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

:;677of this subgroup is questionable." See also p. 179 : "Codeine is probably themost useful mild analgesic because it has a wide effective dosage range."2. AMA Drug Evaluations, 1971, Ch. 43, Antitussive Agents," pp. 359-360:"Codeine is generally accepted as the most useful antitussive. . . . The disadvantagesof the narcotic antitussives have led to intensive inve.stigation to findagents that are effective but relatively free of undesirable effects. As a result,a number of chemically unrelated nonnarcotic antitussive agents have been synthesizedand used clinically. Although the mechanism of action of most of thesecompounds has not been adequately studied, they appear to act primarily by a selectivedepression of the central cough mechanism. IVIany of these newer drugspossess typical anesthetic elfects, but this property does not contribute significantlyto their antitussive action. None of these antitussives has expectorantaction or produces bronchodilation when used in the usual dosage, and none ofthem is sufficiently potent for use in the preparation of patients for endotrachealprocedures. All of the newer agents are capable of reducing experimentally inducedcough, but few of them have been adequately studied in patients with coughof pathologic origin. Even though patients I'eport subjective impressions of improvement,objective measurements oftem fail to reveal a significant reduction inthe frequency of cough."3. Beaver, W. T. M.D., "Mild Analgesics in the Treatment of Pain," .") ModernTreatment 1094 (Nov. 1968). "Codeine is therefore, a very flexible drug inthat the physician may adjust the dose within wide limits to cope with a considerablerange of pain intensity." (p. 1110) "In summary, oral codeine is aneffective mild analgesic of proven merit with substantial versatility in terms ofuseful dosage range ... In view of a time-tested record of efiicacy and safety,a physician would do well to consider the use of codeine before prescribing newerdrugs which ultimately prove deficient in one or the other of these virtues."4. Jaffe, Jerome H., M.D., "Narcotic Analgesics," in The PharmacologicalBasis of Therapeutics (Goodman and Gilman, eds.) 2.53,271, asserts that amongantitussives, nonnarcotic agents do not yet suffice as substitutes for opiates, andpoints out that present clinical studies are inadequate in this regard. Therefore,he concludes that "for the present, the older narcotic cough suppressantssuch as codeine, hydrocodone, and dyhydrocodeine remain the standards againstwhich nonnarcotic agents will be measured." To the same effect is Goth, A., M.D.,Medical Pharmacology 274 (1970).5. Eddy, Nathan B., M.D. (with Drs. Hans Friebel, Klaus-Jurgen Hahn andHans Halback), "Codeine and Its Alternates for Pain and Cough Relief," 40Bulletin of the World Health Organization 723 (1989) : "For most indicationscodeine is still that antitussive which is pre.scribed most frequently. A major factorsupporting its popularity is the rarity of serious side-effects and of misuse.Another may be the combination of antitussive, pain-relie\ing and calming effects,perhaps appreciated by more physicians and patients than is generallyrealized . . . On theoretical grounds several of the codeine alternates have theseproi>erties desired in a perfect cough depressant(1) they possess significant cough-depres.sing potency ;(2) they depress coughs of different pathological origins(3) their frequency of side-effects is no greatei-, i^erhaps less, than forcodeine ; and(4) they are devoid, or practically devoid, of abuse liability."For none of them, however, is our quantitative and practical knowledge completeenough to establish therapeutic priority." (p. 728)Citing Dr. Seevers, Dr. Eddy also states ". . . codeine can be replaced in certainsiiecified and limited situations, but : Judging from the continued popularityof codeine among physicians and laymen alike throughout the world in spiteof the easy availability of the so-called 'non-toxic' preparations, it seems illogicalto abandon a drug like codeine which possesses, in one agent, not only antitussiveproperties but also pain relief and sedative properties which are helpfulin relieving the discomfort often associated with a cough . . . Codeine serves aneed which is not presently met by other substances ; . . . [the evidence] hardlyjustifies discontinuing its availability."[Exhibit No. 29]Statement of Arnold Becker, Public Defender, Rockland County, N.Y.This is a recommendation to Chairman Claude Pepper, for his Select Committeeon Crime in the House of Representatives for the Congress of the United60-296—71—pt. 2 2.3