pp 308-312 Intoxication, by Dr. Ronald K. Siegel, 1989
“Peggy Sue went square dancing. I saw the pictures and I still couldn’t believe it. She was sitting in my office, passing photographs to me from the family album, and explaining what had happened. Peggy Sue was seventy-three and she looked very tired; the pictures told the story of better days. In her youth she had been a champion square dancer; Bill, her husband and partner, had posed with the trophies to prove it. He still moved with grace as he guided her through the examination procedures. They now lived in a retirement village where Bill took care of Peggy. He helped her out of bed in the morning and tucked her in at night with all the tenderness of a lovesick boy. Peggy could only smile back. Sex was too difficult.
As I examined her, I realized she needed Bill’s help. Her hands were gnarled; her limbs were stiff; and her joints were red and swollen. She could move only short distances with a slow shuffle. While she was able to hold a glass of water with two hands, turning a doorknob was impossible. She needed help in the bath and with grooming. None of these signs of advanced rheumatoid arthritis caused me to disbelieve her story of square dancing. It’s just that she got out of her wheelchair to do it.
The medical records told of Peggy Sue’s battle with arthritis for almost twenty years. She had received all the conventional treatments, including gold shots, anti-inflammatory drugs, even surgery on her hands. She sought unconventional steroid treatments in Mexico and was desperate enough to try every new diet, exercise, or massage that promised to ease the progressive stiffness and pain. Then she moved to a desert clinic in California where she received Esterene. Several weeks later, Peggy Sue danced.
The charts in her file showed an increased range of motion as muscle and joint functions became less restrained. Her strength improved, the inflammation and swelling of her joints subsided, and all the examining physicians agreed that Esterene had greatly improved Peggy’s condition. Although she never looked forward to taking the Esterene—she thought sniffing was a most peculiar way to take medicine—Peggy Sue had to agree she felt better, suffered less pain, could move her neck and body more freely, and could do without the dozen aspirins she normally took each day. Even when she was told that Esterene was a stimulant, she still didn’t get a rush from the drug. Bill was the one who seemed excited, though, especially now that his lover could once again get into bed on her own.
I remained skeptical. Peggy Sue’s rising out of the wheelchair seemed like an act straight from a faith healer’s tent show, not the result of medical treatment by a national arthritis center, and Esterene was, after all, a slick trade name for crack! If used intranasally, crack, which is cocaine free base, would be ever so slowly absorbed by the mucous membranes of the nostrils. This would eliminate the rush that Peggy Sue denied experiencing, but would it also prevent abuse? There were over two hundred other people in the Esterene treatment program that I had been asked to evaluate. I was hopeful that detailed study of these patients would provide the answer.
Esterene had been used for more than two years on hundreds of patients, yet I was unable to find a single case of abuse. Some patients had been taking as much as 750 milligrams per day with no ill effects. The program had not proven that Esterene was a cure for arthritis—at best it was only acting as an analgesic and psychomotor stimulant—but it did show that use of a drug, even one with the addicting power of crack, did not have to lead to abuse. It was important to understand how such use could be achieved. If crack could be used without abuse, then maybe any drug could be used safely.
The key to this safety was the ultra-slow absorption of cocaine free base from the nasal membranes. Unlike the smoking of the drug, which results in almost instantaneous intoxication, the effects from topical application were like a time-release capsule. The nose functioned as the capsule and the cocaine free base slowly leached out into the blood. Users experienced mild intoxication but one that seemed to last for hours and didn’t need frequent boosts. It was the same effect achieved by chewing coca. Another aspect of safety seemed to be the medical set and setting for the Esterene use. Users were good patients who were under the direct supervision of physicians; they followed their doctor’s orders and their Esterene labels”
I didn't have long to wait for a group of such users to surface for study. Sensationalist press stories about the Esternene program had prompted many people to experiment with intranasal cocaine free base. Some were cocaine users attracted to the report that snorting the free base was safer than snorting cocaine hydrochloride. Others were elderly people like Peggy Sue who were seeking treatment for arthritis or depression. The state had halted the Esterene program and disciplined the physicians, and as a result people started whipping up home brews of the drug. The authorities were understandably worried. Cocaine free base was not a miricle cure for rheumatoid arthritis, but if people started believing it and feeling better we might have a new population of illegal drug users to worry about: senior citizens! They could be readily be sold on the idea of cocaine as on Coca Cola, which was originally intended as a cocaine tonic for elderly people who easily became tired. We would no more be able to raid retirement homes looking for little old ladies sniffing cocaine than to bust into cancer clinics where patients sometimes received other unconventional drugs.
I found a total of 175 users in the greater Los Angeles area. Surprisingly, most were not experiencing problems. They reported anti fatigue effects, as well as the suppression of chronic pain and discomfort, but they failed to experience problems. They reported antifatique effects, as well as suppression of chronic pain and discomfort, but they failed to experience the rapid and reinforcing euphoria that gives cocaine its addictive (sic- instead say something as hyper alluric, stop reusing a given term in different ways, that simply masks the true addictiveness of caffeine, heroin, and above all NICOTINE) potential. Unlike daily cocaine hydrochloride users who repeatedly dose themselves throughout the day, (into a toxic maniac cycle) people sniffing cocaine freebase administered the drug infrequently and do not show signs of dependency. Some had financial or legal problems associated with their use; several also experienced loss of appetite or sleep. yet their ability to maintain daily doses as high as 1,000 milligrams (?!) without severe dysfunction suggested that safe use was possible even in non medical settings.
The major conclusion of the Peggy Sue story is not that Esterene should be made available by prescription (???). Rather, we see that the people can use certain forms of intoxicants. They can do so safely on the streets as in the clinics. How? In the prescriptions of Esterene the doses of cocaine were as carefully fixed as they had in the coca tea bags. Even street users, without the constraints of a medical set or setting, were handling these preparations. Conversely, the uncontrolled doses of street cocaine or smokable crack can easily lead to abuse if not toxicity itself. The apparent safety of the Esterene emphasized the dictum that a major difference between drug use and abuse is one of dose.
But our culture also views the difference in terms of medical approval. Peggy Sue was engaged in the medical pattern of use. Her crack was a medicine, therefore acceptable. When used by street users for the purposes that are not approved by medicine, the pattern of use is called non medical, therefore unacceptable and immoral. Their crack is a poison. Yet the street users were medicating their health, with the same relative safety that Peggy Sue and other clinical patients enjoyed while medicating the symptoms of arthritis. The resulting intoxication (??? "toxic"???) in both cases was medical, not nonmedical.
The medical purpose of intoxication is easier to understand if we think of intoxicating drugs as adaptogens. Technically, an adaptogen is a substance that helps people adjust to changes in their physical or psychological environments. Adverse fluctuations in their physical or psychological environments. Adverse fluctuations in physiological, chemical, biological, or neurological systems may be corrected by some adaptogens. Thus, if the body or mind is tired, an adaptogen perks up functioning. Conversely, if one is overly excited, another adaptogen may temper the arousal (perhaps different coca leaf alkaloids) perks up functioning. Some adaptogens not only correct imbalances but perform a normalizing function by helping even healthy humans increase their resistance to potential changes . (Imagine applying these last few sentences to the matter of the effects of the different Coca leaf components and in different combinations, let alone the broader matter of food industry sciences).
Many adaptogenic substances are of plant origin and the most famous is ginseng, a plant that can rival cocaine in costs for some exotic preparations. Ginseng has been used worldwide to help the body perform under stress, correct fluctuations in blood pressure, even repair damage from radiation. Many people find it has a mild stimulating effect and also use it for fatigue, depression, and sexual indifference. But this is really no different from the reasons chosen for using the other drugs, such as coca. Proportionately, there is no greater incidence of abuse among the millions who use ginseng than among the comparative number who consume coca.
These findings do not mean that we should outlaw ginseng any more than we should legalize coca (???- let us not dare challenge the status quo). What they show is that coca, cocaine, heroin, marijuana, alcohol, tobacco, and the hallucinogens are just as much medicines as ginseng when used to help us adapt to changes in our physiological or physical environment. (???Tobacco??? What is Dr. Siegel writing about, alien species from outer space with different types of bodies - physiologies - that respond different than humans?) Intoxicating drugs (intoxicating rather than potentially toxic in some higher dosages?!) medicate the needs of the forth drive for a change in state or mood. Whether we use coca tea to help us cope with high altitude sickness, or cocaine to fight the gloom and despair of consciousness, we are still medicating our needs. The purpose of intoxication serves a legitimate medical purpose.
The solution to the drug problem of our species begins when we acknowledge the legitimate place of intoxication in our behavior. We must ensure that the pursuit of intoxication with drugs will not be dangerous. How can we do that?
