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Apolaustic apomorphine
  1. Gerald Stern
  1. Correspondence to Dr Gerald Stern, Emeritus Consultant Neurologist, University College Hospitals, London WC1 3BG, UK; Geraldsterniii{at}gmail.com

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To cease smoking is the easiest thing I ever did; I ought to know because I have done it a thousand times. Mark Twain

Introduction

I first used apomorphine in rather odd clinical circumstances. In 1956, when at sea in the Royal Navy, a rating aged 20 attended the Sick Bay because of a chronic productive cough. He had begun smoking as a child in the air-raid shelters of Edinburgh. Initially, two or three cigarettes a day, he was now smoking 60–70 (afloat a packet of 20 duty-free cigarettes cost a few pennies; 240 to the pound). He had tried unsuccessfully to give up or even reduce smoking because of publicity concerning the dangers of smoking, but after his mother died from a chest infection, he told me that he was prepared to cooperate with any measure to cure his habit.

The available cache of medications unexpectedly contained several ampoules of apomorphine. I guessed a relic of former times when the drug was used to provoke vomiting in alcoholics. With hazy recollections of Pavlovian conditioned reflexes, I decided to try and induce rejection at the sight of a cigarette.

He agreed to smoke freely, but that each cigarette was to be preceded by a subcutaneous injection of ‘one-fifteenth grain’ (about 4.5 mg) of apomorphine hydrochloride. He was not allowed to light his cigarette until the onset of nausea, vomiting, pallor and transient hypotension, which came on suddenly about 10–15 min after an injection. On the first day of the trial, he attempted to smoke—only incompletely—six cigarettes as it took about 2 h to recover from the induced nausea and vomiting. On the second day, he could smoke one and a half and on the third day he could not place a cigarette between …

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