Control of narcotic substances and prevention of addiction in the USSR

Title

Control of narcotic substances and prevention of addiction in the USSR

Sections

Introduction
Preventive measures
Standing Committee on the Control of Narcotics
Treatment of drug addicted persons
Questions of terminology
Differences between alcohol and narcotics
Comparison between alcohol and narcotics from the juridico-socio-legal aspects in the USSR

Details

Author: E.A. BABAIAN,
Pages: 13 to 22
Creation Date: 1979/01/01

Control of narcotic substances and prevention of addiction in the USSR

E.A. BABAIAN,
Candidate of Medical Sciences, Head of Department, USSR Ministry of Health, and Chairman of the Standing Committee on the Control of Narcotics of the USSR Ministry of Health

Introduction

Drug addiction is considered to be a social problem. It was widespread in czarist Russia in Central Asian regions, where the custom of opium smoking prevailed. Cocaine and other narcotic substances were widely used in big cities. During the very first years following the October revolution the custom of drug use was completely eradicated. The success may first and foremost be attributed to the new social conditions that were created for the population, such as the elimination of unemployment, prostitution, beggary and vagrancy as well as raising the people's economic and cultural standard of living.

Another major factor which contributes to the prevention of drug addiction in the USSR is the centralization, in the hands of the State, of the pharmaceutical and drugstore networks. The state system of health services makes it possible to take effective steps to prevent and treat drug addiction. Addicts mainly consist of chronically ill or seriously disabled persons who have taken narcotic drugs, such as morphine and codeine on account of their primary illness. There are isolated cases of use of some wild varieties of cannabis. During the last decade there was not a single case of heroin addiction; the production and use of this substance has long been prohibited. There is no incidence of cocaine, LSD or amphetamine addiction. Soviet law prescribes severe penalties for infringement of the regulations governing storage, preparation, sale and use of narcotic substances. Instigation to use narcotic drugs is also a criminal offence, which is seriously aggravated in the case of instigation of minors.

The Soviet Union continues to take an active part in the struggle against drug addiction and illicit traffic in narcotic substances not only at the national, but also at the international level. It is at present a Party to most international conventions and Protocols, including the Single Convention on Narcotic Drugs, 1961, which supersedes previous international instruments on the subject, and the Convention on Psychotropic Substances, 1971, commonly referred to as the Vienna Convention. The USSR carries out the obligations assumed under these Conventions.

Preventive measures

The country's well organized frontier and Customs services virtually preclude the smuggling in of drugs from abroad. The production of narcotic drugs is under complete control of the State; it is exclusively limited to medical and scientific requirements. The planting of Indian, Southern Chuisk and South Manchurian varieties of hemp as well as of opium poppy is prohibited.

In accordance with the orders of the Ministry of Health, narcotic drugs have always been dispensed on doctor's prescriptions only. Special records are kept of prescription forms and health establishments regularly submit returns of the number of prescriptions issued for narcotic drugs. The drugstores and therapeutic-preventive establishments store narcotic drugs under special conditions and carry out regular checks of their stocks.

Under orders issued by the Ministry of Health all medical establishments and pharmacies are required to report to narcological dispensaries located in the person's place of residence any addict visiting them for the first time, so that he may be registered and treated. In this manner addicts may promptly be detected and treated in the early stages of addiction. The pernicious malpractice of drug "allowances" has long been prohibited.

During the last decade many countries have seen a steady increase in addiction to psychotropic substances listed in the schedules of the Vienna Convention. Particularly dangerous substances are the amphetamines and hallucinogens (LSD and other derivatives of lysergic acid). Addiction to hypnotic substances had already been observed for some considerable time. Due to timely and stringent control this problem does not exist in the Soviet Union.

The World Health Organization has emphasized the problem of road accidents resulting from the consumption of hypnotic and other psychotropic substances by drivers. There is no evidence to suggest that such a problem exists in the Soviet Union. For purposes of prevention, however, the Ministry has issued a special order, drawing attention to the need for great care in prescribing psychoactive substances for drivers and persons responsible for vehicles. If such persons are required to take psychotropic substances on account of illness, they are granted leave with pay for the period of treatment on the basis of a medical certificate.

Standing Committee on the Control of Narcotics

Article 17 of the Single Convention stipulates that Parties will maintain a special agency for the purpose of applying the provisions of the Convention. In accordance with this article a Standing Committee on the Control of Narcotics was set up under the USSR Ministry of Health, which is also entrusted with the control of psychotropic substances pursuant to article 6 of the Convention on Psychotropic Substances. According to instructions in force in the Soviet Union psychotropic substances enumerated in the schedules of the 1971 Convention are listed together with narcotic drugs and are therefore submitted to the same stringent control measures as are the latter.

The Standing Committee is independent of the producer, the consumer and the trading organizations. By a special Government decree it was entrusted with the function to control the quantity of production of narcotic drugs and psychotropic substances. Members of the Committee include well known specialists, medical personnel, pharmacists, pharmacologists, chemists, senior civil servants of the Ministries of Health, Internal Affairs, Foreign Trade, the Customs Department and the Ministry of the Medicinal Industry. At its sessions the Committee has the right to hear all ministries and departments on questions connected with the production, sale. import, export and use of narcotic substances, and to organize assistance to drug addicts. The main tasks of the Committee are:

To prepare reports for the Representative of the USSR to the United Nations Commission on Narcotic Drugs;

To prepare the annual report on the application by the USSR of international conventions;

To prepare a co-ordinated plan of action with the departments concerned to control drug addiction and illicit traffic;

To evaluate new tests to identify narcotic substances and methods of assessing and identifying the presence of narcotic drugs in body fluids as well as to draft instructions thereupon for approval by the Ministry of Health;

To co-ordinate research on narcotic drugs and drug addiction;

To assess the value of new analgesics which do not engender addiction with the purpose of replacing narcotic drugs;

To test the various types of cannabis plants in order to identify the species with the lowest narcotic content;

To evaluate new methods of diagnosing and treating drug addicts and new forms of organizing services to deal with drug addiction;

To compile lists and maintain records on narcotic and psychotropic substances which are under international control;

To study foreign experience with respect to control of drug addiction and illicit traffic.

In conjunction with the Department for the Introduction of New Drugs and Medical Equipment of the USSR Ministry of Health, the Standing Committee:

Functions as the certifying body in cases where this is required according to provisions of the law;

Examines applications for export/import licences and issues certificates;

Examines the consumption of narcotic substances and considers applications by agencies and health establishments from constituent republics for such substances and submits appropriate estimates to the USSR Ministry of Health for approval;

Examines the classification of substances with a view to submitting those that may engender addiction to timely control;

Eliminates from the pharmacopoeia addiction producing substances for which effective substitutes have been found;

Elaborates jointly with Customs officials of the Ministry of Internal Affairs of the USSR control measures for illicit traffic;

Examines applications and issues licences for the production of narcotic substances;

Controls the compliance by the ministries and departments concerned with obligations stemming from the adherance to international conventions and protocols on narcotic substances;

Approves, in conjunction with the ministries and departments concerned, instructions and methodological material relating to production, storage and sale of narcotic drugs;

Approves, in conjunction with the USSR Ministries of Internal Affairs and Health the order of writing off and destroying narcotic drugs;

Elaborates drafts of new laws and other standardizing documents on questions dealing with narcotic drugs.

The Committee publishes lists of narcotic drugs and psychotropic substances which have been classified as narcotics by law. Decisions of the Standing Committee on the above-mentioned questions are binding.

The possibility of carrying out timely control is increased thanks to the fact that the Committee co-operates with the Department on the Introduction of New Drugs and Medicinal Equipment of the Ministry of Health, which comprises expert committees such as the Pharmacological Committee and the Committee on the Study of Side Effects of Drugs. The latter has the function to state in due course which substances may be habit-forming, so that they might be entered in the list of narcotic substances without delay. Frequently the above-named Committee did indicate the results of their research as soon as a new drug had clinically been tested. At the proposal of the two Committees the Standing Committee decided to make amphetamines and other psychotropic substances available on prescription only. Since 1967 the production of LSD and other lysergides has been prohibited.

The Department on the Introduction of New Drugs and Medicinal Equipment and the Standing Committee jointly control therapeutic and research establishments on a regullar basis in the districts ("oblasts") of constituent republics in order to see how the provisions of the Conventions are applied. At the proposal of the Standing Committee the list of preparations containing narcotic substances was revised and shortened. Before issuing a licence establishing the right to produce, store and dispense narcotic substances the Standing Committee satisfies itself that the establishment, pharmacy or plant which applies for the licence meets criteria that make it possible to prevent leakage.

Each year scientific establishments apply to the Main Drug Department of the Ministry of Health for narcotic drugs, substantiating their application with exact calculations. The Committee discusses them at its sessions, introduces corrections and only with the Committee's approval may the factory deliver the quantity stated in the permit to the establishment for scientific and medical use.

Based on article 36 and other clauses of the Single Convention, Soviet law provides for adequate punishment, depending on the gravity of the crime, in cases of violation of the rules of production, sale and storage of narcotic drugs. At the proposal of the Ministry of Health and other departments as well as that of the Standing Committee laws and other judicial documents are regularly updated.

Treatment of drug addicted persons

An important requirement of the Conventions in force is case-finding and treatment of addicts. Article 38 of the Single Convention emphasizes that Parties must devote special attention to the provision of facilities for the effective treatment of drug addicts. In the Soviet Union psychiatric services exist which, besides having other tasks like detection and treatment of alcoholics, are entrusted to detect and treat addicts. Every addict discovered is promptly registered, and a record is established which is sent to the Standing Committee who, on the basis of such records, prepares the annual report of the Government to the United Nations on the state of drug addiction in the country.

A large number of addicts wish to be treated and co-operate in the therapeutic process; others, however, refuse treatment for various reasons but mainly because they do not consider themselves to be ill In these instances the psychiatrist must decide whether he will let the patient-and sometimes also his family-gradually perish, or whether he will treat the patient against his will. The author considers the second path to be truly humane. The psychiatrist's goodwill is, however, not enough to solve the problem; there have to be appropriate legislative acts. According to this juridical principle the group of patients are divided into persons who wish to be treated and those who do not, whereby the latter are to be treated against their will. Undoubtedly treatment approaches for these two, judicially speaking, separate groups differ in specific principles, despite the fact that the methods and means of treatment are the same, or have very much in common.

Treatment of drug addicts is specific because it greatly depends on the effect of one or several narcotic substances inducing a state of addiction in the patient. Thus in organizing treatment account is always taken of the type of addiction (such as morphine). Treatment is provided in both hospital and out-patient settings. The first stage of treatment in the author's opinion is hospitalization for examination and treatment of all patients, without exception. The duration of stay must be sufficiently long (at least 60 days) for first-time admissions as well as for those who, although they have repeatedly been admitted. experience withdrawal symptoms. Naturally the doctor may prolong the stay on medical grounds.

Chronic alcoholics and narcotic addicts are not treated in the same department. For an effective outcome addicts are treated in special hospital departments-psychiatric wards. Their regime is stricter in order to avoid the smuggling in of drugs into hospitals. This prerequisite, it is felt, must be complied with to ensure the success of the whole therapeutic process. Furthermore, if left together alcoholics and addicts would have a negative influence on each other.

From his very first meeting with the patient the psychiatrist-narcologist applies psychotherapy so as to ensure greater success of the whole complex of treatment, including medical treatment. As mentioned earlier, there is a group of patients who refuse to be treated. For such cases there exists a special clause in the legislation, according to which the court may impose compulsory treatment at the request of the family, the establishment where the patient works, or trustees. The duration of stay is also set by the court upon the recommendation of a medical commission.

The system and structure of the narcological services is of primary importance in ensuring early detection, recording and proper observation of drug addicts. The narcological dispensary is the centre of all narcological services in a given territory. Narcologists operate under the dispensary, helped by feldshers and narcological units. The out-patient structure of the narcological services in any given region is instrumental in the detection of patients at the various stages; it allows for follow-up and for observation of the evolution of a case; it also makes it possible to give social aid. Actually the structure of the narcological service enables a doctor to acquaint himself step by step with the individual aspects of the patient, thereby using the sub-division of the narcological service to assist the patient.

Questions of terminology

In keeping with an order issued by the Ministry of Health, the term "narcomania" is used to describe a state induced by the use of narcotic substances. In the author's opinion the term "narcomania" is only to be applied to those cases where non-medical use occurs of a substance which by law is classified as a narcotic substance. In other cases, when a given substance is not listed as a narcotic substance, the term "toxicomania" is used. The term "dependence" is inappropriate for these cases; it is only used to describe a syndrome which, incidentally, does not always accompany certain types of narcomania. In 1965, in the report on its 20th session the United Nations Commission on Narcotic Drugs clearly explained (see document E/CN.7/488, para. 115) that the term "addiction had been universally accepted for a long time and was entrenched in national legislation and international instruments, including the 1961 Convention. The Commission could not, therefore, change the existing terminology in treaty texts. It was felt that acceptance of the new term might create administrative difficulties as well as complications of a legal nature. Moreover, since a decision to place a substance under international control was based on its more or less harmful effects, it was immaterial what term was used." At the 23rd session, held in 1969, it was stated (see document E/CN.7/523/Rev.1, paras. 211-212): "The Commission did not, however, agree to replace the term 'drug addiction' by the term 'drug dependence' as the former term was more suited to administrative application. The Commission asked the Secretariat to use in all documents for the Commission the term 'addiction' for the cases of dependence on a narcotic drug and to avoid the words 'dependence' or 'dependent' in connexion with narcotic drug addiction." The above quotations show that the position of the USSR fully corresponds to the position taken by the United Nations in respect of narcotic substances.

It may be permitted to recall that, as a rule, terms not only carry a substantive pharmacological connotation but also a juridical one. Many medical terms are connected with legislative acts and cannot, therefore, be arbitrarily used, proceeding only from the medical point of view. The above is especially important when dealing with terms denoting drug use, and it is even more important when applied to drug addiction, where not only domestic, but international law is applied. The study showed that frequently specialists use terms which do not fully reflect the juridical, social and medical aspects of the problem. Most frequently the terms are used from purely medical and clinical points of view, which is inappropriate in cases of drug addiction.

It should be remembered that terms used, first and foremost the terms "narcotic substance" and "narcomania" are not so much the concern of medical personnel as that of lawyers, social scientists and civil servants. These terms are used from a certain point of view, especially from the point of view of jurisprudence and social sciences in international protocols and conventions as well as in national law. From the legal aspect a substance is recognized as being narcotic only if three prerequisites apply: medical-if a given substance has a particular effect on the central nervous system (stimulating, depressive, hallucinatory etc.) for which it may be used for non-medical purposes; social-if the non-medical use occurs on a scale that lends it social importance, and juridical-if, proceeding from the two above-mentioned prerequisites the appropriate agency empowered to do so (in the Soviet Union it is the Ministry of Health) recognizes it as a narcotic substance. In the absence of one of these prerequisites there is no ground to consider a given substance (synthetic, biological or vegetative) as narcotic.

When using the term "narcotic substance" the need for a notification would have to be studied and, following the established order, the inclusion of this substance in one of the schedules of the Single Convention. Thereby one has to take into account the legal acts providing for the limitation of production and agree with the international control agency on the quantity of the substance to be produced. Information has regularly to be provided to the United Nations on production and consumption. It is known that narcotic substances are subject to an export/import licensing system providing for the return to the exporting country of the export authorization endorsed by the Government of the importing country. Thus it may not be satisfactory to use the term "narcotic drug" in respect of any substance proceeding only from the pharmacological position, since this term has to accommodate the medical as well as the juridical and social concept of a substance.

However a legal use of a substance is not always immediately accompanied by recognition of its abuse potential. The new substance may for a long time not prove to be a substance of abuse on an important social scale.

As said before, the term "narcomania" is determined not only-or rather not so much by the clinical as by the medico-juridical and social aspects. It may only be applied to those types of abuse of substances recognized by law to be narcotic. Such use of terms made it necessary to introduce an additional concept in the terminology, namely the term "toxicomania" which defines the damage to health induced by a substance which has not yet been juridically recognized as being narcotic. Accordingly, once a substance has been recognized by juridical act to be a narcotic substance, the diagnosis of "toxicomania" is changed into the diagnosis of "narcomania". Unlike other diseases, narcomania and toxicomania as social phenomena allow for a change of diagnostic label, while the clinical picture remains unchanged.

Differences between alcohol and narcotics

Similar considerations should be used to study the terminology connected with alcoholic beverages and alcoholism. Alcoholic beverages cannot be recognized as being narcotic, and alcoholism cannot be put into the category of "narcomania". The difference between alcoholic beverages and narcotic substances or between alcoholism and narcomania is much greater than the difference between narcomania and toxicomania. The latter differ only from juridical and social points of view, while alcoholism and narcomania differ also in some substantive medical points; for example physiologically human blood always contains from 0.01 per cent to 0.03 per cent of endogenic alcohol, even without the use of alcoholic beverages, which does not apply to narcotic or other substances inducing narcomania and toxicomania.

The discovery of physiologically active polypeptides, such as enkephalin or endorphins, in certain regions of the CNS does not undermine this conclusion, since these polypeptides are present in the receptor apparatus and not in the blood; furthermore they do not resemble narcotics structurally and their concentrations are extremely minute.

There exists a special enzyme structure in the human organism splitting alcohol and absorbing it into the metabolic process. Several mechanisms responsible for ethanol oxidation have been described. These include alcohol dehydrogenase (ADH) and systems oxidizing ethyl alcohol in microsomes (MEOS). Levels of ethyl alcohol in the body may also be affected by other mechanisms, including those responsible for the formation of glucuronides and conjugation with sulphate, as well as by mechanisms of fatty acids esterification.

It must also not be forgotten that 10 per cent of the energy balance of the human being is formed through endogenic alcohol. This again is not applicable to narcotic substances. Thus when using the term "alcoholic beverages" and "narcotic drugs" one must be aware of the fact that from the medico-juridical and social point of view these substances are classified in different categories. The following tables set out the differentiating characteristics:

Comparison between alcohol and narcotics from the juridico-socio-legal aspects in the USSR

Alcohol

  1. Is attributed to be a food product.

  2. The use of the majority of the alcoholic beverages is linked to their taste qualities, which is characteristic for the category of food products.

  3. Use is permitted; it is on free sale. Use is not counter to law.

  4. The law does not provide for any limitations of use, or single doses.

  5. The quantity to be produced is decided by the planning and trading organizations. There is no limitation on the international level.

  6. The amount used is determined by the user himself.

  7. The law does not provide for punishment for everyday use.

  8. Citizens have the right to keep it at home without any special permits (storing is lawful).

  9. Alcoholic inebriation is frequently the reason for criminal and hooligan acts.

  10. Frequently before committing a crime the criminal brings himself to a state of alcoholic inebriation in the hope of justifying the crime or to summon up "courage".

Narcotics

  1. Is attributed to be a medicament or a chemical substance.

  2. Use is never linked to taste qualities.

  3. Is made available only on doctor's prescription, not allowed to be given to drug addicts. Use without a doctor's prescription is illegal.

  4. Strictly limited single doses and the volume of single handout. The prescription is a document held to strict account.

  5. The quantity of production is strictly limited by the USSR Ministry of Health and the standing Committee on narcotics; the corresponding international conventions provide for limitations on the international level of the volume of production and use.

  6. The user has no right to decide on the use of narcotic substances. Only the doctor decides.

  7. The law provides for punishment for illicit use without the prescription of the doctor.

  8. Storing without special permission is a criminal offence.

  9. Most frequently a drug addict commits crimes or acts of hooliganism while in the search for narcotics or with the aim of receiving same.

  10. No cases are known of a drug addict taking narcotic substances to commit a crime in the hope of justifying his actions or to summon up "courage".

It is believed, that free ethyl alcohol is present in minute quantities in men and animals. It is not yet known whether it represents a metabolic intermediate or is formed by bacterial fermentation in the intestines. The concentration of endogenous alcohol may be different in different individuals, but specifically it may increase in response to different stimuli, to hypoxia in particular. The normal level of endogenous alcohol in the human body is probably equal to 0.018 per cent (Kionka-Hirsch, 1924), but higher values were also reported (Widmark, 1922).

Alcohol content in human blood under physiological conditions is indicated below according to different authors

Author

Year

Technique

Alcohol content In percentage

Schweissheimer
1913
Nicloux
0.33
Widmark
1922
Widmark
0.03
Kionka-Hirsch
1924
Interferometry
0.018
Candela
1930
Widmark
0.04
Ciettler
1932
Ciettler
0.04
Harger
1938
Chemical
0.027
Vacca Boeris
1946
Newman
0.018
Cakl
1954
Widmark
0.03

Comparison between alcohol and narcotics from medical aspects

Alcohol

  1. Physiologically there is 0.01-0.03 per cent of it in the human blood.

  2. Ten per cent of the energetic balance in the human is from endogenic alcohol.

  3. Physiologically the human organism has special enzymes to split alcohol.

  4. Alcohol produces a thermal effect in the organism (1 g alcohol gives 7 caleries).

  5. Health education makes recommendations on limiting the use of alcohol, Mainly attention goes to the abuse of alcohol consumption (exception: children, pregnant women, patients).

Narcotics

  1. Without the intake of narcotic substances, there is physiologically none in the organism.

  2. Narcotics do not participate in the energetic balance.

  3. The organism has no special enzymes which can split narcotics.

  4. Narcotic preparations do not produce any thermal effect.

  5. Health education is careful not to cause any curiosity about narcotics, is carried out among particular people (drug addicts) and is aimed at stopping its use without the prescription of the doctor. It is recommended that doctors strictly limit the use of narcotics for medical indications.

Accordingly it is of great importance for international and domestic law as well as for the appropriate organization of control that alcoholism and drug addiction are clearly separated. Merging these two phenomena may confuse the issue of narcotics control. The psychological implication of such mergence, particularly with regard to drug education, may complicate the doctor's role vis-a-vis his patient and the public.