The Pharmacological and Epidemiological Aspects of Adolescent Drug Dependence. Proceedings of the Society for the Study of Addiction, London, 1 and 2 September 1966

515 Pages·1968·11.78 MB·English

by  C. W. M. Wilson (Eds.)

The Pharmacological and Epidemiological
Aspects of
ADOLESCENT
DRUG DEPENDENCE
Proceedings of The Society for the Study of
Addiction, London, 1 and 2 September 1966
Edited by
c. w. M. WILSON
Trinity College, University of Dublin
&
SYMPOSIUM PUBLICATIONS DIVISION
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Copyright © 1968
The Society for The Study of Drug Addiction
First edition 1968
Library of Congress Catalog Card No. 67-19415
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CONTRIBUTORS TO THE SYMPOSIUM
Simon Albury, B.A., Dr. Henry Brill,
Atlantic House, Vice-Chairman,
Holborn Viaduct, London, E.C.I. New York State Narcotic Addition Control
Commission,
1855 Broadway,
Helen Bartley,
New York,
Department of Psychology, N.Y. 10023, U.S.A.
Macquarie University,
Eastwood, N.S.W.,
Australia.
Professor F. E. Camps,
President of the Society for the Study of
Professor Arnold H. Beckett, Addiction,
Head, Department of Pharmacy, The Department of Forensic Medicine,
Chelsea College of Science and Technology, The London Hospital Medical College,
University of London. University of London,
Whitechapel,
London, E.l.
David Beiles, M.S.,
Director of Education and Information,
National Association for the Prevention of Dr. K. R. Capper,
Addiction to Narcotics, Director of the Department of Pharmaceu-
520 1st Avenue, tical Sciences,
New York City, 10016,
The Pharmaceutical Society of Great
N.Y., U.S.A.
Britain,
17 Bloomsbury Square,
Dr. Nils Bejerot, London, W.C.I.
Department of Social Medicine,
Karolinska Institutet,
Industrivagen 13, James G. Coleman, M.P.S.I.,
Stockholm 60. Barrister-at-Law,
Registrar of the Pharmaceutical Society of
Ireland,
Irving S. Benjamin, M.P.S., A.M.B.I.M., 18 Shrewsbury Road,
A.I. Pharm. M., Dublin 4, Ireland.
General Manager,
Martindale Samoor Ltd, Wholesale Chemists,
Salem Road, Dr. H. O. J. Collier,
London, W.2. Director of Pharmacological Research,
Parke Davis and Co.,
Dr. T. H. Bewley, Staines Road,
Consultant Psychiatrist, Hounslow,
Tooting Bee Hospital, Middlesex, Great Britain.
Tooting Bee Road,
London, S.W.I7.
P. H. Connell, M.D., D.P.M.,
Physician,
Dr. Hans-Reinhold Bienert, The Bethlem Royal Hospital and The
C. H. Boehringer Sohn, Maudsley Hospital,
6507 Ingelheim Am Rhein, Denmark Hill,
Federal Republic of Germany. London, S.E.5.
ix
X CONTRIBUTORS TO THE SYMPOSIUM
Dr. E. E. Galal, Mr. Frank Hirschfeldt,
General Director, Committee on the Question of Addiction,
Research Control Centre, National Board of Health and Welfare,
The Egyptian Organisation for Pharma- Sub Secretary,
ceutical Chemicals, and Medical Wallingatan 2,
Appliances, Stockholm 1.
6-7 Avramos Street, Sweden.
Pyramids Avenue,
United Arab Republic.
Dr. C. R. B. Joyce,
Dr. M. M. Glatt, Department of Pharmacology and
Consultant Psychiatrist, Therapeutics,
St. Bernard's Hospital, The London Hospital Medical College,
Southall, Turner Street,
Middlesex, London, E.l.
England.
Dr. I. Kemp,
Dr. Roy Goulding,
Institute of Neuro-physiology,
Director,
University of Oslo,
Poisons Reference Service,
Norway.
Guy's Hospital,
London, S.E.I.
Dr. R. Kumar,
Dr. J. D. P. Graham,
Beit Memorial Research Fellow,
Department of Materia Medica and
Pharmacology Department,
Pharmacology,
University College London,
Welsh National School of Medicine,
Gower Street,
University of Wales,
London, W.C.I.
The Parade,
Cardiff,
Wales. Professor Ake Liljestrand,
Statens Farmaceutiska Laboratorium,
Professor Walther Graubner,
Fack,
C. H. Boehringer Sohn,
Stockholm, 60,
6507 Ingelheim Am Rhein,
Sweden.
Federal Republic of Germany.
Dr. R. C. Greenberg,
Dr. Arnold Linken,
Health and Welfare Department,
Student Health Association,
London Borough of Barnet,
University College London,
Gateway House,
Gower St.,
322 Regents Park Road,
London, W.C.I.
Finchley,
London, N.3.
Dr. R. E. Lister,
Dr. Milton Helpern, Head, Applied Pharmacology Division,
Chief Medical Examiner, Arthur D. Little Ltd.,
City of New York, Inveresk Gate,
520 1st Avenue, Musselburgh,
New York, Midlothian,
N.Y. 10016, U.S.A. Scotland.
Dr. Andrew Herxheimer,
Department of Pharmacology and Dr. Lennart Ljungberg,
Therapeutics, Chief Psychiatrist,
The London Hospital Medical College, Beckomberga Hospital,
Turner Street, Bromma 4,
London, E.l. Sweden.
CONTRIBUTORS TO THE SYMPOSIUM XI
Dr. Donald B. Louria, Mrs. Judith Piepe,
Second (Cornell) Medical Division, Social Worker,
Bellevue Hospital, 6, Dellow House,
1st Ave. and 26th St., Cable Street,
New York, London, E.l.
N.Y. 10016, U.S.A.
Dr. R. W. Rasor,
Chief, National Institute of Mental Health,
Professor A. D. MacDonald, Clinical Research Center,
Department of Pharmacology, Lexington,
The University, Kentucky, 40407,
Manchester, U.S.A.
England.
Dr. Melitta Schmideberg,
Dr. N. B. Malleson, European Editor,
Director, International Journal of Offender Therapy,
Research Unit for Student Problems, President,
Student Health Service, Association for the Psychiatric Treatment
University of London, of Offenders,
2 Woburn Square, 199 Gloucester Place,
London, W.C.I. London, N.W.I.
Dr. I. Schrire,
Mr. Dean F. Markham, Medical Director,
The President's Advisory Committee on The Research Institute,
Narcotic and Drug Abuse, Smith Kline & French Laboratories, Ltd.,
The White House, Welwyn Garden City,
Washington, D.C., Hertfordshire,
U.S.A. England.
Dr. Hannah Steinberg,
Professor R. Muelling,
Department of Pharmacology,
University of Lexington,
University College, London,
Kentucky,
University of London,
U.S.A.
Gower Street,
London W.C.I.
Miss E. C. Murphy,
Probation Officer, B. J. Thomas, F.P.S.,
Middlesex Area Probation and After-care Head of Professional Services Dept.,
Service, Allen and Henburys Ltd.,
17-19 High Street, Bethnal Green,
Harlesden, London, E.2.
London, N.W. 10.
Baron W. K. Van Dedem, Ll.B.,
Assistant District Attorney,
Dr. John Owens,
District Court of Amsterdam,
Consultant Psychiatrist,
Borssenburg,
All Saints Hospital,
Amstelveen,
Lodge Road,
The Netherlands.
Birmingham, 8,
England. Dr. G. Varenne,
L'Ecole de Criminologie et de Police
Professor W. D. M. Paton, Scientifique,
Department of Pharmacology, Bruxelles,
University of Oxford, Chef de Service de Neuro-Phychiatric,
Oxford, Universite de Gand,
England. Belgium.
Xii CONTRIBUTORS TO THE SYMPOSIUM
Professor O. L. Wade, Professor L. Wislicki,
Department of Therapeutics and Department of Pharmacology,
Pharmacology, The Hebrew University—Hadassah Medical
Institute of Clinical Science, School,
Queen's University of Belfast, Jerusalem,
Grosvenor Road, Israel.
Belfast 12,
Northern Ireland.
Dr. D. C. M. Yardley,
Professor C. W. M. Wilson, St. Edmund Hall,
Department of Pharmacology, University of Oxford,
Trinity College, Oxford,
University of Dublin, England.
Dublin 2,
Ireland.
PREFACE
THE Society for the Study of Addiction to Alcohol and Other Drugs was
founded in London in 1884 and has been studying scientific problems related
to addiction to drugs and alcoholism for the eighty-four years since its
foundation. Dr. Norman Kerr was the first President from 1884 to 1899.
Other past presidents have included Sir William Wilcox, Sir Humphrey
Rolleston, and Sir Norwood East from 1940 until 1945. In its earlier years the
Members of the Society read scientific papers which were concerned with
problems related to the actions and effects of alcohol on individuals and on
various aspects of our social structure. However, as the use and abuse of
crude and synthetic drugs has changed and developed in the population, the
Society has extended its interests and field of discussion. The Society now
aims to promote communication and spread of scientific knowledge about
dependence on drugs and alcohol, and other forms of dependence associated
with compulsive behaviour, and to encourage the systematic study of these
forms of dependence. The Society does not seek to exercise any control over
the opinion or practice of its members. Its prime objective is to further the
scientific study of the drugs which in consequence of their uncontrolled use or
abuse in society can give rise to dependence in individuals or can produce
deleterious social effects. Membership of the Society is open to medical
practitioners and to others with a professional interest in its scientific aims.
The Society holds quarterly meetings in London, and holds a one-day Sym-
posium once each year, the Proceedings of which are published in the British
Journal of Addiction.
The British Journal of Addiction is the official Journal of the Society.
Dr. J. T. Kelynack was appointed as its first Editor in 1903. Dr. J. Y. Dent,
who was well known for his work on the treatment of alcoholism with apro-
morphine, was Editor of the Journal from 1941 to 1961, and in 1962 he was
succeeded by Dr. M. M. Glatt. Under the editorship of Dr. Glatt, the Journal
is published quarterly and has expanded greatly so that it now includes a wide
range of scientific articles on all aspects of drug dependence and alcoholism.
In view of the rapid and extensive spread of drug abuse in society and the
consequent development of drug dependence which has followed and is now
apparently usurping the previous dominant position of alcohol as a drug of
dependence in Western culture, the Council of the Society decided to institute
a series of major international symposia which will be held at regular intervals
in order to discuss and assemble the available modern knowledge about
xiii
XIV PREFACE
aspects of dependence. At these meetings it intends to choose subjects for
discussion which are relevant to the problems of the times and conditions in
the culture, which require assembly of diverse information for their clarifica-
tion, and whose examination may lead to a clearer understanding, more
objective control, and effective treatment of the undesirable changes associated
with dependence in all its forms in our society. The Society held its first
International Symposium in September 1966. The subject chosen for dis-
cussion at this Symposium was The Pharmacological and Epidemiological
Aspects of Adolescent Drug Dependence, and the Proceedings of this Sym-
posium have been assembled, and edited for publication, in this Volume.
INTRODUCTION
F. E. CAMPS
IN view of the small number of people who have experience in drug
dependence from the clinical aspects, it is an achievement in itself that nearly
all those in this country who have scientific and sociological knowledge
of the subject, and also some of the leading authorities from abroad, have
contributed to the Proceedings. The contents of the Proceedings alone
indicate that the subject of Adolescent Drug Dependence is not one of
narrow restriction, but embraces a breadth of interest which includes the
clinician, the pharmacologist, the biochemist, the epidemiologist and, in all
social problems, the medico-legalist, the psychiatrist and the social worker.
The broad spectrum on which the programme for this Symposium was based
is an indication of the scientific importance of the subject which is far greater
than many may appreciate. On the other hand it may be felt that the problem
has, in this country, been seized on by the press for its sensational aspects
and this may have given to the public and the politicians a false slant about it.
The Symposium itself, and publication of the proceedings, show that by a
scientific approach the subject may be placed in its true scientific perspective.
It is no easy problem to discuss and yet it should neither be argued from a
defeatist point of view nor in an atmosphere of too much confidence.
Last year I read a paper at the joint meeting of the Pharmaceutical Society
and the Osier Society, and I think it may be of interest to you to hear what
I said at a stage when LSD was not really being seriously considered as a
problem:
"It is only recently that the consumers have come to be regarded as ill
rather than criminal, and the pedlar more criminal than the addict." If, at
this stage, we pause for a moment to examine similar drugs in everyday use,
such as coffee and alcohol, which do not suffer from the same stigma, a
remarkable resemblance to the situation under discussion in these Proceedings
will be seen.
Coffee is decent—good; a pep pill is not—bad. Heroin therapeutically
for the sick is regarded in some quarters as irreplaceable—good; as a drug
it is something best forgotten—bad. Alcohol is a social asset, and a stimulant
in illness—good; with an overdose it is a nuisance; as a disease, alcoholism
is bad and something to be swept under the carpet. Yet, in the U.S.A. there
are about five million cases of alcoholism, and even in this country at present
there are more than 200,000. These figures when compared with those of
xv
XVI INTRODUCTION
drug addiction, the source of so much publicity, are minute. This gives some
reason for thought. In the context of these curious contradictions, it is appro-
priate that the whole situation should be examined in an objective manner;
any prejudices which exist should be discarded and the whole position should
be examined anew on the basis of the information presented here.
What better subject for a controlled experiment could we have than the
problem of LSD 25 which is still scarce and almost uncontrolled, and has
potentialities for research and for treatment? It is relatively safe when used
under conditions commanding proper clinical observation. Cannabis has
pharmacological and sociological effects similar to those of LSD. However,
unlike LSD, cannabis has the pharmacological peculiarity that its active
constituents can easily be absorbed by inhalation when the resin is smoked.
This gives it a social attraction, and provides an argument for its social
use in the same way as tobacco. As pointed out in the Proceedings, isolation
of the chemically active constituents of cannabis has now put raw extracts
of the plant in the same class as opium used to be when morphine had been
isolated and identified, and the way was open for the chemist to make
modifications in the compound so that it could be investigated pharmaco-
logically under controlled scientific conditions. On the other hand both
LSD and cannabis may have serious side-effects and probably induce
psychological dependence. Therefore in order that the therapeutic and even
the social potentialities may be developed and exploited for the maximum
benefit of the community as a whole, it is essential that these and similar
drugs, which will inevitably be developed from them, should be maintained
under strict control in the future. It is quite possible that their scientific
investigation may enable us to develop valuable new tools for exploring
hitherto unknown aspects of mental activity, and provide the testing ground
for certain basic philosophies. However, as has been the case with other
drugs which have been developed for human use, such as the oral contra-
ceptives, chemical development must precede experimental pharmacological
investigation; the experimental pharmacology must precede the human
pharmacology, and limited clinical trials can only be permitted after the
human pharmacology is complete. When the safety of the tools has been
confirmed, hypotheses can be evolved to explain the mechanisms by which
the hitherto unknown parts of the human machine function. This is the stage
at which use of the new psychedelic drugs is justified for testing the basic
philosophies of man.
There is a contemporary school of thought which adopts the attitude
"If I want to do something, why shouldn't I do it?—it is a free country".
This is supported by the contention: "after all I can kill myself, suicide is
no longer a crime. If this applies to my body, why not to my brain?" If
carried to its logical conclusion, this may be acceptable provided that, in
any instance, only a single individual is involved, and that at all times he is