The road to controls: barbiturates, amphetamines, tranquillizers and hallucinogens

Sections

Barbiturates
Amphetamines
Tranquillizers
Hallucinogens
The special committee
The committee's report
Measures of national control
Measures of international control
LSD and similar substances
Consideration by the Commission on Narcotic Drugs (twenty-first session)
Conclusion 17

Details

Pages: 15 to 19
Creation Date: 1967/01/01

The road to controls: barbiturates, amphetamines, tranquillizers and hallucinogens

International concern over these psychotropic substances which are outside the scope of the narcotics treaties, goes back to 1954 in the case of amphetamines and to 1956 in the case of barbiturates and tranquillizers.

As far as the hallucinogens are concerned, it was not till 1963 at the eighteenth session of the Commission on Narcotic Drugs that statements were made about the problem of LSD; from this late beginning, however, LSD in particular has aroused the greatest concern, and at present this substance and similar hallucinogens have been singled out for immediate control measures.

The Commission on Narcotic Drugs in 1965 and in 1966 has discussed the problem of controlling all these four groups of substances in some detail, and it has received a report from a special committee set up to make a special study of the matter. Before discussing the Committee's report and the actions that are proposed in the matter of applying control to these psychotropic substances, it would be useful to recapitulate the stages by which the problems they pose and concern about them have matured.

Barbiturates

In October 1956 the Expert Committee on Addiction-producing Drugs of the World Health Organization was presented with evidence that the consumption of barbiturates continued to increase and the situation in respect to this group had not ameliorated. The Committee held that barbiturates were habit-forming and in some circumstances could produce a drug addiction dangerous to public health, although it recognized that differentiation among the barbiturates with respect to the intensity of this liability could not yet be made. The Committee reasserted the opinion that national control measures were sufficient at that time, but that they needed close attention and in some instances definite strengthening:

  1. barbiturates, whatever the dose or admixture, should be dispensed only on prescription;

  2. a prescription should specify the number of times it may be refilled or repeated;

  3. there should be a record of such prescription. "1

The Commission on Narcotic Drugs at its twelfth session in April/May 1957 adopted a resolution on the abuse of barbiturates.2 It recalled its former discussions on the danger involved in such abuse, and recalling also that, contrary to the common opinion, the greatest social danger presented by barbiturates does not arise from acute poisonings (in spite of their frequent occurrence), it noted the definition given by the World Health Organization. Barbiturates were subject to special control in some countries only, and the Commission recommended therefore that all governments take the appropriate legislative and administrative measures of control to prevent abuse.

At its seventeenth session, the Commission adopted a resolution (Res. 4(XVII)) in which it recalled its resolution VI of the twelfth session, considered the social dangers and the danger to public health arising from the abuse of barbiturates as reported by the World Health Organization, and recommended that governments should take appropriate steps to place the production, distribution and use of such drugs under strict control.3

Amphetamines

In 1954 the World Health Organization Expert Committee on Drugs Liable to Produce Addiction had recommended that governments should provide for the dispensing of amphetamines only on prescription; each prescription should specify the number of times it might be refilled or repeated and a careful record should be kept of each prescription. 4

At its tenth session in 1955, the Commission on Narcotic Drugs discussed the possibility of including amphetamines among the drugs to be controlled under the proposed Single Convention, but it felt that the control measures at the national level as recommended by WHO would suffice for the time being, since it could not be said that these drugs were addiction-producing in the same sense as morphine or cocaine.5

1 Wld. Hlth. Org. Techn. Rep. Ser. 1957, 116, Section 9.

2 Report of the Twelfth Session, Chapter IX, and Resolution VI in Annex II.

3 Report of the Seventeenth Session, Chapter IX.

4 Wld. Hlth. Org. Techn. Rep. Ser. 1954, 76, p. 11.

At its eleventh session in 1956, the Commission adopted a resolution on the amphetamines problem. It recalled its preceding discussions, considered the increase in cases of poisonings by amphetamines in many parts of the world, the number of accidents and even deaths due to the abuse of amphetamine-based proprietary medicines designed to control the appetite, considered the serious consequences of the abuse of stimulating amines and the psychic troubles caused by these drugs, and found that they possessed properties which made them analogous to addiction-producing substances. In view of the fact that these drugs had already been submitted to special control in some countries while they were sold without control in others, the Commission went on to take note of the dangers arising from their abuse and to recommend that governments should provide measures of control to prevent such abuse.6

Tranquillizers

In October 1956 the World Health Organization Expert Committee on Addiction-Producing Drugs gave attention to the very rapidly increasing use of tranquillizers and ataraxics.7 The Committee believed that these substances were diverse in their chemical characteristics but similar in their central sedative action, and must be classed as potentially habit-forming. There was also evidence that excessive use could lead to appearance of the characteristic withdrawal syndrome. The Committee concluded that in this respect this group of drugs resembled barbiturates, should be subjected to national control, and that their continuing clinical use should be followed very closely with a view to an eventual evaluation of their relation to public safety.

At its twelfth session in 1957, the Commission on Narcotic Drugs adopted a resolution on the question of tranquillizers. It noted the WHO Expert Committee's views, and recommended that governments keep a careful watch for any abuse of these substances with a view to taking necessary measures of control.8

Since these initial recommendations were made by international bodies, the problem which the three groups of substances posed continued to grow, and subsequent discussion in the Commission and in WHO has embraced all these substances together.

5 Report of the Tenth Session, para. 154.

6 Report of the Eleventh Session, Chapter IX, Res. IV in Annex II.

7 Wld. Hlth. Org. Techn. Rep. Ser. 1957, 116, Section 10.

8 Report of the Twelfth Session, Chapter IX and Res. VII in Annex II.

At the Plenipotentiary Conference for the Adoption of a Single Convention, held in February-March 1961 in New York, a resolution was submitted that all these substances should be studied with a view to determining what action the international community should take with respect to them and how far it should go in the matter of control. The resolution was supported by twenty-five countries, but failed by one vote to obtain the required majority; it could not be annexed therefore to the official records of the Plenipotentiary Conference.9

The eighteenth World Health Assembly adopted in 1965 a resolution in which, inter alia, it requested the Director-General to study the advisability of international measures of control of sedatives and stimulants.l0

The WHO Expert Committee in July 196511 noted again "the increasing frequency of abuse of sedatives or stimulants not classified internationally as narcotic drugs" and "the epidemic-like spreading of this abuse particularly among young persons in certain countries" as expressed in the WHO Assembly resolution. The Committee recalled that it had repeatedly recommended the need for better control both of sedatives and stimulants at the national level. Realizing, however, that national efforts are still often insufficient, the Committee recommended the following measures:

  1. Availability on medical prescription only, as repeatedly recommended in earlier reports;

  2. Full accounting of all transactions from production to retail distribution;

  3. Licensing of all producers;

  4. Limitation of trade to authorized persons;

  5. Prohibition of non-authorized possession; and

  6. Establishment of an import-export authorization system.

Hallucinogens

The first reference to LSD in the Commission on Narcotic Drugs was made at the eighteenth session in 1963.12 The Chairman (the representative of France) referred to press reports that LSD was being misused. The representative of Canada confirmed that the substance was causing great concern to his government and other statements on behalf of the Netherlands and the World Health Organization bore out the potential dangers of the misuse of LSD.

9 E/CONF.34/L.38. See also United Nations Conference for the Adoption of a Single Convention on Narcotic Drugs; Official Records, Vol. 1; The Summary Records of Plenary Meetings, Fortieth Plenary Meeting (UN Publication, Sales No.: 63.XI.4).

l0 Eighteenth Session, Resolution WHA, 18.47.

11 Wld. Hlth. Org. Techn. Rep. Ser. 1965, 312, Section 7.

12 Report of the Eighteen Session, para, 247.

The World Health Organization Expert Committee later that year "took note of the increasingly frequent reports of poorly controlled clinical administration and non-medical use of lysergic acid diethylamide (LSD25)".13The Committee remarked that irregular use was reaching alarming proportions and it stated that it was particularly disturbed by the publicity being given to LSD. In its opinion immediate measures with respect to distribution and availability of LSD were necessary. In this connection it also referred to the abuse of other hallucinogenic agents such as mescaline; the abuse of these seemed to be less widespread than in the case of LSD but the committee felt that watch should be kept, and corrective measures taken, where necessary. The Commission on Narcotic Drugs at its next session in 1964 noted the observations of the Expert Committee and shared the concern that it had voiced. An article by four distinguished pharmacologists in the Bulletin of the World Health Organization in 1965 14 gave a definition of drug dependence of hallucinogens of the LSD type. In December 1965 the Commission established a special committee to consider the problem of putting control upon barbiturates, amphetamines and tranquillizers. In the discussion leading to the establishment of this committee there was no particular focus on LSD as such, though a reference to mescaline was made in one of the documents prepared for this session. By the time the committee met in August 1966 however, LSD had sprung to a notorious prominence, and the committee gave it urgent and immediate attention leading to its adoption of a special resolution. The underlying concern over drugs which have a depressive or stimulant effect on the central nervous system (barbiturates, amphetamines and tranquillizers), and which had motivated the World Health Assembly to adopt its important resolution of 1965 and which had led the Commission later that year to set up a special committee, (a proposal endorsed by the Economic and Social Council), has become overshadowed by the grave consequences of the abuse of LSD which has occurred in a few countries in the west. At the time of writing, out of all the psychotropic drugs which are now the subject of study from the point of view of having them put under appropriate controls, LSD is considered to present the greatest immediate danger.

The special committee

The recommendation by the Commission on Narcotic Drugs that a committee should make a careful and detailed study with a view to evolving control and other measures required for other substances not yet under international control referred in its direct context to barbiturates, amphetamines and tranquillizers. The Economic and Social Council, in approving its recommendation spoke of "substances not under international control such as barbiturates, amphetamines and tranquillizers.15

13 Wld. Hlth. Org. Techn. Rep. Ser. 1964, 273, Section 7.

14Eddy, N. B., Halbach, H., Isbell, H., and Seevers, M. H. (1965) Bull. Wld. Hlth. Org., 32, 721.

The committee's members consisted of Canada, the Federal Republic of Germany, France, India, Japan, Mexico, The Union of Soviet Socialist Republics, the United Arab Republic, the United Kingdom and the United States of America. Several other countries sent observers while the World Health Organization, the Permanent Central Narcotics Board and the Permanent Anti-Narcotics Board of the League of Arab States were also represented.

The committee's report

After its meeting in August 1966 the committee adopted its report which recalled the World Health Organization Expert Committee's view that the common feature of drug abuse is dependence, psychic or physical. The various types of dependence have been described by workers in the field as dependence on such or such drugs (dependence of morphine-, barbiturate-, LSD-type, etc.). The committee stated that the primary consideration in raising the matter of control was public health and safety. Having laid down these criteria, the report went on to make this assessment: "First, as presenting the most acute problem, and showing signs of such spread as to demand immediate action, one must consider LSD (lysergic acid diethylamide; LSD-25; lysergide). Second are substances which act as stimulants or depressants to the central nervous system, whether they are specifically referred to as amphetamines, barbiturates or 'tranquillizers'. The place of these drugs in the over-all drug abuse pattern is varied. The stimulants and sedatives are abused separately, in combination, with each other, or with the narcotics; and the pattern of multiple abuse is becoming increasingly important. In contrast, abuse of LSD is generally by itself. Abuse of all these substances has too often spread in epidemic-like fashion, particularly among young people."

The committee found some evidence of production outside the pharmaceutical industry to supply those who sought to abuse these drugs. It ventured the opinion that it might be that the market was being exploited; that superfluous production and stocks created the risks of diversion and that the trade and the medical profession had viewed the risks too lightly. There was evidence not only of abuse but also of possibly excessive prescribing and dispensing by doctors, improper self-medication by individuals, and illegal import of drugs to certain countries for abusive purposes, though on the last point the evidence was not conclusive. The committee pointed to various lacunae in knowledge about these drugs. The precise mechanism and criteria of dependence have not been fully established for each drug. There had not been much research and there was a lack of uniformity among the controls already established through limited national legislation in certain countries; some countries applied full narcotics control to some stimulants and sedatives, others imposed a more lenient regime. There was no general agreement about the dangers of particular substances, and also on the hazards of abuse of sedatives versus stimulants. There was a lack of information about quantities manufactured, used, and abused.

15 Report of the Twentieth Session, para. 373, and Resolution ll04(XL) of the Council.

The committee adopted the general approach of seeking immediate measures to achieve the following aims: (1) controls to restrict abuse, (2) the setting up of a central source of expert advice on the risks presented by particular drugs and (3) collection of information, health education, and guidance to medical services and to the pharmacological industry.

The committee accepted the broad criteria for distinguishing the sedative or stimulant substance to be controlled, recommended by the World Health Organization Expert Committee: the drug should have been found ( a) to have been dependence-producing and ( b) it should be shown to have been abused.

Measures of national control

The committee endorsed the measures recommended by the WHO Expert Committee, in brief:

  1. Availability on medical prescription only;

  2. Full accounting of all transactions from production to retail distribution;

  3. Licensing of all producers;

  4. Limitation of trade to authorized persons;

  5. Prohibition of non-authorized possession for distribution.

As regards the Expert Committee's proposal for the establishment of the import/export authorization system, the committee accepted it in principle and recommended that subject to the study of their feasibility, governments should make provision for introducing import/export controls as soon as possible. Among other material measures the committee endorsed the need for suitable warning notices on the labels of drugs, and the use of international non-proprietary names where available.

Measures of international control

The Committee proceeded from the view taken by the World Health Assembly that national measures to control this health problem have often been insufficient and that attention should now be given to some form of international control. It studied possibilities for such control that might be found within the compass of the Single Convention on Narcotic Drugs, 1961, as the treaty now stood or by an appropriate amendment to it. It formed the opinion that any new scheme, if drafted with proper flexibility, could be adapted to meet the special problems presented by new drugs. As regards the nature of the controls, the committee felt that central assessment and advice on stimulant and sedative drugs requiring special control which it had already recommended, together with controls on imports and exports, would provide a basis for international collaboration. The essential need was to ensure that all governments took the minimum measures it was recommending. Having considered these possibilities the committee unanimously asked that the Secretary-General begin with the minimum of delay and as a matter of urgency a detailed study of the legal, administrative and other questions that would arise.

LSD and similar substances

The Committee considered the problem posed by the hallucinogens and LSD in particular separately from that of the stimulants and depressants of the central nervous system. It expressed itself forcefully as regards international measures on these in addition to national measures of restriction. Its resolution on LSD 16 recognized the grave danger of the abuse of LSD and asked governments to clamp down on production and supply of this substance, the distribution of which should be placed under official supervision. It further asked that use be restricted to scientific and medical purposes and the administration of LSD be permitted only under very close and continuous medical supervision. All other usage of these hallucinogens was to be condemned and governments were urged by it to take all steps of prevention. The committee recommended that the Secretary-General, without delay and in consultation with WHO, explore the most appropriate means of bringing LSD and similar substances under international control via the Single Convention or otherwise.

Consideration by the Commission on Narcotic Drugs (twenty-first session)

In sum the Commission adopted the special committee's report, which it decided to include as an annex The road to controls: barbiturates, amphetamines, tranquillizers and hallucinogens 19 to its own report to the Economic and Social Council. It accepted the common criteria for determining which substances among the four groups under study should be brought under control as proposed by WHO and adopted by the committee. As recommended to it, the Commission requested the Secretary-General to find out from the Director-General of the World Health Organization if WHO would undertake the evaluation of these substances on the basis of the criteria advanced.

16Reported in Vol. XVIII, No. 4.

The commission agreed that strong measures of control at the national level were essential in every case where the criteria were met and these measures should be considered the first step towards international control, which indeed would not be effective unless controls at the national level worked. The Commission took the view that because international control was a longer-term prospect, the more immediate emphasis should be on the principle of mandatory national control by international agreement. It endorsed the recommendation that the Secretary-General, in consultation with WHO and PCNB make a thorough study of the legal, administrative and other questions which would arise if international action were initiated. Such a study should give special priority to the problem of LSD and other hallucinogens.

The Commission gave some thought to the various treaty arrangements that might be effected, firstly to universalize the essential minimum of national controls and then to achieve the international controls which were essential, but it decided to await the Secretary-General's study before forming a definite opinion on this matter. It adopted the resolution recommended by the Committee on LSD and similar substances and strengthened it by requiring not only that governments control production and distribution, but also import and export.

The commission has also approved in principle that a questionnaire should be prepared to find out the world situation regarding production, consumption, export and import etc., in the case of all these substances.

Conclusion 17

These actions taken by the Commission on Narcotic Drugs and the studies it has initiated must await endorsement by the Economic and Social Council. The latter will receive the Commission's report embodying these proposals and will discuss it at its forty-second session in May/June 1967. While in all likelihood the Council will find no reason to differ from the Commission, it cannot be excluded that it may have formed definite opinions of its own, especially since the problem, for example as concerns LSD, is fluid and it may have developed in one way or another during the months between the Commission's discussion and that of the Council. It is also possible that the Council may formulate a decision on the precise treaty arrangement by which international controls could be imposed and national controls universalized.

These formal processes apart, it can now be taken virtually for granted that, in a few years, these substances will be subject to a full measure of national control including controls on imports and exports, and possibly some other measures of an international character.

17A later number of the Bulletin will carry a note on the decisions that the Council will take on these psychotropic substances after it has considered the report of the Commission on Narcotic Drugs.