Features of drug addiction in Geneva

Sections

Introduction
The situation in Geneva
Addicts (A) under medical supervision
Addicts (B) obtaining narcotic drugs by illicit means
Comments on the consumption of narcotic drugs in the Canton of Geneva
Conclusion

Details

Author: M. HAENNI,
Pages: 7 to 16
Creation Date: 1964/01/01

Features of drug addiction in Geneva

M. HAENNI, State pharmacist in Geneva (Pharmacien cantonal) with an introduction by Dr. H. FELDMANN

This study was made originally in two parts: an introduction by Dr. H. Feldmann, which contained a definition of drug addiction, a description of the addiction syndrome, a description of the clinical forms of drug addiction, and a study of its sociological and medico-legal aspects. Lack of space unfortunately made it impossible to publish the full study. The first part - the introduction by Dr. Feldmann - was left out except for its last paragraphs, and some of the data in the second part were deleted. The full study will be published in one of the next issues of theRevue internationale de criminologie et de police technique, the official publication of the International Centre of Criminological Studies, Geneva. THIS work is of special interest because it deals with drug addiction in an unusual environment - namely, a relatively small city (about 260,000 inhabitants), which is a very important touristic and international centre, with a very large resident alien population, a great number of visitors in transit from all parts of the world and considerable amounts of foreign money constantly changing hands. Given these unsettling circumstances, Mr. Haenni's study illustrates how remarkably slight so far has been the incidence of drug addiction. Such cricumstances are probably unique in the world and, therefore, it is impossible to draw a comparison with any other city, since normally a city of 200,000 people shows a much wider range of social conditions than Geneva, which has an extremely low percentage of economically weak classes and a very high percentage of non-citizens. An attempt has been made to compare the Geneva situation with that of other cities for which data were available, but it was soon found out that the basic elements differed too widely to establish any similarity or differences. It is to be hoped that studies of the same type may be carried out with the same exhausting care for other and more common types of urban centres so that more light can be thrown on the etiology and "way of life" of drug addiction.

Introduction

The International Centre of Criminological Studies requested Dr. Bavaud, Cantonal Medical Officer, and Mr. Heanni, Cantonal Pharmacist, to carry out a study of drug addiction in the Canton of Geneva, analysing all prescriptions for narcotic drugs filled by Geneva pharmacists and addressing the following questionnaire to the physicians treating the twenty-three known drug addicts:

- How many drug addicts have you treated among your patients ?

- For how many patients have you prescribed narcotic drugs ?

- Which drugs have you prescribed ? Morphine ? Opium (in the form of thebaine extract, laudanum, or paregoric elixir) ?

- How many patients have made a prolonged use of these drugs ?

- For how long ?

- For what reasons ?

  1. Severe physical pain (neuralgia, cancer, other physical pains and, if so, of what nature) ?

  2. Persistent insomnia ?

  3. Mental affliction (melancholia, anxiety, neuroses, etc.) ?

  4. Conscious and deliberate effort to obtain the drug ?

  5. Curiosity aroused by a chance encounter with a drug-peddling addict ?

- How many patients have you treated who showed a drug-addiction syndrome with euphoria, habituation, a state of physical and psychological dependence and craving ?

What personality characteristics did these patients present: dysphoria? listlessness ? egocentric tendencies ? sadistic impulses ? aggressiveness ? irresistible impulses ? anti-social behaviour ? sexual impotence ?

What kind of drugs do these addicts use: morphine ? synthetic substitutes for morphine ?

  1. Pethidine group: Dolosal, Dolantine, Cliradon, Demerol, Mefedina, Sauteralgyl, Spasmedal, Ketobemidone, etc. ?

  2. Methadone group: Heptanal, Heptadon, Mecodine, Mephenon, Physeptone, Polamidon C or Evadol, Methadone, etc.?

  3. Phenadoxone group: Heptalgin, Heptazone, C.B.11, etc.?

  4. Morphinan group: Dromoran, Methorphinan, etc. ?

  5. Palfium group ?

The analysis of the replies to the questionnaire is given hereafter.

It should be emphasized that in the Canton of Geneva, the problem of drug addiction is virtually negligible by comparison, on the one hand, with the abuse of medicaments, especially analgesics, and, on the other hand, with chronic alcoholism, which is perhaps a minor form of addiction but which is made much more important by the widespread alcoholism in the area.

The abuse of medicaments, especially analgesics, was examined by a Federal Commission set up for the purpose; a summary by T. Muller and P. Kielbolz appeared in 1957. This inquiry showed that approximately 150 million pain-killing tablets or powders - an average of thirty per head of population - were sold in Switzerland during 1955. These medicaments are used chiefly by the urban population. A parallel inquiry carried out at Basle showed that only 4% of the population took analgesics regularly and consumed the bulk of the quantity indicated above.

Compounds containing phenacetine, barbiturates or caffeine, taken as tranquillizers, account for most of these "pharmaceutical addicts"

An inquiry among 2,310 Swiss physicians showed that 5,500 patients were abusing medicaments and that 80% of these patients were women. Psychosomatic and psychic disturbances are the commonest root causes of the abuse of medicaments and tranquillizers.

The situation in Geneva

It may be useful, first of all, to describe briefly the essentials of the federal legislation concerning narcotic drugs and its application in the Canton. The following are deemed to be narcotic drugs within the meaning of the federal law:

  1. Natural substances: opium, coca leaf and cannabis, and their active principles;

  2. Synthetic substances which have harmful effects similar to those of morphine, cocaine and hashish, and which are capable of leading to addiction.

Thus, stimulants of the amphetamine type, although they may produce habituation, do not come within the scope of this legislation in Switzerland, whereas in other countries- for example, Denmark- they are classified as narcotic drugs. 1

It should be remembered that, apart from a few rare exceptions applied to mixtures of weak concentration not designed for parenteral administration, narcotic drugs may not be supplied by pharmacists except against a medical prescription which is valid for a single dispensing.

Cf. article entitled: "Consumption of narcotic drugs in Denmark ", by Dr. M. Nimb, Bulletin on Narcotics, vol. X, No. 3, July-September 1958.

In the Canton of Geneva, pharmacists must, at the end of each month, forward to the cantonal pharmacist all prescriptions for narcotic drugs which they have dispensed. In this way, the cantonal pharmacist is in a position to keep a very accurate check both on the consumption and on the consumers of narcotic drugs; addicts frequently change their doctors and pharmacists, and only this over-all picture makes it possible to determine the quantity of narcotic drugs that is supplied to them.

This work of supervision takes a fairly long time, although, with experience, it may be possible to reduce it considerably; however, it is certainly very effective, for this check has led to the detection of several addicts who were obtaining narcotic drugs from many doctors, and also to the discovery of a number of persons who falsified prescriptions. It was through these supervisory operations that we were able to obtain most of the data included in the present study.

This study will consider first the cases of addicts under medical supervision; it will then discuss the behaviour of addicts who obtain narcotic drugs by unlawful means, such as by forging prescriptions or making out false prescriptions bearing forged signatures. On the other hand, the study will not deal with drug traffickers, of whom, in any case, there are few in the Canton of Geneva; the only ones who sometimes fall into the hands of the Geneva police are generally international traffickers passing through the Canton.

Addicts (A) under medical supervision

We conducted an inquiry among medical practitioners concerning 23 cases involving the heaviest consumers of narcotic drugs; these cases are numbered serially from 1 to 23, in the order in which replies were received. They include 16 females and 7 males; 10 married persons, 6 unmarried persons, 5 widows and 2 divorced persons; the predominance of females is obvious.

In order to respect professional secrecy to the fullest possible extent, we indicate the ages of the persons concerned in approximate terms and do not specify their professions or occupations. We consider that the best way of obtaining an over-all picture of the 23 cases is to present the results of our inquiry in tabular form.

We have used the international non-proprietary names for the narcotic drugs involved.

This part is composed of six tables:

Table 1: General data

Table 2: Reasons for the prescription

Table 3: Psychological state of "A" addicts

Table 4: Psychological state of" A" addicts ( continued)

Table 5: Case history of "A" addicts

Table 6: Case history of "A" addicts ( continued)

All the doctors treating the" A" addicts answered negatively the following question concerning the possible origin of the addiction: "Curiosity, combined with a chance meeting with a drug addict acting as proselyte ?"

TABLE 1

General data

Serial No.

Age

Sex

Marital status

For how many years has the patient been using narcotic drugs?

Narcotic drugs used

1
over 80
Female
Married
5
Hydrocodone
2
50-60
"
Single
6
Hydromorphone, Methadone, Pethidine
3 60-70
"
Married
25
Oxycodone
4 40-50
"
Single
20
Levorphanol, Pethidine
5 70-80
Male
Married
4
Hydromorphone, morphine
6 70-80
Female
Widow
4
Ketobemidone
7 70-80
"
" 4
"
8 50-60
"
Married
5
Methadone
9 40-50
"
Married
3
Morphine
10 50-60
"
Single
4
Ketobemidone
11 40-50
"
" 3
Ketobemidone, Pethidine
12 70-80
"
Widow
over 25
Opium, morphine
13 70-80
"
" 2
Dextromoramide
14 70-80
Male
Married
6
Oxycodone
15 50-60
"
" 3
Ketobemidone
16 70-80
"
Divorced
over 40
Morphine
17 60-70
Female
"
over 12
Methadone
18 60-70
"
Married
3
Ketobemidone, Dextromoramide
19 60-70
"
Single
over 20
Morphine
20 70-80
"
Widow
10
Pethidine
21 60-70
Male
Single
5
Dextromoramide
22 60-70
"
Married
10
Opium
23 30-40
"
Married
5
Hydromorphone

Comments on table 1

  1. A comparative analysis of the data in this table shows that:

1 person is between the ages of 30 and 40 years

3 persons are between the ages of 40 and 50 years

4 persons are between the ages of 50 and 60 years

6 persons are between the ages of 60 and 70 years

8 persons are between the ages of 70 and 80 years

1 person is over the age of 80 years

The majority of the addicts under medical supervision at present receiving treatment are between the ages of 70 and 80 years.

  1. It is, however, of more special interest to know at what age this addiction started; table 1 shows for how many years the persons in question have been taking narcotic drugs, and it will be noted that:

5 persons have been using drugs for 20 years and more

3 persons have been using narcotic drugs for 10 to 12 years

6 persons have been using narcotic drugs for 5 to 6 years

9 persons have been using narcotic drugs for less than 5 years.

From these data it is possible to determine the age at which these addicts began to indulge in the use of narcotic drugs.

It is noteworthy that in the case of the majority of the "A" addicts covered by the study addiction started between the ages of 40 and 50 years, probably in consequence of some disease or accident. Thereafter, the curve showing the beginning of addiction declines until it reaches the 70-year line, when it rises again - a phenomenon accounted for by the various diseases which affect the elderly.

  1. In the following list the narcotic drugs used by the "A" addicts are classified in the order of their prevalence:

Ketobemidone
6 cases
Dextromoramide
3 cases
Opium or morphine
6 cases
Oxycodone
2 cases
Pethidine
4 cases
Hydrocodone
1 case
Hydromorphone
3 cases
Levorphanol
1 case
Methadone
3 cases    

TABLE 2

Reasons for the presciption

Serial No.

Severe physical pain (neuralgia, cancer, other types of physical pain and which ?)

Persistent insomnia

1
Serious cardiac inadequacy, mammary neoplasm with metastasis, osteoporosis recurrent neuritic pains
-
2
Pleuro-pulmonar and peritoneal tuber culosis
-
3
Neuralgia, respiratory distress due to cardiopathy, a sequence of painful complaints such as tetanus, botulism, giant urticaria and cramps, febrile nerve pains, dry pleurisy, pul. infarct, physical pains
 
4
Physical pains, extremely painful spasmodic intestinal attacks, serious bilateral renal attack, probably tubercular in origin
-
5
Arteritis of the lower limbs with of ulceration of the right leg creating a painful syndrome which multiple medical and surgical treatments have failed to relieve
Yes, because the pain
6
Painful after-effects of cervical zona, nerve pains
-
7
Cancer of the bladder, visceral neuralgia
-
8
Long-standing addiction
-
9
Renal lithiasis, after-effects of cholecystectomy with frequent liver attacks
Frequent
10
Nephrocolic, pyuria, haematuria, renal abnormality (?), severe physical pains; double nephropexy, after which constant visceral and anal tenesmus, recurrent nephrocolic. Aggravations since the menopause
-
11
Discal hernia, cervical arthrosis. Pains in the vertebral column, trigeminalsis, neuralgia
Yes
12
Long-standing addiction
-
13
Pains from gastric ulcer; in consequence of accidents, chronic rheumatic pains
-
14
Chronic rheumatism, neuralgia
-
15
Thoracoplasty of the whole right half of the thorax. Severe physical pains
-
16
Long-standing addiction. No pains
-
17
Long-standing addiction. No pains
-
18
Ovarian cancer operated, abdominal metastasis, pains due to cancer, at times recurrent dropsical sub-obstruction
-
19
Bone pains, cold abscessess and intestinal pains
At times
20
Severe physical pains
Yes
21
Terebrating ulcer of the right leg with severe pains, lameness. Inadequacy of the myocardium. Hospitalization was required for earlier hemorrhage. Frequent congestions of the lungs
-
22
Uncontrollable pains. Trigeminal neuralgia
Yes
23
Chronic painful condition. Total colectomy with removal of part of the rectum, anus praeter, renal and urethral calculus, with attacks of acute pains
Yes

It is difficult to draw firm conclusions from a study covering only 23 cases. What is particularly striking is the small proportion of cancer patients: 3 out of the 23 persons who at present use narcotic drugs most in the Canton of Geneva; and these 3 patients are not, moreover, amongst the heaviest consumers in the list. There are 4 cases of straight addiction. Furthermore, 9 of the patients are afflicted with moral suffering, 7 are victims of insomnia, 5 consciously crave the narcotic drug and 6 feel euphoria and are in a state of need.

Five of these addicts have attempted a disintoxication cure, but without satisfactory result; this does not mean that disintoxication cures are never successful: some years ago we heard of the case of another addict under medical treatment who was using increasing doses of pethidine, which rose finally to daily injections of as much as 1 g. Eventually, he agreed to submit to disintoxication treatment, and since then - that is, for 3 years - no narcotic drug has been prescribed for him.

Addicts (B) obtaining narcotic drugs by illicit means

The monthly check of all prescriptions for narcotic drugs has enabled us to discover several forgers of prescriptions. Some of these are "novice" forgers who steal prescription forms from the doctor consulted by them, and who write out themselves, in a faltering hand, a prescription for the narcotic drug they seek; they are soon found out, and the necessary measures are taken against them. But there is a more dangerous class of forgers, who employ cleverer and subtler methods, and only a practised eye can detect these forgeries which often bear the marks of great cunning and skill.

TABLE 3

Psychological state of "A" addicts

Serial No.

Moral suffering ? (melancholic, anxious, neurotic)

Conscious and voluntary quest for drug ?

Does this patient show an addiction syndrome with euphoria, habituation, state of physical and psychologica dependence and need ?

1
-
No
Durin manic-depressive attacks
2
No
No
Yes
3
No
No
No euphoria, able to carry out her duties without major hindrance, but is also in state of need
4
No
No
No
5
No
No
--
6
No
No
No
7
No
No
No
8
Neurotic
Yes
Yes
9
-
Yes
Habituation syndrome, state of physical and psychological dependence and need
10
No
No
No
11
No
No
No
12
No
Yes
Yes
13
No
No
No
14
Depressive states
No
No
15
No
No
No, the patient has progressively given up the narcotic drug
16
No
No
Habituation, state of physical and psychologica dependence and need
17
Yes
Yes
Habituation and psycho logical dependence
18
Yes, to some extent
Possibly
Not marked
19
At times
No
--
20
Melancholic suffering, moral suffering
No
No
21
Neurotic
No, consumption is decreasing
No addiction syndrome but state of physical and psychological dependence and need
22
Anxious
No, marked decrease in consumption
No euphoria
23
Anxious
No
No

Three of the most typical cases of this last category are discussed below.

First case: In the course of a monthly check, a number of unusual-looking prescriptions for narcotic drugs were found: the hand-writing was clumsy, the names and addresses of various doctors had been affixed by means of a rubber stamp with interchangeable letters, some of the addresses and telephone numbers were wrong, and the names of the patients were fictitious. From this evidence, it was easy to infer that the prescriptions had been faked by an addict. Since the person concerned had patronized a different pharmacy for each purchase, the pharmacists generally did not notice the fraud. The culprit was, however, caught in the act during another attempt.

Second case: This addict was much more difficult to identify because his methods were more subtle. He was a foreigner in our country and had been wounded in the war; he went to various doctors and asked for a medical certificate addressed to the authorities in his home country to enable him to draw his invalidity pension. He used to explain to the practitioner that the left-hand side of the document or, in the case of large-size letter paper, the upper part (i.e., the part bearing the doctor's name and address) was to be left blank for the subsequent entry of various administrative notes, and that the certificate should appear only on the right half or the lower half of the paper.

All he had to do then was to separate the two parts and so obtain a sheet of paper without any writing but bearing in print the name of a doctor known in the pharmacies and licensed to practice in the Canton of Geneva. On this sheet of paper, he would make out a typewritten prescription for narcotic drug; in the name of a fictitious person or in a name taken at random from the telephone directory; below, he copied or traced the signature of the doctor which appeared on the right-hand side of the certificate.

On other occasions, having obtained from a doctor a prescription for a small quantity of narcotic drugs, he removed, with the help of a bleach, the number of doses prescribed, and (after drying and ironing the sheet of paper) himself wrote in a much larger quantity: the prescriptions then appeared perfectly regular.

These forgeries were discovered quite quickly, but it was difficult to trace the culprit. On being identified, he agreed to submit to disintoxication treatment, but by a succession of lies succeeded in delaying his admission into the clinic for some ten days.

TABLE 4

Psychological state of "A" addicts (continued)

Serial No.

What personality traits does this patient show ?

Uneasiness (dysphoria), loss of vital impulse, egocentric tendencies, sadistic impulses, aggressiveness, behaviour, irresistible impulses, anti-social behaviour, sexual potency ?

Other observations

1
-
No
-
2
-
Uneasiness, egocentric tendencies
-
3
Well-balanced character, scrupulous
No
No euphoria; oxycodone does not induce euphoria in this patient
4
This patient is well aware of the danger of addiction. She always uses the same medicament, but in tenths of ml
No
-
5
Very emotional, hypersensitive patient. At times depressed as a result of his serious arterial disease
No special behaviour problem. Sexual impotence
Essentially in a state preceding general debility, in spite of stimulants and anabolics
6
Very lucid; regrets having to take a drug and limits its consumption to the minimum
No
Compulsory prescription, excellent gen-eral condition
7
Very balanced
No
Compulsory prescription, excellent general condition
8
Willful and hard to please
Uneasiness, loss of vital impulse, egocentric tendencies, sexual aggressiveness
Skeletal
9
Intelligent and sly, but very pleasant family atmosphere
No
-
10
Absorbed in her work; very embarrassed by the spasmodic state of the urinary and intestinal tract. Lively intelligence, very good mental balance
No
-
11
-
No
-
12
-
No
-
13
-
No
Only dextromoramide is both effective and well tolerated
14
Active patient, engaged in scientific re-search with very interesting and useful results
No
Elderly patient, socially and intellectually in excellent condition
15
Active, a plodder at work
No
-
16
Stable
Sexual impotence resulting from addiction
-
17
Of unstable character
Uneasiness, loss of vital impulse, egocentric tendencies
-
18
-
Egocentric tendencies, diminution of impulse
-
19
-
-
Has difficulty in decreasing dose
20
-
Loss of vital impulse
-
21
-
Loss of vital impulse
Obesity
22
Hyperactivity, strong active personality, often given responsibility
Uneasiness, loss of vital impulse, egocentric tendencies
The patient's condition is much improved
23
Enjoys life. Is very upset that he cannot work steadily
No
-

TABLE 5

Case history of "A" addicts

Serial No.

Has this patient used other or the samedrugs in other cantons or countries ?

To your knowledge, have other doctors prescribed narcotic drugs for this patient ?

1
No
No
2
No
No
3
No
Dicodid injections for persistent dry pleurisy given by another doctor
4
No
?
5
No
During an occasional replacement, prescriptions have been made out by another doctor, depending on symptoms
6
No
Perhaps in the absence of the patient's own doctor
7
No
No
8
Came from Egypt, habituated to Physeptone
Yes
9
No
Yes, has seen 34 Geneva doctors !
10
No
No, except occasionally during earlier attacks
11
No
No
12
No
Yes
13
No
No
14
Yes, Pethidine in England
No
15
No
No
16
Yes, France, Spain
Yes
17
Yes, probably in other cantons
Other doctors in the absence of the patient's own doctor
18
Once or twice Dilaudid-Atropine, the remainder of the time supp. Cliradon; before that Palfium
Yes, by replacement doctor
19
Yes, sometimes Pantopon
Yes, since 1942
20
In France
Yes, in France
21
Yes, in other cantons
Yes
22
Yes, morphine in Italy, which did not suit
Yes
23
Yes, Cliradon; Scopolamine does not suit him
Yes

Experience has proved that to obtain the drug for which he craves the addict lies with extraordinary glibness and achieves his purpose by putting on a persuasive show of genuineness.

Third case: This was the case of a woman of foreign nationality who had at one time kept a bar and who had come to Switzerland, paradoxically enough, to receive disintoxication treatment. As a matter of fact, she actually began the treatment, but before long, succumbing to an irresistible craving for drugs, she discontinued it. She then first approached some traffickers from her own country, and an individual (whom she knew only by his first name) delivered to her at Geneva, at a ransom price, a quantity of heroin which was probably adulterated, for 30 g were used up in about a month. In this sorry plight and being at her wits' end, she employed, as a last resort, the usual stratagem of consulting two or three doctors from whom she purloined a number of prescription forms. She wrote out some prescriptions herself, not for heroin, which is completely prohibited in Switzerland, but for a preparation with an oxycodone base which, she told us later, suited her very well.

These forgeries were spotted quite easily but the offender could not be traced for a long time. Eventually, she was arrested when presenting her last remaining forged prescription in a pharmacy. The particulars given above came out in the course of the inquiry which followed.

Unfortunately, after an appearance before the examining magistrate, this addict escaped from the female guard who was taking her back to a psychiatric clinic to which she had been committed, and probably crossed the frontier.

TABLE 6

Case history of "A" addicts (continued)

Serial No.

Has patient previously received dis-intoxication treatment ?

If so, where and with what result ?

1
By a psychiatrist at home
With partial success
2
-
-
3
No
-
4
No
-
5
No
-
6
Did not seem useful
-
7
No
-
8
Yes, in Egypt
Negative
9
Yes
Without result, interrupted the treatment
10
No
-
11
No
-
12
No
-
13
No
-
14
No
-
15
No
-
16
Altogether about 8 years' treatment between 1920 and 1938 without success
Only partial success: a period of diminution of the dose
17
Yes, but inadequate and under bad technical conditions
Poor result
18
Not considered useful in view of the prognosis
-
19
No
-
20
No, treatment actually inadvisable because it will be necessary to return to a similar medication to relieve pain of anginous origin
-
21
Treatment not advisable; one neurologist had in fact advised against it
-
22
Yes
Without result
23
No, not advisable
-

In the first two cases cited, addiction was of medical origin; in other words, induced by regular prescriptions for narcotic drugs given during a physical illness. In the third case addiction seemed to be definitely perverse in origin.

Comments on the consumption of narcotic drugs in the Canton of Geneva

From a comparative analysis of the consumption of narcotic drugs during the last three years in the Canton of Geneva, it appears that consumption is declining steadily in spite of the large increase in the population. What is the reason for this ? It seems that the quantity of narcotic drugs consumed varies with the state of health of the population and, more particularly, with the number of cases of influenza: when a relatively serious epidemic of influenza breaks out, as happened in the winter of 1959-60, prescriptions for narcotic drugs, in particular those for hydrocodone and thebacon, increase considerably. The winters of 1960-61 and 1961-62 were not so hard, and the quantity of narcotic drugs dispensed consequently decreased. Particulars of the consumption of narcotic drugs during these last three years are given in table 7.

In this table the term "substances" means narcotic drugs supplied individually (example: laudanum, with an extract of opium base), or those used in the compounding of certain medical prescriptions (example: a potion containing extract of opium), or those used in the manufacture of products or patent medicines which are exempt from control (example: extract of opium used in the manufacture of paregoric elixir).

It may be of interest to establish the percentage of the narcotic drugs, in doses, accounted for by the consumption by the" A"addicts out of the total number of the doses consumed in the year 1961-1962, as shown in table 8.

TABLE 7

Comparative table for the consumption of narcotic drugs in the Canton of Geneva during the last there years 1 June 1959 to 31 May 1960- 1 June 1960 to 31 May 1961 - 1 June 1961 to 31 May 1962

 

1 June 1959 to 31 May 1960

1 June 1960 to 31 May 1961

1 June 1961 to 31 May 1962

Group of medicaments

Substance in grammes

Number of doses

Substances in grammes

Number of doses

Substances in grammes

Number of doses

Opium and morphine
10,457.48 52,639 3,271.6 52,258 3,229.5 44,854
Pethidine
14.4 62,917 12.5 57,862 3.3 50,808
Methadone
0.45 8,316   9,043 1.0 7,884
Oxycodone
  20,156 4.4 17,661 85.0 19,064
Hydrocodone
42.77
l 19,667
292.4 102,859 274.9 108,608
Hydromorphone
0.6 17,896 0.64 17,820   11,650
Cocaine
1, 239.5 12 1,054.0 4 9,477.9 4
Coca leaf
10,024.0   8,808.0   1,088.0  
Levorphanol
  6,589   3,533   3,928
Dextromoramide
  67, 116   72,019   46,376
Thebacon
  35,693   29,147   28,250
Nicomorphine
  45   260   239
Ketobemidone
  26, 174   25,644   24,152
Normethadone
  9,205   7,775   8,775
Grand total of substances and doses
21,779.20 426,425 13,443.54 395,885 14,159.6 354,592

TABLE 8

Number of doses of the narcotic drugs used by the "A"addicts in relation to the total number of doses of the same narcotic drugs consumed

 

Total number of doses of narcotic drugs

Number of doses used by the 23 "A" addicts

% of total

Opium and morphine
44,854 10,807 24
Pethidine
50,808 3,625
7. l
Methadone
7,884 3,718 47.2
Oxycodone
19,064 16,994 89.1
Hydrocodone
108,608 700 0.64
Hydromorphone
11,650 3,640 31.2
Levorphanol
3,928 678 17.3
Dextromoramide
46,376 4,020 8.7
Ketobemidone
24,152 6,290 26
Total
317,324 50,472 15.9

As regards the 6 categories of narcotic drugs (doses) used by the "A" addicts, the consumption by these addicts accounts for 15.9 % of the total consumed.

If one takes as a basis the total number of doses of narcotic drugs dispensed in the Canton (354,592), consumption by the "A" addicts (50,472) accounts for 14.23 %.

The figures for the weights of substances can be converted into normal doses: if the total consumption of narcotic drugs, calculated in doses, for the year 1961-62 (448,091), is taken as a basis, it will be seen that the "A" addicts used 11.26 % (50,472).

Similarly, it is possible to work out, for the last two years, the percentage which the consumption of each narcotic drug (calculated in doses) accounts for out of the total consumed; and it is possible, likewise, to determine the consumption of each narcotic drug (calculated in doses) per 1,000 inhabitants; for this purpose, we take the figures of 258,000 and 266,500 as representing the number of persons living in the Canton of Geneva on 31 December 1960 and on 31 December 1961, respectively.

This is expressed in table 9, in which we have omitted coca leaf and also cocaine, for this latter drug is practically only used for local anaesthesia by doctors.

Conclusion

1. In our study we have disregarded codeinc, dihy-drocodeine (Paracodine) and ethylmorphine (Dionin), for these products are exempt from the control of narcotic drugs as from the time when they enter the pharmacy; only the wholesale trade in these substances is subject to the narcotic drugs legislation, It should not be inferred from this that these medicaments can be supplied generally without prescription: actually, under the provisions of the cantonal legislation, they may not be so supplied except in very small dosages.

TABLE 9

Percentage of the total consumption accounted for by each narcotic drug, calculated in doses, out of the total consumed, and consumption per 1,000 inhabitants (the narcotic drugs are classified in order of the extent of their use)

 

Number of doses per 1,000 inhabitants

 

Name of narcotic drug

Number of doses 1960/61

Percentage of total

Number of doses 1961/62

Percentage of total

1960/61

1961/62

1.
Hydrocodone
122,325 25.14 126,938 28.33 474 476
2.
Opium and Morphine
123,118 25.30 115,644 25.81 477 434
3.
Pethidine
57,987 11.92 50,841 11.35 225 191
4.
Dextromoramide
72,019 14.80 46,376
I0.35
279 174
5.
Thebacon
29, 147 5.99 28,250 6.30 113 106
6.
Ketobemidone
25,644 5.27 24,152 5.39 99 91
7.
Oxycodone
17,881 3.68 23,314 5.20 69 87
8.
Hydromorphone
17,820 3.66 11,650 2.60 69 44
9.
Normethadone
7,775 1.60 8,775 1.96 30 33
10.
Methadone
9,043
l. 86
7,984 1.78 35 30
11.
Levorphanol
3,533 0.73 3,928 0.88 14 15
12.
Nicomorphine
260 0.05 239 0 05 1 0.9
Total
486,552 100.00 448,091 100.00 1.885 1,681.9  

Codeine is a common ingredient of cough mixture and also of certain analgesics.

The use of ethylmorphine has been all but discontinued, while dihydrocodeine is found in the trade practically only in the form of patent medicines such as Para-codine.

As regards diacetylmorphine (heroin), the trade in and use of this substance are prohibited throughout Switzerland by the Federal Act of 1951.

We should add that we did not deal with the problem of hashish (Indian hemp), which does not exist in our country.

2. We realize that some addicts are still unknown to us, in particular those who use preparations which, though containing narcotic drugs, are exempt from control because of the low narcotic content. One of the medicaments most commonly used for this purpose is paregoric elixir ( Tinctura Opii benzoica of the Swiss pharmacopoeia), which contains 0.25% extract of opium (or 0.05% morphine) and which the pharmacists may sell without restriction in quantities up to 60 g. By going from one pharmacy to another, the persons concerned can accumulate a fairly large quantity of this product. As the elixir has an alcohol base, a person who consumes it to excess becomes an addict and an alcoholic at the same time. In fact, as the morphine content is very low, the addict must take it in fairly large quantities in order to achieve the desired effect and in so doing he necessarily absorbs a lot of alcohol.

It is held in some quarters that the very fact of the high concentration of alcohol (approximately 50%) limits the use of the elixir, but experience proves that this assumption is not always well founded.

3. We are perfectly aware of the limited interest of our research, especially as it deals only with a small Canton of fewer than 300,000 inhabitants. If a like study could be carried out in some other Swiss Cantons, it is probable that from the collation of the various studies some truly interesting conclusions could be drawn, since they would cover a much larger number of cases.

However, it is possible that the other Cantons would find it more difficult than ours to undertake a similar study, for, unless we are mistaken, Geneva is the only Swiss Canton where the pharmacists are obliged to forward to the control authorities all the prescriptions for narcotic drugs which they dispense.