Third session of the World Health Organization Expert Committee on Drugs Liable to Produce Addiction

Abstract

The Expert Committee on Drugs Liable to Produce Addiction held its third session in Geneva from 7 to 12 January 1952.1

Details

Pages: 39 to 41
Creation Date: 1952/01/01

Third session of the World Health Organization Expert Committee on Drugs Liable to Produce Addiction

The Expert Committee on Drugs Liable to Produce Addiction held its third session in Geneva from 7 to 12 January 1952.1

During this session it examined a series of problems, regarding a certain number of which it submitted formal recommendations.

Ipecopan

The Committee examined a request of the Swiss Government regarding the position, under the provisions of the 1925 Convention, of Ipecopan and its following commercial preparations: Ipecopan malted tablets, Ipecopan solution, Ipecopan malted syrup, Ipesandrine sugar-coated tablets, Ipsandrine solution, Ipesandrine syrup.

The Committee reaffirmed its opinion that Ipecopan powder should not be exempted from the provisions of the 1925 Convention for the reason stated in the report on its second session, but expressed the opinion that such exemption should be granted for the preparations mentioned which contained not more than 0.2 per cent anhydrous morphine compounded with other medicaments. The Committee recommended that its opinions, with respect to Ipecopan and its commercial preparations, should be notified to the Economic and Social Council.

Expert-advisory panels and committees are an essential part of the machinery of WHO. Their purposes and functions are to provide the Organization with technical advice on particular subjects The Director-General has authority to establish expert advisory panels and to select and appoint their members, who undertake to contribute by correspondence and without remuneration technical information or reports on developments within their own specialities. They serve in their personal capacity and not as representatives of governments, institutions, organizations, or other bodies. Expert committees are convened to discuss particular subjects; their members are selected by the Director-General from the advisory panels, the choice being governed by the agenda of each session. The selection of members of both expert advisory panels and committees is based primarily upon their ability and technical experience, with due regard to adequate geographical distribution.

The following took part in the third session of the Expert Committee on Drugs Liable to Produce Addiction:

Sir Ram N. Chopra, Professor of Pharmacology; Director, Drug Research Laboratory, Srinagar, Kashmir, India (Vice-Chairman);

Dr N. B. Eddy, Chief, Section on Analgesics. Division of Chemistry, National Institute of Arthritis and Metabolic Diseases, National Institutes of Health, Bethesda, Md., U.S.A. (Rapporteur);

Dr H. Fischer, Professeur de Pharmacologic à. la Faculté de Médecine de l'Université de Zurich, Switzerland;

Dr. G. Joachimoglu, Professor of Pharmacology; Chairman, Superior Health Council, Ministry of Hygiene, Athens, Greece (Chairman);

Dr J. La Barre, Professeur de Pharmacologic à. la Faculté de Médecine et de Pharmacie de l'Université de Bruxelles, Brussels, Belgium;

Dr. B. Lorenzo-Velázquez, Professor of Pharmacology, Faculty of Medicine, University of Madrid, Spain;

J. R. Nicholls, D.Sc., Deputy Government Chemist, Government Laboratory, London, United Kingdom;

Dr. F. Verzar, Professeur de Physiologie à la Faculté de Médecine de l'Université de Bâle, Switzerland.

L. Atzenwiler, Secretary of the Permanent Central Opium Board, represented the Secretary-General of the United Nations, and

Dr. P. O. Wolff, Chief, Addiction-producing Section, WHO, was the Committee Secretary.

Morphine derivatives

  1. 6-Methyldihydromorphine. The Committee received additional information with respect to this substance which confirmed its previously expressed opinion that it must be classified as an addiction-producing drug.

  2. N-Allylnormorphine. The Committee received information on the action of N-Allylnormorphine in addicted and previously addicted individuals, leading to the conclusion that liability to its use by addicts is very slight.

  3. Dihydrocodeine and acetyldihydrocodeine. The Committee previously expressed the opinion that dihydrocodeine and acetyldihydrocodeine are liable to produce addiction. The Committee decided that its opinion regarding these drugs is equally applicable to all their salts and recommended that the Secretary-General of the United Nations should be notified accordingly.

  4. Morpholinylethylmorphine. The Committee expressed the opinion that morpholinylethylmorphine is not more liable than codeine to produce addiction and is therefore not assimilable to the drugs mentioned in article 1, paragraph 2, subgroup (a) of group I of the 1931 Convention, and that it is less readily convertible than codeine to an addiction-producing drug and is, in consequence, assimilable to the drugs mentioned in group II of that Convention. The Committee recommended that this opinion should be communicated to the Secretary-General of the United Nations.2

  5. Situation regarding diacetylmorphine. The Committee reiterated its opinion, as expressed in its previous reports, with respect to the continuing gravity of the diacetylmorphine situation. Concerning the request for information circulated to governments by the Director-General of WHO, it is now possible to state that there are fifty member States of WHO who have discontinued, or are willing to discontinue, the medical use of diacetylmorphine. The Committee was gratified by this evidence of changing attitude on the part of the medical profession of many countries in favour of the dispensability of diacetylmorphine inasmuch as at the time of its first session, held in January 1949, so far as was known, there were only twenty-four countries which had discontinued the medical use of the drug.

The Committee was of the opinion that the complete abolition of legally produced diacetylmorphine in the world would greatly facilitate the struggle against illicit use of this substance. The Committee recommended, therefore, that the Executive Board of the World Health Organization should take steps to approach again those States which have not yet answered the first inquiry of the Director-General, or who do not yet consider it possible to discontinue the medical use of diacetylmorphine, asking them whether or not they could do without the drug in the interest of international public health and safety, particularly in view of the fact that the physicians of so many countries find other agents equally satisfactory for symptomatic relief.

Synthetic substances

SYNTHETIC DERIVATIVES OF MORPHINAN TYPE

The Committee was of the opinion that the régime laid down in the 1931 Convention for the drugs specified in article 1, paragraph 2, group I, should be applied to two synthetic substances of morphinan type and to their salts: 3-hydroxy-N-methylmorphinan and 3-methoxy-N-methylmorphinan. The Committee recommended that this opinion should be communicated to the Secretary-General of the United Nations.

SYNTHETIC DERIVATIVES OF PETHIDINE TYPE

The Committee expressed an opinion similar to the opinion stated above regarding a substance of "pethidine" type known by the symbol NU-1932.

The Committee stated that as far as the following substances were concerned: pethidine, bemidone, ketobemidone, α-l,3-dimethyl-4 phenyl-4-propionoxypiperidine and β-l,3-dimethyl-4 phenyl-4 propionoxypiperidine, the opinion it expressed in 1949 with respect to their addiction liability and its recommendation to put them under the régime laid down in the 1931 Convention for the drugs specified in article 1, paragraph 2, group I, should be equally applicable to all their salts. The Committee recommended that this opinion should be communicated to the Secretary-General of the United Nations.

2 See page 20 of the present issue.

SYNTHETIC DERIVATIVES OF METHADONE TYPE

The Committee stated that in regard to the following substances: methadone, iso-methadone, phenadoxone, 4,4-diphenyl-6-dimethylamino-heptanone-3 and 4,4-diphenyl-6-dimethylamino-3-acetoxyheptane, its opinion expressed in 1949 with respect to their addiction liability and its recommendation to put them under the régime laid down in the 1931 Convention for the drugs specified in article 1, paragraph 2, group I, should be equally applicable to all their salts. The Committee recommended that this opinion should be communicated to the Secretary-General of the United Nations.

Definitions of addiction and habituation

During its second session held in January 1950, the Committee, at the request of the Commission on Narcotic Drugs, propounded definitions of drug addiction, addiction-producing drugs and habit-forming drugs.3Taking into consideration the experience since acquired, the Committee reiterated its opinion that a distinction can and must be made between drug addiction and habituation (habit), and between addiction-producing and habit-forming drugs, that the terms are not interchangeable, and that only the expressions "drug addiction" and "addiction-producing drugs" should be used in documentation with respect to substances brought under, or to be brought under, international control. The Committee decided, further, to clarify the distinction between addiction and habituation (habit) by the following statement:

The cycle of administration leading to addiction may begin in legitimate medical use but becomes established as a serious problem through self-administration beyond medical need. In the development of addiction there is an interplay between pharmacological action and the psychological make-up of the individual.

3 "Drug addiction is a state of periodic or chronic intoxication, detrimental to the individual and to society, produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include:

"1. An overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means;

"2. A tendency to increase the dose;

"3. A psychic (psychological) and sometimes a physical dependence on the effects of the drug".

"An addiction-producing drug is one which produces addiction as defined".

"A habit-forming drug is one which is or may be taken repeatedly without the production of all the characteristics outlined in the definition of addiction and which is not generally considered to be detrimental to the individual and to society".

There are some drugs, notably morphine and pharmacologically morphine-like substances, whose specific pharmacological action, under individual conditions of time and dose, will always produce compulsive craving, dependence, and addiction in any individual. Addiction will develop sooner in those individuals whose psychological make-up leads them to seek and find escape in the pharmacological action of drugs. Sooner or later there must come a time when the use of the drug cannot be interrupted without significant disturbance, always psychic (psychological) and sometimes physical. With these drugs pharmacological action is paramount, psychological make-up adjuvant. Such drugs cause individual and sociological damage and must be rigidly controlled.

There are other drugs which never produce compulsive craving, yet their pharmacological action is found desirable to some individuals to the point that they readily form a habit of administration, an habituation. Administration of such drugs can be interrupted without significant disturbances. With them psychological make-up is paramount, pharmacological action adjuvant. They cause no sociological damage and do not need rigid control.

There are some drugs whose pharmacological action is intermediate in kind and degree between the two groups already delineated so that compulsive craving, dependence, and addiction can develop in those individuals whose psychological make-up leads them to seek and find an escape in drugs. With these substances psychological make-up is the determining factor but pharmacological action plays a significant role. In some instances individual and sociological damage may develop, but since the incidence of the damage is not general, the type and degree of control of drugs of this group are better left at present to national consideration.

Coca chewing

The report of the Commission of Enquiry on the Coca Leaf clearly shows that coca chewing is detrimental to the individual and to society. The Committee, therefore, was of the opinion that coca chewing comes so closely to the characteristics of addiction as defined by the Committee in 19504 that it must be defined and treated as an addiction, in spite of the occasional absence of some of those characteristics.

Cannabis preparations for medical purposes

The question of justification of the use of cannabis preparations for medical purposes was discussed by the Committee. It was of the opinion that cannabis preparations are practically obsolete. So far as it can see, there is no justification for the medical use of cannabis preparations.

Barbiturates

The Committee reviewed the situation with respect to the use and abuse of babiturates throughout the world and the effects of chronic intoxication from these substances. In consequence, the Committee was of the opinion that the barbiturates must be considered drugs liable to produce addiction, dangerous to public health, although differentiation among them with respect to the intensity of this liability cannot be made at this time. The Committee, therefore, was of the opinion that it is advisable to take measures to strengthen the control over these substances on the national level. Such measures might include:

4See above, page 40.

  1. Barbiturates should be dispensed only on prescription;

  2. . Each prescription should specify the number of times it may be refilled or repeated;

  3. A careful record should be kept of each prescription.

International non-proprietary names for drugs liable to produce addiction

The Committee discussed ways in which the process of selecting names on the international level would be the most expeditious in regard to drugs liable to produce addiction. The Committee was of the opinion that a common name for a drug liable to produce addiction which may be brought under international control should be selected at the earliest possible moment. The Committee therefore recommended that all agencies concerned be invited to inform WHO as early as possible concerning drugs which may be addiction-producing. The Committee was gratified to learn that the Permanent Central Opium Board and the Drug Supervisory Body employ, in all their documents, the nonproprietary names already selected by WHO for drugs liable to produce addiction, and that ,the Board is urging all governments to employ these names whenever possible.

Approval of the Expert Committee's opinions and findings

The Executive Board of the World Health Organization, at its ninth session, adopted the following resolution:

"The Executive Board

"1. Adopts the report of the Expert Committee on Drugs Liable to Produce Addiction on its third session;

"2. Thanks the members of the Committee for their work;

"3. Authorizes publication of the report; and

"4. Requests the Director-General again to ask those States which have not yet answered his first inquiry regarding diacetylmorphine, and those which do not yet consider it possible to discontinue its medical use, whether or not they can do without the drug in the interest of international public health and safety, particularly in view of the fact that the physicians of so many countries consider that there are other substances which are satisfactory substitutes for diacetylmorphine."