The Homœopathic Proving of Heroin

Heroin is a powerful analgesic and narcotic. It is a diacetyl derivative of morphine which is the most important alkaloid in opium.

Opium poppies have been cultivated in many areas. Remains of cultivated poppies dating to the 4th Millennium BCE have been found in Mesopotamia and in Switzerland. Its cultivation was widespread in Egypt by 2,000 BCE. It was widely used as a medicine and Assyrian medical tablets of the 7th Century BCE describe its medicinal use. It was used in classical times as a medicine and to procure healing dreams in the Temple of Aesculapius, the god and inventor of medicine. The Turks took opium to increase their courage and decrease fear.

Opium was widely used in 18th and 19th century Europe as an analgesic, narcotic, and to suppress coughs. It was generally taken as Laudanum, in which it was dissolved in strong wine. It was used by the working class to keep children quiet and make life more bearable and was taken by many of the figures of Romantic Literature, especially Coleridge and De Quincy. It was so central to the economy of the Raj that two wars were fought with China to prevent its prohibition. Hong Kong and the Jardine Matheson Company arose out of these wars and the opium trade.

In the first years of the Nineteenth Century a German chemist Friedrich Sertürner was able to extract the pure Principum Somniferum, the first Alkaloid which he named Morphium after the god of sleep. Morphine was purer and so easier to gauge the correct dose and with the invention of the hypodermic in the 1850s it began to replace opium in medicine and general use in the West.

Morphine was widely used in the Franco-Prussian, the Crimean and the American Civil Wars and opiate addiction was known as the "Soldier's Disease".

It was at first hoped that injection with a hypodermic would not cause habituation (addiction). However, this hope was short lived.

In 1874 CR Adler Wright, a pharmacist at St. Mary's Hospital in Paddington boiled morphine with acetic anhydride and created dia-morphine. Dia-morphine is more lipid soluble than Morphine and so delivers the drug across the blood brain barrier more quickly and efficiently. Although dia-morphine itself does not attach to the opiate receptors in the brain, it quickly breaks down to Morphine and other metabolites that do.

It was nearly a quarter of a century after the discovery of dia-morphine that the Bayer Pharmaceutical company. began to market Heroin alongside their very successful Aspirin, which was also an acetic derivative of an already used analgesic. Heroin was named from the German Heroisch (heroic, powerful), like laudanum (laudare, to praise) it was given a name promising greatness that was not to materialize. It was assumed to be non-addictive and was promoted as a treatment for morphine addiction as well as a cough suppressant. Its addictive nature was soon recognized. In the US it was restricted in 1914 and prohibited in 1924. However, Heroin was fast becoming an important recreational drug and through the thirties it was in widespread use, both by the poor and by Hollywood celebrities. Supplies dried up in the US during the War, but in the fifties it resurfaced associated with the Beat poets, particularly Kerouac and Burroughs, but also as part of the gang culture in the cities.

The Vietnam War, like the wars before it, produced a vast number of soldier addicts, and the tragic deaths of rock giants like Jimi Hendrix and Janis Joplin gave it a particular image that included danger, glamour and despair. For many it generated an excitement, a dicing with death. It always represented the darker side of drug-taking. In more recent years those addicted to heroin tend to be people who feel no hope in their lives and no means of sharing in the prosperity enjoyed by society at large. For them it can act as an anaesthetic, blunting the pain of exclusion, of homelessness, abuse and poverty. Dia- morphine is used to ease severe pain in hospital and hospices.

Heroin can be taken in a number of ways. It can be smoked, Chasing the Dragon (the burning heroin moves like a writhing snake). This is inefficient and requires quite pure heroin to have much effect. Ingestion is even more inefficient with much of the heroin being cleared by the liver before it can reach the brain. Skin popping, in which the drug is placed in cuts under the skin, is used but not common. The principal means of taking the drug is mainlining, or shooting up, in which it is dissolved in a little water and injected into a vein. This gives the fastest and most extreme rush. Another important method is snorting the powder up the nose where it is absorbed through the nasal mucous membrane. In West Coast America where supplies are from Mexico and generally of low purity, mainlining is common. On the East Coast supplies from South America are much purer and so snorting is more common. Average purity of Heroin in the States has risen from less than 4% to near 40% over the last twenty years. In the same time the price has dropped to a quarter of what it was.

It is impossible to readily gauge the long term effects of Heroin use as it is so entwined with a destructive lifestyle. There are a great number of "chippers", non-addicted regular users, and addicts who maintain their habits within a conventional lifestyle. These people are much less likely to have a run in with the law or the medical profession and their experience of Heroin is generally ignored. The long term effects experienced by the typical junkie, are often related to social factors more than to the direct effect of the drug. Users automatically become criminals and often find themselves funding their habits through criminal activities. Their contact with the underworld makes violence and death much more likely. They often live in squalid conditions and so are subject to general ill health. What money they have is spent on drugs and though Heroin dulls the pain of hunger, it has been found that users with a ready supply of food do not emaciate or suffer from malnutrition. Babies born to addicts may suffer withdrawal symptoms but this is disputed. Most babies are underweight and more likely to die in infancy, but this is as likely to be a result of the difficulties that their mothers' experience and may have nothing to do with the drug. Cough suppression may cause bronchitis and respiratory infections to be more common, but again malnutrition and poor living conditions are a much bigger factor. Needle use causes many of the medical side effects of Heroin. Abscesses are common at injection sites and many diseases, including HIV and Hepatitis, are transmitted through shared needles. Many users are also involved in prostitution which increases the risk of STDs. The Heroin used is cut, or diluted, with other substances. Milk sugar might be used, but so are many other substances. Talcum powder is insoluble and so can cause problems in the blood vessels. Mannite, a mild laxative, is sometimes added to counteract the costive effects of the drug. Quinine has been added, reportedly since an outbreak of malaria in the 1940s killed many addicts, and it can make some users react badly. Vitamin C or lemon juice is used to make the Heroin more soluble before shooting up. This led to a superficial bacterial infection becoming fatal for many users in the UK in recent years. Other drugs and adulterants can make the drug much stronger than expected leading to overdoses.

The short term effects of Heroin are to reduce pain, to depress many nervous reactions. It suppresses the cough reflex and also suppresses appetite, libido, energy, circulation, and respiration. Most overdose deaths are caused by respiration becoming so depressed it stops completely. It effects the Locus coeruleus in the brain, reducing fear and anxiety. Peristalsis is inhibited in the colon resulting in constipation. It affects the Anterior Pituitary Regulating Hormone which in turn affects the Lutenising and Follicle Stimulating Hormones resulting in amenorrhoea. The peripheral blood vessels become dilated causing a sense of warmth or heat often with perspiration. The pupils of the eyes become pinpricks. Other effects might include: nausea, vomiting, lethargy, sedation, hepatic and renal dysfunction, coma, stupor, faintness, hallucination, euphoria, pruritis, urticaria and skin rashes. A sense of well being may replace depression and low self esteem. Inhibitions may be removed.

Addicts become habituated to the drug and need continually higher doses. It has been shown in rat experiments that tolerance is environment specific and users can tolerate much higher doses if taken in their usual environment. However, much of that tolerance is lost if the drug is taken in an unusual environment. This has resulted in many overdoses where an addict takes the usual dose but in a different setting.

Abstinence in habituated users results in physical withdrawal symptoms, these include: terrors, restless sleep, muscle and joint pain, vomiting, diarrhoea, gooseflesh, irritability, nausea, cramps, urinary incontinence, chills, runny nose and spasms (hence "kicking the habit").

I decided to conduct a proving of heroin partly because it seemed there should be a place for it in the Materia Medica given its prevalence in our society. Over the years I have observed the lives of several heroin addicts and watched a child grow up whose parents were both users at the time of her conception. I was interested to see if their experiences were mirrored in the symptoms of the provers.

Much of what happens in a proving cannot be documented as symptoms or rubrics as it has not occurred strictly within the confines of the proving. However, the experiences of those that are in contact with the proving can inform our understanding of the emerging remedy and are worth recording for that reason. Synchronous events occurring around the time of the proving are at the very least interesting to observe. Dr. Shipman's trial for poisoning his patients with dia-morphine spanned the month the proving was conducted. The morning of the day the proving began I had a new patient whose occupation was the fostering of babies born to heroin addicts. That evening the BBC broadcast the first of two programmes documenting the lives of young heroin users. One of the provers dreamt of shit being thrown around the room. There is a scene in Trainspotting where the same event occurs.

Everyone involved in provings is aware that symptoms are experienced by those associated with the proving who have not taken the remedy. This happens in the case of supervisors and those involved in a relationship with the group concerned. The proving of heroin entailed difficult and at times alarming experiences for those of us supervising. Several people reported unusually aggressive and dangerous driving behaviour. Others experienced rage quite out of proportion to the situation. One supervisor, normally a gentle person, was ready to kill a railway official when his train was late. The proving was blamed for extraneous events that occurred around the time and even many months later. I think it would be fair to say that the proving of heroin shocked those of us involved in conducting it at the price demanded of us.

I became unusually very ill and lay for several days in a place somewhere between consciousness and unconsciousness, a state I had experienced once before about thirty five years ago. I also suffered from the symptoms of tonsillitis and malaria, which again had occurred many years previously. Due to the severity of my symptoms I decided to put the proving aside for a while. In fact I put all the notes in my garden shed and buried the rest of the remedies at the bottom of my garden. Six months later I retrieved the notes and began again to study the information we had gathered. Within a week I developed the same symptoms I had experienced six months previously. It is now over two years since the proving was first conducted.

I thought it would be interesting to record the experiences of some heroin users in order to see whether there was any similarity to the symptoms produced by the provers. Here are some of the stories of former addicts.

"Everyone is your friend. It gives a huge amount of love for the people you are with. It doesn't matter who they are. You just feel love and contentment with them. The surroundings can be squalid and you can have no money or food but after that fix all is bliss for at least two hours."

"I would feel cocooned from all ills and warm even if not in a warm place. I overdosed several times, rather like going under an anaesthetic, no fear at all."

"When I mainlined there was an initial rush lasting a few minutes. Then I would feel terrible nausea and vomit, vomiting which was easy and immensely pleasurable."

"I had taken many drugs but never experienced such a wonderful physical feeling. My body felt delicious and the world seemed a blissful place to be. All my distress and all my problems disappeared. The next day I felt a strong physical pull to the place I knew would give my next fix. As the day wore on the pull became stronger. It was as if an invisible string was drawing me there. It was my body not my mind that was pulling me and the pull was so strong I had to follow."

"It was pain killer in the biggest sense. It killed emotional and psychic pain as well as physical pain. There is no hunger, sadness, anger or loss when you are stoned on heroin."

"Unfortunately if I took it for more than a few days I would experience sinking nausea and diarrhea, painful crampings of the abdomen and just want to lie down. I broke into a cold sweat."

"You do anything for that next fix, steal off anyone, your mother, even steal the morphine proscribed for her pain as she is dying."

It is difficult at a certain stage in conducting a proving to be able to extract a real sense of the feeling of the substance, beyond the words of the provers. It was not until I attended a musical production of the life of Janis Joplin in Greenwich Village in New York that I felt convinced I understood what heroin was about. The young woman who played the part of the singer bore an uncanny resemblance to her both physically and musically. Her tragic but poignantly productive short life was portrayed through her songs and letters. Janis Joplin grew up in the Southern States of America. Her music was heavily influenced by the Blues tradition which had grown out of the music of the suffering of the Negro slaves. Singing was one way they could endure the painfulness of their lives. It seems that Janis Joplin felt a pain that was greater than the experience of her life. It was as if she had taken on the pain of those who sang the Blues, music she recreated in her own songs. To numb that pain she took to heroin, dying at the age of twenty seven of an overdose. In the sixties the "glamorous" use of heroin by hippies and musicians was most widespread on the West Coast of America. The majority of the citizens of the United States are descended from immigrants who were fleeing persecution and deprivation in their homelands . They in their turn all but destroyed the native peoples of the "new country" who had lived in harmony with the natural world. Out of this has been built a culture, one of the side-effects of which has been the increasing destruction of the environment. At the same time America attempts to numb the pain of its land and people. Nowhere in the world is the use of painkillers more widespread. The understandable pain and shock following the events of September 11th demonstrated how suffering had been kept at arm's length. All of these considerations helped me understand what Rajan Sankaran terms the vital sensation, that point where the emotional and physical meet. In heroin this would seem to be the numbing of pain.

Heroin is part of the Papaveraceae family. It has been difficult to distinguish it from Opium. It would seem that the main difference is that in Heroin there is the feeling of an outcast, being despised by society and in many instances hunted down by the forces of law and order.

Prover	Gender	Dose	Prover	Gender	Dose
1	F	30c	10	M	30c
2	M	30c	11	F	30c
3	F	30c	12	M	30c
4	F	30c	13	F	30c
5	M	30c	14	F	30c
6	M	30c	15	F	30c
7	M	30c	16	F	30c
8	F	30c	17	F	30c
9	F	30c	18	F	30c

Times given are the actual time of day, not time from taking the remedy. XX.XX indicates no specific time was noted.

Days are numbered from 1, the day the remedy was taken. Day 0 indicates a symptom that was general and not tied to a particular date.

AS An altered symptom, one previously experienced but with at least one quality changed.

IOS An old symptom that is felt with significantly greater intensity than before.

The remedy was prepare by the Helios Homoeopathic Pharmacy by the Hahnemannian single vial method.