World Health Organization Expert Committee on Addiction-producing Drugs: Twelfth report

Abstract

The Expert Committee on Addiction-producing Drugs of the World Health Organization held its twelfth session in Geneva from 21-27 November 1961. Extracts from the report of the Expert Committee are reproduced with minor modifications.

Details

Pages: 42 to 43
Creation Date: 1962/01/01

World Health Organization Expert Committee on Addiction-producing Drugs: Twelfth report 1

The Expert Committee on Addiction-producing Drugs of the World Health Organization held its twelfth session in Geneva from 21-27 November 1961. Extracts from the report of the Expert Committee are reproduced with minor modifications.

An essential task of the Expert Committee is to advise the World Health Organization in making its finding and decisions under the international treaties on narcotic drugs, on extension of control to new drugs or exemption of drugs from control. Actions modifying the scope of the international control of drugs resulting from the twelfth session of the Expert Committee are not included here, but are in a note on page44 of this issue of the Bulletin.

Khat( catha edulis)

The Committee discussed the characteristics of the habitual use and abuse of khat in certain regions, particularly East Africa and the west coast of Arabia, and the progress in the research on its medical aspects undertaken by the World Health Organization on the invitation of the Economic and Social Council of the United Nations. The Committee was informed, in particular, of the present state of the chemical and pharmacological identification of the active principles of khat. It was of the opinion that clarification on these points was essential and should be available before a sound medical appraisal of the chronic use of khat could be made.

Work of International Bodies concerned with Narcotic Drugs

The Committee noted that several matters referred to in the report of the sixteenth session of the Commission on Narcotic Drugs of the Economic and Social Council2 and in the latest reports of the Permanent Central Opium Board3 and Drug Supervisory Body4 had a direct relevance to items of its present agenda. From the Commission's report it was apparent that the illicit production of and traffic in heroin continued to increase, in spite of the marked reduction in its medicinal use. In addition, it had been noted that in some areas there was a definite trend towards the use of heroin by opium addicts. A factor in this trend might be the limitation imposed on the use of opium without comparable attention to enforcement of restrictions on the availability of heroin. It was clear, therefore, that further reduction of the availability of heroin, the drug of choice of many addicts and in the illicit traffic, must be attained by the strictest enforcement of controls.

WHO Technical Report Series (1962), No. 229.

United Nations, Commission on Narcotics Drugs (1960), Report of the Sixteenth Session (April-May 1961) ( Economic and Social Council, Official Records, Thirty-second Session. Supplement No. 9) Geneva (document E/3512).

United Nations, Permanent Central Opium Board (1960), Report to the Economic and Social Council on the Work of the Board in 1960, Geneva (document E/OB/16).

United Nations, Drug Supervisory Body (1960), Estimated World Requirements of Narcotic Drugs in 1961, Geneva (document E/DSB/18).

The reports of the Permanent Central Opium Board3 and the Drug Supervisory Body4 showed that the consumption of codeine continued to increase. In the view of the Committee there was no evidence that this could be accounted for by a greater need for antitussives nor apparently had the trend been retarded by the use of new synthetic antitussives. Most likely the increase in codeine consumption had resulted from the marked and rapid introduction of new analgesic preparations containing codeine, readily available without prescription in many areas. In most places such preparations accounted for the bulk of the codeine used. Codeine had a relatively low addiction liability and codeine addiction appeared infrequently in spite of increasing codeine consumption. The use of codeine and codeine preparations would be advantageous as long as it avoided the use of more addicting substances. It would be hazardous if it led to a habit of drug administration and induced substitution of a more dangerous drug.

The Committee had repeatedly stressed the need for the earliest possible complete and correct information to the medical profession on the addiction-producing and habit-forming properties of drugs together with the information on their therapeutic properties. The Committee was particularly concerned about the way in which this information was made available and stressed when substances were presented.

While there was still much room for improvement in this respect, it was noted that in regard to both the desired and undesired effects of such drugs useful information media existed, the development of which should be encouraged.

Single Convention on Narcotic Drugs, 1961

The opportunity afforded to the World Health Organization to initiate a notification and the arrangement of the schedules more explicitly with respect to the degree of hazard to public health would surely expedite the work of this committee. However, delay in the implementation of international control might result from the change in the mechanism of decision with respect to such control unless the time scheduling or the work of the international organs concerned with establishing narcotics control could be adapted to the new situation.

Medical Control of Addicts

The Committee noted that article 38 of the Single Convention took account of the fact that withdrawal and rehabilitation of addicts could be achieved by a variety of means. The Committee noted also a preliminary compilation of national laws and regulations prepared by the Secretariat which showed that, whereas many States had enacted laws for both the compulsory and voluntary admission for withdrawal treatment, they had given much less attention and provided almost no legislation for the second and essential phase of complete treatment; i.e., rehabilitation aiming at reduction of relapses.

Withdrawal must be the first step in treatment; but if cure was to be successful rehabilitation must follow, and some increase in interest in and attention to the latter was shown by the recent establishment of rehabilitation facilities in a number of places. For neither aspect of treatment could precise rules and regulations be laid down to fit every case. The first required an absolute drug-free environment and the second the efforts and co-operation of all agencies in the community which could help in the medical, social and economic re-establishment of the individual without his reliance on drugs. The Committee would re-state its belief that a programme of civil commitment of the addicted individual to medical authority until a cure was attained was well adapted to the over-all requirements of treatment.

In connexion with the establishment of treatment and rehabilitation facilities, the Committee would emphasize the immediate need for the broadening of efforts in this direction. It was suggested that one way of initiating or stimulating such efforts would be the organization of seminars in conjunction with broader operational programmes where such organiza- tion could be effected appropriately to the local or regional situation.

Research

The Committee heard and discussed accounts of tests for addiction-liability employing the dog and the rat as test subjects. It noted that a report was being prepared by the Secretariat on all the methods now available for tests of addiction liability in animals and man, and plans were under way for a scientific group to consider and evaluate these methods.

New research projects on addiction had recently been introduced in various places and scientific programmes for research in the field of alcoholism were being extended to include problems of basic mechanisms and epidemiology of addiction in its broadest sense. The Committee believed that this was a promising approach taking advantage of the experience so far gained in the related field of alcoholism.

The Committee was also informed that consideration was being given by the World Health Organization to the support of specific research projects in the field of addiction, as it has suggested in earlier reports.5

World Health Organization Technical Report Series, 1960, 188, 10 (section 4).