MISCELLANY EFFECTS OF STP
PSYCHOTROPIC PREPARATIONS AND SUICIDES IN FRANCE
CHEMICAL CONSTITUENTS OF THE MORNING GLORY SEED
NARCOTICS AND THE PREMATURE INFANT
ADDICTION AMONG THE HILL TRIBES OF THAILAND
NARCOTIC ANTAGONISTS
Author: Paul REUTER
Pages: 3 to 8
Creation Date: 1968/01/01
All international conventions with humanitarian and social objectives have established States' obligations which can be split up into two categories. The first, comprises rules which oblige the State to establish under its internal order laws and regulations and agencies to enforce their application, supervise compliance and punish violations. The second category contains rules which are binding on the State in its relations with other States and with the various international bodies responsible for ensuring the implementation of the convention.
This applies to the Single Convention on Narcotic Drugs of 30 March 1961 which, for the Parties to it, replaces all other conventions on narcotic drugs (article 44). [ 1] The Single Convention contains provisions, first, on the production, manufacture, distribution and possession of and internal trade in narcotic drugs as well as the repression of violations and, second, on the import of and international trade in such drugs and the estimates and statistical returns to be transmitted to the International Narcotics Control Board, the information to be furnished to the United Nations Secretary-General and the assistance which States must afford each other for control purposes.
It is worthwhile to dwell a little on the distinction between these two categories of obligations in order to bring out their interrelationship more clearly.
It is understandable that the narcotics problem should not have been a concern of international law until certain countries enacted national legislation establishing the first rules reserving narcotic drugs for licit purposes. Historically, it is the States, the national civil services and public authorities which have constituted and which still constitute today the initial and indispensable setting for the life of the individual in society. It was in the first place up to the States alone to act by establishing rules and agencies to control the abuse of narcotic drugs. They very soon found, however, that although action at the national level was still paramount, it was by itself inadequate: it was not enough that the States should undertake, under a convention, to act in an organized, far-sighted and strict manner, each on its own behalf and within its own national limits; they needed in addition to strengthen their national authorities by fitting them into an international system of supervision by international bodies, inter-governmental collaboration and mutual assistance.
The original of this article is in French.
The drug problem is in fact one of international proportions. In 1912, it had been the dangers radiating out from the formidable focus represented by the under-developed, colonial or semi-colonial countries of the Far East which had brought the States signatories of the 1912 Convention together at The Hague, but today a highly industrialized State manufacturing a variety of drugs could constitute a hazard to all its neighbours by too readily supplying narcotics, or even psychotropic substances, to all customers passing through or visiting the country as tourists. The development of any kind of international relations creates international solidarity: if the first, and nefarious, manifestation of such solidarity is shown in the organization of the illicit traffic, it is only to be expected that the national authorities will also be brought closer together to express a solidarity that is virtuous.
Thus for a variety of reasons the problem of the protection of the individual and society against the abuse of narcotic drugs transcends national boundaries. In the first place, the licit international trade in narcotic drugs involves the exporting State, the importing State and sometimes the transit State, and the main purpose of the 1925 Convention was to organize international control over this international trade. However, in this respect the States are bound to one another by other links, less direct, but more profound than those of foreign trade.
In fact, the national agencies must pool their knowledge and all their authority in order to face up to these dangers. From the medical angle, the removal of the most dangerous products from therapeutic practice and the detection of the harmful effects of the new "miracle" drugs which the constant march of science puts on the market are tasks which require a great deal of patience and courage; the forces of inertia, ignorance and vested interests sometimes combine against the doctors and public health officials in order to hold up progress: the international framework constituted by the United Nations and the World Health Organization will provide the national officials with the indispensable means of stepping up their activities and engaging the attention of public opinion on a less narrow front than that of certain national disputes. It can also be claimed without any risk of error that it is frequently necessary to adopt an international vantage point to solve an internal problem.
These few remarks show that there are numerous and profound bonds between national and international control and that they should not be separated or set at variance on arbitrary grounds.
This general comment was needed to give full weight to another point, the validity of which should not be underestimated: the application of international control is based in its entirety on the rules and institutions of each national legislation.
In the modern world, the States realize that it is their duty and to their advantage to sign the 1961 Convention with the minimum delay. The States thus realize the adjustments which they must make in their national laws and agencies. For a State which already possesses internal rules and institutions which have been developed and tried by experience, the implementation of the 1961 Convention calls for no innovations, while a State which has no such rules and institutions must establish them.
The following discussion represents an attempt to demonstrate the validity of this thesis and its implications.
It is well known that the main instruments of international control are the statistical returns which must be furnished to the International Narcotics Control Board (article 20) and the estimates of drug requirements (article 19), which prescribe the limitation of manufacture and importation (article 21) and export (article 31). The other obligations are more general in character, such as that relating to the information to be furnished to the Secretary-General by the Parties (article 18), to co-operation and mutual assistance in taking action against illicit traffic (article 35) or even special regulations governing the cultivation of the opium poppy, the coca bush, the coca leaf and cannabis (articles 23, 24, 26, 27, 28).
Without examining all these rules in detail, we might consider the major ones.
It is sufficient to read the list contained in articles 19 and 20 to see how far-reaching they are.
The statistical returns (article 20) relate in principle to past facts: production or manufacture, utilization, consumption, imports and exports, seizures and stocks. These are the data to be supplied in annual or quarterly returns to the Board. The setting out of this information on printed forms supplied to the national authorities by the Board raises no difficulty and merely requires that copying errors be avoided. On the other hand, the meticulous collection of all these data presupposes a national legislation which incorporates, within the close mesh of its stipulations, all the professions likely to possess narcotic drugs from start to finish.
The estimates of drug requirements (article 19) relate to future data, i.e. consumption, utilization and stocks. The estimate can in practice be based on already known past data, adjusted however in the light of facts gleaned from information or surveys, of either medical or non-medical character, in the possession of the national authorities. To begin with, then, they are based on the same material as the statistical returns, but they have additionally to include medical, demographic, economic, social and commercial data, i.e. information far more extensive than that required for materials accounting or for a statistical office.
It is quite clear that such estimates and statistical returns cannot be compiled unless the States (article 17) have an administration for putting the provisions of the Convention into effect. The main duty of this administration is to act as a clearing-house for the information obtained from the customs, the pharmaceutical and medical services, manufacturers, importers, tradesmen, persons possessing drugs, and even the police (cf. articles 18 and 35). If this national administration supplies reliable material for the compilation of the data, which serves in its turn as the basis of international control, this control can be highly effective; if the administration is occasionally negligent or lacking in firmness, the international control system, possibly by cross-checking with the national data obtained from other countries, may alert the State responsible so that it can take rapid steps to remedy the situation. If, on the other hand, major elements of a country's legislative or administrative structure are defective, the international control system can usually do nothing more than point to the existence of a chronic situation which the sanctions laid down by the Conventions are frequently incapable of remedying.
This is the conclusion to be drawn from the long practice of the Permanent Central Narcotics Board and the Drug Supervisory Body, the international control organs, established under the 1925 and 1931 Conventions and superseded recently by the International Narcotics Control Board, and from the experience of those who have taken part in its activities. I shall revert later to the possible implications of this observation. But this is the lesson which thoroughly permeates the entire
Single Convention which, together with the regulations on international control, imposes on States very wide obligations regarding their purely domestic legislation: article 17 (need for a special administration); articles 22, 23, 25, 26, 27, 28 (special regulations on cultivation); article 29 (manufacture); article 30 (trade and distribution); article 34 (measures of supervision and inspection); article 35 (action against the illicit traffic); article 36 (penal provisions); article 38 (treatment of drug addicts); etc.
If these provisions are examined in broad outline, some ideas emerge which might benefit from further elucidation.
Firstly, in terms of conventional international law, these provisions relate to matters which come under what were known as the "internal affairs" of States. For there is no doubt whatever that it is indeed a matter of encroaching upon a legislation, administration, and a system of control and repression which are still covered by the sovereignty of each State.
This explains why the Conventions exercised a degree of caution, so that the international commitment remains appropriate to the means possessed by each State and is adjusted to the particular conditions of each national context.
As a result of this concern, some of the articles of the 1961 Convention were formulated as recommendations which each State must adapt to its own particular situation. This applies, for example, to article 37 on liability to seizure and confiscation; article 38 on the desiderata for the treatment of drug addicts; article 36, paragraph 2 ( b) on extradition and article 30, paragraph 3 on the use of international non-proprietary names of drugs. In other articles, the Party's obligations are to be understood only "subject to its constitutional limitations" (article 36, paragraph 1 on punishable offences and article 23, paragraph 3 on the establishment of a single government agency on opium); or "subject to the constitutional limitations of a Party, its legal system and domestic law" (article 36, paragraph 2 on the prosecution of offences; article 36, paragraph 3 on the nature of criminal jurisdiction and article 36, paragraph 4 on competence); and "having due regard to their constitutional, legal and administrative systems" (article 35 on illicit traffic). An obligation is sometimes made particularly flexible: "The Parties shall follow as closely as may be practicable" the form of import certificate approved by the Commission (article 31, paragraph 5); "the Parties shall as far as possibile", enforce the uprooting of all coca bushes which grow wild (article 26, paragraph 2).
In certain cases, preferring not to impose one particular control procedure rather than another, the Convention appears to convey more than a desire and less than an obligation. An example of this is provided when the decision is left to the discretion of each Party concerned as to whether "these measures are necessary or desirable "; this is the case in the so-called system of "counterfoil books" for the issue of medical prescriptions for narcotic drugs or the "double red band" for the inner packages containing drugs (article 30, paragraph 2( b) (ii) and paragraph 4); the same applies to article 22 on the prohibition of cultivation.
However, one should not exaggerate the importance of these instances of flexibility, which are quite understandable in the case of a Convention which is supposed to be universally applicable. By the same token, it is not surprising that the Convention provides a dual system for the manufacture and distribution of and trade in narcotic drugs- the State enterprise and the licensed private enterprise. In fact, at the time when the Convention was drafted, both systems were in force, and whatever the system of ownership of these enterprises they must be subject to strict State supervision (article 34).
In effect, as it has already been pointed out, apart from this necessary flexibility, the Convention imposes on States stringent and precise rules which oblige them to draft laws and establish agencies to control and centralize all the information intended for the international control bodies.
Broadly speaking, the system established by the Convention is extremely simple. Narcotic drugs can be consumed only on medical prescription or at least in the legal performance of a therapeutic function (article 30), while the economic activities prior to consumption -- possession (article 33), trade and distribution (article 30), and, especially, import and export (article 31), manufacture (article 29) and possibly cultivation-- can only be carried out by a State enterprise or by an enterprise operating under State licence; the main operations, when carried on by private enterprises, i.e. import and export, are subject to a separate authorization (article 31); all activities relating to narcotic drugs are subject to constant supervision and in particular to extremely stringent record-keeping obligations (article 34).
For some activities, such as the cultivation of opium (article 23), cocaine and coca leaf (article 26) and cannabis (article 28), the Convention regulations are more rigorous. In this case, those Parties which authorize cultivation of the opium poppy do not have a choice between a public enterprise and a private enterprise operating under State licence: they must establish one or more "national agencies ", and preferably a single one (article 23, paragraph 3), whose main function will be to organize cultivation under a stringent system of licences, monopolies for the collection of the crop from the licensed growers, wholesale trade, storage and imports and exports.
This conveys, then, an idea of the scale of the tasks devolving upon the State under the 1961 Convention.
It is true that not all States are in an identical situation with regard to narcotic drugs. The simplest case is that of a State which does not cultivate or manufacture any narcotic drug and confines itself to importing a certain number of them; if, moreover, this State has set up a national public agency for the distribution of all pharmaceutical products and virtually all medical treatment is given by doctors employed by the public authorities, it will have fewer problems to solve than another State in which narcotic drugs are both grown and manufactured, and there is a large private medical practice.
But these are merely differences of degree and not of kind: in any case, no State can do without an adequate legislative, regulatory, administrative, medical and repressive system. It is certain that no State, however recently established, has to perform its obligations in the matter of narcotic drugs in a legal vacuum. All States are normally equipped with a constitutional and political organization and a system of courts, customs authorities and police services, which can be called upon in meeting the obligations laid down by the 1961 Convention. But this merely facilitates their task and represents no problem since the 1961 Convention, while making certain precise stipulations, has always avoided expressing them in such a form that they would clash with the inherent character of the constitutional, administrative, or judicial organization.
The States Parties to the Convention are therefore fully responsible for the performance of their obligations: they must institute effective means for the purpose. This is a general rule of international public law: a State cannot use the pretext of an inadequate legislative or administrative apparatus to escape the performance of an obligation; furthermore, the 1961 Convention refers to that rule. [ 2]
However, this finding, already mentioned above, does not dispose of the problem, particularly for certain States. The international control agencies have known, and continue to know, various categories of States which meet constant difficulties in supplying accurate estimates and statistical returns at the specified times; this situation may have several causes.
The service (often consisting of a single official [ 3] ) responsible for establishing these documents may lack experience. Such a situation is relatively easy to remedy.
An exchange of correspondence with the Secretariat of the international body, a visit to it, or, conversely, a mission by a member of the Secretariat, can give useful results. On a wider basis, seminars or colloquia at regional level can also serve to give a group of officials concerned with problems of narcotic drugs a body of information and a training which makes possible substantial improvements in the efficiency of the responsible national authorities.
At the other end of the scale, there are countries for which shortcomings in statistical returns and estimates are symptomatic of a more serious failing: political or economic obstacles prevent the public authorities from enforcing the law in certain territories or against certain social classes, either under-privileged or over-powerful. In such cases, experience shows that it is always possible to make progress, but within the framework of a broader programme providing for extensive economic aid.
There are also, however, situations intermediate between the two described above. There are States which are prepared to enact domestic laws and appoint officials to enforce them. But they would like to benefit from the experience acquired in this field by the other States; they would like, having regard to their particular situation, certain features of which may be similar to those in some States, others to those in other countries, to receive specific suggestions for model texts; the options opened up by the 1961 Convention merely facilitate the task of those national authorities which are already sufficiently well-informed; the others, while being perfectly aware of the scope of the measures they have to adopt, may experience difficulties with regard to their form and precise content.
The oldest and most highly evolved federal systems contain, at the federal level, departments or agencies which, in the most varied fields, but particularly in those which relate to abstruse technical knowledge, provide advice or technical assistance to the provinces or states, enabling them to wield their sovereign powers, to which they remain attached, in the best conditions. Would it not be possible or desirable to adopt such a principle as a standard rule governing the relations between international organizations and States, and particularly in technical fields such as that of narcotic drugs?
After these few elementary pointers on the real nature and scope of the obligations accepted by the States Parties to the 1961 Convention, this question arises automatically. We must of course proceed with extreme caution and define exactly the object and scope of the actual needs which may be felt by the different States. We can only say that the international organizations should not be precluded a priori from taking an advisory role in the planning and application of national measures.
The subject has already been dealt with on numerous occasions by the most highly qualified representatives of the international organizations. Serious thought should be given to it, and even if it seems impracticable or inadvisable in a particular case, it would remain the faithful expression of an idea the validity of which cannot be challenged: the international organization and the national agency must in the modern world be more and more closely allied.
According to the experiments of Snyder, Faillace and Hollister, low doses of STP
(2,5-dimethoxy-4-methyl-amphetamine) produced a mild euphoria in normal male volunteers. Doses greater than 3 mg may cause hallucinations lasting about 8 hours and similar to those produced by hallucinogenic doses of LSD, mescaline and psilocybin. STP is about 100 times more potent as a hallucinogen than mescaline and only one-thirtieth as potent as LSD. ( Science, 158, 669, 1967).
A comparative study of suicides transferred to the hospital and the morgue has been made by J. Vedrinne et al. Of 1,000 cases of attempted suicide examined in the toxic pathology service at Lyons, 770 were due to psychotropic (including 571 barbituric) drugs. There was a ratio of 2.8 women to 1 man and a total of 26 deaths. ( Revue lyonnaise de médecine, 16, 279, 1967.)
The seeds of Ipomoea violacea L. used in southern Oaxaca (Mexico) for "divinatory" and hallucinatory purposes are being used in the USA by university students for the same purposes as LSD, STP and other hallucinogens. Morning glory seeds contain indol alkaloids, chiefly derivatives of lysergic acid and isolysergic acid (chanoclavine, lysergic acid amide, ergometrine, penniclavine, elymoclavine, isolysergic acid amide). (Ara Der Marderosian-- H. W. Youngken, Jr., Lloydia, 29, 35-42, 1966.)
At the First International Conference on Prematurity of the American Medical Association, B. E. Smith discussed drug hazards to the premature infant in utero and during labour. Dr. Smith said inter alia that maternal analgesia with codeine may be safer for the infant than other narcotics. The side effect of respiratory depression of narcotic analgesics and barbiturates is dangerous in the infant. Among several other drugs that may prove toxic if taken by the mother during pregnancy, the use of phenobarbital can be the cause of haemorrhage in the newborn infant. ( Journal of Amer. Med. Assoc., 203, 26-27, 1968.)
The last number of the Bulletin published, with the permission of the Government of Thailand, extracts from the Report of the UN Survey Team on the Economic and Social Needs of the Opium-Producing Areas in Thailand. The succeeding number will present the recommendations made in this Report.
In considering the place of opium in the socio-economic setting of the hill tribes, it is interesting to note in the Report the estimates of opium addiction among some of the tribes who cultivate the poppy. The Report recalls the conclusions of a study by the Government of Thailand in 1965/66 that there were relatively few opium smokers among the hill tribes. The Government's report had estimated opium addiction among the various tribes to be as follows:
Miao: 9.55 % of the tribal population
Yao: 15.9% of the tribal population
Lahus: 11.17% of the tribal population
The Government's survey had concluded that, of the total tribal population, the Thai Hills opium addicts, on the average, consume 1.34 kg per person per year. The UN Survey Team's Report adds that other findings, although confined to only a few villages, indicate that about 10 % of the Miao adult population are steady smokers and that a considerable number of smokers over that figure use opium occasionally. The UN Survey Team had also observed opium addiction and occasional smoking among certain other of the tribes such as the Karen, the Akha and Lisu.
Increased concern regarding addiction to narcotics has led to an intensified search for narcotic antagonists which produce analgesia without serious side effects. Various narcotic antagonists and their effects have been evaluated. Undesirable properties common to different narcotic antagonists include hallucinations, dysphoria, withdrawal symptoms, sedation, drowsiness and the need for parenteral administration. ( Lancet 1:1310 (June 17) 1967.)
The mechanism of action of narcotic analgesic drugs and their antagonists is discussed by Kosterlitz and Watt. ( British Journal of Pharmacology and Chemotherapy, 33 (2), pp. 266-276.) The "agonist" activity was measured by the extent of contractions of the longitudinal muscle of the guinea-pig isolated ileum, and the "antagonist" activity by the equilibrium and/or recovery rate of these contractions. It was shown that all narcotic "agonists" (heroin, morphine, codeine, levorphanol, dextromoramide etc.) and all narcotic antagonists (pentazocine, cyclazocine, levallorphan, nalorphine etc.) exhibit both "agonist" and "antagonist" actions. Naloxon (N-allylnoroxymorphone) was the only drug examined which has little or no agonist activity and can, therefore, be regarded as a "pure" antagonist. In the authors' opinion the action of the narcotic antagonists is of a competitive nature.
The increasing use of narcotic antagonists (i) in the detection of the cases of narcotic addiction (i.e. nalorphine pupillary test), (ii) in the treatment of narcotic addicts (i.e. cyclazocine) and (iii) in the research of non-addictive potent analgesics to replace dependence-producing drugs in the therapy (i.e. pentazocine) draws attention to the importance of studies on the mechanism of their antagonist action.
1Except the Convention of 26 June 1936 for the Suppression of the Illicit Traffic in Dangerous Drugs, of which article 9 is replaced by article 36 of the 1961 treaty.
2Under article 24, para. 4( b), opium may be imported, notwithstanding the regulations defined in para. 4( a) of the same article, when certain conditions are fulfilled. Among such conditions, reference is made to the establishment of the agency mentioned in Article 23, but it was thought fit to stipulate a further condition: "If such country... has in force an effective means of ensuring that the opium it produces is not diverted into the illicit traffic". In effect, this means that if the Convention is implemented ineffectively it is not implemented at all.
3The international agencies have known cases in which States possessing a highly developed and experienced legislative and administrative system, regularly transmitting the information required under the treaties in an exemplary manner, suddenly performed their obligations in a very perfunctory way. The reason for the sudden deterioration was simply that the official concerned had been posted elsewhere, and that his successor was not properly briefed.