I UNITED NATIONS
W O R L D I - I E A L T N O R G A N I Z A T I O N
NATIONS UNlES
WH O/X F'D/9 1 0 February 1949
OR I G INAL : ENGLISH
EXPERT COWIITTEE ON HAB IT-FORNING DRUGS
L./ Report on the first session
Held 24-29 January 1949, Pala is des Nations, Geneva.
Members: D r . J. BOUQUET, Ex-Inspecteur des Pharmacies, Tunis
D r . N. B. EDDY, Pr incipal Pharmacologist , National I n s t i t u t
United S t a t e s Public Health Service,
Washington (chairman)
D r . J .R. NICHOLLS , Deputy Government Chemist,
Goverment Lab oratory, London
Dr . P.O. '#OLFF, Buenos Aires
Absent:Dr. H.P. CHU, Professor of Pharmacology,
National College of Medicine,
Shanghai
Secretary: Dr . R. MUTIER, Assistant Director-General
Observers: ilnr. V. PASTUHOV, Chief of Section, Division on
iVarcotics, United Nations
M r . A.E. FELKIN, Secretary, Permanent Central
Opium Board and Drug Supervisory Body,
United Nations.
m. L.F. ATZENIIILER, ~ s s i s t a n t - s e c r e t a r y ,
Permanent Central Opium Board and
Drug Supervisory Body; United Nations
Professor H. FISCHER ( ~ u r i c h ) , attended pa r t of t h e
session (25-26 ~ a n u a r y ) i n h i s capaci ty of member 01. the Permanent
Central Opium Board and of the Erug ~ u ~ e r v i s o & Body.
The agends having been adopted, D r . Eddy was e lected
Chairman and D r . 1fJolff Rapportwr .
The question whether, the preparati0.n .Valbinel was t o be exempted
from the provisions of the 1925 Convention was discussed, specia l
s t r e s s being l a i d on t h e content of dihydrooxycodeinone hydrochloride,
t he pos s ib i l i t y of recovering t h i s alknLoid from the preparation, t he
presence of p h e n y l e t h y ~ r n ~ o ~ l ~ e a and whether t h e n u @ s of t a b l e t s
contained i n a tube was such tha t , taken shd t aneous ly : by,.bn addict,
they k d maintain h i s s t a t e of addiction. ,
The following resolut ion was passed: , .
The Committee, . flaving considered a request from the French Goqernment t o have t he preparationvValbine exempted from the provisions of t h e .l925 Convention by appl icat ion of i t s Ar t ic le 8,
Is of' the opinion' that &eh exemption should not be granted in favour of VaZbine# ,and
RECWNDS that , t h i s decision be no t i f i ed t o the Economic and Social, council of t he United Nations f o r transmission t o thd French Government.
2. Notifications by t h e governments of t h e United S t a t e s of America and of t h e United Kingdom concerning METOPON (Doe6 .'iVHO/HFD/2 and %HO/HFD/8) . W
The Committee considered t h e no t i f i ca t ions from the gdvernments
of t h e Unitec! ~ t a t e s ' o f America and of the United Kingdom a s t o t h e
habit-forming proper t ies of methyldihydromorphinone ide
(Metopon HCl) . On the ba s i s of the observations made i n both t h e mentioned
countries, t he Committee adopted t he following resolution: J . - The Committee,
Having considered no t i f i ca t ions from the Governments of the United S t a t e s of America and of the United Kingdom i n regard t o methyldihydr omorphinone hy2rochlor ide (Metopon HC1) under Ar t ic le 11 of the 1931 Convention,
. , a .
Composition of Valbine? .
~ihydrooxycodeinane hydrchloride 1 mg Phenylethylmalonylurea 3 CP Extractum pisci4iae 2 Cg Extractum pruni Virginianae' 3 C&' Extracturn Crataegi 5 % ,
per, t ab l e t .
Is of t h e opinion t h a t nLthjridihyc!rc noq7hinone and i t s s a l t s a r e habit-f orming drucs , anc!
RECOW~NDS t h a t t h i s op in ion be n o t i f i e d t o t h e Secret:sry-General of t h e United Nations under t h e provis ions of A r t i c l e 11, paragraphs 3 and 5 of t h e 1931 Convent ion,
N o t i f i c a t i o n rece ived from t h c Belgian Government re[;czr6ing 3 . -------.__ - . - - . - - - - -_-----.- ...-a-- 1
acetyldihydrocode ine hydroch lo r idc"G~~e _ _ l _ _ l name : -I hcetyicodone --.I-,-. -- I_C--- ) Tdz6; - E u / I ~ P D / ~ )
The Comi:"ue has consicered a n o t i f i c c t i o n received from t h e
i3olgian Gove:?nment ;vi-tJl r.: s ~ e c t t o acety',6*ihydrocc?deine
(C-, -.3 H 22 0 2 i\i (o,c~,,,cF!,) I - I C ~ + M 2 o;, .
The Committee has no u p e c i f i c information on t h e habit,.foraing
proper ty of ace2,yldihy(frococfeine, but i s of t h e opinion that, t h i s
substance i s conve r t ib l e t o dihydrocodeine which, i? t u r n , i s
convex% Yule t o dihjdromorphine , a h a b i t -f o1:nin;i drug, The s ta tene l l t
wi th r e spec t t o conversion Lo a hczbit..forrning drug a p p l i e s e q ~ ~ a l l y
t o o the r s s f e r s of c?.ihydrocodeine anc? t h e i r s a l t s , %c! a l s o t o
d i l ~ y d r ocodeine and i t s s a l t s ,,
The Committee
RF:COIvBdENDS t h a t t h e Committeeis opinion t h a t Cih)-drocodeine, i t s e s t e r s and t h e i r s a l t s a r e conve r t jb l a t o dihydromorphine , a habit-f orming drug, should be c~mr~iunicated t o t h e Secretary--Generni of t h e United NaSi.ons.
4. Protocol s igned i n P a r i s on 19 November 1948 W..---. __ .-..-.---_ -.v
The Committee no5cd t h a t t h i s Protocol , a l though not h ~ j i.ng
y e t rece ived the necessary number of f i n a l s igna tu re s , i s expec t s? t o
e n t e r i n t o force i n t h e ve ry nerw fu tu re . Therefore, f o r p r a c t i c a l
pwposes, t h e Cclr~mi.~tee ddcided t o proceed a s i f t . h i n Pra t ,oco i were
a c t u a l l y i n fo rce ,
5, 1 -7 ethyl-4--p'henyl.i~ fperidine-.4-.carboyylic as i d ethyl ~ s t e r -" -_-_-_ "" ___ __- _ _.-. "- _"__-__ _____" --..._ "....~.^-..--"".n~U /..-A-
( t he hydronhloridc of which i s known under t h e nrunes of. Dolant in, Demerol, Pe th id ine , PirS.dosa1, e t c , )
The Commitfee tms informed of t h e s t e p s taken i n May 1945 by the
Prcsiden5 of t h e Cou-ncil of t h c League of TJations t o have 7.-~ct,h;~: ?-.
phewl-13iperidine--4-carbowlic a c i d e t h y l e s t e r subjectcr? t o t h e
measures of c o n t r o l provided i n t h c 1925 Con.crention,
~ ~ H o / H E ' D / ~ page 4
The Committee considered, however, t h a t t h e supervision thus
exerc ised i s not s u f f i c i e n t t o ensure t h e i n t e r n a t i o n a l cont ro l of
such a powerful habit-forming drug. Therefore,
Thc Cornnittee i s of t h e opinion t h a t , by v i r t u e of
A r t i c l e 1, paragrn2h 2, of t h e Protocol of 1948,
l-methyl-4-phenyl--piperic!ine-4--carboxylic a c i d e t h y l e s t e r and
i t s s a l t s should be considered as capable of producing add ic t ion
and should the re fo re f a l l under a r t i c l e 1, paragraph 2, Group I
of the 1931 Convention, an8
F,ECO?&V!ENL7S thaz t h i s opinion be n o t i f i e d t o t h e Secretary-.
General of the United Nations.
6 , Other Substances o f the Dolantin type .---v -
Afte r having exgrcssec! i ts opinion on l-methyl-4-phenyl-
piperidine-4-carboxylic acid e t h y l e s t e r ( i tem 5 ) ) t he Committee
bel ieved t h a t the onus was u2on it t o cons ider a l s o t h e manjr o ther
s l~bs tqnces ~f s i m i l a r s t r u c t ~ ~ r e Itnorvn at present , and t,o r n i ~ i c k rcTerence
i s made i n memoranda by Prof. F ischer (doc. E / O B / ~ Rev.1) and
D r . ltrolf f ( doc . ~ H o / K F D / ~ )
From t h e e v i d e v r , before it,
The Committee i's of t h e ailinion t h a t
l - m e t ~ l - 4 - m e t a h y ~ r o x y p h e ~ 1 - i ~ i p e r i i n e - 4 - c r b o l i c ac id e t h y l e s t e r (Bemidone)
l-methyl-4-metahydroxypbenyl-4-propionyleridine ( et o- emi id one )
- 1 , 3 - ~ i m e t h y l - 4 - p h e n y 1 4 - p r o p i o n o ~ - p i i n e (NU-1196)
P -1,3-dimethy1-4-phenyl4-propi~noxypiperidine (NU-1779)
a r e a l l substances of s i m i l a r chemical s t r u c t u r e (type: ~ o l a n t i n ) 2 7 - an.! d ~ f i r l i t c l y haki'; f i , - mii~g, 112 s~;;xLL LL L L . ~ i.,~' i . ; l i # A $-, i) i ' i &L
a c t i o n when t h e Protocol of 19 November 1948 comes i n h fo rce , and
RECOMMENDS t h a t t h i s opinion be notif iec! t o the Secretary-
General of the United Nations,
--v.- -- - <-
- See finnex l.
7. 6-dimethylamino-4,4-diphenyl-3-heptanone and substances of similar type
From t h e evidence before it,
The Committee is of the opinion t h a t the following syrithetic
6-dimethylarnino-4,4-diphenfl-3-heptanone (~aethad one, kmfcione , e t c . )
64imethylamino-5 -rnethy14,4-diphenyl-3-hexanone ( isornethadone )
6dimethylamino-4 ,4-eiphenyl-3-heptanol
6-m~rphol in0-4,4-dii>henyl-3-heptan0n~ ( C, B .l1 1 should de f in i t e ly be considered as habit-forming,3 and should be
noted f o r appropriate act ion when t he ,Protoco'l of 19 Moverhber 1948
comes i n t o force, and
RECOMMENDS t h a t t h i s opinion be no t i f i ed t o t he secretary-
General of the United Nations,
8. Precaut ioxxiry measures with regard t o ' synthet ic substances
The Committee is of the opinion t h a t other compounds of a
s teucture similar t o those re fe r red t o under item 6 (Dolantfn type)
and item 7 (Methadone type) must be under suspicion a s t o t h e i r
having habit-forming proper t ies u n t i l t h e contrary be proved. The
Committee considers t h a t governments shou3.d watch these compounds
with extreme care and should t ake appropriate act ion immediately on
t he discovery of t he addicting proper t ies of any one of them.
With reference t o t h e experience already gained. with some members
of the Dolantin and Methadone groups, i
The Committee
REC-NDS tha t provision should be made i n any new convention,
whereby substances of a par t i cu la r chemical type, analogues of
which have been proved t o be habit-forming, could be placed under l
cont ro l u n t i l such time a s they are shown not t o be habit-forming.
9. Diacetylmorphine
The Committee, having noted the views expressed by t h e Permanent
Ce Board and the Drug Supe B&y on the question of
3 see ~ n n o x ?,
diacetylmorphine, consic?ered t h e inc rczse i n t h e f i g u r e s of constlmp-
t i o n of t h i s substance i n some uf t h e coun t r i e s mentioned i n
document E/oB/~. Reference w a s a l s o made t o Recommendation V1 of
t h e 1931 Convention which was basec! on t h e view ergressec! by t h e
Committee o f Exper t s of t h e Conference f o r t h e L imi t a t ion of t h e
manufacture of nzrcot i c dru;;s (1931), and which emphasized "the h ighly
dangerous cha rac t e r of d iace t j lmorphine a s a drug of add ic t ion and t h e
g ~ s s i b i l i t y i n most, i f no t a l l , c a scs , of r ep l ac ing it by o the r dru,;s
of a l e s s eangerous charac te rq ,
Having hearc! a s ta tement by Professor ~ i s c h c r ~ with which it
f u l l y agreed, t h e Committee expressec? a f e e l i n g of a larm over t h e
e x i s t i n g s i t u a t i o n ~ i t h regar? t o diacetylmorphine and s t r e s s e d t h e
fact t h a t t h e r e a r e 24 c o u n t r i e s i n which diacetylmorphine is no t used
a t a l l . 5
The Committee is of t h e opinion t h a t f u r t h e r information is urgent-
l y needec? as t o t h e rezsons governing t h e present use of diacetylmorphine
i n some coun t r i e s , p a r t i c u l a r l y wi th reg,arc! t o it S p o s s i b l e dispensa-
b i l i t y . Such d a t a might be secure2 through t h e good o f f i c e s of t h e
Yiorld Medical Associat ion, I n add i t i on , d i r e c t i n q u i r i e s might be
undertaken by t h e senc?.ing of an e x p e r t t o c o u n t r i e s where t h e consumption
of diacetylmorphine i s high, i n o rde r t o a s c e r t a i n from l o c a l phys ic ians
anc? h o s p i t a l and s i ckness insurance s e r v i c e s t h e reasons f o r t h e
p re sc r ib ing of t h i s drug,
The Fxpert Committee
EIECOm&NI)S t h a t s t e p s should be taken t o secure information on
t h e use o r d i s p t n s a b i l i t y of c ' izcetylmoq~hinc i n t he va r ious
c s u n t r i e s through t h e dorld ldedical Assoc ia t ion and by sending m
exL2ert t o coun t r i e s where t h e consumption of diacetylmorphine i s
hi&.
See Annex 2
5 h u s t r i a Bulgar ia Greece Lwcemburg Polanc! Spain
United S t a t e s of iimerica
Costa. Rica Cuba Dominican Ke;?ublic Guat ernala Honcluras Nexico Nicaragua Salvador
B r a z i l Chile Colombia Peru . Venezuela
China Japan
EVIDENCE ON THE 2DDICTION POTE??:',',I".LITY OF COiJlPOUllTDS OF THE D O L M I I t "UlD !:BTH!DOPF; TY FdS
( ~ 2 t c by D r . N.B. Eddy)
The Reszaxch Dcpartnent ;f the US Public Haalth Service Hospital
a&xington, Ky., USA, hss carried ?ut t e s t s on the addiction
po t en t i a l i t y X' new synthetic substances of the Dei.~erol and Methadone
types (J. h e r . med. ASS., 2.35, &88-894, 194'7; Proc. N.Y. Acad. Sci.,
51, 1-74, 1948) including the following, as y e t unpublished:
1 l-methyl-4-metahydro~heny~-piperidine-4-carbo~lic acxd
e thy l e s t e r emid id one).
This substance i s p rac t i c a l l y i den t i ca l with Demerol i n the reac-
t i ~ n s which it produces and i n the dosage required t o praduce euphoria
i n post-addicts or t o supp-ess abstinence phenemena of an established
mclrphine addiction. Its addiction poten+,ial i ty then is considered
t o be very l i k e t h a t o f Demerol i t s e l f .
2 l-me thyl-4-me t a h y d r ~ w p h ~ n y l - 4 - p r o p i o n y l - p r d n et o-
Bemidone ) . I n s ingle dose, t h i s substance pr~duce:. intense euphoria i n
former morphine addicts , It read i ly suppresses abstinence phenomena
of an established morphine addiction. The behaviour of men experi-
mentally addicted t o Keto-Bemidone i s very simi1a~- +o the behaviour
of men addictad t o morphine. Tolerance develcped ts sedative action,
the e f f ec t on the e lec t rcencepha lo~am, the erne%ic e f f e c t and the
ef f ec t on the thermal rad ia t ion pain th re shald . Follonring abrupt
withdrawal of Keto-Bemidone af ter ada in i s t r a t i sn f o r 42 t o 60 days,
an abstinence syndrome developed very rapidly ( i n l e s s than 10 hours)
which was so int;ense as t o be regarded as po ten t ia l ly dangerous GO
l i f e , and which declined rapidly.
The evidence i s unequivoc a1 %h : iL lie t =--Bemidone produce S a type
of a d d i c t i m which i s very s i m i l = t o addiction t o the drugs of the
mmphine s e r i e s and which i s S. g rec t t h a t the drug s h ~ u l d n? t be
used i i i c l i n i ca l medi,-ine unless i t can be shmn t o pnssess great
advantage wer the pqtent e ~ a l g a s i c s already available.
This evidence has bean plhescntcd t . the C~mmi.;ei?ner ?f Narc 2tiC.s
o f the United S t a t e s ?f ilmi?rica m d t o the manuf3ccturers wh? h91d the
'V\HO/APD/~ page 10
p a t e n t ln K e t il -2e;r,i4- nc . r~ie l a t t e r ha~~re as a r e s u l t v , , l u n t a r i l y
suspend,d pr:ducti:ri ~f 1<3 t S-Bemid-.ne and p l ans f r i t s rnmkcting.
3 and 4 ;-l ,3-.ciixie t~l-4-pher1yl-4-p.r~pi~:r1 >xy-.pipe r i d i n e and
p -1, j--dimc thyl--4.-pht iyl-?-p i p i . n jxy-piperidin? ( CU-l196 u?d NU-1779 )
Both :-?f th,,se s u b s t ~ i ~ c e s ar? m-)rc e f f e c t i v s t han DemerQ i n the
prqduct i -n -f auph ) r * l a i n p >st-r iddicts and i n t he s u p p e s s i o n c f 8.b-
s t i nencc .;lf sri ? ~ t ~ i , ? ~ i S'., ,d :!,irphini, r ~ d d i c t i - ) n o The $--is-mer i s twice
as. ef fec t iv ; , t ~ c ;lfi-i S j~c>r thrc, r f u r t i ~ n l s 2s effzct j -vu es Dc.rnar~l
' i n t h e s s r t s p o c t s . %:fk, then: ;ri: c.asldered t lir?.~.~e groc tor a d d i c t i ~ n
p:tcnti?Lity th2n ljumer ..L.
5 6-d1mcthyl~iriin~-il, 4-diph3nyl-3-haptpncjl.
This s u b s t m c e !>:L; n t p r ? d u c ~ d i ;uph<xia i n p x t - a d d j - c t s i n t b s
dcszs ~ d - i l i n i s t e ~ c l /9~-120 mg.), and has only very s l i g h t e f f e c t
t hc abstinen-lc 2henmena " m s s t z b l i shed mcirphinc a d d i c t i m . It
?ls> has v3ry wec?k :PC! act,i:n. I t s add ic t inn p ~ t c n t i a l i t y
appczrs t:~ ba lw.
I n t h i s substirnce 2.1 hydrsxyl g 3 u p has bean aca ty la tdd as i n t h e
change frr-,m mxph ine t o her. , in. I n csnsequznce a n d g c s i c a c t i ~ n hes
bzen incr$esed a t l eas t 2s ~LLI::I ;is i n idethadene. The c~mpcund pr;-
duces mnrkcd e ~ i i h x i e i n pmt-addic Ls and re?.dil;y suppresses thd
abst inence phan~mena ,P cn e s t ~ b l i s h c d idd diction. IL i s c ~ n s i d e r e d
,-I I 6-ni:r;~!~~lin:-4,1.-d~.pl~~n.lrl-3-ho~~~n~ne (CB-XI;.
Smzil d2scs (i5-20 mg. ) p r . 3 d - x ~ an i n t e n s e bwt n , t l c n g l a s s i n g
e u p h x i c rd?.cti, n i n p o s t - x l d i c t s ; l ~ x g a r d2ses ceuse a sevcrc t -xic
circul~.t-..1-;. r zc?c l i fn . SwAl d .szs rncrk~dly reduc; t h c in tc?ns i ty r f
abstinunc;, pncn;me,.:,a )f m-.r.phind add ic t s , but " ,~sz pl-ien~i-rc?na r e t u r n
t c t h e i r f nn;r iriti,r,ei ty i n 2 h ~ u r s . This c;rnp>und i s con:,idtrcd
t o h w e a s t rong ~ ic l2 i c t i . n ?s t~nt ic? ; l i t ; r , as grca:, , p r j b d ~ l y , as t h a t
ANNEX I1
DUaTYLMORPHm
(Heroin)
Memoranc?un by Professor H, Fischor
,The danger constituted by heroin is nowadays undisputed*
Widespread heroin addiction i n New York between 1912 and 1920, and the
perilous years between l 9 M and. 1930 i n Egypt ( ~ u s a e l l Pacha) are cases
i n point, Because of few or inadequate control mea$ures, heroin pro-
duction flourished, and i l l i c i t trade i n t h i s product was exploited t o
a remarkable degree of efficiency by contraband dealers, even aPter the
entry into force of the Conventions of 1925 and 19 om tha t time
onwards, the unlawrul production of'herofn grewb and bounds i n
China, par t ly with the help of European chemists. Ever increasing
imports of acet ic anhydride were a clear ineication of the proportions
a~stuned i n tha t country by heroin product ion, which amounted t o dozens
of tons per year.
The heroin smoking-habit introduced in China was a part icular ly
pernicious form of heroin addiction ( nd, e t c, ) . During t h i s
period, the production of diacteylmorphine osci l la ted between 10, 20 and
X tons per year, It i s a known fac t t the time of the Japanese
invasion (1933 t o 1935)$ Japan made g
and Jehol with narcotics, including not only opiwn f o r smoking purposes,
but a lso heroin. During the second. world war, Japan used heroin as a
weapon in carrying out i t s genocidal policy 5x1 Ihnchukuo, You w i l l no , doubt r e c d l the Mulcd.cn factory, whose production of diacety'lmorphine
reached 50 tons annually.
1% would seem logica l t o completely ban the use of a poisonous drug
which has wreaked such havoc throughout the world during the l a s t 50
years. The Convention of 1931 was designed for t h i s purpose, but only
a few countries adhered t o i t s s t ipulat ions, In t h i s regard the Unitec?
States has scrupulously carried out i ts obligations for the past 20 years,
From a medical point of view, heroin shoulc? continue t o be used only if
i t s t a l u e a s a drug can be proved; t h a t is, if no other drup c m fulfil
the same purposes, and it should at l e a s t haGe def in i te therapeutic
q ~ m l i t i e s . In my opinion, none cf t h e aforeraent ioned condi t ions
i s f u l f i l l e d by t h i s d r u ~ .
US e mnttcr of f a c t , he ro in i s g s n e r a l l y cunsiclered a s an
extremely c'angerous dru, . J14ost dgc t o r s an6 h o s p i t a l s r e f r a i n f r o n
us ing it, and ~vould no 9 u b t agree t o i t s c9~mnplete e l imina t ion
tkrout t lout t he I V ~ L 12. I n ;,,ite 9f t h i z , we f i n ? n ~ y r ~ ~ . l v e ? t,nd-7y ill
t h e ilresence of n s i t u a t i a n which i s both anomalous and d i squ ie t ing ,
I n c e r t a i n ccun t r i eg , d o c t ~ r s a r e ; r e s c r i l ~ i n g hcro in vvith ever
i n c r e a s in;, frcqucncjr, a n d i n FiriLani! i n p a r t i c u l a r , t h e r e is cause
f o r alarm.
For doc tors , t h e increased use of he ro in i n v a r i o u s coun t r i e s i s
d i f f i c ~ , l t t o understand, a s t h e o;rini?n of t h e medical body throughout
t h e world is unanimous a s t o t h e harmful na tu re of hero in , both from
e medical and n a r c o t i c viewpoint.
A s
General ly speaking, d iacoty lnorphine i s more t o x i c t han morphine,
a s t h e resul . tant ana lges i c e f f e c t i s from f o u r t o e i g h t t k n u s t ~ o r e
powerful. Its seda t ive and ;7ara ly t ic e f f e c t on t h e r e s p i r a t o r y - system
i s much g r c a t e r t han t h a t produced by morphine, as 0,007 grams of
diacetylmorphine i s s u f f i c i e n t t o b r i n g on r e s p i r a t o r y p a r a l y s i s ,
Diacetylmorphine i s p re sc r ibed f o r t h e same s p e c i f i c i;urposes as
morphine: f o r p a i n f u l cp ,ndi t ims , i nc lud ing thosc caus iq ; insomnia and,
above a l l , f o r i r r i t a t i o n s af t h e r e s p i r a t o r y t r a c t , more ? a r t , i c ~ x l a r l y
t hosc c n c ~ > u n t e r e l i n ,~ulrnonary t u b e r c u l o s i s an,! i n c a s e s of t u b e r c u l o s i s
of t h e la rynx , Diacetylm3rphine i s c ~ n t r a - i n e i c n t e d when dealin; wi th
emphysema, asthma and h e a r t t roub le .
The e l imina t ion of hero in i s c ' i r e c t l y r e l a t e d t o t h e prcscr i ;? t ions
made by doc tors . Heroin can bc prescr ibe? f c r cough cond i t i cns and
i r r i t a t i s n s ir, t h e res ; ) i r2 t cjry t r a c t , as f o r examplc , i n p u l m ~ n a r y
t u b e r c u l o s i s and i n ca ses of t u b e r c u l o s i s of t h e larynx, b u t t o a l e s s e r
degree as a c e n t r a l ana lges i c , In o the r words, t h e s 2 s c i f i c medical
u ses of ?.iacetxlrndrphine a r e not t o be d i s t i ngu i shed from those of o t h e r . . ana lges i c s used i n cau?,h conclitions, such a s mor2hine, a c e ~ , ~ c J L , ~ , G U ~ U L ~ L ~
di lnudide , pernonide, and dicoc?ide,
A s a ct3uch remedy, t h e r e is consequently no medical j u s t i f i c a t i o n
f o r *>refer r ing diacetylmorghine t o o t h e r dru; s , or of even p lac iqg it i n
wo/m/9 page 13
the same category, Possible r epe r~us s ions on the resp i ra to ry t r a c t
and the ease and rap id i ty with which addiction can be acquired, a r e
f ac to r s which c l ea r ly indicate t h a t it cannot be considered as useful
a s t h e above-xpentioned drugs,
A s is indicated i n t h e repor t submitted by the Permanent 0entra.l
Opium Board t o the Social and Zonomic Council on the work a c ~ ~ ~ l ~ ~ i i s h e d
by the Board i n 1948, there are f i v e countries whose consumption of
ylmorphine reached 2 kg, per mil l ion inhabi tants and f i v e a ther
i e s where over 5 kg . xere consumed. By order of highest con-
sqt ion, %hese countries a r e : Italy, New Zealand, Sweden, Austral ia,
and CanaCla, One country inland) uses more than 25 kg . of diacetyl -
morphine per mil l ion inhabitants, In contrast , among t h e 74 countr ies
and 96 colonies and t e r r i t o r i e s mentioned, n t r i e s and 21 terri-
t o r i e s have not made provision f o r d iace t
The following are some of the countr tylmorphine :
United States, Japan, Austria, Bulgaria, Hungary, Spain, Poland, Mexico,
Braz i l and Eg;~pt,
I h e a r t i l y commend tb WHO Expert Cornittee on Habit Forming Drugs
f o r having included i n i ts present programme of work the question of
diacetylmorphine, which i s a matter of serious concern t o the Permanent
Opium Board a s well as t he Drug Supervisory Body, Neither the
n t Central 9 i u m Board nor the Supervisory Body sees the necess i ty
or even the u t i l i t y of increasing the consumption of heroin i n Finland,
I t a l y and other countries, f o r reasons which have been put forward by
cJoctors i n those countries. Lf, i n Finland, sickness insurance
organizations encourage t he use of heroin because doses are smaller than
t h e correagonding morphine or codeine doses, and are consequently cheape#,
a doctor who i s aware of h i s respons ib i l i t i e s , should not consider t h i s
a c t as su f f i c i en t j u s t i f i c a t i on fo r administering heroin in such,ala,rming
The Permanent Central Opium Board and t he Supervisory Body m u l d
consider it most des i rable t o have t h i s problem elucidated a s soon as
t h e 'WO Expert &omi t t ee , The supervision of in te rna t iona l
i n diacetylmorphine would thereby be g rea t l y f a c i l i t a t e d , and
t h e committees which a r e entrusted with t h i s t ask could only p ro f i t from
a serious study of t h i s question,
A s 2ub l i c h e a l t h problems are involvu-'. , t h e Oj3ium Board and t h e
Supervisory Body a r e agreed t h a t t h e ;MO Expert Committee shoulc' t a k e
c a r e of t h i s matter .
Avai lable i n fwmat ion proves beymc d a u l ~ t t h a t t h e use of
diacetylmorphine f o r rne$.ical purposes cannot be s o l e l y considered as a
sequel t o t h e war,
If t h e .vHO E q e r t Committee, a f t e r having t h o r ~ u g h l y examined t h e
problem of diace5ylmorphine,wre t o a r r i v e a t t h e conclusion t h a t bo th
from a medical p o i n t of view and from t h a t of pub l i c h e a l t h throughout
t h e world, it wou-ld be advisable t o completely e l imina te d i a ~ e t y l m o r p ~ l i n e ,
such a c snc lus i c~n i ~ ~ l d i ! be of t h e g r ~ a t c s t inq~or tance fc.r t h c afore-
mentioned con t ro l bodies . If one cons iders t h a t 25 S t a t e s m+ 27
T e r r i t o r i e s have a l r c a 2 y given up t h e use of diacetylmorphine f o r medical
p r p o s e s , such a recornmcndation by t h e Permanent Cent ra l 93ium Board
an2 t h e Supervisory Body would not seem t o o rnuch t o hope fo r . k
recommendation on t h e s e l i n e s had alrea6.y been presented as Resolu t ion 6
of t h e Convention of 1931, t h e t c x t of .~uhicf; fol lows:
"The Conference, r e c 9 g n i z i n ~ t h e h igh ly 2angerous cha rac t e r of
diacetylmorphine as a d r y ; of a d d i c t i o n and t h e p o s s i b i l i t y i n
m o s t , i f no t a l l , c a ses or" r e p l a c i n g it by o the r drugs of a
l<:;s dangerous cha rac t e r ;
R.3COMMENDS t h a t each government should 6xamine i n conjunct ion
1'3th t h e medical p ro fe s s ion t h e p o s s i b i l i t y of abol i sh ing o r
r ~ s t r i c t i n ~ y i t s lJSi?, an.? should communicate t h e r e s u l t s of such
examination t o t h e Secretary-General of t h e League of Nations.ff
If one t akes i n t o cons ide ra t ion t h e harm brciught about; fin t h e world
by diaadylmorphine s ince i t s appearance> and t h e thousands of he ro in
a d d i c t s who have f a l l e n v i c t ims t o t h e drug, t h e disappearance of
diacetylmorphine from world markets coulti only bc c..nsidered as a boon
and a s t e p i n t h e r i g h t ! i rcct ion, h~orecver , a complete ban on t h e
product ion of diacetylmor;3hine ~vould g r ~ a t l y facilitate t h e supe rv i s ion
of narcotj-CS, a s c o n t r o l bodies coulc! r i g h t l y c{)ncluc'.e t h a t hero in
discovered rin;rwhere i n t he world ciulcl only t o c~nt rakanc? , and even t h e
possess ion of t h i s dancerous p o d u c t m u l d c o n s t i t u t e an infr ingement of
c onvent ions.
I n order t o a t t a i n t h e requirec' g c s l - t h e cor;q)lete abcllit ion
of heroin - ~1 s c i e n t i f i c a l l y 3.12' , ~ s y c h o l o ~ i c a l l y ;?lnnncd ?r~;~aganr!a
cmi3aign s h o d ? be inauguratt;:! i.n -.rc?er t o c mvince c'octors ancl
governments the worlr' over t h a t t h e c ~mplo te abolj- t ion of 2i:-cetyl-
morphine i s an urzent necess i ty i n the s t r u c g l e t o c u r t a i l t h e use
.r)f dm;s which w e 2 menace t o public h e ~ l t h .
It woulcl k,c most d e s i r a t ~ l s th:it t h e iciO Expert Gommittee make
a stucly of t h i s ques t ion a t t h i s time, a s a new conventicm - t h e
f u t u r e Opium Convention - i s being dra~rm up and i s on t h e po in t of
being presented t o the var ious supervisory bo$.ies f o r nut o t i c s , and
t o governments.
t UNITED NATIONS NATIONS UNlES
W O R L D H E A L T H O R G A N I Z A T I O N
ORGANISATION 1ClOM)IALE DE LA SA-
WHO/HFD/~ Corr. 1 16 March 1949
ORIGINAL : ENGLISH
EXPEBT CObUITTEE ON HABIT-FORMING DRUGS
Report on the f i r s t session
Held 24-29 January 1949, Pa la i s des Nations, Geneva.
On page 7 amend item 1 0 (a) t o read a s follows:
(a) 3-hydroxy-N-me thy1 morphinan
The a t t en t ion of the Committee was drawn t o the f a c t t h a t German
and Swiss chemists have produced by d i r e c t synthesis a compound known
as 3-hydroxy-N-methyl morphinan, i n which the s t ruc ture of na tura l ly
occurring morphine a lkaloid has been nearly a t ta ined (R. Grewe, (1946)
Naturwissenschaf ten, 33, 333; (1947) ~ngew . Chem., 59, 194. The new - compound d i f f e r s from morphine chemically only i n the absence of t he
oxygen bridge and of the alcoholic hydroxyl i n posi t ion 6. It has
been shown i n the laboratory t o possess marked analgesic action,
greater than t h a t of morphine i t s e l f , and t o exh ib i t many of the other
charac te r i s t i cs of morphine action. ,
l The synthesis of 3-hydroxy-N-methyl morphinan i s d i f f i c u l t and a t
the moment probably not commercially feas ible . Nevertheless synthesis
of re la ted compounds i s going forward and the Committee i s of the
opinion t h a t progress i n t h i s f i e l d must be watched very carefully.