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

30rally in opium. By indirect, the substances which are derived frommorphine and codeine by modification of one sort or another, suchas hydrocodone, hydromorphone, oxymorphone, oxycodone, andheroin, which, of course, is paramount in the problems of drugdependence.Let me start off by saying unequivocally that the natural opiates,direct and indirect, can be replaced by synthetic substances presentlyavailable. I am not alone in this belief. Dr. Seevers has already sostated and I believe Dr. Brill will concur in this opinion. Also, asDr. Seevers indicated, the Committee on Drug Addiction and Narcotics,now the Committee on Problems of Drug Dependence of theNational Research Council, has on at least four occasions adoptedresolutions, the sense of which is the same.Referring to the descriptions which were in the statement preparedfor the committee on specific alternates, these cover a wide range, notso wide strictij speaking from the chemical standpoint, but a widerange in potency when we think in terms of dosage only. There are alsosome variations in the surrounding j)roperties of the various compounds.We have compounds which are several times—I am talkingabout compounds which are presently available on the market—wehave compounds several times more potent than morphine; levorphanol,for example, which is like morphine in all essentialrespects and equally dependence-producing. We have phenazocine,somewhat different chemically, which is also several times morepotent than morphine and shows a slightly reduced dependence potential.It has not become very popular because the difference is not asgreat quantitatively as hoped in the beginning.We also have potential substitutes which are less effective dosewisethan morphine. The most popular of these is Demerol, or meperidine,or pethidine. It has 40 or 50 different names around the world. It isonly about one-sixth to one-eighth as potent as morphine, thinking onlyof dosage. It is equally dependence-producing. As a matter of fact, it ismy personal opinion relative to its pain-relieving properties it has agreater dependence potential than does morphine itself.Then we have pentazocine, which is quite different from Demerolin its chemistry and belongs to a new class of compounds to be referredto in somewhat more detail in a moment. It is about one-fourth aspotent as morphine. It has essentially no physical dependence potentialor such physical dependence potential as it possesses is of a differenttype from that of morphine. It does have subjective effects which afew people have found to their liking, especially if they have beenabusing other drugs and there are a small number of cases of abuse ofpentazocine reported. Pentazocine is being accepted to a verj^ considerableextent by the medical profession: its sale is increasing and it isproving to be a quite effective compound.There is a difference in these compounds with respect to their relativeoral and parenteral use, oral and subcutaneous or intramuscularuse. The first I mentioned, levorphanol, is equally effective by mouthas by injection. Practically all of the others are less effective by mouththan by injection. Ppntazocine perhaps is another exception, the rangebetween its oral and parenteral dose is narrower than for most of theother compounds.