Vincent Dole (18 May 1913 in Chicago – 1 August 2006) was an American doctor, who, along with his wife Dr Marie Nyswander (died 1986), pioneered the highly controversial practice of substituting the synthetic narcotic agonist methadone to treat heroin addiction. Drs. Dole & Nyswander, in establishing Methadone Maintenance Treatment (MMT), revolutionized addiction medicine which for a Century had been based on the conventional and widely held view (circa 1965) that narcotic addiction was the result of an intractable moral defect. His work resulted in the partial re-legalization of opioid maintenance in the United States. For this contribution he was a recipient of the prestigious Lasker Award for Medicine, sometimes referred to as "America's Nobels"
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Dole was educated at Stanford University and Harvard University, earning degrees at both and joining the Rockefeller Institute for Medical Research in 1941. During World War II, he was a lieutenant commander at the Naval Medical Research Unit at The Rockefeller Hospital.
Dole & Nyswander's skeptical approach to the view that addicts of (certain) drugs were morally unfit, criminals in our midst helped to return the treatment of chemical dependency to doctors, from whom it had been usurped by the anti-narcotics constabulary.
Drug-seeking behavior, like theft, is observed after addiction is established and the narcotic drug has become euphorigenic. The question as to whether this abnormality in reaction stems from the basic weakness of character, or is a consequence of drug usage, is best studied when drug hunger is relieved. Patients on the methadone maintenance program, blockaded against the euphorigenic action of heroin, turn their energies to school work and jobs. It would be easy for them to became passive, to live indefinitely on public support and claim that they had done enough in winning the fight against heroin. Why they do not yield to this temptation is unclear, but in general they do not. Their struggles to become self-supporting members of the community should impress the critics who had considered them self-indulgent when drug-hungry addicts. When drug hunger is blocked without production of narcotic effects, the drug-seeking behavior ends.[1]
Their achievement was made at a time before the discovery of stereo specific opioid receptor sites distributed throughout the central nervous system, brain and spinal cord, which were activated by naturally produced ligands called endorphins (for "endogenous morphine") & enkephalins to facilitate the body's own process of modulating painful stimuli from acute and/or chronic trauma. It was soon discovered these endogenously-produced agents had important molecular similarities to the plant-produced alkaloids morphine & codeine. The discovery allowed Pharmaceutical Companies to create new generations of semi-synthetic and synthetic opioid agonists (agents which mimic the effects of endorphins), antagonists (agents, such as naloxone (Narcan) which reverse the effects of agonists, essential in treating overdose), and even a separate category of "agonist-antagonists" which possess properties across a broad spectrum of different receptors (e.g. Mu, Kappa). Researchers continue to expand our understanding of how the human body regulates everything from reaction to noxious & pleasurable stimuli, temperature, pressure, emotions, learning, and many other physiological processes. The scientific leap also has doubled the choices available to opioid addicts with the availability in recent years of treatment from individual medical practitioners dispensing sub lingual buprenorphine HCl in the form of (Subetex & Suboxone), following the same principles discovered by Dole & Nyswander.
Supreme court interpretations of the 1914 Harrison Narcotics Tax Act had criminalized opioid dependency as well as the use of any opioid "for the sole purpose of maintenance." Thus began the saddest chapter of America's longest war: the stigmatizing and criminalizing of dependent individuals as well as the physician who prescribe them drugs. This directly led to the under utilization of opiates such as morphine in terminally ill patients out of a fear of becoming addicted - oftentimes expressed by the patients to the doctors. Medical schools provided almost no instruction on addiction; making Dr. Dole's research program a courageous act.
In 1964, at Rockefeller Institute (now known as Rockefeller University), Dole and Nyswander initially treated six addicts during the first year, but the results of this work "were sufficiently impressive to justify the trial of maintenance treatment of heroin addicts admitted to open medical wards of general hospitals in the city."[1] By 1967 over 300 patients were receiving daily doses of methadone, a potent synthetic opioid with an especially long half-life. "After the patients had reached the stabilization level (80 to 120 mg/day methadone) it was possible to maintain them with a single, daily, oral ration, without further increase in dose."[1] The rate of successful retention in the program was close to 90%, more than double anything previously demonstrated by abstinence-only programs which up to then had been the only alternative to incarceration. Dole's patients not only largely stopped heroin use, they expressed an interest in family, friends, work, and becoming fully engaged members of society once more. Though psychiatrists were available counseling was not mandatory. Dole found that the shift of priorities from daily drug-cravings and the endless quest to keep the abstinence syndrome at bay restored to these individuals an inherent sense of self-worth; resumed family responsibilities as well as employment. The doctors noted that although methadone satisfied the physical cravings of heroin addiction, patients soon became completely tolerant to its effects. Patients would remain "dependent" on methadone but could otherwise continue their lives normally...choosing when to gradually withdraw themselves by a graduated lowering of the dose over several months.
Habituation results from exposure to any stimulus for long enough. The body always strives for homeostasis or balance, which is why the sudden withdrawal of methadone, morphine, alcohol, cigarettes, precipitates what is called the withdrawal abstinence syndrome.
"As for the cured addict, involves a controversy as to the goal of therapy. Those of us who are primarily concerned with the social productivity of our patients define success in terms of behavior–the ability of the patients to live as normal citizens in the community–whereas, other groups seek total abstinence even if it means confinement of the subjects to an institution. This confusion of goals has barred effective comparison of treatment results."[1]
In 2006 there are well over one million methadone treated patients in the world. Politicians in the United States have threatened to curtail the measly budget appropriated for addiction treatment as a total percentage of the U.S. yearly budget for the so-called War on Drugs. The most recent example was in 1998 when New York Mayor Rudy Giuliani threatened city methadone programs. Shortly after making the announcement that he intended to close all programs in New York City he reversed his position, after overwhelming pressure from constituents and even Drug Czar Gen. (Ret.) Barry McCaffrey. The programs that were part of the Health and Hospitals Corporation (HHC) continued to receive funding to comply with Federally-mandated patient counseling, physician & psychiatric oversight, and referrals to non-profit needle-exchanges, family support & welfare services.
Dr. Dole died in 2006 at the age of 93, from complications of a ruptured aorta, survived by his third wife Margaret Cool, his three children; Vincent Jr, Susan, and Bruce, and five grandchildren.