- Email: [email protected]
Spain Editors of independent drug bulletins form an international society
1440
The debate about controlled drug prescribing has split the. profession down the middle. It may be summarised thus: THE ARGUMENTS CONCERNING THE PRESCRIPTION OF CONTROLLED DRUGS
For:
Against: 1. it maintains the condition of
addiction; it was a public health exercise to protect people from the black market; 3. it is not a doctor’s job to control the illicit use of
2.
drugs;
the addict will maintain the condition anyway a stable supply benefits the addict and provides pure, clean drugs; doctors are obliged, like anyone else, to help society combat the breaking of the
law; 4. barbiturates and alcohol are not prescribed because they are
damaging - why opium?
5. the
illegal use of drugs is not curbed by prescription;
’
6. addicts traffick their
.7.
if alcohol were prohibited, it would be more humane to prescribe a daily dram of whisky than see someone sell their last possessions for methelated spirits; there are still insufficient properly controlled clinics;
prescribe less;
prescriptions; addicts supplement their prescriptions;
prescribe more;
8. the efficacy of maintenance doses is not proven;
the contrast between the USA and England 1920- 60 suggests otherwise.
Madden,3
talks of the "soil" (the personality), the "seed" of the (nature drug), and the "environment" (society or a culture), metaphor that has been embellished by "the what?" (what sort of person in what culture using what drug), "the how?" (how often and how controlled is the drug use, and how the drug is consumed), and "the why?" (with as many answers as there are drug takers). Law and custom govern the environment. Alcoholism in Arabia, for instance,
Round the World
is rarer than in Scotland. This rule is supported by a coincidence of addiction rates and the culturally approved drugs. For example, among 50 million English (among whom alcohol is socially used, even promoted), there are 500 000 alcoholics- 107o rate. Among 40 million Siamese (among whom opium is socially used, though increasingly officially discouraged), there are an estimated 400 000 addicts-1 % rate. Opium, like alcohol, can be widely used without the inevitability of addiction. The prevalence of addiction to a particular drug is critically affected by its availability and acceptability. Both of these are controlled by laws and mores. In addition, there are rapid temporal fluctuations in the incidence of drug abuse. Of American servicemen who had become addicted to opium in Vietnam, only 1007o remained addicted one year later. Times of social stress seem to lead to greater consumption of drugs. It is probably not a coincidence that the current increase in opium use occurs at a time of high unemployment and industrial restructure. In our rudderless society, with unemployment and the demise of
organised religion, opium (of one sort or another) is the religion of the people. Addicts give up when they are ready to and special detoxification units do little to expedite this. Probably all the units do is enable addicts to survive until they are prepared to stop. Addicts will return to their drug taking unless they have reviewed the advantages and disadvantages of use and feel the disadvantages to be greater. Psychiatric treatment must discover why addicts abuse drugs or alcohol and then work with them to seek alternative methods of dealing with the problems muffled by drug dependence. Liverpool Drug Dependency Clinic 30 Hope Street Liverpool L1 9BX
JOHN MARKS
REFERENCES 1. Edwards G. The Meaning and Treatment of Alcohol Dependence Br J Hosp Med 1967; 2: 272. 2. Gossop M Living with Drugs. London Temple Smith, 1982 3. Madden S. Guide to Alcohol and Drug Addiction. Bristol. John Wright, 1982
West
Germany
DRUG EXPORTS TO THE THIRD WORLD: COMPANIES ACCUSED OF .
From
our
Correspondents
DOUBLE STANDARDS
Iserlohn, Westphalia, early in June, development action and groups from 12 European countries and representatives from India, Peru, the Philippines, and Rwanda discussed Health and Medicines in the Third World. The meeting, organised by the Bundeskongress entwicklungspolitischer Aktionsgruppen (BUKO) IN
consumer
Spain EDITORS OF INDEPENDENT DRUG BULLETINS FORM AN INTERNATIONAL SOCIETY
AT the end of May the European regional office of WHO and the Spanish Ministry of Health and Consumer Affairs held a meeting in Madrid of editors and publishers of independent drug bulletins produced or planned in various countries. Although the meeting was intended as a European one, many people from other continents expressed interest and came. All are trying with modest means to improve the ways in which medicines are used. They have many difficulties in common, but few understanding colleagues with whom to discuss them.
Participants in the Madrid meeting decided to form a society of editors in order to facilitate cooperation. Its first formal meeting will be in Stockholm around the time of the 3rd World Conference on Clinical Pharmacology and Therapeutics in 1986 (July 28-Aug 1). The
interim committee of the International Society for Independent Drug Information invites all editors of independent drug bulletins (ie, those which carry no drug advertising) to write for further details about the Society to the committee, c/o Dr M. N. G. Dukes, WHO European Office, Scherfigsvej 8, DK-2100 Copenhagen, Denmark.
in collaboration with Health Action International (HAI), criticised the export to the Third World of drugs that are dangerous, obsolete, or too expensive: "National drug regulatory authorities support this unethical and scientifically indefensible activity by neglect and inaction. Standards of safety and marketing for drugs on the home market should apply equally to drugs that are exported." The groups want to see effective control of drug exports from Europe.
Since the early ’70s the pharmaceutical industry’s exports to the Third World have been criticised by experts in drug therapy, by politicians from developing countries, and by groups working there. Neither the industry nor the drug regulatory authorities concerned have responded adequately to the charges of irresponsible marketing of drugs in developing countries. Examples were given to illustrate present abuses. The antidiabetic drugs phenformin and buformin were withdrawn from the market in most developed countries, including the Federal Republic of Germany, in 1978/79 because thev cause life-threatening lactic acidosis. As a result of lobbying bv the industry, however, the licences for these drugs (’Daopar’. [phenformin and glibenclamide] Hoechst; ’Silubin Retars
The debate about controlled drug prescribing has split the. profession down the middle. It may be summarised thus: THE ARGUMENTS CONCERNING THE PRESCRIPTION OF CONTROLLED DRUGS
For:
Against: 1. it maintains the condition of
addiction; it was a public health exercise to protect people from the black market; 3. it is not a doctor’s job to control the illicit use of
2.
drugs;
the addict will maintain the condition anyway a stable supply benefits the addict and provides pure, clean drugs; doctors are obliged, like anyone else, to help society combat the breaking of the
law; 4. barbiturates and alcohol are not prescribed because they are
damaging - why opium?
5. the
illegal use of drugs is not curbed by prescription;
’
6. addicts traffick their
.7.
if alcohol were prohibited, it would be more humane to prescribe a daily dram of whisky than see someone sell their last possessions for methelated spirits; there are still insufficient properly controlled clinics;
prescribe less;
prescriptions; addicts supplement their prescriptions;
prescribe more;
8. the efficacy of maintenance doses is not proven;
the contrast between the USA and England 1920- 60 suggests otherwise.
Madden,3
talks of the "soil" (the personality), the "seed" of the (nature drug), and the "environment" (society or a culture), metaphor that has been embellished by "the what?" (what sort of person in what culture using what drug), "the how?" (how often and how controlled is the drug use, and how the drug is consumed), and "the why?" (with as many answers as there are drug takers). Law and custom govern the environment. Alcoholism in Arabia, for instance,
Round the World
is rarer than in Scotland. This rule is supported by a coincidence of addiction rates and the culturally approved drugs. For example, among 50 million English (among whom alcohol is socially used, even promoted), there are 500 000 alcoholics- 107o rate. Among 40 million Siamese (among whom opium is socially used, though increasingly officially discouraged), there are an estimated 400 000 addicts-1 % rate. Opium, like alcohol, can be widely used without the inevitability of addiction. The prevalence of addiction to a particular drug is critically affected by its availability and acceptability. Both of these are controlled by laws and mores. In addition, there are rapid temporal fluctuations in the incidence of drug abuse. Of American servicemen who had become addicted to opium in Vietnam, only 1007o remained addicted one year later. Times of social stress seem to lead to greater consumption of drugs. It is probably not a coincidence that the current increase in opium use occurs at a time of high unemployment and industrial restructure. In our rudderless society, with unemployment and the demise of
organised religion, opium (of one sort or another) is the religion of the people. Addicts give up when they are ready to and special detoxification units do little to expedite this. Probably all the units do is enable addicts to survive until they are prepared to stop. Addicts will return to their drug taking unless they have reviewed the advantages and disadvantages of use and feel the disadvantages to be greater. Psychiatric treatment must discover why addicts abuse drugs or alcohol and then work with them to seek alternative methods of dealing with the problems muffled by drug dependence. Liverpool Drug Dependency Clinic 30 Hope Street Liverpool L1 9BX
JOHN MARKS
REFERENCES 1. Edwards G. The Meaning and Treatment of Alcohol Dependence Br J Hosp Med 1967; 2: 272. 2. Gossop M Living with Drugs. London Temple Smith, 1982 3. Madden S. Guide to Alcohol and Drug Addiction. Bristol. John Wright, 1982
West
Germany
DRUG EXPORTS TO THE THIRD WORLD: COMPANIES ACCUSED OF .
From
our
Correspondents
DOUBLE STANDARDS
Iserlohn, Westphalia, early in June, development action and groups from 12 European countries and representatives from India, Peru, the Philippines, and Rwanda discussed Health and Medicines in the Third World. The meeting, organised by the Bundeskongress entwicklungspolitischer Aktionsgruppen (BUKO) IN
consumer
Spain EDITORS OF INDEPENDENT DRUG BULLETINS FORM AN INTERNATIONAL SOCIETY
AT the end of May the European regional office of WHO and the Spanish Ministry of Health and Consumer Affairs held a meeting in Madrid of editors and publishers of independent drug bulletins produced or planned in various countries. Although the meeting was intended as a European one, many people from other continents expressed interest and came. All are trying with modest means to improve the ways in which medicines are used. They have many difficulties in common, but few understanding colleagues with whom to discuss them.
Participants in the Madrid meeting decided to form a society of editors in order to facilitate cooperation. Its first formal meeting will be in Stockholm around the time of the 3rd World Conference on Clinical Pharmacology and Therapeutics in 1986 (July 28-Aug 1). The
interim committee of the International Society for Independent Drug Information invites all editors of independent drug bulletins (ie, those which carry no drug advertising) to write for further details about the Society to the committee, c/o Dr M. N. G. Dukes, WHO European Office, Scherfigsvej 8, DK-2100 Copenhagen, Denmark.
in collaboration with Health Action International (HAI), criticised the export to the Third World of drugs that are dangerous, obsolete, or too expensive: "National drug regulatory authorities support this unethical and scientifically indefensible activity by neglect and inaction. Standards of safety and marketing for drugs on the home market should apply equally to drugs that are exported." The groups want to see effective control of drug exports from Europe.
Since the early ’70s the pharmaceutical industry’s exports to the Third World have been criticised by experts in drug therapy, by politicians from developing countries, and by groups working there. Neither the industry nor the drug regulatory authorities concerned have responded adequately to the charges of irresponsible marketing of drugs in developing countries. Examples were given to illustrate present abuses. The antidiabetic drugs phenformin and buformin were withdrawn from the market in most developed countries, including the Federal Republic of Germany, in 1978/79 because thev cause life-threatening lactic acidosis. As a result of lobbying bv the industry, however, the licences for these drugs (’Daopar’. [phenformin and glibenclamide] Hoechst; ’Silubin Retars