Quasi-Medical Use of Opium

Sections

I. OPIUM-EATING
II. THE CURRENT POSITION
III. CONSUMPTION OF RAW OPIUM

Details

Pages: 19 to 23
Creation Date: 1953/01/01

Quasi-Medical Use of Opium

This paper deals primarily with the quasi-medical use of opium on the sub-continent which now comprises India, Pakistan, Burma and the French and Portuguese 1 settlements in India, It first deals with the practice of the eating of opium, and presents opposing views as well as the official attitude in the past on this subject. Secondly, it gives the present stand on this question as taken by the various governments directly interested. Thirdly, it gives statistics of consumption of raw opium with a view to indicating the magnitude of the problem.

I. OPIUM-EATING

The eating of opium has been regarded primarily as a matter of domestic concern, and up to now has not been directly covered by the International Opium Conventions. However, this practice was the subject of considerable discussion in the past whenever the question of the limitation of opium to medical and scientific needs was considered by international bodies.

The usefulness of opium in medical treatment is well-known.2The quantities of opium used for purely medical purposes in the recognized indigenous systems of medicine in India (e.g., the Ayurvedic and Tibbi systems) are very small. However, opium is frequently prescribed by unqualified persons, such as peddlers and shopkeepers who, because of its easy accessibility and because of its well-known property of relieving pain and bowel conditions, advocate its use indiscriminately in a large variety of common ailments.3

"Eating-opium" is combined with spices, amber, aloes, cochineal, musk, etc.; at times rice or similar substances are added.4On the sub-continent the practice was, and still is, either to pound the drug, mix it with water and drink it or to take it in the form of a pill. Generally, opium obtained from the excise shops is consumed in. the crude form, but not infrequently it is mixed with other ingredients such as saffron, musk, sugar, etc.

1. Importation of raw opium into Portuguese settlements was exclusively for medical purposes.

2. "The most important use medically for opium, in place of the pure alkaloids, is for the effects on the gastro-intestinal tract. As elsewhere, the predominant action is that of the morphine content, since the anti-spasmodic effect of benzylisoquinoline alkaloids is relatively small. It delays the emptying time of the stomach and alters peristalsis in the small and large intestine by producing marked muscle spasm. In this way opium finds a great use in the treatment of diarrhoea of many etiologies, especially in the severe dysenteries... Because of its power of dilating the vessels of the skin opium tends to increase the sweat and is therefore useful in minor infections, such as colds, grippe, muscular rheumatism, and the like." (United States Dispensatory; Osol-Farrar, 24th Edition, 1947, p. 790).

3. R. N. Chopra, "The Present Position of the Opium Habit in India", in the Indian Journal of Medical Research, Vol. XVI, No. 2, 1928; p. 403.

4. T. J. Addens, " The Distribution of Opium Cultivation and the Trade in Opium", 1939, p. 37.

Opium-eating is a traditional practice that has existed on the sub-continent for centuries, and in moderate quantities it has been regarded, and continues to be regarded in backward areas, as a useful remedy or preventive for fevers and other illnesses. According to Addens, 5 eating-opium is a household medicine par excellence, andis used in case of diarrhoea, dysentery, cold shivers, fits of fever, asthma, chronic coughs, rheumatism, diabetes and abdominal and other body pains. 'It is, according to the same authority, a preventive remedy against malaria, especially in swampy districts.

On the other hand, modern science and medicine have raised considerable doubts as to the actual value of opium taken in the traditional way, as has been claimed. An Indian authority states, with reference to the view that the "anarcotine" or narcotine content of opium is beneficial for malaria, that "we have tried this alkaloid in a number of cases but found no clinical or experimental evidence forthcoming to support the claim that it possesses any marked anti-malarial action". 6 Similar doubt is raised with regard to the function of' opium in averting fatigue or in. increasing the capacity for work, or in keeping off: damp and cold. 6 This authority points out that there is, nevertheless, a wide-spread belief among the people in the efficacy of opium against all sorts of illnesses, and they use it either on their own initiative or on the advice of unqualified persons. This belief is buttressed by the age-old and wide-spread prejudice which still exists against Western medicine.

The Health Committee of the League of Nations felt that solely from the medical and health points of view, medical use of opium should be considered the only legitimate use and that all non-medical use should be recognized as abuse. Furthermore, in the opinion of doctors the use of opium as a stimulant could not be. considered as legitimate even in tropical countries. The British representative made a reservation in regard to the use of opium in Eastern countries.

5. T. J. Addens, ibid.,p. 106, paragraph 11.

6. R. N. Chopra, ibid.,pp. 403-406

The traditional and quasi-medical uses of opium were brought into prominence as a result of the findings of the Royal Commission of 1893, and the official attitude 7 on this subject generally was based on the report of this Commission. The main arguments used are embodied in the following statement 8 made at the 1912 Conference. "The prohibition of opium-eating in India we regard as impossible, and any attempt at it as fraught with the most serious consequences to the people and the Government. We take our stand unhesitatingly on the conclusion of the Royal Commission which reported in 1895, viz., that the opium habit as a vice scarcely exists in India, that opium is extensively used for non-medical and quasi-medical purposes, in some cases with benefit, and for the most part without injurious consequences; that the non-medical uses are so interwoven with the medical uses that it would not be practicable to draw a distinction between them in the distribution and sale of the drug; and that it is not necessary that the growth of the poppy and the manufacture and sale of opium in British India should be prohibited except for medical purposes. Whatever may be the case in other countries, centuries of inherited experience have taught the people of India discretion in the use of the drug, and its misuse is a negligible feature in Indian life." And again: "Opium is in virtually universal use throughout India as the commonest and most treasured of the household remedies accessible to the people. It is taken to avert or lessen fatigue, as a specific in bowel complaints, as a prophylactic against malaria (for which its relatively high anarcotine content makes it specially valuable), to lessen the quantity of sugar in diabetes and generally to allay pain in sufferers of all ages. The vast bulk of the Indian population, it must be remembered, are strangers to the ministration of qualified doctors or druggists. They are dependent almost entirely on the herbal simples of the country, distance and the patient acceptance of hardships standing in.the way of prompt access to skilled medical relief. In these circumstances, the use of opium in small quantities is one of the most important aids in the treatment of children's sufferings. It is also a frequent help to the aged and infirm, and an alleviation in diseases and accidents which are accepted as incurable. To prevent the sale of opium except under regular medical prescription would be a mockery; to many millions it would be sheer inhumanity."

7. The considerations stated were largely in respect of the position of the Government of India, but they may be assumed to apply to other areas where the practice of opium-eating for quasi-medical purposes existed.

8. Quoted in a paper by Sir William Meyer, which was originally put before the Conference of 1912 as a speech, at the third session, with reference to the resolution which formed the basis of Article 1 of the Convention of 1912. See Appendix 1, "Report of the British Delegates to the International Opium Conference held at The Hague, December 1911-January 1912", Miscellaneous No. 11 (1912).

The quasi-medical use of opium was justified along similar lines at meetings of the Advisory Committee9, the League Assembly 10 and at the 1925 Conference. At the latter, the Indian delegation pointed out that "by limitation to strictly medical purposes the American delegation intended, as they explained in committee, limitation to the prescriptions of medical practitioners holding a European or equivalent qualification. But such doctors with registrable qualifications are few in number in India; there is comparatively little demand for their services, and the vast masses of the population are too poor and remote to procure their attendance, even if they wished for it. The American proposal would therefore have caused great hardship; it would have eliminated the greater part of the remedial uses of opium in India, would have made its employment when self-administered by the sufferer a punishable offence, and would, of course, have precluded all possibility of recognizing practitioners of the indigenous systems of medicine."11

At the same time it was stated that the annual per capita consumption in British India 12 was less than 18 grains or about 1.1 grammes, which was not greatly in excess of the figure suggested by the medical committee of the Conference as reasonable for the medical and scientific requirements of countries possessing a highly organized system of medical assistance, viz., .45 gramme of opium at 10 per cent morphine content. In 1952 the per capita consumption was reported to be .349 gramme. For the raw opium eaten in India is understood to have a lower morphine content, and the Indian figure of per capitaconsumption includes veterinary uses.

In 1939, the Government of India observed that the suppression. of the use of raw opium for eating could not "be undertaken until the organization of medical services throughout the country has been greatly advanced since at present it is an administrative impossibility to distinguish between the quasi-medical use of opium and its use as an indulgence; nor indeed have they felt themselves to be in a position to undertake the complete abolition of the eating of opium as an indulgence, even if it were practicable to distinguish between such use and the quasi-medical use of opium in sickness".

II. THE CURRENT POSITION

In recent years, the Governments of India, Pakistan and Burma have accepted the basic principle that the consumption of opium should be restricted exclusively to medical and scientific needs. But due to the inadequacy of the medical services in all these areas, and also due to the administrative impossibility of abolishing the existing system of consumption of raw opium these Governments have declared that they are not in a position to enforce total prohibition immediately and have adopted short-term or long-term schemes of progressive prohibition with a view to limiting the consumption of opium exclusively to medical and scientific needs. The following information indicates the present position of the various governments on this question.

9. See, e.g., statement by Mr. Campbell at the fifth session of the Advisory Committee on Traffic in Opium and other Dangerous Drugs, C.418.M.148.1923.XI, pp. 17-20. Also see statement by Mr. Nind at the 23rd session of the Advisory Committee (C.240.M.147.1938.XI, p. 73).

10. See, e.g., statement by Mr. Sastri in Committee No. V. Records of the Second Assembly, Minutes of Committee No. V, pp. 342-343.

11. Report of the Indian Delegation to the International Opium Conferences at Geneva, 1924-1925, pp. 25-26.

12. The annual per capita consumption in British India for subsequent years, as given in the annual reports of India, was the following: 1936-0.60 gr.; 1937-0.62 gr.; 1938-0.60 gr.; 1939 - 0.62 gr.; 1945 - 0.58 gr.; 1946 - 0.59 gr.; 1947 - 0.46 gr.

Burma

In 1946, the Government of Burma indicated that its opium policy was under revision, but that the danger of total prohibition could not be overlooked. The decision reached was that opium would, in future, be available only for quasi-medical and scientific purposes and, in some excluded areas, on certain religious and ceremonial occasions. In 1947, it was stated that opium would be made available for medical and scientific purposes only, and that the issue of opium for religious and ceremonial occasions would be discontinued. At a meetingof Government officials on 11 February 1948, a policy was laid down which, inter alia, adopted the principle that "the sale of opium for profit should cease altogether and that the definite programme be drawn arriving at the gradual extinction of the habit of opium consumption within 5 years".

Ceylon

In1950, the Government of Ceylon reported that opium was not issued to registered eaters or smokers, that no licences had been issued in the last two and one-half years, and that no licences will be issued in the future.

Pakistan

The Government of Pakistan recently declared it had "decided to reduce the consumption of opium gradually so as to restrict its use ultimately to medical and scientific purposes only. It will, however, be difficult for this Government to limit immediately the consumption of opium for these purposes unless the term 'medical use' is amplified to include non-medical purpose as well ..."

India

Information available in respect of India is more extensive. At the second session of the Commission on Narcotic Drugs, the representative of India pointed out that the Indian Government had felt that it would be impolitic, and perhaps even not humane, to stop the practice of eating opium until adequate medical services were made available to the population. Nevertheless, the Government had chosen as its policy to discourage opium-eating and steps would be taken to put this into effect. In this connexion, hestated that India had already started manufacturing medicinal opium and opium alkaloids, and added that the average quantity of opium eaten per capita was below the limit set by the League of Nations. At the fourth session of the Commission, the representative of India stated that the Indian Government's policy of non-intervention with regard to the moderate use of opium had undergone a radical change, and that the Government had stated categorically in the Constituent Assembly in March 1948 that it had decided to agree to the suppression of the production of opium, except for medical and scientific purposes, and that it would put that policy into effectat the earliest possible date. As a result, the Central Government and the Provincial Governments, as also the Indian States, had ordered the gradual suppression of the production of opium within a specified period. In instructions sent to the Provincial Governments in July 1948, the Indian Government had requested them to decrease their purchases of opium from the opium factory at Ghazipur by ten per cent annually, and it was considering the convening in June 1949 of a conference of the Ministers of the Provincial Governments and the Indian States to study the development, extent and co-ordination of prohibition measures. He also pointed out that the new Indian Constitution which was to be promulgated in 1950 stipulated that the Government would make every effort to stamp out the consmuption of raw opium within its territory.

At the All India Opium Corference, held in New Delhi, 1949, (which was attended by Provincial and States Excise Representatives, and presided over by the Minister of Finance, Government of India), the current policy was defined and the following formal resolutions in respect of the quasi-medical use of opium were unanimously adopted:

"1. The Conference recommends that, within a maximum period of ten years, the use of opium for other than scientific and medical purposes should be totally prohibited. It will, however, be open to each Province or State or Union of States to achieve this objective within a shorter period.

"2. Recognizing that the quasi-medicaluses of opium are not desirable, and should be stopped as early as possible, the Conference resolves that so far as such quasi-medical uses are concerned, even within the foregoing period, they should be subject to such restrictions as a Province or State considers reasonable and practicable. For reducing consumption of opium, such restrictions may provide ( a) that the quantity issued even to registered addicts should be severely restricted, and reduced, and allowed under a strict permit system after obtaining a medical certificate; ( b) that it would be open to the Provinces, and the States and Unions of States to prohibit in any selected area the use of opium by individuals except on medical prescription; ( c) that it would be open to the Provinces, the States and Unions of States to progressively reduce the quantity issued even for quasi-medical uses. In particular they recommend to the maritime Provinces, States and Union of States the prohibition of the sale of opium for non-medical purposes in the port towns and cities, at the earliest opportunity, compatible with effectiveness.

"3. The Conference recommends that each Province, State, Union of States in the Indian Union which already allows excessive consumption should within the shortest possible period,and in any case before four years, take effective steps to bring down the per capita consumption of opium to a level not exceeding the League of Nations limit...

"4. The Conference recommends that, having regard to the possibilities of misuse or unauthorized consumption of opium, the Provinces, States and Unions of States should carefully regulate the grant of quotas to even registered medical practitioners and pharmacists.

"5. The Conference recommends that exports for oral consumption and non-medical uses should be eliminated, subject only to existing commitments being honoured..."

III. CONSUMPTION OF RAW OPIUM

The statistics available for the countries concerned do not show separate figures for quasi-medical use. However, some indication of the order of magnitude of the problem may be obtained from the figures for the consumption of raw opium.

India

The opium processedfor consumption within India is called "excise" opium. This consumption has always been indicated in the past to be for medical, quasi-medical and non-medical purposes. More recently, the Government of India declared that "manufacture of prepared opium is prohibited except for personal consumption from Excise Opium the user is legally entitled to possess... The quantity used by opium smokers to make prepared opium for their personal consumption is not ascertainable because at present no machinery exists in most of the States to distinguish between opium eaters and opium smokers".

The consumption of raw opium for medical, quasi-medical and non-medical purposes, as declared to the Permanent Central Opium Board, was the following:

Year

Kilogrammes

1936
222,700 (British India and Indian States)
1946
329,998 (British India and Indian States)
1947
238,580 (Dominion of India and Indian States)
1948
203,589 (Dominion of India and Indian States)
1949
122,527 (Dominion of India)
1950
150,571 (Republic of India)
1951
156,784 (Republic of India)

Pakistan

The situation as regards the consumption of opium for other than medical and scientific purposes is not quite clear. The cultivation of the opium poppy for the production of opium is prohibited. However, in 1947, 45.2 hectares and in 1948, 33 hectares were placed under such cultivation in Khairpur State under the direction of the State administration. In 1949 about 105 hectares were placed under poppy cultivation as an experimental measure by the Central Government under its supervision and control, and in 1950 about 824 acres were placed under similar cultivation. Furthermore, in 1950 an opium alkaloid factory was established at Lahore by the Government, and 597 kilogrammes of excise opium at 90 degrees consistence was manufactured.

In its annual reports, the Government of Pakistan gives information regarding the total revenue in the form of excise duty, licence fees, etc., realized from opium lawfully imported into Pakistan for consumption, but gives no information regarding the uses to which such imports were put or the total quantities consumed. The annual reports of India state the quantities exported to Pakistan and the reportsof the Permanent Central Opium Board contain information on this subject.

According to a report of the Board, the consumption of raw opium was declared to amount to 16,418 kg. in 1947; 16,755 kg. in 1949 and 15,774 kg. in 1950. The following quantities of imports of raw opium from India were reported to the Permanent Central Opium Board:

Year

Kilogrammes13

1948
166 (reported by Pakistan; in addition, 8,386 kg. were reported as being imported from "Other Countries")
1948
20,566 (reported by India)
1949
7,851 (reported by India)
1950
12,567 (reported by Pakistan: statistics incomplete)
1950
5,465 (reported by India)
1951
10,102 (reported by Pakistan)
1951
11,140 (reported by India)

According to the annual reports of India, India exported to Pakistan the following quantities: 28,637 kg. of excise opium in 1948; 6,920 kg. of opium in 1949; 14,668.64 kg. of excise opium in 1950; 11,141.21 kg. of excise opium in 1951.

Information regarding the uses (medical, quasi-medical, non-medical) of the quantities imported or locally produced is not available.

Burma

The consumption of opium in Burma is difficult to estimate as no reliable statistics on this subject are available. Up to 1936, the consumption of " excise"opium in Burma was shown as part of the consumption in India. For example, in 1936, the consumption of " excise"opium in Burma was 21,944 kg. In subsequent years, the Government of Burma reported that Burma was neither a producing country, nor a country in which raw opium was being standardized. However, there was production of opium in the Shan States, as follows:

13. The Government of Pakistan in a letter (E/119-58) of 16 April gave the following figures for imports of raw opium from India: 1948, 16,188 kg.; 1949, 16,423 kg.; 1950, 18,014 kg.; 1951, 11,041 kg. The difference between Pakistan's import figures and India's export figures is due to the time lag in the dates of dispatch and receipt.

Year

Kilogrammes

1937 23,021
1938 27,042
1939 18,189

Since 1946 no information on the local production of opium is available.

The annual reports of India indicate the quantities of opium exported to Burma as follows:

Year

Kilogrammes

1938 22,443
1939 22,443
1940 36,397
1941 33,597
1942 3,783
1943 2,240
1946 22,398

The uses (medical, quasi-medical, non-medical) which the quantities produced locally or imported were put to are not clearly distinguishable.

Ceylon

In the past, the eating of raw opium has been prevalent in Ceylon. Thus, for example, in 1937 there were 1,827 registered consumers who obtained raw opium foreating, and 265 kilogrammes of raw opium were sold to registered consumers and to Ayurvedic physicians for their medicinal preparations.

In 1947, the Government of Ceylon suggestedthat the supply of raw opium be continued to keep the eaters from dying. But this policy was changed, and in 1950 it was reported that opium was not being issued to eaters or smokers and thatno licences for this purpose had been issued in the last two and one-half years.

The consumption of raw opium, as declared to the Permanent Central Opium Board, was the following:

Year

Kilogrammes

1936 383
1946 136
1948 139
1949 71
1950 25

French Settlements in India

The practice of opium-eating exists to some extent in the French settlements in India. In the annual reports of France it was stated that the progressive prohibition plan of reducing consumption by 10 per cent, similar to the plan in India, was applied in these settlements. The consumption of raw opium, as declared to the Permanent Central Opium Board, was as follows:

Year

Kilogrammes

1936 551
1946 666
1947 663
1948 524
1949 287
1950
nil
1951 160

14. In the annual report of France for 1951 (E/NR.1951/42) It was stated that the Indian Union resumed delivery of opium for eating during that year.