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Related post: Coffee is of undoubted value in the preliminary struggle of
reducing morphine to a minimum, especially to alleviate the
giddiness and depression on first rising in the morning.
Here also light alcoholics may be of value at times, but
brandy is apt to produce weakness of the will and an in-
creased desire for morphine. Bromidia at night may help
in reducing the allowance. At the height of the supreme
struggle, which follows on the second and third day after
total suspension, all these agents are of no perceptible
value. The whole list of hypnotics produce drowsiness
without allaying the intense distress and muscular spasms
which harass and prevent sleep. The list of heart tonics
may stimulate the pulse, but do not mitigate pain. The
valerianate of ammonium, mentioned by De Quincey, I have
not observed to be of any value. It is here that we may
realize the immense gulf between opium and the rest of the
pharmacopoeia.
It was while attempting to treat a patient long addicted
to morphine by hypodermic injection that I noticed in a lay
paper an incidental allusion to the cure of the morphine habit
by the sulphate of codeine.* Unfortunately, I have never
been able to correspond satisfactorily with the author of
this hint in regard to the matter. The standard literature
on the therapeutic uses of codeine I have found to be scant
and unsatisfactory, for it is generally reckoned to be identi-
cal in effect with morphine, but less powerful. During one
of Price Of Venlafaxine the numerous attempts to abandon morphine in the case
above mentioned, when the suffering had become intolera-
ble, I determined to try Buy Venlafaxine codeine as a substitute. A hypo-
dermic injection of one grain of the sulphate dissolved in
hot water was given, with the most satisfactory result.
Aside from accounts of experiments on the lower animals, I
think I am in a position to assert from my own experience
with this drug that no amount of codeine is identical in ef-
fect with any amount of morphine. The effect in the case
under consideration was little short of magical. In half an
hour the severe pain in the lumbar region and down the
sciatics had completely subsided, and the patient, after ex-
pressing an instinctive belief that the necessary stepping
stone across the chasm had been found, arose from his
couch and went about his vocations as usual. This relief
continued for four hours. The difference in effect between
morphine and codeine under these conditions becomes vivid-
ly apparent. An eighth of a grain of morphine will relieve the
peculiar pain, but there is added a certain positive Venlafaxine High effect on
the cerebrum, and the patient is aware that he has again
* Since the events recorded in this article took place I have noticed
a brief reference in the Medical Annual to a paper by Gitterman on the
use of codeine as a substitute in treatment of the morphine habit (Medizi-
nal-Zeitung, p. 121). There are no details, and I have not been able to
secure his original paper. These are the only two references to the
subject I have seen.
Jan. 7, 1893.]
SULPHATE OF CODEIXE IX THE MORPHINE HABIT.
11
taken morphine. After one grain of sulphate of codeine the
pain simply fades away ; the effect is much less profound,
and the patient does not feel as if he had taken anything.
The codeine treatment was subsequently followed up
systematically, one to two grains being given everj- three
hours, according to the urgency of the symptoms. This
course was continued during the first five or Venlafaxine Online six days, then
the intervals were gradually lengthened till on the fourteenth
day it was dropped entirely without any great difficulty. I
think the ultimate easy success of this treatment lay in the
comparatively prolonged use of the codeine, allowing time
for the substitution of one habit for the other. I should
hardly expect any benefit from its use in any attempt at
very rapid reduction. After having gradually reduced the
morphine to a minimum, say one half or one quarter of Venlafaxine Price a
grain in twenty-four hours, the codeine may be substituted.
During the period when the storm from total abstinence
from morphine would be at its height the codeine must be
used with corresponding freedom ; ten or twelve grains in
twenty-four hours were used in this case. On account of
its comparative insolubility, it is best used by heating with
the required amount of water in Mirtazapine Venlafaxine a Venlafaxine Mirtazapine spoon over a spirit lamp,
and the solution should be injected immediately before it
cools sufficiently to allow recrystallization. There is no dan-
ger of an overdose, as the barrel of an ordinary hypodermic
syringe will hardly hold more than two grains in solution.
During a period of ten or fourteen days the patient is
instinctively aware of a change going on in his constitution.
There is a partial Venlafaxine Buy but permanent recovery of tone in the
nervous system which gives confidence in the final result.
In dropping the codeine on the fourteenth day the discom-

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