Narcotics control in the Republic of Togo
Licit traffic in drugs
B. CONTROL OF LICIT TRAFFIC
Illicit traffic in narcotic drugs
B. PSYCHOTROPIC SUBSTANCES
LSD, Amphetamines, Barbiturates, Tranquillizers
HAZARDS OF LSD
AMPHETAMINES AND DRIVING
CONTROL OF SOME CHEMICALS USED IN THE MANUFACTURE OF NARCOTICS
Author: F. JOHNSON-ROMUALD
Pages: 41 to 46
Creation Date: 1969/01/01
Pharmacist-in-chief of Togo, Inspector of Pharmacies
The Togolese Republic, which became independent on 27 April 1960, is a territory in West Africa, 56,000 km 2 in area, bounded on the south by the Gulf of Guinea, on the east by Dahomey, on the north by Upper Volta, and on the west by Ghana. Approximately rectangular in shape, its greatest width and length are about 100 and 800 km respectively. Though larger than Switzerland (45,000 km 2) by 25 per cent, its population of 1,600,000 is three and a half times less, though its population density of more than twenty-eight inhabitants per km 2 is one of the highest in West Africa.
The capital, Lomé, is a town of 120,000 inhabitants, situated on the coast about half-way between Accra (Ghana), 180 km away, and Cotonou (Dahomey), 150 km away, which is itself only about 180 km from Lagos (Nigeria). A very busy coastal road links Accra to Lagos, passing through Lomé and Cotonou, the physical witness of centuries of trade and human migration, whose importance we shall consider later from the standpoint of the illicit traffic in narcotic drugs.
Another geographical factor which should be emphasized from the start is the " penetrable " character of African frontiers, including those of Togo. They are not based on ethnic or natural features, but on political events of the last hundred years. Often the local people move freely across the boundaries, and this affects all commerce, both licit and illicit.
To close these general remarks, it should be added that, thanks to German-Togolese co-operation, Lomé now possesses a deep-water harbour with the status of a free port, and, as the fruit of French-Togolese co-operation, an international airport.
Togo's present health services may be summarized in the following figures:
At Lomé , a national hospital centre with 800 beds. At Sokode, the second largest town, about 350 km inland, a regional hospital with 300 beds. Together with those in other health institutions, Togo now has about 2,000 beds, or one for each 800 inhabitants.
The original of this article is in French.
Besides these health institutions, there are about 150 dispensaries, or one for each 10,000 inhabitants.
There are barely 50 doctors, or one for each 30,000 inhabitants, and about 30 of these are in the capital, so that some regions have only one doctor for each 150,000 inhabitants.
With such a shortage of doctors, it is not surprising that 80 per cent of medical care is provided by paramedical personnel (nurses, technical assistants, midwives), numbering in all 200 nurses and technical assistants and 80 midwives.
This same shortage explains the special importance attached by Togo to its four para-medical schools:
The National State School for Nurses, with 30-35 recruits a year;
The National School for Midwives, with about 10 recruits a year;
The National School for Health Assistants, with 5-6 recruits a year; and
The National School for Laboratory Assistants, with 4-6 recruits a year.
It should be noted, however, that under the regulations only doctors are permitted to prescribe narcotic drugs.
Included with doctors are five dental surgeons who are also permitted to prescribe narcotic drugs.
There are 14 certificated pharmacists working in the private sector and four in the public sector.
In view of the inadequacy of the private pharmaceutical distribution network, and recognizing the elementary fact that rational and continuous progress in public health is inconceivable in an under-developed country unless medicines are brought to the people, since 1961 the Togolese Republic has been endeavouring to create, alongside the private network and without infringing its rights, a public distribution network to cover ultimately the entire country and fulfil two apparently conflicting aims - social service and profitability: social because prices are low enough for at least 50 per cent of the population, instead of 5-10 per cent as previously, to be able to afford to pay them; and profitable also, because the volume of business makes it possible to cover, and more than cover, the costs of the operation. This experiment, which led on 17 March 1967 to the creation of the Togolese National Pharmacy Office, " Togopharma " - replacing the former Supply Pharmacy, is represented today by 30 or so pharmaceutical stores spread over the country, as well as two State pharmacies directed by certificated pharmacists, charging uniform prices throughout the country.
Only certified pharmacists are authorized to import, keep, handle and issue narcotic drugs. In regions where there are no certified pharmacists, the doctors of medical institutions are allowed a measure of discretion in this respect.
During the period of French trusteeship, Togo was brought under the international narcotic drug regulations by France, which was a Party to the international Conventions of 1925 and 1931 and the 1948 Protocol. In practice, thus, it was French control procedure that was applied. Starting in 1959, one year before independence, France allowed self-governing Togo to begin to assume full responsibility. After independence in 1960, Togo remained a Party to the above-mentioned Conventions and continued control as in the past.
If our information is correct, this system of control is approximately the same as in all French-speaking States of Black Africa, and despite its traditional character, it may be worth while to recall its main features.
In pharmaceutical matters, French law divides poisonous substances into three classes called " Tables " and designated by the letters A, B and C respectively.
Table A includes in principle all substances which can properly be called " toxic ", that is, harmful in very small doses, of the order of about 1/10 mg per cg. Table C covers products described merely as " dangerous ", that is to say, producing symptoms of poisoning only in doses of more than 1 dg or even 1 g. Table B covers toxic substances liable to produce the well-known phenomenon of dependence, that is, narcotic drugs.
Under French pharmaceutical regulations, no product in Tables C, B or A can be issued without a medical prescription duly signed by a qualified doctor. The pharmacist registers the prescription in a " prescriptions register ", and enters the registration number on the prescription. Prescriptions for Table C products are renewable if the doctor does not object, and for Table A products if the doctor states so specifically. After the drugs have been issued, prescriptions are returned to the patient. They may be made out on whatever kind of prescription form the doctor chooses.
Table B prescriptions must be written out in a special counterfoil booklet kept by the doctor. The prescribed quantities should not, in principle, exceed the normal dose for seven days (the seven-days rule). Quantities and doses must be written out in full: e.g. seven ampoules of onecentigramme of morphine hydrochlorate. Prescriptions are not renewable and must not be returned to the client, who receives only a copy prepared by the pharmacist. They must also be entered by the pharmacist in a special register called " Narcotic Drugs Register " or " Table B Register ".
In pharmacies, narcotic drugs must be kept in locked cupboards. In many hospitals, though it is not required by the regulations, staff in charge of drugs often insist on empty ampoules being returned for re-use.
The Inspector of Pharmacies, who in Togo is also the head of the Narcotic Drugs Office of the Ministry of Public Health, may at any time check the stocks of drugs in pharmacies, the propriety and correctness of prescriptions, as well as the accounts and the stock-keeping.
So much for relations between retailers and customers.
With regard to relations between suppliers and importers, it must first of all be made clear that the Togolese Republic neither produces nor manufactures nor exports narcotic drugs. Up to the present it is an importer exclusively.
Import licences are delivered only by the Inspector of Pharmacies, who acts as the representative of the Ministry of Public Health. The form of this licence is shown opposite.
These licences are granted in principle only to private pharmacies (14 in all) and to the National Pharmaceutical Office, " Togopharma ".
Deliveries are accompanied or preceded by an export certificate in duplicate, issued by the competent authorities of the exporting country, one copy of which is returned to the said authorities after endorsement by the consignee, while the second copy is retained by the Inspector of Pharmacies.
The Inspector of Pharmacies also acts, on behalf of the Ministry of Public Health, as the official correspondent of the United Nations Division of Narcotic Drugs concerning the licit and illicit traffic and annual reports and, as concerns the International Narcotics Control Board, is alone competent to fill in the regular forms and questionnaires such as A/S, B/S, C/S forms, etc.
The system of control of the licit traffic in narcotic drugs described above has so far given complete satisfaction in Togo. The limited annual volume of transactions - about 20 import licences at most - the small number of persons handling the products, and the almost total ignorance of the great mass of the people concerning manufactured drugs, considerably reduce the risk of diversion, even by medical and para-medical staff, who so far at least have shown very little tendency to abuse of these substances. Great vigilance is still necessary, however, particularly in respect of dependence-forming drugs during treatment, since with narcotic drugs the transition to dependence is all too easy.
It is to be hoped - seeing that we have near neighbours whose regulations are less strict than ours - that the practical regulations governing narcotic drugs can be unified for the whole West African region. The desirability for such unification will appear even more clearly in the study of the illicit traffic.
Manufactured drugs, (opium and its derivatives, synthetic products etc.) do not, at the present time, cause any serious concern to the Togolese authorities, so far as the illicit traffic is concerned. In fact, as we have seen, legal imports are strictly controlled, and for various reasons, the risks of diversion are limited.
But the speed of modern communications, easily penetrable frontiers, and the opening of the international airport and free port of Lomé call for some measure of care and vigilance. Did not an international band of traffickers attempt in January 1968 to make use of the international airport of Lomé to introduce 20 million dollars worth of Nigerian bank notes into Nigeria when they were about to be demonetized?
The licit use of cannabis (Indian hemp) has been forbidden in Togo since 1955. However, while not yet constituting a real danger, cannabis is increasingly attracting the attention of the Togolese authorities.
Some say that cannabis was introduced into the West African region at the time of the Phoenicians. Others say that its introduction was contemporaneous with the Moslem penetration and was promoted by travellers arriving from the Middle East, particularly from Arabia, across the Ethiopian plateau. Still others say that the plant came to West Africa with the slave trade as one of the " currencies " used by the slave traders.
However that may be, various indications suggest that the plant has been known for a very long time in West Africa.
But a number of writers prefer to believe that cannabis is a more recent importation into West Africa dating only from the end of the Second World War, with the return of ex-soldiers or merchant seamen to their home countries. But the facts relied on by these writers do not necessarily conflict with the possibility that the plant was brought to Africa in earlier times. Sailors or ex-soldiers may merely have helped to reveal to the public and the authorities the effects of a plant whose geographical distribution, frequent occurrence in the wild state, and use in very old ritual ceremonies, are difficult to explain on the assumption that it was introduced only a generation ago.
Cultivation and uses
Botanists say that cannabis grows wild in certain tropical forests. Others maintain that this "wild" growth is really secret cultivation in forest clearings. Both hypotheses seem reasonable, but the uses to which cannabis is put rather support the theory of clandestine cultivation.
First it is believed that cannabis is used in various concoctions for ritual ceremonies of fetishist cult-groups. Novices are recruited to these groups at the summons of gods, as manifested, for example, when a dancer falls into a trance during a public ceremony, the dancer having previously received a sizeable dose of some cannabis concoction.
Cannabis is also smoked in the form of cigarettes sold clandestinely at 25 to 50 francs CFA [ 1] a piece, or 10 to 20 US cents.
It may also be chewed with cola nut, which increases its stimulating and euphoric power; a similar effect is obtained by steeping the plant in trade alcohol or "sodabi". [ 2]
Until the last few years, the Togolese authorities had no knowledge of any illicit traffic in cannabis in their territory. The first indications to attract attention were frequent street fights at the Lomé bus station, a number of traffic accidents which could scarcely be attributed to alcohol, the clandestine sale of "special" cigarettes with no manufacturer's name, and certain products chewed by drivers or drivers' mates to "kill hunger", etc. The first offenders observed or arrested were Nigerians or Ghanaians; and here we see the significance, already mentioned above, of the Accra-Lagos coastal road through Lomé. At the present time, this road constitutes the busiest channel for the illicit cannabis traffic in our country, in the light of the relative frequency of seizures on transport workers or traders using that road.
It should, however, be pointed out that the number of cases detected by the police is still small, from 6 to 20 a year, with sentences varying from 15 days to 6 months imprisonment and quantities seized rarely exceeding 100 g or so.
LSD is still unknown in Togo. We only mention it and other hallucinogens for the record. The other psychotropic substances (amphetamines, barbiturates, tranquillizers) are of more direct concern in Togo.
Under the French regulations, which are still applied in Togo, these are treated as toxic substances usually included under Table A or Table C. The juxtaposition in African towns of two forms of society, traditional and modern, the resulting semi-permanent state of tension in which certain persons live and the phenomena of psychological maladjustment to be observed in numbers of people have all encouraged a move towards making barbiturates, particularly tranquillizers, subject to regular medical prescription. It would be wrong to speak of "traffic" in the case of these substances, because they are kept and issued in accordance with normal pharmaceutical procedure. Mention may, however, be made of a certain vogue for a particular barbiturate preparation with a very well-known trade name, [ 3] a powerful analgesic which has become so popular that the man-in-the-street seems to have got into the habit of asking his doctor or his pharmacist for it as if it were aspirin. But even in this case, there is as yet no question of "traffic", since the regulation supply channel is respected; but a certain vigilance seems nevertheless desirable.
The real illicit traffic seems to be in amphetamines. These "pep pills" are sought after by students and school-children, who complain that they are too sleepy to learn their lessons properly, and particularly by men who are worried about their "lack of strength". Some unscrupulous traffickers accordingly advertise these products as "clearing the head" or "increasing virility", etc.
It is here that the full extent of our frontier problem appears. Amphetamines can be legally obtained in Togo only from pharmacies, on medical prescription but Togolese markets stalls are literally swamped with these substances, imported from neighbouring countries. A few packets seized prove beyond question that they are of British manufacture.
Some people have kindly recommended us to organize regular police raids on markets and confiscate all products of this type found there. This would certainly be a solution, but not for long, because the products would immediately disappear under the counter. Moreover, even if they finally vanished from the markets of Lomé, they would turn up again in the surrounding villages or in localities in the interior, or on stalls along the roadside. Is our police force big enough for such a task? Truly a labour of Sisyphus when it is remembered that the root cause, the excessive penetrability of frontiers, would remain untouched.
Whence, as pointed out above, the necessity for uniform regulations at the regional level. Some international control of the manufacture, export and import of these substances would also help considerably to "limit the damage".
While, therefore, the control of the licit traffic in the Togolese Republic, can at present be regarded as satisfactory and while the illicit traffic in manufactured drugs (opium and its derivatives and synthetic products) seems practically non-existent, some reservations, as we have said, must be expressed about the future, in view of the opening of the free port and the international airport of Lomé, since it is always an easy matter to divert international traffic from its customary route.
And it is the fact that Togo is crossed by an important communication artery - the coast road from Accra to Lagos - that appears to be the main stimulant to the illicit traffic in cannabis that has been noted during the past few years.
Finally, the practical unreality of frontiers in Africa makes it difficult for us to solve the problem of the invasion of our markets by amphetamines, so long as no international control of production and export of these products has been instituted. And such control would be strengthened by unifying national regulations concerning toxic substances throughout the whole West African region.
To conclude this study, may we point out, so far as the legal aspect is concerned, that the Togolese Republic acceded to the 1961 Single Convention on Narcotic Drugs in 1963 and that its internal laws were supplemented in 1962 by a decree establishing a service for the suppression of the illicit traffic in narcotic drugs.
According to Dr. Levin of the United States National Institute of Mental Health, the most common hazards of LSD are as follows:
Panic reaction: this occurs when the drug taker realizes that he cannot control the unique experience triggered in him by the drug. He desperately wants to end its effects because he "cannot stand it", and fears he is losing his mind.
Paranoid reaction: during the drug session, the person becomes suspicious that someone is trying to poison him or control his mind. These feelings usually last about 72 hours after the drug wears off.
Recurrence: days, even months, after stopping the drug, the person unaccountably may repeat his drug- induced reaction. The recurrence frequently takes place during some stressful situation and the patient may fear he is going insane.
Loss of judgment: judgment becomes impaired during LSD use. "Individuals have been known to walk out of windows because of the conviction that they can fly. Others have reported feelings of invincibility and are willing to do extremely dangerous things because they believe that if their physical body dies, their spirit will live on."
In the opinion of Dr. Levin, broader awareness of these dangerous effects seems to be contributing to an apparent decline in the use of LSD ( Canada's Mental Health, 16, 28, 3-4, 1968).
The present status of adequate therapeutical use of appetite suppressant (anorexiant) drugs is discussed by L. J.P. Duncan and J.F. Munro (Edinburgh). The drugs most commonly used to help in weight reduction are amphetamines. They are not specific central appetite suppressants but their central stimulant effect is considered to be responsible for the reduction of food intake. The risk of the use of these drugs under medical supervision is reasonably small, but their significant central stimulating effects can lead to habituation and addiction (drug dependence) mainly in cases of considerable numbers of obese persons who are psychologically disturbed at the same time ( The Practitioner, 200, 1195, 167-174, 1968).
The use of amphetamines by car drivers is discussed in a paper prepared by the Food and Drug Administration of the United States: "Amphetamines may increase alertness and efficiency for a short time; but this effect may be followed by headache, dizziness, agitation, irritability, decreased ability to concentrate, and marked fatigue. The most important fact for drivers to consider is that excessive, unsupervised use interferes with the body's normal protective symptoms of drowsiness and fatigue. The feeling of exhaustion is short-circuited, causing a driver to use up reserves of body energy until a total and sudden collapse may occur. But before collapse there may be a period of decreasing driving ability and alertness, even though the driver thinks he is driving very well. Another often-reported effect is that of seeing things in the road that are not really there - mirages or hallucinations similar to the delirium tremens of the alcoholic. Such "visions" may cause the driver to swerve into oncoming vehicles or off the road" (Drugs and Our Automotive Age, FBI Law Enforcement Bulletin, April 1967, p. 16).
Legislation placing acetic anhydride and acetyl chloride under control as regards import has been introduced in Thailand, in Laos and in Singapore.
Permits for the import of acetic anhydride and acetyl chloride are granted in Thailand to pharmaceutical firms after careful screening. Monthly records of the use of the chemicals must be kept by the firm. On the spot verifications are carried out by government officials.
The Commission on Narcotic Drugs had repeatedly drawn attention of Governments to the danger of diversion of acetic anhydride and acetyl chloride for illicit purposes in view of their use in the conversion of morphine into heroin and to the need for control of their import and distribution, especially in countries close to areas of opium cultivation.
In Latin America, Bolivia issued a Supreme Decree on 27 December 1963 which regulates and controls the sale of sulphuric ether and acetone, ingredients used in the manufacture of cocaine.1
One US $ = 245 francs CFA.2
Sodabi = redistilled palm wine, of about 50-600 alcohol.3
A mixture of' butalbital, amidopyrine and trimethyxanthine (the brand of a well-known firm).