A note on synthetic narcotics
Author: Charles Vaille, Gabriel Stern
Pages: 25 to 30
Creation Date: 1956/01/01
Gabriel Stern the co-author of the article, is Chief of the Bureau of Narcotics if the above-mentioned Ministry.
The manufacture of synthetic narcotics has become, since the last war, a new factor in the campaign against drug addiction. It has led to a good deal of heated argument during the last few years, which is likely to increase the difficulties.
In two papers published in the last two numbers of the Bulletin on Narcotics two entirely different conclusions were reached, on technical grounds, by their authors. A. Nordal1 wrote: "As far as their margin of therapeutic safety is concerned, the natural drugs are by no means inferior to the synthetic ones. In fact, morphine is in this respect superior to all known analgesics," whereas M. H. Seevers2came to the conclusion that "On the contrary, the scientific and medical advances in the synthetic narcotic field have been so rapid that even today very few natural products are indispensable to the public health."
It is not the purpose of this note to re-open this technical controversy; at the request of several of our colleagues in the United Nations Commission on Narcotic Drugs, we should, however, like to draw attention to some of the psychological and social problems arising in connexion with narcotic drugs, the importance of which has been underlined by fifty years of international work on this subject. The question of synthetic narcotics cannot in fact be treated from a purely technical standpoint.
I. NATURE OF NARCOTIC DRUGS
It is unnecessary to revert to the definitions proposed for the various drugs; the addiction-producing effects3 are unfortunately only too well known. Addiction itself is no longer in dispute, even if there is still some arguement about certain terms used in those definitions. Moreover, it is no longer necessary to stress the value of the experimental work done to establish the addiction-producing properties of chemical substances; a tribute must, however, be paid to the scientists of the U. S. Public Health Service Hospital at Lexington, who have played such an important part in that connexion.
N. B. Eddy, H. Halbach and O. J. Braenden have recently published a noteworthy summary of recent work in this field.4
A. NORDAL. Natural and synthetic drugs with morphine-like effects considered from a pharmacognostic point of view, Bulletin on Narcotics, Vol. VIII, No. 1.2
M. H. SEEVERS. Medical perspectives on international control of synthetic narcotics, Bulletin on Narcotics, Vol. VIII, No. 2.3
French: "action toxicomanogene", a term first used by Dr. P. O. Wolff.
This paper, to which the Commission on Narcotic Drugs rightly paid a tribute at its eleventh session, calls for more detailed study than is possible in this note. While it is not proposed to discuss the conclusions, some doubt must be expressed about the methods used. For instance, as the authors themselves point out, tests made on drug addicts cannot be automatically applied to people who are not drug addicts. This does not mean that we wish to criticize the tests in any way. Moreover, the American scientists have never under-estimated the importance of psychological factors, which create a by no means negligible element of uncertainty. At all events, this fine piece of work blazes the trail for future research. As a whole, the experiments carried out at Lexington are without parallel in this scientific field and an attempt must be made to draw from them as many lessons as possible with regard to the theory of the subject.
One striking fact that emerges from the study is the relative parallelism between the analgesic action of a substance and its physical dependence property. The authors mention seven substances out of seventy-eight studied which appear to them to be exceptions to this rule. Exceptions are always instructive, but it does not seem to us that a clear distinction has been established between these seven substances and the others. Let us now examine these exceptions.
This would indeed appear to be an exception when its capacity to produce physical dependence in man is compared with its analgesic effect on mice. If, however, its property of physical dependence is compared with its analgesic action on man, as is more logical, oxycodone will be found to conform to the general rule of relative parallelism. This is true, as indeed the authors themselves have recognized, in the case of all products where considerable differences are found between their analgesic action on man and on animals. Hence, it is not possible to consider them as exceptions. Tests on oxycodone addicts carried out in France show beyond question that its addiction-producing potency is similar to that of morphine.
The authors refer to the article entitled "Synthetic Substances with Morphine-like Effect: Relationship between Analgesic Action and Addiction Liability, with a Discussion of the Chemical Structure of Addiction-Producing Substances "by Dr. Nathan B. Eddy, Dr. H. Halbach and Dr. Olav J. Braenden, published in the Bulletin of the World Health Organization, 1956, 14, No. 3, pp. 353-402. A corrigendum and addendum to this article were published in Volume 14, No. 4, of this Bulletin. An advance copy of the article was published in United Nations document E/CN.7/311. Where the authors mention this article, they refer to this document. The page references are to the English version of the document. This article, inter alia, mentions 14 exceptions from general parallelism of analgesic and addictive properties. It includes, inter alia, Table II (pp. 365-380) and Table IV (pp. 385-388). Table II gives quantitative data on analgesic effectiveness and addiction liability of many drugs. Table IV gives index figures on the analgesic action and physical dependence property of these drugs. These figures indicate the position of each drug in their order of effectiveness, as well as the relation of their properties in respect to those of morphine. These quantitative data and index figures are based on experiments made on men or mice in the laboratories of the National Institutes of Health, United States of America. [Editor’s note.]
2. Betaprodine and Alphameprodine
There seems to be a misprint here.5On page 386, the authors state that the physical dependence property of these two substances has been assigned the number 142 which corresponds exactly with the data in Table II, page 375.5However, the order of effectiveness of these two products is given as 32-33, whereas morphine (index 100) has an order of effectiveness of 24-29. The number 142 should have an order of effectiveness lower than that of morphine. If the order of effectiveness given by the authors is ignored, it is clear that there is a relative parallelism between the analgesic action and the property of physical dependence which prevents these two products being considered as exceptions.
The physical dependence property of this product has been assigned the number 25 (p. 386), presumably obtained from the dose administered (p. 376). However, it is stated in a note: "24-hour substitution carried out, 200 mg. subcutaneously every 4 hours. The morphine abstinence syndrome was completely suppressed." The question arises whether this was not a single experiment, in which case smaller doses which might possibly have had the same effect were not tried out. If this assumption is correct, it is obviously not certain that this product is an exception.
This product has been assigned the physical dependence property index < 83, obtained from Table II (p. 377).5It would, however, appear that in this case also the experiment was made only with a dose of 60 mg which produced " spectacular relief " of abstinence. In Table II the dose is therefore given as < 60. In this case the physical dependence index should not result in a figure of < 83, but > 83, and here again only if experiments with smaller doses had been made would we feel justified in expressing an opinion on the subject. It should also be noted that our remark about oxycodone also holds good for phenadoxone, for if it is twice as potent as morphine in its action on mice, it is six times less potent in the case of man. It would thus appear that this substance is not an exception either.
5. Dihydrocodeinone enol acetate
Once again, a great difference is found in the action on men and on mice and it is therefore not possible to regard this substance as an exception.
With regard to the last product, Betachloromorphide, mentioned on page 391, the authors themselves state on that page that the physical dependence figure is uncertain.
The seven exceptions mentioned by the authors are not therefore absolutely conclusive. All that can be said is that there is some hope, and that research in that direction should be carried further.
See note 4.
For the time being, however, it would be wiser to take it as a general rule6 that there is a relative parallelism between analgesic action and the physical dependence potency.
It must be stressed in this connexion that such parallelism can never be more than relative.
In so complex a field as that of drug addiction, variations must be expected not only from one individual to another but even in the same individual according to circumstances. And if only because of the psychological factors which, even if their importance is minimized, cannot be completely eliminated, there is no hope of establishing a strictly proportional relation between two different physiological phenomena provoked by the administration of one and the same product.
In this respect there is absolutely no difference between "natural" and "synthetic" drugs. Indeed, no one has ever claimed that there could be, and it is certainly not on such grounds that a different attitude should be adopted towards synthetic as opposed to natural drugs. Incidentally, it may be pointed out that this difference in attitude must generally speaking apply to any new drug, even of natural origin.
Do the experiments with new drugs provide conclusive evidence of their addiction-producing properties and the extent of the scourge they might become?
The answer to both these questions is no. Social factors, as efforts have been made to show, intervene in the aetiology and development of drug addiction. Study of the social scourges due to drugs points to the paradoxical a priori conclusion that the magnitude of such scourges is not proportional to the intensity of the addiction-producing properties of the products which give rise to them.7
The extent of the scourge seems to depend on the living conditions of the population affected and also on the preventive measures adopted by governments-finally, then, on the social aspect of the problem.
It has rightly been stressed that products now regarded as addiction-producing were not characterized as such when they first began to be used. Is it necessary to recall that it was the therapeutic use of heroin and pethidine that led to the misuse of those substances?
In short, there are two important facts to be borne in mind:
(1) That valid tests can be conducted regarding the physical dependence potency of an analgesic product. So far, a relative parallelism has been noted between analgesic action and physical dependence potency.
(2) In the present state of affairs, however, such tests can provide no certainty as to the extent of the addiction to which an analgesic product may give rise.
This suggests that a solid factual foundation for the attitude to be adopted towards synthetic drugs is mainly to be sought in fields other than the purely technical one.
II. UTILITY OF SYNTHETIC DRUGS
We shall first dispose of the economic aspect.
From a purely economic standpoint it clearly will be in the interest of any country, other than an opium producer which has a chemical industry of its own, to use only synthetic substances.
As everyone knows, no biological law can be regarded as absolute, even when there are no known exceptions.7
Ch. VAILLE and G. STERN. "Les stupéfiants : fléau social ", Expansion scientifique française, Paris, 1955.
We trust, however, that this consideration will never be decisive in determining the attitude of governments towards synthetic drugs.
Even those countries which have taken the most draconian measures with respect to synthetic drugs have not absolutely forbidden the use of those which make an important contribution to therapeutics.
They have never questioned the need to pursue research with a view to producing a sufficiently effective analgesic having little or no addiction-producing properties.
Even if some may have expressed doubts about the theoretical possibility of such an achievement, the practical and theoretical advances in modern chemotherapy show that no technical problem must be dismissed a priori as insoluble.
Here again there is no reason to believe that anyone has ever suggested opposing scientific research.
The question whether synthetic drugs should be used turns on two technical points : their presumed analgesic action and their addiction-producing properties. Any other therapeutic properties they may possess, though not, of course, negligible, are none the less of secondary importance. The essential purpose of any analgesic is to relieve pain, and the essential quality of any effective analgesic is the relative unlikelihood of its producing addiction.
It has been claimed that some synthetic drugs set up less severe respiratory depression and gastro-intestinal reactions than morphine. This fact is not disputed, but such advantages must be weighed against the disadvantages which we shall mention later.
It has also been asserted that a synthetic drug addict is easier to treat. However, all experts agree that the withdrawal of the drug from an addict presents no major difficulty. It is after that stage that the difficulties begin, when it is a question of his readjustment to normal life and of preventing recidivism. No superiority can be claimed for synthetic drugs in this respect.
Consequently, any superiority that a synthetic drug might have over a natural drug with comparable analgesic properties could only lie in its distinctly weaker addiction-producing potency; and it is impossible to claim today that synthetic drugs possess that characteristic.
The proposal has been made to the United Nations Commission on Narcotic Drugs that the criterion for the use of a synthetic drug should be that it is indispensable for public health.
The interpretations given to that proposal have tended to cast doubt on the commonsense of those advocating such a criterion. The expression "indispensable for public health" implies either that the drug makes an important contribution to therapeutics, as already indicated, or that its use is a practical necessity owing to insufficient supplies (for whatever reason) of natural analgesics for the sick.
There has been some debate as to the authority competent to decide whether a drug is indispensable or not. As, however, the international conventions provide for the establishment in each State of an administration for the purpose, inter alia, of "organizing the campaign against drug addiction by taking all useful steps to prevent its development", 8 it is self-evident that the task should devolve on that administration which, having obtained all the necessary technical advice, is alone competent to pass final judgment, because it alone is in possession of all the facts of the case. Among the technical opinions on which the decision is based the views of the medical profession must clearly carry the greatest weight.
Article 15 (c) of the so-called Limitation Convention signed at Geneva on 13 July 1931.
From a purely technical standpoint, one is bound to agree with A. Nordal9 that in therapeutics synthetic drugs have no decisive superiority over natural drugs and vice versa, if their comparative advantages only are taken into account.
Hence, it is when one comes to consider the disadvantages that one gets to the root of the problem.
III. DISADVANTAGES OF SYNTHETIC DRUGS
The real point at issue is the way in which any new drug can be put on the market with no restrictions other than observance of the national and international provisions deriving from the Conventions.
In point of fact, the drugs in question are mainly synthetic ones, a large number of which are included among new products, while very few natural drugs are found among them.
The right to try out a new product under supervision is beyond question, for that is the only way to assess its properties. But this right must be restricted to some extent.
Before the sale of a new product to the public is authorized, it should, after adequate physiological experiments, be subjected to clinical tests, which is the only way in which we can ascertain its action on man. These tests, as is the practice in many countries, should be made only in hospitals and similar institutions under the direction of independent experts (i.e., not selected by the manufacturer) and on voluntary patients. It should be possible to carry them out on as wide a scale as may be necessary and for the length of time required to form an opinion.
Only after the clinical experts have presented their conclusions should the decision whether or not to authorize the sale of the drug to the public be taken.
The dangers of hastily allowing a new product to be used for several years by the medical profession in general in order to assess its effects are very considerable. This practice may perhaps have been common at one time, but it is precisely its disadvantages which have led to the development of the clinical tests referred to above.
It is hardly necessary to point out that, administratively, it is much easier to refuse an authorization than to cancel one issued several years earlier.
It must also be borne in mind that the 1948 Protocol enabling the existing Conventions to be applied to new products has been ratified by only 47 States and that it is by no means universally applied. Furthermore, in quite a large number of States, a new product is sometimes made available to patients before the decision to bring it under the narcotic regulations is reached.
Finally, as a matter of principle, it is not sufficient to take note of the present situation; its logical implications must also be grasped.
There is no field to which the proverb "prevention is better than cure" can more appropriately be applied than that of narcotic drugs.
(a) Control of manufacture and trade
It was stated in 1951 l0that in 1949 it was already easy to foresee that a considerable number of synthetic drugs would be evolved in a few years’ time. Thirty of them (not counting their various possible salts) have already been brought under international control, but the number in existence is much larger.
Are we to wait until there are a thousand of them before enquiring whether the number of such drugs is not a danger in itself ?
Can anyone today fail to realize that the campaign against addiction depends on control of production, trade, and the use of drugs ?
If it is to be effective, control must be complete and its efficacy is in inverse proportion to the number of items controlled.
It can be confidently asserted that even at present no effective control could be exercised in any country over the thirty synthetic narcotic derivatives internationally recognized as such, if they were all in use.
Hence the number of synthetic drugs raises from the very outset the problem of the efficacy of control.
Let us take as an example the customs officers responsible for checking foreign trade transactions. How are they to identify all these drugs when even the most distinguished chemists have to consult technical works in order not to lose themselves among the multitude of new chemical products ?
It is more than probable that a synthetic narcotic derivative exported under its chemical name would pass unnoticed by any customs service in the world.
It therefore seems to us that the mere fact that the number of synthetic derivatives is steadily increasing gives a specific character to this category of drug.
The difficulties of controlling their manufacture need hardly be stressed. We are all aware of the defects in the control of the manufacture of opium alkaloids and the fraudulent practices which they have made possible, despite the existence of sound data on which to base control.11
The fact that no important cases of illicit trafficking in synthetic drugs have so far been discovered is not really reassuring. It is merely a matter of time.
Moreover, the supply of natural products through illicit channels is unfortunately sufficient to make it unnecessary for addicts to look elsewhere.
In view of the relative ineffectiveness of the efforts to suppress the illicit traffic, laudable though they are, one can well imagine what the struggle would be like if synthetic drugs were added to the natural ones.
It would be flying in the face of all experience in this field to await the discovery of cases of illicit traffic before vainly seeking a remedy, when there is still time to prevent them.
But, if we wait, on whose shoulders will the moral responsibility for such traffic fall ?
(b) Control of use
France is one of the countries where the consumption of natural drugs (morphine, heroin, cocaine and oxycodone) has fallen since the end of the war.10
Ch. VAILLE and G. STERN "Le problème des stupéfiants synthétiques", in La Presse médicale, No 33, 18 May 1951.11
Ch. VAILLE and G. STERN, "Control of the opium alkaloid manufacturers", United Nations, Bulletin on Narcotics, Vol. VIII, No. 2.
This reduction has been obtained mainly through very strict control of the use of drugs. This control has revealed12 that too many doctors prescribe narcotic drugs without due regard for their addiction-producing properties and in many cases when other remedies would be equally effective.
The problem is not peculiar to France. It is sufficient to examine the table given below, based on data taken from the latest report of the Permanent Central Opium Boardl3relating to countries of comparable social levels, to see that the consumption of drugs is abnormally high in certain countries.
CONSUMPTION OF MORPHINE AND PETHIDINE IN 1954
(in kg per million inhabitants)
Union of Soviet Socialist Republics
For a long time the part played by the therapeutic use of drugs in causing addiction was neglected. Yet it is undoubtedly an important one in countries with highly organized health services.
It is not easy to make an accurate assessment of the effect of the discovery of synthetic drugs on the general volume of drug consumption at the present time. Nor is it an easy matter to compare pre-war and post-war figures, especially as the 1931 Convention seemed to have brought about a steady decline in the consumption of traditional drugs (morphine, cocaine, heroin).
For an independent comparison of these factors, we must take the morphine consumption figure for 1950, when there were as yet no declared figures for the consumption of synthetic drugs throughout the world.
We then find that :14
World consumption of morphine in 1950
World consumption of morphine in 1954
World consumption of pethidine in 1950
World consumption of metadone in 1954
See Ch. VAILLE and G. STERN, " Medical and Social Aspects of Drug Addiction in France ", United Nations, Bulletin on Narcotics, Vol. VI, No. 2, May-August 1954.13
Document E/OB.11, November 1955.14
Report of the Permanent Central Opium Board, op cit.15
This 1950 figure is higher than those for 1949 and 1948 and lower than that for 1947, a year when pethidine was still little used. The date selected is one which brings out the decline in the use of morphine and does not minimize it.
There was thus a fall in morphine consumption of about 500 kg, offset by a consumption of 11,413 kg of pethidine and 553 kg of methadone.
Although the doses for administration of these three products are not identical, the 553 kg of methadone alone largely offsets the 500 kg decline in morphine consumption.
Hence, it would not be far from the truth to say that practically speaking the consumption of pethidine has come to be purely and simply superimposed on that of morphine.
It can therefore reasonably be claimed that the appearance of synthetics has increased the licit consumption of narcotic drugs.
There is nothing surprising about this, for it usually happens that when the number of articles of consumption is increased total consumption increases too.
But there are other special reasons for the increase in the case of synthetic drugs. It is a fact that a certain proportion of doctors are less aware of the addiction-producing properties of synthetic analgesics than of those of natural ones-indeed, some may even be said to be totally unaware of them.
The Expert Committee of the World Health Organization, realizing this danger, expressed the opinion 16 that the growth of pethidine addiction can be combated only if its use be undertaken with full realization of its danger, and its administration attended by the same precautions as are recognized for morphine.
The need for special measures in the case of synthetic drugs had not escaped the notice of WHO, since the Expert Committee, in its fifth report, asked for the dangerousness of the addiction potentiality of pethidine to be brought to the attention of the medical profession throughout the world.16
To set an example, the Ministry of Public Health in France had quite recently to make representations to one of the most authoritative medical journals for having published a study on the therapeutic value of pethidine, in which it referred to the "slight danger" of that substance, without mentioning its addiction-producing properties.
It is difficult to believe that the French medical profession alone is insufficiently informed on the subject, in view of the fact that, thanks to the co-operation of doctors, the number of prescriptions of synthetic drugs has decreased in France since the war.
It is obvious that the 453 cases of addiction to meperidine (a derivative of pethidine) reported by those authors constitute only a small proportion of the number of American meperidine addicts, if only because 416 of them had volunteered for treatment.
The fact that the number of synthetic drug addicts is smaller on the whole than that of natural drug addicts at the present moment does ?not warrant the assertion that the danger of synthetic drugs has been exaggerated.
To make such a claim would be to ignore two vital factors : the start which natural drugs had over synthetic drugs and the existence of a large and long-established illicit traffic in heroin.16
WHO Technical Report Series No. 95, Geneva 1955, and document C.L.15, 1955, A 2/447/P.3.17
Journal of the American Medical Association, 19 February 1955.18
For an analysis of this article see VAILLE and STERN, "Les stupéfiants: fléau social ", op. cit.
In view of those facts, the proportion of synthetic drug addicts is already very alarming, as the following figures show : 19
Federal Republic of Germany
United States of America
The paper by Rasor and Crecraft confirms the relationship of cause and effect between the therapeutic use of a drug and the addiction to which it gives rise and, hence, between the volume of licit consumption and the number of addicts.
According to the authors, "All of the persons interviewed were vaguely aware of the dangers of becoming addicted to meperidine but regarded it as less likely to produce any toxic effects and less likely to produce addiction; if they should become addicted, they believed it would be easier to discontinue the use of meperidine than any of the commoner opiates. Furthermore, meperidine was more readily available; many hospitals take less precaution in safeguarding their supplies of meperidine than their supplies of other narcotics. Many felt that the stigma attached to using meperidine was much less than that attached to the use of opiates and ... that the observable signs of addiction to meperidine were less obvious to others than the signs of addiction to opiates."
It is instructive to look through advertising matter sent out - in perfectly good faith - by the manufacturers of synthetic narcotics to medical practitioners, and to see how reticent they are about the addiction-producing properties of those drugs.
A medical practitioner who prescribes morphine, oxycodone or heroin must, at this time of day, be aware of the risk he runs.20
This does not apply, however, to the new synthetic analgetics offered to him, which he will be inclined to prescribe in cases where he would not prescribe morphine, for example.
It seems to be necessary to stress on every possible occasion the relatively large number of cases of addiction arising from the therapeutic use of drugs.
This fact is brought out in every statistical survey of addiction.21
The situation today is the same as it was in 1889, when Dr. Pichon wrote on the first page of his book:22 "For a long time it has been necessary (and even today is most often the real cause of the trouble) to lay the blame solely on the therapeutic use of drugs."
If Pichon's work had received more attention when it appeared, much of the harm done by narcotics could have been averted.19
Economic and Social Council, Commission on Narcotic Drugs. Summary of Annual Reports of Governments, 1954.20
This is one of the reasons why heroin is not prohibited in France, where less than 10 kg are consumed per year, mostly by patients dying of cancer. If it were banned, it would have to be replaced by synthetics at least equally capable of producing addiction.21
See Summary of Annual Reports of Governments, loc. cit.; and VAILLE and STERN, Bulletin on Narcotics, loc. cit.22
Dr. G. PICHON: "Le Morphinisme ". O. Doin, Paris, 1890.
In its sixth report, the Expert Committee on Drugs liable to produce Addiction expressed the opinion23 that "the risk of addiction through the use of synthetic drugs is neither greater nor less than the risk encountered through the use of morphine, related opium alkaloids, or substances derived therefrom".
It appears, however, from the context, and more clearly still from the oral explanations given at the eleventh session of the Commission on Narcotic Drugs,24that this opinion is derived from scientific experiments on synthetics, and that the Committee, having discussed in detail the psychological aspects of the problem of synthetic narcotic drugs, reached the conclusion that it should not express any definite opinion within the framework of its specific report and should avoid overlapping with the Commission's work.25
From a physiological standpoint, the synthetic and the natural products are on the same footing.
The only difference between them is in their psychological and social effects.
(c) Effect on the illicit traffic
If judgment on the possible effect of the increasing use of "synthetics" on the illicit traffic is suspended until abundant factual evidence is forthcoming, it will be too late to save the situation.
It has already been observed that some addicts whose condition is due to medical treatment with, for instance, pethidine, satisfy their craving by procuring narcotics of any kind on the illicit market. This fact proves that the new form of addiction is bound to stimulate the illicit traffic, which does not depend entirely on the traffickers; demand is also an important factor.
Experience shows that there will always be persons unscrupulous enough to satisfy the demands of addicts by every possible means, for some of them create those demands.
Experienced officials are always very discreet when discussing the illicit traffic. They are sometimes heard to say that they have not discovered any illicit traffic, but never that it does not exist.
Nearly fifty years ago some far-sighted individuals laid the foundation for an international system of control which is an effective weapon against drug addiction.
Their efforts notwithstanding, and despite international co-operation, we still have to deplore the existence of an illicit traffic, the extent of which is merely suspected, and above all the large-scale use of narcotic drugs for illegitimate purposes.23
WHO Technical Report Series, No. 102; Geneva, 1956.24
298th meeting, Provisional Summary Record, p. 5.25
The main reason for this state of affairs is that preventive measures were taken only after the damage had already been done.
The most we can hope is that the growth of this scourge has been checked.
The results achieved may be jeopardized if the use of numerous synthetically-manufactured narcotic drugs is allowed to increase.
Three basic factors are involved:
(1) the number of synthetic drugs;
(2) the increasing volume of their consumption;
(3) the role of therapy in the aetiology of drug addicts.
It seems highly probable that the importance of these factors will increase.
There are two schools of thought about this serious problem.
The first holds that it is enough to make the new drugs subject to the existing provisions regarding narcotics, and considers even a partial prohibition of the use of certain synthetics unwarranted and liable to endanger scientific progress.
The second considers it necessary only to permit the use of such synthetic drugs as are regarded as indispensable for public health, and to prohibit the remainder.
International bodies cannot take the place of national ones in solving the social problems raised by drug-addiction. Their function is to consider from a realistic standpoint what measures are required to prevent the increase of addiction, and to make such recommendations to governments as are calculated to further that end.
Should any Party feel unable to act upon such recommendations, it should none the less, in a spirit of international solidarity, take into account the dangers to which its attitude exposes the other Parties.
That is the idea underlying the proposal to limit the use of synthetics; it is a preventive measure; its application presents no difficulties; it does not affect the treatment of the sick, nor does it hamper scientific research. Nowadays it is relatively easy to produce a new synthetic analgesic; it is more difficult to find one that is not, or is only very slightly, habit-forming. The man who first discovers it will deserve the more credit on that account.
Lastly, as usual where narcotic drugs are concerned, economic factors should be disregarded. We know from past experience that, in this field, economic interests rarely coincide with those of the patients and of the general population.