Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

.-' . ,/.•.335,!',,tiou. While uoue of ttie natm-al or synthetic analgesics could be classed as veryexpensive drugs, there are cost differtnials which may be significant. Finally,patients exhibiting allergic or idiosyncratic reactions to one narcotic may tolerateanother without difficulty, a fact which alone would seem to justify having avariety of alternative agents available.In view of the fact that numerous totally synthetic analgesics and antitussiveshave been available for many years and have been very heavily promotedto the practitioner by the pharmaceutical industry, the continuing relianceof the physician on opium alkaloids in particular clinical situations cannotsimply be ascribed to therapeutic conservatism. On the contrary, there is, ifanything, a general tendency for the physician to embrace the use of a newdrug somewhat prematurely in the hopes that it will provide a therapeuticadvantage over the drug or drugs which he had been previously prescribing. Drugswhich have withstood the test of time such as digitalis glycosides, penicillin,atropine, the barbiturates, aspirin, morphine, and codeine have done so becauseboth controlled scientific experiments and vast clinical experience have shownthem, in competition with newer agents, to be drugs of choice in certain clinicalsituations.The very existence of a substantial body of clinical and experimental informationabout a drug greatly enhances the value of this drug in rational therapeutics,because it delineates the full spectrum of a drug's therapeutic possibilities, definesprecisely those situations in which the agent may be of particular value, and byforewarning the physician, minimizes the likelihood of the occurrence of unexpectedadverse effects. The published world literature on morphine, and to alesser extent on codeine and nalorphine, substantially exceeds that availablefor any of the total synthetics. If these agents were to be made unavailable, thephysician, and hence the i)atient, would loose the benefit of medicine's vatst collectiveexperience with these drugs. Furthiermore, since it is impossible for anyindividual physician to become equally expert in the use of all available drugtherapies for every disease or symptom he treats, good medical practice dictatesthat the physician become thoroughly familiar with and proficient in the use ofa few of the many drugs usually available for the treatment of a particularproblem. Then, in the absence of an overriding consideration to tlie contrary, herestricts his prescribing to those agents with which he has had the most extensivepersonal experience, an approach which favors the most judicious adjustmentof dosage regimen and provides optimal therapeutic benefits whileminimizing the omnipresent risk of adverse effects to therapy. Great numbers ofphysicians routinely use opium derived narcotics and antagonists as drugs offirst choice in many clinical situations, and have develope