World Health Organization Expert Committee on Addiction-producing Drugs: Thirteenth report
Work of International Bodies concerned with Narcotic Drugs
Terminology in Regard to Drug Abuse
Consideration governing the Medical Use of Narcotics
Khat (Catha edulis)
Abuse of Hallucinogenic Agents
Pages: 53 to 55
Creation Date: 1964/01/01
The Expert Committee on Addiction-producing Drugs of the World Health Organization held its thirteenth session in Geneva from 25-30 November 1963. 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 thirteenth session of the Expert Committee are not included here, but are in a note on page 55 of this issue of the Bulletin.
The reports of the seventeenth  and eighteenth  sessions of the Commission on Narcotic Drugs of the Economic and Social Council, the relevant resolutions of the Economic and Social Council,  and the reports of the Permanent Central Opium Board  , and Drug Supervisory Body  were summarized by the Secre-
tary. Several items referred to in these reports were relevant to the Committee's present agenda.
With reference to the recent regional conference on coca-leaf problems and the relevant resolution of the Economic and Social Council, the Committee noted with satisfaction that there is now general agreement on the harmfulness of coca leaf chewing and that the problems connected therewith are to be regarded as a concomitant of unfavourable socio-economic circumstances with detrimental effects on the individual as well as the society. The general acceptance of this point of view should help in directing efforts towards the betterment of the underlying environmental conditions, wherever possible as part of the general social and economic development of the areas concerned, and towards the eventual solution of the coca-leaf problem.
With reference to the economic significance of coca leaves arising out of a possible increase in the legal production of cocaine for medical purposes, the Committee wishes to draw attention to the fact that the medical needs for cocaine have decreased considerably in the past few decades, as a consequence of the continuing development of synthetic local anaesthetics which can replace cocaine in the majority of its therapeutic indications. Therefore, further reduction in the legal manufacture of cocaine is likely and desirable, and this should diminish opportunity for diversion to illicit uses. The Committee was disturbed by the fact that in spite of this there is an upward trend in the abuse of cocaine, particularly in combination· with other drugs.
The Committee was glad to note that the Commission on Narcotic Drugs and the Permanent Central Opium Board  were now placing increased emphasis on the sociological and economic aspects of drug abuse. It expressed the hope that the Commission's resolution requesting Member States of the United Nations or of the specialized agencies to encourage research on these aspects of the problem would contribute to the elucidation of the epidemiology of drug abuse already called for both by the WHO Expert Committee  and by the WHO Study Group on the Treatment and Care of Drug Addicts.
In connexion with the Commission's resolution on the control of barbiturates, the Committee wished to point out that there were a number of non-barbiturate sedatives, hypnotics and other drugs with sedative effect which had been shown to be abused and to produce ill-effects similar to those of the barbiturates. This was of particular significance where the sedative effect was not the one for which the drug was primarily used in medicine, but could be made use of properly under some circumstances, and might also lead to abuse. This may be illustrated by certain of the antihistamines developed as anti-allergic agents, but exhibiting sufficient sedative action to be used, and abused, as sedatives. Another pertinent case is the recent observation of an epidemic-like outbreak of abuse of hypnotic drugs in a particular region. Methaqualone, originally developed as an anti-malarial, is currently advertised as a sedative, and although introduced into that region only a year ago, is now reported to constitute about four-fifths of the total amount of hypnotic drugs abused in the group studied.
Sudden changes in the drug of choice for abuse amongst groups within a population or in circumscribed areas such as referred to above tend to show, in the Committee's view, the relevance of sociological and environmental factors, as distinct from individual motives, in the etiology of drug abuse. Such fluctuations thus indicate the need for immediate national control measures, as repeatedly recommended by the Committee for drugs of abuse not under international control (barbiturates  or other sedatives  and amphetamines  ).
With regard to the proposal made in the Commission on Narcotic Drugs for an investigation into the causative role of phychoactive substances in accidents, especially road accidents, the Committee believed that such investigations could profitably be combined with similar studies on the role of alcohol.
The Committee took cognizance of the 1963 edition of the "Multilingual list of narcotic drugs under international control." The list has been greatly expanded, partly by the inclusion of names of new drugs, but more particularly by additional names for drugs already known. The list is a helpful tool for anybody working in this field. The Committee hopes that this document will be kept up to date.
The Expert Committee attempted in 1952, and later (1957) revised, a definition of addiction applicable to drugs under international control. It sought also to differentiate addiction from habituation and wrote a definition of the latter which, however, failed in practice to make a clear distinction. The definition of addiction gained some acceptance, but confusion in the use of the terms as between addiction and habituation and misuse of the former continued. Further, the list of drugs abused increased in number and diversity. These difficulties have become increasingly apparent and various attempts have been made to find a term that could be applied to drug abuse generally. The component in common appears to be dependence, whether psychic or physical or both. Hence, use of the term "drug dependence" with a modifying phrase linking it to a particular drug type in order to differentiate one class of drugs from another has been given most careful consideration.
"Drug dependence" is defined as a state arising from repeated administration of a drug on a periodic or continuous basis. Its characteristics will vary with the agent involved and this must be made clear by designating the particular type of drug dependence in each specific case- for example, drug dependence of morphine type, of cocaine type, of cannabis type, of barbiturate type, of amphetamine type, etc.
The Expert Committee recommends substitution of the term "drug dependence" for the term" drug addiction" and "drug habituation"
It must be emphasized that drug dependence is a general term selected for its applicability to all types of drug abuse and carries no connotation of the degree of risk to public health or need for a particular type of drug control. The agents controlled internationally 'continue to be those that are morphine-like, cocainelike and cannabis-like, however produced, the use of which results in drug dependence of morphine type, drug dependence of cocaine type, and drug dependence of cannabis type. Other types of drug dependence (barbiturate, amphetamine, etc.) continue to present problems, but their description under the general term "drug dependence" does not in any way affect the measures taken to solve them. The general term will help to indicate a relationship by drawing attention to a common feature associated with drug abuse and at the same time permit more exact description and differentiation of specific characteristics according to the nature of the agent involved.
The Committee has on many occasions stressed the medical aspects of the treatment of addicts and the precautionary attitude that should be adopted by physicians in this connexion and in the use of narcotics generally in their practice. Its attention was drawn to a recent report setting forth in considerable detail the whole philosophy of the use of narcotics in medical practice. It was felt that this report constituted a useful guide towards the attainment of the objectives that the Committee has stressed.
The Committee studied a report by the Secretariat on the medical aspects of the habitual chewing of khat leaves. In this report the somatic and psychic symptoms brought about by the chewing of the leaves were reviewed and explained as the effects of the specific active principles contained in the leaves. Besides tannins in apprecible amounts, it has been possible to identify (+)-norpseudoephedrine (cathine) and a chemically and pharmacologically closely related substance, which disappears when the plant is dried and is presumably a step in the biosynthesis of cathine. These two substances are amphetamine-like in respect of structure and pharmacodynamics, but there is evidence that their effects are less powerful than those produced by equivalent amounts of, for example, methamphetamine.
The Committee considered that while khat and pure amphetamine substances produced medical effects that were similar although of different degree, the lower activity of khat was due in the main to differences in dosage, route of administration and the circumstances in which the one or the other were consumed. In addition, khat produced gastro-intestinal symptoms due partly to its high content of tannins.
The Committee realized that the habitual chewing of khat had led, in some areas, to socio-economic phenomena detrimental to the individual and the community, such as loss of man hours and diversion of income, with malnutrition and aggravation of disease as consequences.
The Committee was of the opinion that the problems connected with khat and with the amphetamines should be considered in the same light because of the similarity of their medical effects, even though there were quantitative differences and specific socio-economic features; this was all the more desirable since the problems with respect to khat were confined at present to a few countries in one region.
The Committee took note of the increasingly frequent reports of poorly controlled clinical administration and non-medical use of lysergic acid diethyl amide (LSD-25). In spite of warnings, irregular use is reaching alarming proportions. The Committee was particularly disturbed by the publicity given to the uncontrolled use of this drug and the damage that the indiscriminate use of so powerful an agent has already produced. The problem is at present a local one. In the Committee's opinion, immediate measures with respect to distribution and availability are necessary.
Other instances of indiscriminate use of agents with related effects such as peyotl (mescaline), piptadenia peregrina (bufotenine), and rivea corymbosa were noted. The misuse in these instances appears to be less widespread than in the case of LSD-25, but a watch should be kept and corrective measures taken where necessary.1
WHO Technical Report Series (1964), No. 273.2
United Nations, Commission on Narcotic Drugs (1962), Report of the Seventeenth Session (May-June 1962) ( Economic and Social Council. Official Records: Thirty-fourth session. Supplement No. 9), Geneva (document E/3648).3
United Nations, Commission on Narcotic Drugs (1963), Report of the Eighteenth Session (April-May 1963) ( Economic and Social Council. Official Records: Thirty-sixth session. Supplement No. 9), Geneva (document E/3775).4
United Nations, Economic and Social Council (1963), Official Records: Thirty-sixth session, 2 July-2 August 1963. Supplement No. 1: Resolutions, Geneva, p. 21 (document E/3816).5
United Nations, Permanent Central Opium Board (1961), Report to the Economic and Social Council on the Work of the Board in 1961, Geneva (document E/OB/17).6
United Nations, Permanent Central Opium Board (1962), Report to the Economic and Social Council on the Work of the Board in 1962,Geneva (document E/OB/18).7
United Nations, Drug Supervisory Body (1961, 1962), Estimated World Requirements-for Narcotic Drugs in .1962 and 1963, Geneva (document E/DSB/19 & 20).8
United Nations, Permanent Central Opium Board (1963), Report-to the Economic and Social Council on the Work of the Board in-1963, Geneva : (document E/OB/19).9
United Nations, Commission on Narcotic Drugs (1962), Report of the Seventeenth Session, resolution 2 (XVII) (document E/3648, p. 22).10
Wld. Hlth. Org. Techn. Rep. Ser., 1960, 188, 11.11
Wld. Hlth. Org. Techn. Rep. Ser., 1957, 131, 11.12
United Nations, Commission on Narcotic Drugs (1962), Report of the Seventeenth Session, resolution 4 (XVII) (document E/3648, p. 31).13
Wld. Hlth. Org. Techn. Rep. Ser., 1957, 116, 10 (sections 9 and 10).14
Wld. Hlth. Org. Techn. Rep. Ser., 1958, 142, 10 (section 6).15
Wld. Hlth. Org. Techn. Rep. Ser., 1961, 211, 9 (section 2.2).16
United Nations (1963), Narcotic drugs under international control. Multilingual list (document E/CN.7/436).17
Wld. Hlth. Org. Techn. Rep. Ser., 1952, 57, 9 (section 6.1).18
Wld. Hlth. Org. Techn. Rep. Ser., 1957, 116, 9 (section 8):19
Council on Mental Health, 1963, "Narcotics and medical practice", J. Amer. Med. Ass., 185, 976.20
Wld. HIth. Org. Techn. Rep. Ser., 1956, 102, 12 (section 7); 1957, 116, 9 (section 7).