Escape into nightmare / by Inayat Khan

Escape into nightmare by lnayat Khan Throughout history , humans have known drugs of natural ori- gin which may help them to escape from the unpleasant fea- tures of life , whether real or imaginary , by using fermented liquor or plant products such as opium , coca leaves , cannabis and more recently khat: The realisation that these substances have the capacity to produce depen- dence and abuse came only slowly. Mor- phine was first recognised as a cure for opium addiction, and then found to produce addiction itself. Heroin, another synthetic substance ( diacetyl morphine) , was invented as a harmless cure for coughs but its dependence- producing properties were soon disco- vered and its use was outlawed. Cannabis in its various forms was used in different cultures, despite its harmful effects. Studies are continuing on plant material and the substances isolated therefrom to determine the therapeutic principles and explain the harmful effects. Chewing coca leaves was once the mainstay against hard work in the mountainous region of the Andes ; today cocaine is considered one of the most powerful dependence-producing substances obtained from natural resources. In fact , it was the large-scale use of some of these natural products which drew attention to the need for control of such dependence-producing substances and at the same time to the desirability of reducing the demand for them. There is still great concern in the minds of the public and national authorities about the abuse of narcotic drugs and psy- chotropic substances derived from plant material. Additional problems have arisen from the use of modern synthetic drugs cre- ated in large numbers by scientists in medicine and industry. Chemicals of great therapeutic benefit are now avail- able as narcotic drugs with an opiate- like action , and also in the wider area of psychotropic activity-stimulants of the 22 central nervous system, sedatives, hyp- notics and tranquillizers. These syn- thetic drugs do indeed produce relief, but they also produce dependence , and create nightmarish public health and social problems when they are diverted into illicit traffic. Efforts to provide an international legal framework for the control of psychoactive drugs , begun by the Inter- national Opium Commission in Shang- hai in 1909, have resulted in a number of international treaties. The formula- tion of the 1961 Single Convention on Narcotic Drugs, with its 1972 amending Protocol and the 1971 Convention on This painting by a heroin addict reflects the nightmare world of drug dependence. Photo WHO/K. Brodie Psychotropic Substances, are the major milestones in the development of coor- dinated international control of depen- dence-producing drugs . WHO gives high priority to the res- ponsibility assigned to it by the inter- national drug control treaties-responsi- bility which includes assessing each sub- stance for its medical qualities. Particu- larly over the past ten years, WHO has devoted greater resources and efforts to reviewing the benefit and risk ratio of narcotic drugs and psychoactive sub- stances. These reviews concentrated on three types of drug: amphetamine-like substances; opioid agonists and an- tagonists; and benzodiazepines. Amphetamines are synthetic powders formed into a variety of tablets and capsules for medical use , sometimes in combination with other drugs . In the 1950s and 1960s they were widely pre- scribed for depression and to suppress the appetite. Today they are little used , but are occasionally recommended for hyper-activity in children. Many of these substances produced dependence and have been widely abused, so they have been placed under very strict control in most countries. Some of the examples are fenetylline and cathinone. The latter is an active principle of the Catha edulis plant (khat). Opioid agonist and antagonist drugs are very useful in pain relief but can produce a state of dependence and thus are liable to abuse. On WHO's recom- mendation, pentazocine is the only drug of this type so far to have been placed under international control, while the others are being monitored by WHO. Benzodiazepines are used to control anxiety and tension, to sedate and to help induce sleep and muscle relaxation. They are the most commonly prescribed group of drugs in nearly every society and, being safer, they have replaced barbiturates for most medical purposes. These tranquillizers are taken by mouth and are not injected to any extent by drug abusers. The proportion of women using tranquillisers is double that of men. Many users may be dependent to some extent. Tranquillizers depress mental activ- ity and alertness, but don't generally make people as drowsy or as clumsy as barbiturates do . Nevertheless, they do impair driving and other skills. Like alcohol , they can sometimes release aggression by lowering inhibitions. On their own , tranquillizers rarely produce the euphoria associated with barbiturates or alcohol, a fact which probably accounts for their lack of popularity as recreational drugs. But psychological dependence on ben- zodiazepines is quite common amongst long-terms users and can be very dif- ficult to cope with. People sometimes feel confused, irritable and anxious after they stop taking the drug. In early 1984, the UN Commission on Narcotic Drugs, which had initially requested WHO's recommendations, placed 33 commercially available benzodiazepines on schedule IV of the 1971 Convention, thus cautioning pa- tients and those who prescribe these drugs and the concerned industry. These drugs already required a physician's pre- scription in developed countries, so this action alerted developing countries to use these useful drugs with caution. • W ORLD HEALTH, June 1986