World Health Organization

Abstract

The Expert Committee on Addiction-producing Drugs of the World Health Organization held its ninth session in Geneva from 6 to 11 October 1958 and made a report which was noted by the Executive Board of the World Health Organization at its twenty-third session, held in Geneva from 20 January to 3 February 1959 (resolution EB 23. R21, Official Records of the World Health Organization, 1959, 91).

Details

Pages: 45 to 47
Creation Date: 1959/01/01

World Health Organization

Expert Committee on Addiction-producing Drugs: Ninth Report [ 1]

The Expert Committee on Addiction-producing Drugs of the World Health Organization held its ninth session in Geneva from 6 to 11 October 1958 and made a report which was noted by the Executive Board of the World Health Organization at its twenty-third session, held in Geneva from 20 January to 3 February 1959 (resolution EB 23. R21, Official Records of the World Health Organization, 1959, 91).

Extracts from this report are reproduced hereafter with minor modifications. Actions modifying the scope of the international control of narcotic drugs, such as placing a new drug under control or removing it from control, will not be reported here, but in the note at the end of the present number of the Bulletin.

WORK OF INTERNATIONAL BODIES CONCERNED WITH NARCOTIC DRUGS

The Secretary summarized the report of the thirteenth session of the Commission on Narcotic Drugs of the Economic and Social Council; [ 2] the relevant resolutions of the Economic and Social Council; [ 2] and the reports on sessions of the Permanent Central Opium Board [ 3] and the Drug Supervisory Body. [ 3] Among the items of interest, particular note was taken of the publication of the Multilingual List of Narcotic Drugs under International Control, [ 4] which should be invaluable to all concerned in this field. The Committee was pleased to know that it was hoped to keep the list up to date by appropriate supplements, and its members would be prepared to assist in this work.

The value of the United Nations document "Supplementary information on synthetic and other new narcotic drugs" [ 5] was recognized. The Committee emphasized that expressing consumption of drugs in terms of therapeutic doses instead of in gross amounts enabled a more realistic assessment to be made of their relative uses.

The Committee was pleased to note that there was increasing acceptance of the principle, set out in its sixth report, [ 6] of making no distinction, for the purposes of control, between the group of natural alkaloids and their derivatives on the one hand and the group of synthetic substances on the other.

ABUSE OF NON-OPIATE ANALGESIC MIXTURES

The attention of the Committee was drawn to certain mixtures, Containing phenacetin and other agents such as aminophenazone, caffeine and a sedative, which are potentially habit-forming and which under conditions of excessive use have presented characteristics approaching those of addiction. Their prolonged use and potential misuse should be followed closely for an eventual valuation of their effect on public safety.

NON-ADDICTING ANTTTUSSIVES

The Committee discussed the steadily increasing consumption of codeine and dionine as reported by the Permanent Central Opium Board [ 7] and the Drug Supervisory Body, [ 7] which it does not seem possible to account for solely by population increases. It may be due largely to the increasing use of codeine in analgesic mixtures, but partly also to the use of codeine and dionine as antitussives. In this connexion, the Committee would draw attention to the development of methods for the evaluation of antitussive action, through which it has been demonstrated that such action can be produced by agents which are neither analgesic not addicting. Outstanding examples are noscapine [ 8] and dextromethorphan. Other non-analgesic substances (including possible non-analgesic optical isomers of analgesic synthetics) are likely to possess similar action. Investigation and use of non-addicting antitussives should be encouraged, with a view to helping the prevention of drug addiction.

MEASUREMENT OF TOLERENCE AND PHYSICAL DEPENDENCE IN CLINICAL PRACTICE

The Committee received a report on the employment of a new technique to determine the development of physical dependence when analgesics are used in the treatment of chronic pain. [ 9] Periodic administration of nalorphine in fixed relation to an analgesic dose was the tool, and the drugs compared were morphine, oxymorphone, and anileridine. The Committee considered the work of very great importance as a complement to the Lexington addiction liability studies on post-addicts, and was pleased to learn that the new method will also be employed in the study of other analgesic drugs.

CLASSIFIED INFORMATION ON NARCOTICS

Two years ago, the Expert Committee on Addiction-producing Drugs [ 10] commented upon the desirability of having available a centralized source of information on drug addiction, if possible in the form of abstracts of published papers. A year later, [ 11] the Committee was informed of the possibility of establishing such a collection of information, because support had been afforded by the National Institute of Mental Health, Bethesda, Maryland, United States of America, the intent being to deal with all aspects of addiction-producing and habit-forming drugs, including relevant experimental, clinical, and statistical data.

It has been found that a complete abstracting service is not possible, at least at the present time. However, work has begun on the collection of all available information (reprints, official documents, manuscripts, abstracts, etc.). This material will be entered bibliographically on a Keysort card. Also, according to an established code, the items of information (drugs described, drug effects, modifying factors, tolerance, habituation and addiction) in each piece of collected material will be indicated on the card together with the relevant code numbers. These code numbers will be punched on the margin of the card to facilitate the finding of data on a particular subject.

The collected documents are being kept at the National Institutes of Health, Bethesda, Maryland. As a contribution to this collection, it is hoped that the members of the Expert Advisory Panel on Addiction-producing Drugs, or any others interested, will make available to the Chief, Section on Analgesics at the National Institutes of Health, either directly or through the Chief, Addiction-producing Drugs Section, World Health Organization, copies of their own papers in the field of narcotics and any other material, duplicate reprints, etc., which they can spare.

The main file of Keysort cards will be prepared and kept at Bethesda. A duplicate set of the index cards will be kept in the Addiction-producing Drugs Section, World Health Organization, Geneva. Photocopies from which Keysort cards may be prepared as well as photocopies of original material will be furnished on request, as far as possible, the purpose being not only to establish the collection, but also to facilitate its availability.

UNIFICATION OF CHEMICAL NOMENCLATURE FOR NARCOTIC DRUGS

In view of the procedure now in regular operation for the coiningof proposed international non-proprietary names for narcotic drugs, the Committee considered that such names should always be used to designate these drugs. Where it was necessary to use a chemical name, the nomenclature adopted should be identical with that placed opposite the proposed international non-proprietary name in the published lists [ 12] or consistent with the principles which have been applied to other drugs in these lists if no such name had been published.

In this connexion, the "Multilingual list of narcotic drugs under international control ", and any supplements thereto, may be of assistance in finding the appropriate chemical. nomenclature of a drug known by another description.

CARRIAGE OF NARCOTIC DRUGS IN FIRST-AID KITS OF AIRCRAFT ENGAGED IN INTERNATIONAL FLIGHT

The Committee's attention was directed to the discussion on the above subject appearing in the report of the thirteenth session of the Commission on Narcotic Drugs and to the relevant resolution of the Economic and Social Council. [ 13] The Committee considered that such carriage might be permitted provided that (1) there was evidence of the medical need for narcotics in the circumstances of air travel, and (2) an adequate system of control could be ensured.

PROPOSED SINGLE CONVENTION ON NARCOTIC DRUGS

The Committee received the third draft [ 14] and welcomed the opportunity to make a number of comments which will be considered by the Executive Board.

Treatment of Drug Addicts

The Committee believed that drug addiction, whatever its incidence, is always a serious problem which should be handled medically, as outlined by the report of the Study Group on Treatment and Care of Drug Addicts. [ 15] It is desirable to make treatment compulsory in the sense that it should always be undertaken, but the Committee believed that the treatment need not necessarily be in a closed institution.

NOTE

Changes in the Scope of Control

The international treaties on narcotic drugs make provision for changes in the scope of control by means of a procedure which involves governments, the Secretary-General of the United Nations and the World Health Organization, in particular its Expert Committee on Addiction-producing Drugs. The procedure may be applied not only in respect of the extension of control to new drugs, but also in respect of exemption from control of drugs or their preparations.

The international procedure for extending control to new drugs or exempting drugs from control is put into motion upon an application being made by a government to the Secretary-General of the United Nations. Such an application is, however, not necessary in the case of exemption of preparations and of extension of control under articles 8 and 10 of the International Opium Convention, signed in Geneva on 19 February 1925.

During 1958, several requests were received from governments regarding extension of control to new drugs or exemption of certain preparations from control. The following decisions were made by the World Health Organization:

  1. The drugs dimenoxadol, normorphine, levomoramide and their respective salts should be placed under the more severe of the two principal regimes of control applying to narcotic drugs - viz., under that which is applicable to morphine or morphine-like drugs, in view of their dangerous addiction-forming properties. It may be noted that the drug levomoramide and its salts had previously been placed provisionally under the same control regime by the Commission on Narcotic Drugs at its thirteenth session, 28 April to 30 May 1958;

  2. The drug nicomorphine, being an ester of morphine, was automatically subject to the same regime of control as that applying to morphine or morphine-like drugs;

  3. The requests for exemption from control of certain preparations containing the drugs normethadone and dioxaphetyl butyrate, both of which are already under the international control regime applicable to morphine or morphine-like drugs, should not be granted in view of the possible dangers involved;

  4. The drug norcodeine, having only slight addiction-producing properties comparable to those of codeine and being not convertible into an addiction-producing drug with morphine-like effects, could not legally be placed under international control; however, it was recommended that this drug be controlled in the same way as codeine, which is subject to the less severe of the two principal control regimes governing narcotic drugs;

  5. In reviewing the previous decision taken in 1955 with regard to the drug propoxyphene, it was concluded that for the same reasons as those applying to norcodeine, propoxyphene could not legally be placed under international control. However, it was recommended that this drug be controlled in the same way as codeine;

  6. In view of clinical experience having shown that the addiction-producing potentiality of' oxymorphone was less than had been anticipated and that it might be considered comparable to morphine, and that in some circumstances oxymorphone had medicinal advantage, the opinion was expressed that restrictions on the manufacture, import and export of oxymorphone needed not be more severe than those applicable to morphine-like drugs. This means that the recommendation made by the World Health Organization in 1954 that it was desirable to avoid the manufacture of and trade in oxymorphone in view of its particularly dangerous addiction-producing properties need not be implemented any more. This recommendation was made by the World Health Organization at the same time at which it decided toplace oxymorphone under the regime applicable to morphine;

  7. No decision was made in respect of:

(-) 3-Hydroxynormorphinan

2'-Hydroxy-2,5,9-trimethyl-6,7-benzmorphan

3-Allyl-1-methyl-4-phenyl-4-propionoxypiperidine

2-piperidinomethyl-7-benzoylbenzodioxane

2-morpholinomethyl-7-benzoylbenzodioxane

2-piperidinomethyl-7-(p-methoxybenzoyl) benzodioxane

2-morpholinomethyl-7-(p-methoxybenzoyl) benzo-dioxane.

1

WHO Technical Report Series (1959), No. 160.

2

See Bulletin on Narcotics, Vol. X, No. 4.

3

See Bulletin on Narcotics, Vol. X, No. 1.

4

Multilingual List of Narcotic Drugs under International Control (document E/CN.7/341).

5

Supplementary Information on Synthetic and Other New Narcotic Drugs. (document E/CN.7/339).

6

See Bulletin on Narcotics, Vol. VIII, No. 1.

7

See Bulletin on Narcotics, Vol. X, No. 1.

8

International non-proprietary name proposed for narcotine.

9

See article by Drs. N. B. Eddy, L.E. Lee & C. A. Harris, Bulletin on Narcotics, Vol. XI, No. 1, p. 3.

10

See Bulletin on Narcotics, Vol. IX No. 1.

11

See Bulletin on Narcotics, Vol. X, No. 1.

12

i.e., the List of Drugs under International Control, a United Nations document issued yearly as an addendum to the Report of the Division of Narcotic Drugs (the last one is document E/CN.7/356/Add.2, 28 January 1959). Also the lists of international non-proprietary names published from time to time in the WHO Chronicle.

13

See Bulletin on Narcotics, Vol. X, No. 4.

14

The Single Convention on Narcotic Drugs (Third Draft) (document E/CN.7/AC.3/9).

15

See Bulletin on Narcotics, Vol. IX, No. 3.