis sativa var. Indica): of the mulberry family, its drugs are used especially by the Asian and African Muslim peoples (under the name halil) and in Mexico (Marijuana). It contains an essential oil (cannabinol) that paralyses the brain. It produces intoxication and sometimes delirium, while leaving a glimmer of consciousness. f) Peyotl: a drug obtained from Anhalonium lewini (a cactus), used in Mexico. Its stupefying alkaloid (mescaline) causes visual hallucinations with the eyes closed.
II. ON THE LICITNESS OF THE USE OF STUPEFACENTS
It is clear that, with regard to the abuse of stupefacents, the moral judgment can only be one of condemnation: the pursuit of pleasure obtained through the obscuring of the higher faculties and biophysiological degeneration is, in fact, contrary to human nature. pleasure (v.) as an exclusively ultimate end represents an inversion of values and is therefore essentially immoral. Moral condemnation is further grounded in the physical-biological condemnation (degenerate offspring, organic disintegration, asociality, neuropsychic abnormality) with which nature burdens the drug addict.Nor is there any dispute concerning the use of stupefacents and narcotics in the field of anesthesia and as analgesics for surgical procedures: their employment is humane, reasonable, and therefore moral (v. NARCOTICI).
But moral questions may arise concerning the use of stupefacents when, in addition to relieving pain, they have other negative effects. If, in a particular case, these substances were to 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 confronted with two effects, one good and the other bad; hence this is a case for applying the principle of double effect. Their use will therefore be licit if: a) the analgesic effect cannot be obtained with other substances that would avoid the harmful effect, either because none exist or because they produce other, more serious disadvantages; b) neither the patient who requests such stupefacents nor the physician who prescribes their use intends the hastening of death; otherwise, this bad effect would be nothing other than the means of obtaining the good effect, and one would thus fall back into the immoral principle that the end justifies the means; c) finally, a certain just proportion exists between the bad effect and the good one, so that it is reasonable to perform the action despite the bad effect (v. RUTANASIA).
Often the alleviation of pain can be achieved only through the deprivation of consciousness. The loss of consciousness is undoubtedly an evil, because it places a person in a state of dehumanization; depriving someone of consciousness against his will is illicit and, even if a dying person desired it, it would likewise be illicit if the patient were not prepared for death, either because he needed to settle temporal affairs of considerable importance or because he needed to put his soul in order; it would be a crime to remove the still-present possibility of gaining eternal life. The administration of hypnotics to provide the rest necessary for a specified period is not, however, illicit.
Moreover, it should be observed that, although death and pain are evil in themselves, they can provide an occasion for the exercise of many virtues, such as patience and penance, especially during the final periods of life, when, the passions that might have led him astray having ceased, a person more easily directs his soul toward God. It is therefore not considered appropriate to make abundant use of stupefacents, even within the limits of what is licit.
III. LEGAL REGULATION
The social and individual danger posed by narcotics has induced the governments of the more advanced countries to enact legislative measures intended to limit their recreational use, first determining the world requirement for scientific and therapeutic purposes, allocating production among the cultivating countries, and regulating their 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 dependent on the “Economic and Social Council” of the United Nations.In Italy, the provisions governing the trade in narcotics and suppressing their abuse are found in the Consolidated Text of the health laws (R. D. 27 July 1934 no. 1265), arts. 148–60; various aspects are also addressed by the Penal Code, arts. 445, 446, 447, 613, 729.
For the timely prevention of the spread of abuse, the physician has the duty to report within two days to the P. S. authorities any person under his care who proves to be suffering from chronic intoxication due to narcotics. For these substances, the pharmacist is required to demand a medical prescription accompanied by complete indications of the patient’s first name, surname, and address, 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 authorities.
Costante Scarpellini
IV. THE FIGHT AGAINST OPIUM
The abuse of opium was introduced into China by the Europeans; in the so-called Opium War (1840–42), its importation was imposed by force upon the defeated country. In the years 1729, 1796, and 1800, the Chinese Emperors prohibited its cultivation and use by means of extremely severe edicts. 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 question from the apostolic vicar 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, no. 815).It seems that some apostolic vicars had been too inclined to punish opium smokers with excommunication, since on 30 October 1843 Propaganda advised the apostolic vicar of Malacca to apply this extremely severe penalty with discretion (ibid., no. 1035). The Church’s attitude, however, did not change, as is clearly demonstrated by the response given by the Holy Office on 10 March 1852 to the apostolic vicar of Chensi, in which it was stated that the cultivation, trade, and use of opium remained forbidden to Christians under the gravest penalties (ibid., no. 1071). On 20 September 1850 the same Holy Office, in an instruction to the apostolic vicars, decreed that opium smokers could be baptized only if there were moral certainty that they would abandon this vice (ibid., no. 1103). After the Opium War, the civil laws prohibiting the cultivation of the poppy were abolished, and this cultivation became a source of prosperity for several provinces. For Christians, almost all of them in severe material hardship, abstaining from poppy cultivation without suffering extremely serious harm was difficult. Moreover, it was observed that men accustomed to using opium placed their lives in danger by abstaining from it completely. Therefore, on 23 March 1878, the Holy Office, in response to a request from the apostolic vicar of Kuy-Tschou, permitted the cultivation of the poppy subject to certain precautions, as well as its medicinal use (ibid., II, no. 1489).
On 4 July 1883 Propaganda recommended that the apostolic vicars establish in China a movement for temperance in the use of opium, as had been done in Europe and America against alcoholism (ibid., no. 1599). Since the response of the Holy Office of 1878 had been given an excessively broad interpretation, the same Holy Office declared on 29 December 1891 that the cultivation of the poppy remained lawful only for medicinal purposes; instead, because of the great dangers arising from it, its cultivation, trade, and use were in general prohibited to Christians. The severest ecclesiastical penalties were threatened against recidivists and habitual offenders (ibid., no. 1776). In response to a request from the apostolic vicariate of Chensi, the Holy Office declared on 25 April 1894 that Christians could neither lease land on the condition that the poppy be cultivated there nor accept opium as payment of the rent itself; they were not, however, obliged to prohibit the tenant from cultivating it (ibid., no. 1867). On 2 October 1931 the apostolic delegate, Msgr. C. Costantini, reaffirmed the relevant ecclesiastical legislation, namely: 1) Christians may not be admitted to the Sacraments, nor catechumens to Baptism, if they cultivate or engage in the opium trade; 2) the cultivation of the poppy in itself is not illicit, but in China it constitutes an immoral act because of its disastrous consequences; 3) missionaries, in cooperation with the government, must combat 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 question of opium.