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August 19, 1974

Nature of Heroin Dependence

Author Affiliations

Royal Free Hospital School of Medicine Liverpool Road Branch London, N. 1

JAMA. 1974;229(8):1046. doi:10.1001/jama.1974.03230460014010

To the Editor.—  The problem of treating heroin addicts continues to go unresolved. The supporters and detractors of methadone maintenance programs produce more and more evidence to support their divergent views. The sobering fact remains that we are no nearer success in the treatment of heroin addiction than we were a decade ago.The small quantity of heroin found in the average illegal bag is insufficient for most addicts to develop true physical dependence.1,2 The symptoms and signs of withdrawal as described in generations of textbooks are not primarily related to the pharmacological effects of the drug, or the lack of it, but to the patient's innate fear of not getting his next fix. When true physical symptoms develop, which take about 72 hours to become pronounced, we find evidence to suggest that they are associated with an increase in detoxifying chemicals in the liver that accumulate in the