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

58Chairman Pepper. Without objection, they will be admitted.Thank you very much Doctor, for coming today.(The material referred to follows :)[Exhibit No. 5(a)]Prepared Statement of Dr. Henry Brill, Director of Pilgram StateHospital, New York, N.Y.On the feasibility of replacing natural opium products with totallysynthetic substances in medical practice.Mr. Chairman and Members of the Committee: I am Dr. Henry Brill ofBrentwood, N.Y., and a member of the committee on alcoholism and drug dependenceof the American Medical Association and the Committee on Problemsof Drug Dependence of the National Research Council. I am also immediate pastchairman of both committees and a member of the World Health OrganizationExpert Committee on Drug Dependence. However, my statement here today ismade in a purely personal capacity and I am not here as a representative of anygroup or organization.I believe you already have testimony to the effect that as long ago as 19ol, theCommittee on Drug Addiction and Narcotics (now the Committee on Problemsof Drug Dependence), National Academy of Science-National Research Councilwas questioned about the possibility of completely replacing natural opiumproducts with synthetic substances in the practice of medicine. The answer atthat time was a qualified affirmative and, as you know, the answer today hasbecome an unqualified aflSrmative. With this I fully concur and agree that fromthe scientific and pharmacological point of view, such a substitution is entirelypracticable.The question now before your group is different from that which was posedin 1951. That question related to a state of national emergency in which it wasassumed that stocks of opium were exhausted and irreplenishable. Today thisNation is, I believe, in a secure position with respect to such an emergency andthis improvement is to a significant degree the direct result of a major coordinatedresearch effort in which the National Academy of Medicine-National ResearchCouncil Committee played a prominent role under the leadership of Dr.Nathan Eddy who was its chairman for most of that time.You are now interested in the situation with respect to a complete substitutionin a nonemergency situation and this entails consideration of an importantfactor in addition to those considered in response to your first question and Irefer to the established patterns of medical and pharmacological practice.From all personal exi^erience, I am led to believe that the synthetics are playinga large and growing role but yet it appears that the natural opium productsand their derivatives are still extensively used in spite of the availability ofheavily advertised synthetic replacements. The U.N. publication "Statistics onNarcotic Drugs for 1969," table 5, indicates that the amount of morphine convertedinto codeine actually rose worldwide from 112,350 kilograms in 1965 to146,084 kilograms in 1969 and the corresponding U.S. figures rose from 20,089to 23,084 kilograms. The increases were irregular but the figures seem to showthat the natural products continue to play a very large role in world medicineand in the United States and that the U.S. share is significant but by no meansdecisive in the overall figures.It would thus seem that any plan to influence the drug dependence field byterminating the use of natural products would call for reorientation of thisaspect of medical practice within the United States and in other countries aswell. The issue which would have to be considered includes the relative costsof the natural and synthetic products and the relative familiarity of public andthe health professions with the many characteristics of each of the variousdrugs because in practice few drugs are entirely or e.'^sentially identical. Theytend to vary among themselves as to speed and duration of their primary actionand the relative intensity and timing of their many other properties. From allavailable information, it would seem that a replacement is technically feasiblebut it would also appear that this would call for full consultation with organizedmedicine and pharmacy. In order to be fully acceptable, such a transitionwould require further research to explore the many pharmacological characteristicsof the substitute drugs in the multiplicity of clinical situations and the