Tranquillizers placed under controls.

On the basis of a recommendation by the World Health Organization (WHO), the Commission on Narcotic Drugs has decided to place 33 widely prescribed tranquillizers, known as benzodiazepines, under international control -- requiring, among other restrctions, that they be dispensed only by prescription.

Foremost on the list is diazepam, a psychotropic drug sold under dozens of brand names, including Valium. Among other brand names are: Alboral in Mexico; Anding in China; Anzepam and Calmpose in India; Dialag in Switzerland; Pacitran in Brazil; Saromet it Argentina; Sedavil in Japan; Sedapam and Tensium in the United Kingdom.

This class of drugs -- used to lessen anxiety, to induce sleep and to reduce muscular spasms -- has proven therapeutic value, but has been shown to be dependence-producing. Misuse and abuse lead to public health and social problems, according to WHO.

The recommendation to place these tranquillizers under international control follows a year-long, drug-by-drug review by WHO of all benzodiazepines available commercially at the end of February 1983. Data from a number of sources, including industry and Interpol, served as a basis for the recommendations.

As part of the WHO review of this class of drugs, requests for information on various benzodiazepines were sent to all States.

Many countries did not feel that abuse of these substances was a serious public health problem, although in some countries there had been a definite and rapid increase in the number of abuse cases. Sweden, for example, noted that the abuse of hypnotic-sedative drugs was almost of the same magnitude as that of abuse of alcohol. Such abuse, some countries noted, could impair driving ability or diminish the capacity for work.

Most countries indicated that preparations containing benzodiazepines could only be sold on medical prescription. In the opinion of the United States, these drugs were very safe "when used at therapeutic dose levels". The United States and several other countries were of the view that risk of abuse rises significantly when benzodiazepines are used in conjunction with other drugs or with alcohol.

Pentazocine: WHO had also made a recommendation concerning the inclusion of pentazocine, a pain-killer, under Schedule III of the 1971 Convention on Psychotropic Substances. It based its recommendations on evidence demonstrating that pentazocine had the capacity to produce a state of dependence and central nervous system changes resulting in disturbances of mood and behaviour. WHO said it was being abused and constituted a public health and social problem, warranting the placing of the substance under international control. In the United States, pentazocine is sold commercially under the name "Talwin".

The Commission had first decided to include pentazocine in Schedule IV of the 1971 Convention, but then reconsidered the matter and voted (34 to 1, with 5 abstentions) to include it under the more stringent control of Schedule III. This would require that it not only be dispensed by prescription, but that it also be subject to more detailed record-keeping. Alfentanil: In response to a notification from the Government of Belgium, WHO had examined relevant evidence and found that alfentanil had a pharmacological profile closely resembling that of morphine. There was a general consensus to include alfentanil in Schedule I of the 1961 Single Convention on Narcotic Drugs.

These actions were taken at the eighth special session of the Commission on Narcotic Drugs, which was held at the Vienna International Centre from 6 to 10 February. This was the first Commission meeting since its membership was enlarged under a 1983 resolution, from 30 to 40 as of 1 January 1984, (E/1983/5) Drug Abuse Toll

Tamar Oppenheimer, Director of the Division of Narcotic Drugs, gave the Commission an overview of the drug abuse situation. She said the provisional figures from only 14 States of Western Europe for 1982 had recorded nearly 1,400 deaths connected with drug abuse.

Regarding illicit traffic in benzodiazepines, most seizures had been of substances diverted from licit sources.

The Commission decided to place these substances under Schedule IV of the 1971 Convention on Psychotropic Substances. At the international level, substances placed under Schedule IV require licences for manufacture, trade (both export and import) and distribution. They may be dispensed only by medical prescription and reports are required on quantities of drugs manufactured.

As with the 1961 Single Convention on Narcotic Drugs, the Convention on Psychotropic Substances comprises four schedules, Schedule I being the most stringent. The 1961 Convention is designed to cover drugs primarily derived from plant raw material, whereas the 1971 Convention deals with psychotropic substances.

"This death toll must be added to the destruction of the talent and promise of many young people", she continued. Greater emphasis must be placed on preventive measures, in addition to reducing illicit supply and manufacture and interdicting the illicit drug traffic, she said.

The Commission also considered the report of the International Narcotics Control Board (INCB) for 1983. The President of the INCB, Professor Victorio V. Olguin, said the controversial views regarding the alleged harmlessness of the nonmedical use of cannabis had unfortunately contributed to the important increase in the abuse of that substance.

"In the interest of their own population, Governments of countries where these debates are still going on should carefully consider the consequences which have resulted from a permissive attitude in other countries", Mr. Olguin stated. The Commission requested INCB assitance in reducing excessive stocks of licit opiates and poppy straw.

A resolution was also adopted recommending that Governments consider all appropriate measures needed to confine the cultivation and licit use of cannabis products to medical and scientific purposes. An accelerated long-term study of the effects of cannabis on humans was also recommended.

Drug Abuse Control Fund: giuseppe di Gennaro, Executive Director of the United Nations Fund for Drug Abuse Control (UNFDAC) described the Fund's recent activities. The Commission commended UNFDAC'S efforts in combating the spread of drug abuse worldwide. Several speakers cited projects successfully carried out with assistance from UNFDAC, such as law enforcement and treatment in Egypt, introduction of crop alternatives to opium poppy in Pakistan and Thailand and national and regional master plans in the Andean subregion.

Italy, whose primary concern was coca production in the Andean subregion, announced a special-purpose contribution of about $41 million over a five-year period in support of UNFDAC'S programmes.

The following officers were unanimously elected by the Commission: as Chairman, Istvan Bayer (Hungary); Vice-Chairmen, Maurice Radrianame (Madagascar) and Mairaj Hussain (Pakistan); and Rapporteur, Benjamin Huyghe-Braechmans (Belgium).

THE REGIONS

In its 1983 report the International Narcotics Control Board (INCB) gives special attention to countries in which problems relating to drug abuse, illicit trafficking and uncontrolled or illicit production of narcotic raw materials are most acute, or where developments are of particular interest to the international community.

Some developing countries are at very high risk from the use and abuse of drugs, partly because they do not have the resources to effectively control the importation and distribution of drugs for medical use. The international community should be prepared to render prompt assitance in this area, the Board stated. Governments of the countries concerned were advised to study Mexico's successful programme to locate and destroy illicit poppy and cannabis cultivation.

Following are regional situations as described by the INCB:

Near and Middle East: The Board noted that over 50 per cent of the heroin consumed in North America and over 75 per cent of that consumed in Western Europe originates in this area. Use and dependence among the local population have been spreading rapidly, particularly in Pakistan. The cultivation and abuse of cannabis continues, Lebanon being the main source of cannabis resin from this region. The abuse of psychotropic substances diverted from the licit trade is also rising.

The Board's view is that only the eradication of uncontrolled and illicit opium poppy cultivation will contain the rapidly growing heroin abuse problem in the region. the regional governments are making determined efforts to control production, trafficking and abuse of drugs, the Board said. The efforts of Turkey had been particularly effective.

South Asia: The Board expressed concern about illicit production in the region and its use as a transit area for illicit trafficking. Populations in transit countries are at high risk. Both India and Sri Lanka are mainly transit countries for opiates and cannabis resin, although in Sri Lanka there is also local illicit cultivation of cannabis.

Cannabis is grown extensively in Nepal and a wide range of drugs is available in the country due to insufficiently strict airport controls. Drug abuse among the local population calls for improved treatment facilities.

East and South-East Asia: The region continues to be a major source of illicit opiate production, trafficking and abuse. There is also abuse of imported psychotropic substances. A Board mission visited several countries in the region to obtain information on the efforts of authorities to control drug abuse. Effective action at the national, regional and interregional levels has resulted in the apprehension of traffickers, seizures of large quantities of drugs and destruction of illegal laboratories. However, "the dimensions of the opiate production problem requre accelerated efforts to provide poppy farmers with alternative ways to earn their livelihood and to destroy illicit cultivation."

The bulk of the opium produced illicitly in this region originates in Burma and is transported mainly through Thailand to other countries in the region and beyond. Increased co-operation between these two countries has caused major disruptions to the producing and trafficking organizations. Both countries, with the assistance of the United Nations Fund for Drug Abuse Control (UNFDAC), are developing crop replacement projects for poppy farmers. Opiate abuse continues in both Burma and Thailand.

Singapore, due to stringent law enforcement measures, has managed to contain the trafficking problem, although cannabis and psychotropic substances continue to be abused.

Malaysia continues to be a centre of trafficking in opiates, mainly from Thailand or Burma. The local drug abuse problem has escalated rapidly, particularly among the young. Law enforcement and preventive education activities have been increased with the assistance of UNFDAC.

Heroin, brought by sea from Thailand, continues to be easily available in the Territory of Hong Kong despite large seizures. Preventive education programmes and treatment for the local addict population are provided by community and government agencies. New, more stringent legislation is aimed at the financial operation of drug traffickers.

Far East: China had invited a delegation of the INCB to have discussions with authorities concerned with drug control. The Chinese have indicated their intention to increase their participation in the international drug control system, which is considered essential to achieving full international co-operation.

The most serious drug abuse problem in Japan involves stimulant substances. Although the total number of abusers is small, the recent rate of increase has been steep. Organized crime is involved in the trafficking of these substances and law enforcement measures have been strengthened.

Eastern Europe: Drug abuse, although not widespread, usually involves psychotropic substances which are diverted from licit channels. The main control problem is the illicit transit of narcotic drugs across the territories of the region, which these countries are endeavouring to suppress.

Western Europe: Illicit drug trafficking and abuse continues to increase steadily. Cannabis abuse is very widespread with the Near and Middle East being the main source. Both heroin and cocaine are widely available despite recent large seizures. The availability of psychotropic substances is also causing concern. However, since some countries in the region have recently passed new regulations for the control of these substances, it is hoped that there will be a marked decrease in their availability.

In view of the growing illicit trafficking and consumption of drugs in this region, the Board feels that political support for action against drug abuse is vital as is inter-regional co-operation between enforcement agencies. It said the permissive attitude in some countries is a threat to international drug control.

North America has serious and multiple drug abuse problems. Cannabis is the most prevalent drug of abuse in Canada, where preventive education programmes and treatment and rehabilitation activities are receiving increasing attention. Heroin and cocaine, however, are becoming increasingly available and diversion of legally obtainable opiates also takes place.

In the United States, there has been a rise in heroin abuse, and abuse and trafficking in cocaine continues to escalate. Although cannabis is still the most widely used drug, there is a continued decrease in its use among high school seniors. Nevertheless, its widespread availability remains a cause for concern. Stimulants, sedatives, depressants and hallucinogens are also available for abuse, the sources being domestic illicit manufacture, diversion from licit channels and smuggling from abroad. In order to combat this serious problem, the United States is making major efforts in the areas of education, prevention, treatment and rehabilitation. In addition, extensive campaigns have been launched to suppress drug smuggling and to eradicate domestic cannabis.

Within the same region Mexico has taken an early and comprehensive approach to drug abuse and control. The authorities are persistent in their efforts to eradicate domestic cannabis and opium cultivation and have also made large seizures of cannabis and cocaine. Cannabis abuse remains widespread, however.

Caribbean, Central and South America: The region is the world's chief source of cocaine, a major source of cannabis and a transshipment point for methaqualone. The Bolivian and Peruvian Governments have plans to initiate effective programmes to decrease the production of coca leaf by diversifying agricultural production. A particular problem in the countries of Bolivia and Peru is the deeply ingrained habit among the rural populations of coca leaf chewing. Bolivia and Peru have recognized its harmful effects and the need for its suppression.

The authors of the 1961 Single Convention on Narcotic Drugs recognized that the immediate eradication of coca leaf chewing was not feasible and allowed a period of 25 years from the date of entry into force of the treaty in 1964 for the progressive elimination of the non-medical use of coca leaves. "However, the reality of the present situation indicates that the abolition of coca leaf chewing will not be feasible by 1989. Accordingly, the long overdue steps in this direction should be initiated promptly."

The Board recommends that "Governments should lay down as soon as possible a phased plan and a target date so that the habit may eventually be suppressed. In support of such efforts the sustained assistance of the interational community is of paramount importance."

In Colombia coca leaf cultivation appears to be spreading; indeed land is being cleared and used for this purpose. Colombia also continues to be the main supplier of cannabis, the cultivation of which may also be increasing. Destruction of several millions of coca and cannabis plants has taken place and further cannabis eradication and coca control programmes are envisaged. Nevertheless, given the serious situation in Colombia, especially with regard to coca leaf cultivation, the authorities were urged to prevent further spread of cultivation of these plants.

Brazil has become an important transit country for cocaine and for chemicals needed for its illicit manufacture. Controls have, however, been imposed on trade in these chemicals. Both psychotropic substance and cannabis abuse by the local population are causing concern.

In the Caribbean, Jamaica is an important centre fvor illicitly cultivated cannabis. In addition to cannabis abuse, cocaine abuse is emerging among the local population. The report indicates that vigorous action is required to counteract both the cultivation of cannabis and its trafficking, which is extensive. In other parts of the Caribbean there is a considerable amount of sea-borne trafficking, and islands are used as refuelling stations for vessels smuggling cannabis from Colombia. The Central American countries continue to be used as transit areas for illicit trafficking, and there is also some illicit opium poppy and cannabis cultivation.

Africa: Available information indicates that the absence of adequate control facilities is attracting illicit drug traffic, although its magnitude and that of drug abuse is still not fully known. Attempts are being made to establish Africa as a source of cannabis, as a market for psychotropic substances and as a transit area for illicit traffic in these substances. These attempts should be contained before they become serious problems, the Board said.

Drug abuse is not extensive in Africa although the use of cannabis is increasing, especially among the young in urban areas. The cultivation of cannabis is also increasing. Manufactured drugs from outside the region are being introduced into some African countries and their abuse is causing concern.