History of Heroin

Sections

HEROIN AS A WONDER DRUG
ABUSE OF HEROIN
INTERNATIONAL CONTROL OF HEROIN
LICIT MANUFACTURE AND CONSUMPTION OF DIACETYLMORPHINE
PRESENT STAGE OF THE HEROIN PROBLEM

Details

Pages: 3 to 16
Creation Date: 1953/01/01

GENERAL & TECHNICAL

History of Heroin

INTRODUCTION

The great advances in medical therapy in the past century have been due largely to the rapid development of chemistry and pharmacology. During this period innumerable compounds obtained in chemical laboratories, were tested for their pharmacological activity. Those proving satisfactory were then produced commercially.

The extent of public acceptance and usage of any one drug has usually been determined by the medical profession. The use of many of the new compounds was only of short duration; they were frequently replaced by other compounds found to be more effective, or which did not provoke inconvenient side reactions.

The case of "Heroin" (diacetylmorphine) is almost unique. Hailed as a wonder drug, it was received with enthusiasm by the medical profession. Inevitably, the deleterious effects of the drug were discovered. Although many doctors discontinued prescribing heroin and all warned against careless use of the drug, the market for it continued to flourish. A dangerous addiction-producing drug, it was not easy to curtail its usage.

This paper proposes to trace the story of heroin from its discovery and enthusiastic acceptance until its present doubtful status to-day.

HEROIN AS A WONDER DRUG

Although diacetylmorphine was not prescribed as a medicine much before 1900 its preparation had already been reported in 1874 by C. R. Wright at St. Mary's Hospital in London.[1] The main purpose of his work was to determine the constitution of some natural and purified alkaloids. By boiling anhydrous morphine alkaloid for several hours with acetic anhydride he was able to isolate acetylated morphine derivatives. The general conception of the morphine molecule in those days was that it was represented by the double empirical formula[2] which gave rise to the rather confusing nomenclature in his article. The extreme acetylated derivative which he obtained, he called " Tetra acetyl morphine." This compound corresponds to diacetylmorphine according to our present nomenclature.

This "Tetra acetyl morphine" was sent to F. M. Pierce, Associate at Owens College, London, for biological assay. After having tested the compound in animal experiments he reported the following results to Wright. The effects were:1"... great prostration, fear, sleepiness speedily following the administration, the eyes being sensitive and pupils dilated, consider able salivation being produced in dogs, and slight tendency to vomiting in some cases, but no actual emesis. Respiration was at first quickened, but subsequently reduced, and the heart's action was diminished and rendered irregular. Marked want of coordinating power over the muscular movements and the loss of power in the pelvis and hind limbs, together with a diminution of temperature in the rectum of about 4°, were the most noticeable effects."

From a medical point of view the interest in this new morphine derivative was not very high for the first twenty years. In 1890, a German scientist, W. Dankwortt,[3] prepared diacetylmorphine by heating anhydrous morphine with excess acetylchloride. The result of his work is important, not from the pharmacological, but from the chemical point of view. Because of the nature of the compounds he was able to isolate, he concluded that the morphine molecule had a simple empirical formula rather than the double one.

In the last decade of the 19th century Dreser[4] and other investigators studied the physiological effects of diacetylmorphine. The favourable reports of these investigators along with the growing interest in the drug shown by the medical profession of that time, led the Bayer Company in Eberfeld, Germany, to start production of the compound on a commercial scale (1898).

The new compound was marketed by Bayer under the name "Heroin." (The name is probably derived from "heroisch" which in German medical terminology means large, powerful, extreme, one with pronounced effect even in small doses.) Later this name became a synonym for the drug.

The new remedy received a spontaneous and widespread acceptance comparable to the acceptance of drugs like penicillin or cortisone in the past few years. The high frequency of tuberculosis and other respiratory diseases had created a great demand for an effective remedy and it was hoped that heroin would meet this need.

Prescribed for almost all illnesses in which codeine or morphine had been found, heroin was also considered to be effective in combating addiction to these two drugs. This enthusiasm for the new drug is best illustrated in the medical literature of the time. Though by no means exhaustive, these following excerpts are typical of the writings of the day.

In 1898, Strube[5] reported on the results of studies at the Medical University Clinic of Berlin. Testing heroin on 50 patients afflicted with phthisis, he found it effective in relieving their cough and in producing sleep. Though Strube observed no adverse effects, he felt that further observations were necessary to determine whether continual use might be harmful or lead to chronic "heroinism".

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At the request of Dreser, Floret experimented with the drug in the Poliklinik der Farbenfabriken (1898).[6] He found it valuable in the treatment of bronchitis, asthma and tuberculosis. For cases of dry bronchitis where codeine has been ineffective, Floret reported that heroin was unusually prompt and dependable.

These were among the experiments that led to Dreser's[7] endorsement of heroin at the congress of German Naturalists and Physicians in 1898. Claiming that heroin was ten times as effective as codeine in the treatment of respiratory diseases, he estimated that it had only one-tenth of the toxic effects.

H. Leo[8] in reporting the frequent success he had observed in administering the drug, gave a detailed case history of one of his patients. In 1896, the patient, then 71 years of age, developed a severe cough with expectoration and suffered from dyspnea. After being hospitalized in the summer of 1897, and again in the summer of 1898, the patient was finally sent to a sanatorium in November 1898. By this time his condition had become considerably worse. Respiration was rapid and difficult, fat and muscular tissue had deteriorated, the lungs were enlarged and heart action was poor.

By February 1899, drugs no longer afforded the patient any relief and he was unable to sleep at night. Heroin was then prescribed. The description of the treatment follows:

"February 4. The patient had been given the first dose the evening before. The night was still without sleep, but the cough was looser and effortless. Also the dyspnea was not so pronounced. After he had taken the drug he felt very comfortable and stated that he no longer felt sick. The action of the heart was somewhat more regular. The appetite was better.

"February 5. The patient had obtained some sleep. The sensation of fear that was always with him was gone. The respiratory frequency in the morning was 23. The cough was without difficulty.

"February 6. The patient slept soundly most of the night, in a reclining position. The respiratory frequency in the morning: 20. The action of the heart was regular.

"The heroin was then withdrawn for eight days. The ailments he had suffered before gradually returned. Heroin was again administered and had the same beneficial action as before."

Manges[9] who had previously reported on the advantages of heroin over morphine in the treatment of coughs, phthisis and asthma, reiterated his confidence in the drug in 1900.[10] Reviewing the treatment of the 341 respiratory cases by his colleagues, he stated that addiction was noted in less than eight per cent, without the bad effects accompanying morphine treatment. Where most of the cases included in Manges report did not show habituation, in two cases it had also been found to be successful in breaking addiction to morphine.

Prompted by Harnack's[11] warning in 1899, that heroin might be a dangerous poison, Turnauer[12] tested the drug for the possibility of harmful after effects. After treating 48 cases of phthisis, bronchitis and dyspnea, Turnauer noted a tolerance to the drug. After administering heroin for a long period, he found that the dosage needed to be increased. He stated that he found "No harmful results, especially as I observed no abstinence symptoms whatever. Generally it appeared that in all cases in which period of time was allowed to elapse the full effect could again be obtained with small doses ... It may be concluded that, regarding tolerance to heroin, certain individuals react peculiarly and it is recommended that in the case of old and feeble persons, the initial dose should not be over 0.005 g."

Horatio C. Wood[13] Jr., 1899, also found that the dosage had to be increased in order to remain effective. He warned that experimentation was still not adequate to warrant the conclusion that heroin was not addiction producing.

Many other investigators recommended the use of heroin at the turn of the century. Most of them failed to refer to the danger in its usage or implicitly stated that it did not lead to tolerance.

In 1901, Joseph Jacobi, basing himself on the use of heroin in 85 cases, claimed the drug as superior as a cough-soothing remedy. Although he found its use more effective with patients who had never used strong narcotic drugs, he reported that any tendency towards tolerance could be averted if dosage was curtailed for several weeks. He also recommended that its use should be alternated with morphine or codeine.

At about this time the enthusiasm for heroin started to wane. Morel-Lavallée[15] in 1902 warned against its habit-forming properties although he thought it safer to use than morphine. Along with many others Morel-Lavallée advocated treatment by heroin in demorphinisation. His practice was criticized by Jarrige[16] in 1902 who claimed that physicians would thus make "heroinists" of their patients. Citing several cases of heroinism, he was emphatic in his contention that the withdrawal of heroin was much more painful than that of morphine. Rather than reducing the use of narcotics, the advocation of heroin was responsible for many persons becoming drug addicts.

In 1903 Pettey[17] reported that of the last 150 cases he had treated for drug addiction, eight were heroin users and of these, three had first become addicts through the use of heroin. He further reported that the heroin habit was just as difficult to cure as the morphine habit.

Sollier,[18] in 1905, deplored the use of heroin in the treatment of morphinism. This practice, he claimed, had resulted in the number of heroin addicts becoming as great as that of morphine addicts. Heroin was extremely toxic and the extent of poisoning in the heroinists he had seen, was much greater than it would have been for the same amount of morphine. Sollier found that the mental and physical deterioration from the use of heroin was very rapid. He opposed its use in the treatment of both morphinism and respiratory diseases.

In the same year Atwood[19] reported a case of heroinism in a woman who had become addicted to heroin after its use in surgery. Although not as vehement as Sollier and Jarrige, Atwood advised caution in prescribing the drug. Atwood believed cases of heroin addiction to be rare, but he pointed out that such cases would become more common if no discretion was used by the medical profession and he was against its prescription for coughs, recurring headaches, rheumatism and other chronic diseases.

At that time, however, there was no other drug that could fully replace heroin for some medical indications, and the medical profession was still in favour of it in spite of knowing many of its disadvantages.

As J. D. Trawick[20] of Kentucky expressed it (1911): "I feel that bringing charges against heroin is almost like questioning the fidelity of a good friend. I have used it with good results, and I have gotten some bad results, such as a peculiar bandlike feeling around the head, dizziness, etc., but in some cases referred to, it has been almost uniformly satisfactory."

ABUSE OF HEROIN

It took a long time for the medical profession to realize the full danger of heroin addiction. On the other hand, very little time passed after the drug had become readily available before the underworld and smugglers discovered that heroin possessed properties even beyond those of other narcotics, which have since made it the main drug of addiction in many parts of the world. The analgesic and euphoric properties of heroin are much greater per gram than those of morphine.[21] There is no depression of the alimentary tract as is found in morphine. Whereas morphine usually is administered by a hypodermic needle, heroin can be sniffed into the system.[22] This is an important fact since many people are, to start with, repelled by the use of a hypodermic needle. However, persons addicted to heroin soon come to use it hypodermically and even intravenously. As the sensible effect wanes with increasing addiction, they try larger doses and more drastic methods of self-administration, always trying to recapture the stimulation of the drug. The addiction-forming properties of heroin are more pronounced even than those of morphine. It produces a disregard for the conventions and morals of civilization and these symptoms progress more rapidly than with other habit- forming drugs. Heroin addiction is the most difficult to cure; sudden withdrawal may lead to cramps, convulsions, and even to death from respiratory failure. The post-convalescent treatment, both psychological and physical, is longer and more difficult than with morphine.

Drug addiction is an international problem. The addicts preference however seems to vary greatly in different regions. In the Far East opium has been used as a narcotic for centuries,[23] in the middle East hashish.[24] In South America the chewing of coca leaves is an old habit.[25] Of the so-called "white drugs," the European addict has usually confined himself to cocaine and morphine.[26] There are three places in the world where heroin addiction has attracted more attention than any other drug addiction: U.S.A., especially the eastern part, Egypt, and China. In other places heroin addiction has been more sporadic.

The first place where heroin addiction seems to have been a major problem was the United States of America. The main site of the addiction was New York where 98 per cent of all drug addicts were reported at the time to be heroin addicts.[27]

The Public Health Service Hospitals in the United States discontinued dispensing heroin at its relief stations in 1916. In 1920 the House of Delegates of the American Medical Association at its 71st annual session adopted the following resolution: "that heroin be eliminated from all medicinal preparations and that it should not be administered, prescribed, nor dispensed; and that the importation, manufacture, and sale of heroin should be prohibited in the United States."[28]

Several other authorities, especially the police, supported this resolution. The growing number of crimes in the larger cities in the United States alarmed the public. In 1922 while there were seventeen murders committed in London there were 260 in New York City and heroin addiction was blamed for a number of the New York murders.[29] Carleton Simon, Special Deputy Police Commissioner in New York wrote (February 1924):[30] "Ninety-four per cent of the criminal drug addicts arrested in New York City use heroin regularly. Placing the consumers receiving their drugs from the illicit narcotic street venders in New York City at a minimum of 10,000 (based upon statistics of arrests), using at an average of ten grains a day per individual, we have a total of 76,000 ounces as the yearly quantity of heroin used by the narcotic addicts who procure their drugs on the streets in New York City alone." The entire amount of heroin prescribed by the entire medical profession in the State of New York was in the same period estimated to be fifty-eight ounces.

The result of these observations was a congressional law that prohibited the import of crude opium for the purpose of manufacturing heroin (June 1924).[31]

The production of heroin by pharmaceutical factories ceased within a very short time. As a substitute for heroin, the factories concentrated their efforts on the production of codeine. The quantity of codeine substituted for heroin must be about two to six times the weight of the quantity of heroin originally used if a similar medicinal effect is to be obtained. Since there is little difference between the quantities of heroin and codeine produceable from a given quantity of opium, the quantity of opium required to be imported into the United States had to be greater after the enactment of the law. This is the main reason for the high opium import of the United States shortly after 1924.[32]

Although the legitimate production of heroin practically ceased after 1924, the addicts' demand for the drug continued to be supplied by smugglers. The heroin traffic in United States reached its peak in the last part of the 1920's. By 1930-1932, there was a sharp drop in the traffic due mainly to international restrictions. The heroin still in the illicit traffic was generally adulterated.

When World War II started, stricter border controls and lack of shipping lessened the illicit supplies of heroin. To stretch the supplies the traffickers resorted to more and more adulteration and dilution of the drug. The heroin finally obtained by the addict often contained less than two per cent of heroin. Many addicts were involuntarily cured, some without even realizing it. Others broke off the habit at least temporarily.

AVERAGE PERCENT OF ADULTERATION OF HEROIN FOUND IN ILLICIT TRAFFIC CALENDAR YEARS 1938, 1939, 1940 and 1941

Full size image: 10 kB, AVERAGE PERCENT OF ADULTERATION OF HEROIN FOUND IN ILLICIT TRAFFIC CALENDAR YEARS 1938, 1939, 1940 and 1941

* By the time the drug reaches the addict, much of it is less than 1% pure.

As one stated: "If I could get good heroin or morphine again I would probably go back to using the drugs. As it is, I won't touch it as it has so much other stuff mixed with it that it is dangerous." [33]

The following figures show the amount of seized heroin in the United States from 1930 till 1950:[34]

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Another part of the world where heroin addiction attracted attention was Egypt. From ancient times hashish had been used as a narcotic in this country. The use of narcotics was however not such a serious problem before the "white drugs" came into the picture.[35]

This started in 1916, cocaine first being sold non-medically and shortly afterwards heroin. The price of the new narcotic was kept low to start with, until the vice had spread and caught large numbers of victims in its grip.[36]

There were even instances when contractors were paying their labourers with heroin.[37] The vice spread to every class of Egyptian society and a new kind of slum was formed as the result of heroin addiction. The hygienic conditions among the addicts were often beyond description and all sorts of sicknesses followed in the wake of heroin. Thus a great epidemic of malignant malaria started among the addicts in 1928, spread by the hypodermic syringe, which was injected into one person to the other without being disinfected after the use.[38] The total number of addicts in Egypt at the end of the 1920's has been estimated to half a million. Taking into consideration that the total population of Egypt at that time was about 14 million, the extent of the problem may be realized.

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Total number of seizures containing Heroin
- - - - -
Total number of seizures containing Opium
- - - - -
Total number of seizures containing Hashish
----------
Total number of seizures containing Cocaine

Before the first World War, there had been no drastic narcotic regulations in Egypt. The maximum penalty was 7 days' imprisonment or a fine of LE 1.[39] There had been no need for stronger measures. When it became evident that the heroin habit had become a serious problem, a new law was enacted which became effective in 1925. This new law made the trafficking in and the possession of narcotics illegal, classifying the offence as a "délit"with a maximum penalty of 1 year's imprisonment and LE 100 fine. During the first twelve months after the enactment of the new law, 5,600 prosecutions were made under it in Cairo alone. Within the year the maximum penalties were increased to 5 years' imprisonment and LE 1,000 fine. The new law made the drug traffic much more difficult in Egypt, but wholesale smuggling of the heroin began and increased in intensity until 1929. It is interesting to compare the number of seized heroin samples with the other narcotics in Egypt after the narcotic law in 1925. The number of seizures is a good indication of the traffic in narcotics. It seems from the table that the addiction to heroin in Egypt reached its peak in 1929 and from then on it dropped rapidly.

This drop after 1929 was due to two causes. The 1925 Convention on Narcotic Drugs had just come into effect and international measures quickly cut down the supply from all sources that made any pretense of legality. Also, new and vigorous legislation was enacted by the Turkish Government, and three big factories in Turkey were closed down. To start with, most of the illegal heroin in Egypt came from Europe,[41] but through stricter control these sources were closed and Turkey became the main source of supply. The manufacturers in Turkey transferred their equipment to other countries they thought to be more safe. Most of it went to Bulgaria where in a short time three or four larger factories were in operation.[42] One of the Bulgarian factories opened in October 1931 and in the first months turned out 1,500 kilogrammes of heroin which was smuggled out in trunks into Germany and France en route to Hamburg for the American market, and to Marseilles for the Egyptian and the Far Eastern markets. This new site of heroin production was discussed by the League of Nations Advisory Committee on traffic in opium and other dangerous drugs in 1931 with the result that the Bulgarian Government closed down the factories and made the manufacturers once again homeless.

TABLE SHOWING THE RESULTS OF ANALYSES AS REPORTED BY THE LEGOMEDICAL OFFICER IN EGYPT40

 

1922

1923

1924

1925

1926

1927

1928

1929

1930

1931

1932

1933

1934

1935

Hashish
241 500 1016 2465 1853 1260 1865 2935 2534 2789 1759 1214 1173 863
Opium
38 83 162 621 407 669 720 681 756 1433 989 1052 992 938
Morphine
105 105 590 2500 225 347 353 134 115 74 48 39 49 116
Cocaine
119 148 569 1000 226 426 220 122
--
10 5 5 7 1
Heroin
--
11 35 1872 3783 7475 8150 10000 7456 6947 1685 377 261 684
 

1936

1937

1938

1939

1940

1941

1942

1943

1944

1945

1946

1947

1948

1949

Hashish
569 609 574 1038 1296 1450 2048 2159 1269 1259 2211 3978 4238 4660
Opium
806 1020 955 2156 2388 2321 1569 1440 1644 2011 2235 3269 3753 3302
Morphine
25 7 14 21 3
--
5 2 6 8 7 17 5 7
Cocaine
1
--
--
--
9
--
--
1 2 8 16 12 7 13
Heroin
802 761 874 1375 594 113 18 1
--
--
29 38 13 30

China now became a center of heroin production and the epidemic spread of heroin addiction. This country was already suffering from the use of smoking opium and the Chinese authorities had with varying results tried to stamp out opium addiction. Around the beginning of the century, the "white drugs" began to arrive in China from Europe.[43] Small amounts were imported legally for medical and scientific use, but most of it was smuggled in through the coastal ports. The greater potency of morphine and heroin was discovered by an increasing number of former opium addicts, especially in the coastal cities. In addition to products from the western world, Japanese pharmaceutical firms also started the manufacture of great quantities of heroin, and sent it to the Chinese market to fulfil the growing demand of the newly created addicts.[44]

The cheapness and the potency of heroin attracted the Chinese addict. A few cents would buy a dose of heroin or a heroin cigarette. In pill form the consumption of the drug is more secret and consumes less time than the opium smoking. Whenever the prohibition on smoking opium was periodically enforced by the Chinese Government; the consumption of the white drugs would increase since the absence of the opium odor and the opium pipe made it easier to evade the law. Even when opium smoking was tolerated on condition of registration, the white drugs retained their popularity, for the addicts feared to register because they would then be known and the government might at any time decide to cut off their supplies.[45] Because of civil war, revolutions, and war with Japan, the operation of the laws concerning narcotics in China have often been ineffective. The laws relating to the white drugs are the strictest that China has ever tried to enforce. The Provisional Regulations for the Drastic Prohibition of Highpowered Narcotic Drugs were promulgated in May 1934[46] to deal with the increasingly serious danger of manufactured drugs. According to these regulations, the penalty for the manufacture, transportation, and sale of highpowered narcotic drugs containing morphine, cocaine or heroin was death. The penalty for giving protection to those who manufacture, transport, or sell such drugs was also death.

After January 1, 1937 even uncured addicts were given life imprisonment or executed.[47]

The goal of the government was the suppression of the addiction in a six-year period. The progress obtained under the new laws was abruptly interrupted by the outbreak of the war between China and Japan in 1937. In the unoccupied part of China efforts were still made to suppress the drug habit. When the six-year plan for the suppression of narcotics terminated January 1, 1941, the Chinese Government circulated a statement throughout Free China warning against all further indulgence of opium.[48] In February 1941, the death penalty was decreed for all persons cultivating poppies, manufacturing opium or narcotics, and for the distribution and sale of narcotics. The same law provided that heroin addicts were to be shot if apprehended taking injections or smoking heroin pills and that opium smokers were to be imprisoned from one to five years.

Before and during World War II it was commonly reported that the Japanese occupying forces had protected the manufacture and trade with heroin in their territories. This was confirmed after the war when large heroin factories were discovered by the Allies.[49]

The Commissioner of Narcotics of the United States reported that in one factory at Seoul, Korea, operated by the militarist Japanese Government of that time, 1,244 kilos of heroin were manufactured in 1938; and in 1939, 1,327 kilos. During these two years, while the Japanese occupied Manchuria, 2,400 kilos of this heroin were consigned to the Manchukuo Monopoly Bureau. The normal annual heroin requirements for China, including Manchuria, prior to 1938 were 15 kilos.

The total world medical needs for heroin for 1938 and 1939 were not more than 1,200 kilos for each year. Accordingly, the output of this one heroin factory alone was more than the total world medical needs for heroin.

INTERNATIONAL CONTROL OF HEROIN

The Hague Opium Convention of 1912 placed heroin in the same category as morphine and cocaine.[50] The Convention imposed an obligation on the Contracting Parties to "use their best endeavours" to limit the manufacture, sale and use of the drugs exclusively to medical and legitimate purposes. A control was to be instituted over all persons manufacturing, importing, selling, distributing and exporting the drug and its salts. Registers of the amounts manufactured, imported, and exported were to be kept. Furthermore, dealings with unauthorized persons in the international trade of these drugs were forbidden. All preparations containing more than 0.1% heroin were also to be controlled. There was however no indication how the control over production and distribution should be implemented. Every country was allowed to decide for itself the best method. By the time of the outbreak of the first World War, only eleven countries had ratified the Convention, although seven others had notified their willingness to do so. The peace treaties after the end of the war, however, automatically brought the Hague Convention into force between the parties to the treaties.

The main defect of the Hague Convention was that it created no administrative machinery for the implementation of the principles agreed on.

The Geneva Convention of 1925[51] attempted to get rid of the defects of the Hague Convention and as far as heroin is concerned confined the manufacture to those establishments and premises alone which were licensed for the purpose. It required that all persons engaged in the manufacture, sale, distribution, or export of the drug should obtain a licence or permit to engage in these operations. It required also that such persons should enter into their books the quantities manufactured, imports, exports, sales and all other distribution of the drug. Under the system created by the Convention, the exporter is obliged to obtain from his government an export licence which will only be issued on production of the copy of an import certificate issued by the government of the importing country. A copy of the export authorization accompanies the consignment and must state the number and date of the import certificate so that it can be linked with it. Transit through a third country and the diversion of a consignment were also strictly controlled. By these means a strict check was made possible over the international trade in narcotic drugs. The Convention also abolished under the supervision of the Permanent Central Opium Board set up by the new International Instrument the exemption in the Hague Convention of 1912 for preparations containing not more than 0.10% of the drug.

The Geneva Convention came into force on 28 September, 1928.[52] The sharp drop in seizures of heroin both in United States of America and in Egypt shortly after the enforcement of the Convention began, clearly shows the considerable headway made in the control of the drug traffic. (See graphs on page 8 and on page 9.)

However, the controls brought about under this Convention did not limit directly the quantities of drugs to be manufactured. When in 1929 and 1930 the Egyp- tian Government reported the serious situation that had been created in the Middle East by the existence of uncontrolled factories in Turkey (see page 9), the tenth Assembly of the League adopted unanimously a resolution in favour of a system of limiting the manufacture of dangerous drugs. The system of limitation finally embodied in the Limitation Convention of 1931[53] is based upon estimates which contracting and non-contracting parties are asked to furnish of the drugs required during the coming year. The estimates are based solely on the medical and scientific requirements of the country furnishing them and are designed to include:

  1. The quantity necessary for use as such for medical and scientific needs, including the quantity required for the manufacture of preparations for the export of which export authorizations are not required, whether such preparations are intended for domestic consumption or for export.

  2. The quantity necessary for the purpose of conversion, whether for domestic consumption or for export.

  3. The amount of the reserve stocks which it is desired to maintain.

  4. The quantity required for the establishment and maintenance of any government stock.

These estimates are examined and endorsed by a Supervisory Body set up by the Convention. In cases where the national estimates seem excessive, the Supervisory Body has the right to make recommendations to the governments concerned, with a view to their reduction. In case estimates are not furnished by any country, the Supervisory Body is empowered by Article 2 of the Convention to make the estimates itself. Special restrictions were laid on diacetylmor-phine and its preparations by Article 10 of the Convention. Exports were prohibited, except on the request of the government of a country not manufacturing diacetylmorphine accompanied by an import certificate.

LICIT MANUFACTURE AND CONSUMPTION OF DIACETYLMORPHINE

The effect of the 1925 and 1931 Conventions will be seen from the production figures given below and the graph on page 12.[54] The figures show a drop in acknowledged heroin production from nearly 4,000 kgs. in 1930 to about 1,100 kgs. in 1934 and about 600 kgs. in 1935. The Permanent Central Opium Board reviews the progress of international control of drugs as follows: [55]

(November 1947)

"In the case of manufactured drugs, the period during which the international control can be described as having been world wide in scope is relatively short, the six years 1931-1936. This fact... was due to events ufelated to the problem itself, which resulted in a number of countries ceasing to furnish the Board with the statistics required. Nevertheless, the Board feels justified in stating even on the basis of the short period for which it has complete statistics, that some of the chief aims of the two conventions on the control of manufactured drugs-namely, a complete account of the supplies available (Geneva Convention of 1925) and the limitation of the manufacture to medical and scientific requirements (Limitation Convention of 1931) have been to a large extent and subject to one exception attained."

World Manufacture of Diacetylmorphine

Full size image: 22 kB, World Manufacture of Diacetylmorphine

The exception mentioned concerned the illegal manufacture of heroin in Japan and Korea discussed previously. (See page 10.) It was estimated that from 1934 to 1937, 94 per cent of the world supply was accounted for. From August 1, 1946 the work of the Opium Section of the League of Nations was transferred to the Division of Narcotic Drugs of the United Nations.

As between pre-war and post-war there has been some changes in the proportion of the world's output produced by the heroin-manufacturing countries.[56]

 

Average 1934-1937

1948

Japan
299 kgs.
--
USSR
162 "
--
Germany
60 "
--
United Kingdom
110 "
300 kgs.
Italy
90 "
276 "
Finland
-- "
73 "
Other countries
184 "
184 "
 
905 kgs.
835 kgs.

It is also interesting to note the pre- and post-war legal consumption of heroin in the various countries. (See graphs on pages 12-13.) Whereas in most countries, there has been a decrease in the consumption per million inhabitants, in a few others there has been a marked increase.

PRESENT STAGE OF THE HEROIN PROBLEM

(The question of total suppression of heroin as a drug)

Due to the fact that in various parts of the world the heroin traffic has increased since World War II, creating conditions which have attracted the public's attention, such as the addiction among teen-agers in New York and other large cities in the United States, [58] the question of total suppression of heroin is being discussed by international organizations. The question of world-wide suppression of heroin production is not however of recent date. Such a proposal was made as early as 1923 in the Opium Advisory Committee which recommended the Council to request Governments to communicate their views as to the possibility of total suppression of the manufacture of heroin.[59] The replies from Governments indicated a division of opinion between the Governments which were willing to consider the possibility of total abolition and those which took the view that heroin is indispensable, for medical practice. The proposal for abolition was rejected by the Conference in 1925.[60]

At the 1931 Limitation Conference[61] a proposal was first moved for the total abolition of the use of heroin. This was objected to on the grounds that the drug was of medical value; that practically none was escaping into the illicit traffic for the amounts exported by manufacturing countries on the basis of import certificates, and that, even if heroin were abolished, it could be manufactured from morphine by any trafficker without any particular difficulty. In the result, the legal use of heroin was not forbidden, but special restrictions were put on heroin, in Article 10 of the Convention. In reply to a circular letter sent by the League of Nations to governments in 1934[62] requesting opinions on the possibility of abolishing or restricting the use of diacetylmorphine, 12 countries communicated reasons why they did not feel able to consider abolishing or restricting the use of the drug. Four countries answered that they were in favour of restricting the use of diacetylmorphine, 8 countries stated that the use of the drug was already restricted de jure or de facto in their territories, 9 countries stated that they were in favour of completely abolishing the use of diacetylmorphine. Finally, 7 countries stated that the use of diacetylmorphine was in fact already prohibited in their territories by various measures.

DIACETYLMORPHINE Consumption per inhabitants during the years 1930 to 1934.

Full size image: 74 kB, DIACETYLMORPHINE Consumption per inhabitants during the years 1930 to 1934.

Full size image: 47 kB

The United States Government had already in 1924 prohibited the import of opium for the manufacture of heroin (see page 7).[34]

The Bulgarian Government had prohibited the importation, manufacture of and trade in heroin (25 July 1934).[63]

By decree of August 3, 1933,[64] the Spanish Govern- ment had prohibited the manufacture, import, distribution and consumption of diacetylmorphine.

In Costa-Rica[65] the use of diacetylmorphine had been entirely prohibited from October 24, 1928.

According to the Mexican Health Code[66] (from 1924) the import, export, preparation, possession, use and consumption of the drug was prohibited.

In Greece, heroin was excluded from the list of narcotic drugs whose use was permitted by the Greek State Monopoly (1930).[66]

From 1931, the Polish Government[66] prohibited in its territory the manufacture, import and export of diacetylmorphine.

The indispensability of heroin from the point of view of the medical profession has largely decreased since the introduction of dihydrocodeinone, dihydromorphinone and some of the new synthetic analgesics. In reply to a similar inquiry by the World Health Organization in 1950,[67] 38 member States have replied that they are in favour of dispensing with heroin, while 9 States are in favour of retaining it. The latter, however, includes several of the chief manufacturing countries of the world.

REFERENCES

001

Wright, C. R. A.: On the action of organic acids and their anhydrides on the natural alkaloids, Journal of Chemical Society, 1874, 12, 1031.

002

Raoult: Annales de Chimie et de Pharmacie, 8, 327 and 2, 72.

003

Dankwortt, W.: Archiv der Pharmacie, 1890, 228, 572.

004

Dreser, H.: Pharmacologisches über einige Morphinderivate, Deutsche medizinische Wochenschrift, 1898, 24, Vereins Beilage, 185.

005

Strube, G.: Mittheilung über therapeutische Versuche mit Heroin, Klinische Wochenschrift, 1898, 38.

006

Floret: Klinische Versuche über die Wirkung und An-wendung des Heroins, Therapeutische Monatschrifte, 1898, 12.

007

Dreser: Abstract in Journal of American Medical Association, 1898.

008

Leo, H.: Über den therapeutischen Wert des Heroins, Deutsche medizinische Wochenschrift, 25, 185.

009

Manges, M.: New York Medical Journal, November 1898, 26.

010

Manges, M.: A second report on therapeutics of heroin, New York Medical Journal, 71, 51.

011

Harnack, E.: Über die Giftigkeit des Heroins, München medizinische Wochenschrift, 1899, 46, 881-884, 1019.

012

Turnauer, B.: Über Heroinwirkung, Wien medizinische Presse, 40, 457.

013

Wood, Horatio C. Jr.: The newer substitutes for morphine, peronine, dionine, heroin, Mercks Archiv 1899.

014

Jacobi, J.: Über die Wirkung des Heroins, Wien. med. Wochenschrift, 51, 1853, 1924, 1963, 2017.

015

Morel-Lavallée, A.: Les Alcaloides de l'Opium, Morphine, Héroïne, Dionine, Revue de thérapeutique, 1902, 69.

016

Leynia de la Jarrige, J.: Héroïne, Héroïnomanie, Theses, 1902.

017

Prettey, G. E.: The heroin habit another curse, Alabama Medical Journal, 1902-03, 15, 174-180.

018

Sollier, P.: Heroine et héroïnomanie, Presse med., 13, 716.

019

Atwood, C. E.: A case of heroin habit, Med. Rec., 67, 856.

020

Trawick, John D.: A case of heroin poisoning, Kentucky Medical Journal, 9, 187.

021

Report of the Committee of Experts concerning Diacetylmorphine (Heroin) Records of the Conference for the Limitation of the Manufacture of Narcotic Drugs, League of Nations, Geneva, May 27th to July 13th, 1931. Vol. II. 529.

022

Woods, Arthur: Dangerous Drugs, The World Fight against illicit traffic in Narcotics, New Haven, Yale University Press, 1931, 14.

023

Payne, E. George: The Menace of Narcotic Drugs, A Discussion of Narcotics and Education, New York, Prentice-Hall, Inc. 1931, 17.

024

Todd, A. R.: Hashish, Experimentia, Vol. II/2, 1946, 55.

025

Golden Mortimer, W.: Peru, History of Coca, J. H. Vail & Company, New York, 1901.

026

Wolff, P.: (a) Die Suchten und ihre Bekämpfung. (Morphinismus, Kokainismus, u.a.) Sonderabdruck aus der "Apotheker-Zeitung 1927, f. 17/20, 3.

(b) Cyril et Berger: La "Coco" Poison moderne, Paris, Ernest Flammarion, 26, rue Racine, 1926.

027

Foreign Policy Association, Pamphlet No. 24. Series of 1923-1924, 4.

028

The Journal of the American Medical Association, May 8, 1920, 1318.

029

Foreign Policy Association, Pamphlet No. 24, Series of 1923-1924, 3.

030

Foreign Policy Association, Pamphlet No. 24, Series of 1923-1924, 7.

031

U. S. Treasury Department, Bureau of Narcotics, Regulations No. 2 relating to Importation,... of Opium or Coca Leaves...under the Act of May 26, 1922, as amended by the Act of June 7, 1924, United States Government Printing Office, Washington, 1938.

032

League of Nations document. No. O.C.23(i)4, May 31, 1926, 24.

033

U. S. Treasury Department, Bureau of Narcotics. Traffic in Opium and other dangerous Drugs for the year ended December 31, 1940. U. S. Printing Office, Washington, 1941, 19.

034

(a) Traffic in Opium and other dangerous Drugs for the year ended December 31, 1932. U.S. Government Printing Office, Washington D.C.

(b) League of Nations document. No. C.96 M. 43, 1935 XI, [O.C. 294 (v)], 42.

(c) Traffic in Opium and other dangerous Drugs for the year ended December 31, 1933. U.S. Government Printing Office, Washington D.C.

(d) League of Nations document. No. C. 81. M. 29, 1936, XI. [O.C.S. 294 (z)], 44.

(e) League of Nations Document. No. C. 124, M. 77, 1937, XI. [O.C.S. 300 (c)], 38

(f) League of Nations Document. No. C. 65. M. 27. 1939. XI. [O.C.S. 300 (k)], 38.

(g) Traffic in Opium and other dangerous Drugs for the year ended December 31, 1944. U.S. Government Printing Office, Washington D.C., 1945

(h) League of Nations Document. C. 91. M. 91, 1946, XI, [O.C.S. 300 (2)], 46.

(i) United Nations Document, E/NS 1946/Summary, 3 July 1947, 127.

(k) United Nations Document, E/NS. 1951/Summary 1/Add, 22 March 1951, 18.

(l) Traffic in Opium and other dangerous Drugs for the Year ended December 31, 1950. U.S. Treasury Department, Bureau of Narcotics, U. S. Government Printing Office, Washington: 1951, 18.

035

Thomas Russel Pasha, Egyptian Service 1902-1946, Butler and Tanner Ltd., Fromeand London 1949, 225.

036

Ibid, p. 226

037

Annual Report for the Year 1931, Egyptian Government,Central Narcotics Intelligens Bureau, Cairo, Government Press, 1932, 131.

038

Thomas Russel Pasha : Egyptian Service 1902-1946, Butler and Tanner Ltd., Frome and London 1949, 224.

039

Ibid, p. 225.

040

(a) Egyptian Government, Central Narcotics Intelligens Bureau, Annual Report for the year 1937, Government Press. Bulaq, Cairo, 1938, 114.

(b) Egyptian Government, Central Narcotics Intelligens Bureau, Annual Report for the year 1940, Government Press, Bulaq, Cairo, 1941, 74.

(c) Egyptian Government, Central Narotics Intelligens Bureau, Annual Report for the year 1944, Government Press, Bulaq, Cairo, 1945, 78.

(d) Egyptian Government, Central Narcotics Intelligens Bureau, Annual Report for the year 1949, Government Press, Bulaq, Cairo, 1951, 146

041

Wolff, P.: Deutsche Medizinische Wochenschrift, f. 37/38, 1931, 7.

042

Thomas Russel Pasha : Egyptian Service 1902-1946, Butler and Tanner Ltd., Frome and London 1949, 241.

043

Merril, Frederick T.: Japan and the Opium Menace, Institute of Pacific Relations and the Foreign Policy Association, New York, 1942, 15.

044

Ibid, p 15.

045

Ibid, p 16.

046

Traffic in Opium and Other Dangerous Drugs, Annual Report, 1934, Chinese Government Opium Suppression Commission, Nanking, China, 4.

047

Merril, Frederick T.: Japan and the Opium Menace, Institute of Pacific Relations and the Foreign Policy Association, New York, 1942, 31.

048

Ibid, p. 46.

049

Permanent Central Opium Board, Report of the Work of the Board, United Nations document, Geneva, 21 October 1946, E/OB/1.

050

International Opium Convention, Signed at The Hague, January 23rd, 1912, Article 14(c). (League of Nations document : O. C. 1 (I). 29)

051

League of Nations, Second Opium Conference, Signe at Geneva on February 19th, 1925. (League of Nations document: C. 88. M. 44. 1925. XI. (O.D.C. 106 (3); O.D.C. 7 (2); O.D.C. 130 (1).)

052

International Conciliation, No. 441, 329.

053

League of Nations, Conference for the Limitation of the Manufacture of Narcotic Drugs. (Geneva, May 27th-July 13th, 1931) (C. 455. M.193. 1931. XI.)

054

(a) Series of League of Nations Publications XI. Opium and other Dangerous Drugs, 19.

(b) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1932, XI. 6, 8.

(c) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1933, XI, 4, 68.

(d) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1934, 78.

(e) Series of League of Nations Publications XI, Opium and other Dangerous Drugs,1936, XI, 21, 10.

(f) Series of League of Nations Publications XI, Opium and other Dangerous Drugs,1937, XI, 8.

(g) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1938, XI, 5, 14.

(h) Series of League of Nations Publications XI, Opium and other Dangerous Drugs, 1939, XI, 8, 68.

(i) United Nations Publication, E/OB/5, October 1949, 38.

(j) United Nations Publication, E/OB/7, November 1951, 39.

(k) United Nations Publication, E/OB/7, November 1951, 14.

055

Permanent Central Opium Board, United Nations, Geneva, November 1947, (E/OB/2), 25.

056

Permanent Central Opium Board, United Nations, Geneva, October 1949, (E/OB/5), 17.

057

(a) Permanent Central Opium Board, United Nations, Geneva, November 1950, (E/OB/6) 39.

(b) Permanent Central Opium Board, United Nations, Geneva, November 1951, (E/OB/7) 48.

058

Anslinger, H. J.: The Facts About our Teen-Age Drug Addicts, The Reader's Digest, October 1951.

059

League of Nations, Advisory Committee on Traffic in Opium and other Dangerous Drugs, Minutes of the Fifth Session, (League of Nations Document No. C. 418. M. 184. 1923. XI.), 121 and 205.

060

League of Nations Document No. C. 760. M. 260. 1924. XI. C. 105.

061

League of Nations Document No. C. 191.M.136. 1937. XI., 231.

062

(a) League of Nations Document, No. C. L. 61. 1934. XI.

(b) League of Nations Document, No. C. 178. M. 114. 1936. XI., O.C. 1589(1).

063

Ordinance No. 766, of June 9th 1934, from the Bulgarian Government. Ann. Report from Bulgaria 1934.

064

Decret of 3 August 1934, from Spanish Government. League of Nations file, No. 12/8978/427.

065

Costa Rica: Ley sobre Drogas Estupefacientes, Secretaría de Salubridad Pública y Protección Social, San José de Costa Rica 1930, 4.

066

League of Nations document C. L. 228. 1938, XI. Annex. O.C. 1743 (1).

067

United Nations, World Health Organization, Document No. WHO/APD/23 Add.1., 3 December 1950.