The Soviet doctor and the treatment of drug addiction: "A difficult and most ungracious task"

When in 1922 a prominent Central Asian psychiatrist, Leonid Antsyferov, presented his paper on "hashishism in Turkestan" at the First Scientific Congress of Physicians of Turkestan, he called for the Soviet government to take a number of urgent measures aimed at rooting out this 'evil' or, if such an objective would prove unrealistic in a short term, then at least at reducing it to its smallest possible extent. He argued that repressive measures alone would be insufficient and that the struggle against drug addiction should be conducted by different means, namely enlightenment and treatment. In his view, physicians were to be placed at the head of this struggle because the task of making the masses healthier was particularly close to their mandate [1]. However, at the heart of these anti-drug activities were questions to which Antsyferov did not submit straightforward answers: who would be responsible for treating drug addiction and how these specialists would need to carry out their job?These questions were surely not new to biomedical doctors, who were used to dealing with the opiate consumer both in the heartland of the Russian Empire and in Russian Turkestan. Together with chronic alcoholics and consumers of other drugs, opiate addicts were believed to be in need of treatment and the authority for their treatment belonged to psychiatrists. Well before the Bolshevik's revolt, in the second half of the nineteenth century, Russian physicians began to publish their works on opiates and opiate addiction. Some of them, including pre-eminent psychiatrist from Moscow, Sergei Korsakov (1854-1900), discussed the use of opium in psychiatry and stressed that opium could be a very useful medicine that could be administered in the form of a powder, a pill or an enema for controlling a wide range of conditions including agitated boredom, manic excitement, delirium tremens and epilepsy [2,3]. Other physicians wrote about the potency of opium, the way in which it could alter the