http://exhibits.library.stonybrook.edu/mfp/files/original/6e9ae73f2f05fd439c2995c4af046fb8.pdf b6df40e3cb3caa7dee78178074a53f9a PDF Text Text W5 I—» ¥1 ,’ v- (" MWwW September 26, 1978 TO: HON. Mr. Justice Royal Commission New South Wales FROM: Woodward, Commissioner into Drug Trafficking Fink, M. D. Professor of Psychiatry School of Medicine, State University of Max I am New York at Stony pleased to respond to the invitation to discuss with dependence producing drugs to assist the Commission in regarding the trafficking of proscribed drugs. My its my Brook experience recommendations experience is based on a six year study of the pharmacologic effects of cannabis and cannabis derivatives, both in volunteers in the U.S. and in chronic users in Athens, Greece. I have also studied the efficacy of narcotic antagonists in the treatment of opiate dependence. In these studies, begun in 1966 and continued to 1973, I have administered heroin, methadone and levomethadyl to opiate dependent subjects; and examined the pharmacologic interactions of the narcotic antagonists cyclazocine effects and and naloxone with opioids. I am.Professor of Psychiatry ate the School of Medicine at the State University of New York at Stony Brook. At the time of the studies discussed today, I was Professor of Psychiatry and Director, Division of Biological Psychiatry at the to the National New York Medical College; and a consultant Commission on Marihuana and Drug Abuse, the Veterans Administration, and the National Institute on Drug Abuse. ‘ �this time permit At me to make a number of generalizations about the pharmacology of these compounds. There distinction between opioids apparent in the studies. administration of the opioids, even under controlled conditions, is fraught with risk. into stupor Our and evinced grand mal convulsions which we deemed safe an important is immediately and cannabis which The is subjects have fallen after dosages of heroin for the individual. Seizures occurred in three suffiently striking for us to report it in the scientific literature. In my clinicial experience, three patients subjects, a finding that was died on our wards after opiate overdoses. In two instances, antagonist. and and administered naloxone, a proper the proper diagnosis made But our dosages were not sustained with the subjects died during the night. on our ward. He was some A Such programs in tales are New common. There was a still new, city, It was York were almost every day in the a young addict achieviaggthe age of that A we young man visitor passed The dose was anticipated (or his tolerance had been reduced died during the night, on a medical service. narcotic methadone was drug-free to be discharged the next day. heroin which he injected that night. had sufficient frequency third instance, a detoxified by decreasing doses of who had been we him higher than he by our treatment) and he time, when the methadone read of a methadone death said then that the likelihood of 30 if he were taking opioids at the age of 21 was less than fine in ten. By We contrast, we have found cannabis to be relatively benign. have reported the central nervous system effects in as well as the development of its administration tissue tolerance; but the principal effects �-3in_the cardiovascular and nervous systems are well tolerated, well within the ability of most subjects to accept and survive. For this difference alone, the response of Society to cannabis ought to be different than the response to opioids. In the studies of long term users of hashish in Athens, were struck by their focussed interest on cannabis (hashish). Despite the fact that they had used hashish for more than interest in smoke we and experimentation with opioids was 20 years, their insignificant. They did tobacco in large quantities and did use alcohol. In no instance to were we able document the combined use of hashish and opioids. While such obserbations are not compelling, they do suggest that the connection is probably not inherent in the pharmacology of the drugs, but in the propinquity of the distribution systems. If one is looking for a synergistic use of drugs, we can suggest that cannabis between opioids and cannabis 'and tobacco are clearly used together Perhaps the most antagonists. 3 When / I first by long-term users. interesting studies are those with narcotic became acquainted with the subuect of opiate dependence, four competing theories of treatment were current: abstinence after detoxification, abstinence in the framework of group therapy, cross tolerance to methadone, and blockade by narcotic anttgonists, chiefly cyclazocine. Abstinence after detoxification was a temporary e expedient with an unacceptable relapse rate; abstinence in a group therapy setting was helpful to a very small to implement. The sample of users and very expensive principal treatments antagonists. working with were methadone and methadone and its the narcotic long acting analog, levomethadyl, I found these regimens of limited usefulness. Proper use of methadone did not preclude the use of other drugs such as opiates, barbiturates, alcohol, �and cocaine, and methadone these drugs into the some find extensively. Spillage of additional source of opioid deaths community was an and dependence. we did in were used substitution useful methadone and levomethadyl patients, but our successes were few --- too few or to be considered a success in relation to our costs. to be gratifying Our greatest energy was dedicated to cyclasocine therapy, which I thought was a logical treatment detoxified and this regimen, patients are first in a drug-free state, are gradually and prophylaxis. In after a few days introduced to single daily doses of cyclazocine. This narcotic antagonist has a long duration of action and after a few weeks, single doses of four to five mg are sufficient to block the effects of heroin for more than 2h hours. Thus, patients who up to are on a maintenance dose of cyclazocine have no euphoria or sense of well being heroin and we 25 mg after believed that this negative reenforcement would lead to disuse of heroin and eventually to an end of dependence. But we found many problems with the treatment, the principal one being the 5 2 .; need for voluntary comjliance by the subject daily for a number of years, and few --- he must take the medication patients are so cooperative as to complete a satisfactory treatment course. Lately, other antagonists have been studied, the best known being naltrexone, which is safer and easier to use than cyclazocine. The reason for raising the question of the antagonists is the perspective they give to the medical management of opiate dependence -— there are ways to treat dependent subjects but each method ultimately depends on the cooperation of the subject, something that is difficult to achieve. These experiences with users have made me our ability to solve the opiate dependence problems pessimistic about by present medical or legal means. Opiates are dangerous substances and they should be �-5controlled in their distribution. One wonders, however, whether driving users to the streets has been successful, and whether relaxing controls for greater medical usage may not have some benefits. I am acquainted by reading only with the mixed picture presented by the English regulations for the use of opioids, and despite their difficulty, on balance I think that they are more sensible than the laws in New York, where phsyicians are enjoined from using opioids other than for methadone maintenance in established clinics. I think the present rules away from any the illicit experience with opioids and have driven most made most ptactitioners users dependent on marketplace. Finally, the most extensive experience I have had is with chronic users of hashish in Athens. There, a team of scientists from the New York Medical College and to study a group of The worked together h? hashish users and a matched sample of controls. users were the survivors of a larger sample of chronic users of hashish which ‘ the University of Athens at the was known to the scientists at the University of Athens end of the second World War. We found that the users showed little toxicity -- they were no different from controls in medical or neurologic status, or in tests of brain function. There were some differences in psychologic tests which seemed related to their education. evidence of individuals classify as psychopaths -they were willing to flaunt the law for gratification of their senses. We did find that they had developed a tolerance to the pharmacologic But they were effects of cannabis. 150 mg we would probably They could smoke hashish containing more than THC-delta—9 and develop greater than the effects of doses (over 100 mg in naive subjects. 10 euphoria and cardiovascular responses no to 20 mg doses in our volunteers. Such THC-delta-9) are known to cause vascular collapse we attempted to demonstrate withdrawal symptoms, but �-6the subjects were willing only to remain under our care for three days without smoking cannabis. In this time, we could not demonstrate the classic signs of physiologic withdrawal, but then, perhaps, their inability to cooperate was in itself a symptom of withdrawal. The conclusions of that study were many, but the principal one was that we had failed to find evidence of toxicity for cannabis use. Similar dindings in CostarRica and Jamaica reassure us that our very observations were not spurious. Further studies of this nature were reported at the conference on chronic hashish use held in 1976 at the New York Academy of Sciences (volume 282). These are my experiences. I have lectured often on the problems of cannabis use, and I have come to believe that the greatest risk in my community from the use of cannabis is the risk of legal penalties and imprisonment. There is also a risk of other substance use, since the present distributors of cannabis are acting in defiance of the law, and they seem as willing to sell cocaine, and other abuse substances as to which legalized alcohol and medical risks -— and tobacco same on distribute opioids, sell cannabis. A society substances with well defined toxicity should legalize cannabis as well. For consistency, prescription of cannabis should be and alcohol; -— and accompanied by legalization of the latter proscription of tobacco two drugs should lead to the treatment for cannabis. There is no other rational position based the available evidence. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Correspondence to: Woodward, Hon. 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