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| BOOK REVIEW |
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| Year : 2014 | Volume
: 139
| Issue : 6 | Page : 967-968 |
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WHO Expert Committee on Drug Dependence
Raka Jain
National Drug Dependence Treatment Centre All India Institute of Medical Sciences Ansari Nagar New Delhi 110 029, India
| Date of Web Publication | 4-Aug-2014 |
Correspondence Address:
Raka Jain
National Drug Dependence Treatment Centre All India Institute of Medical Sciences Ansari Nagar New Delhi 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Jain R. WHO Expert Committee on Drug Dependence. Indian J Med Res 2014;139:967-8 |
35 th Report, WHO Technical Report series, No. 973 (World Health Organization, Geneva, Switzerland) 2012. 32 pages. Price: CHF 14.00 / US$ 16.80; in developing countries: CHF 9.80 / US$ 11.76
ISBN 978-92-4-120973-1
The thirty-fifth Report of WHO Expert Committee on Drug Dependence (ECDD) presents recommendations of the committee on psychoactive substances to assess the need for their international control.
Section 1 on Revision of guidelines ensures that the WHO review process has transparency and clarity to the process and procedures as a whole, and is based on scientific and public health-related principles. In particular, it includes current best practices for assessing substances for their liability for abuse, methodology for the Expert Committee to use for arriving at its decisions, and procedures for reporting and publishing reports.
Section 2 on Work of international bodies concerned with controlled substances discusses the work of international bodies concerned with controlled substances since the thirty-fourth meeting of the ECDD. Major issues of discussion were rescheduling of oripavine, dronabinol and its stereoisomers and resolutions related to ketamine.
The third section on Critical review of psychoactive substances reviews two substances, i.e. Gamma -hydroxybutyric acid (GHB) and ketamine (INN), which were initially reviewed at the thirty-fourth meeting, and eventually recommended for a critical review.
Section 3.1 provides discussion of the Expert Committee for GHB in the context of its precursors [Gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD)]. Other issues of GHB pertaining to its identification, pharmacodynamics, discussions of its rescheduling held in thirty-first, thirty-second and thirty-fourth meetings, evidence on its abuse and dependence potential, its therapeutic usefulness, its utility for other purposes and measures taken by various countries to curb abuse were also discussed. Finally, the Expert Committee considered the implications of rescheduling this substance from Schedule IV to Schedule II of 1971 Convention in view of available data on its toxicity and dependence potential, substantial abuse liability and little to moderate therapeutic usefulness.
Section 3.2 discusses ketamine which is a (±) -2-(o-chlorophenyl)-2-(methylamino)-cyclohexanone. The issues related to critical reviews discussed in thirty-third and thirty-fourth meetings for its rescheduling, evidence on dependence potential, actual abuse and its therapeutic usefulness are also covered. During the meeting, concerns were raised if ketamine were placed under international control. It was thought that bringing ketamine under international control would adversely impact its availability and accessibility. This in turn would limit access to essential and emergency surgery, which would constitute a public-health crisis in countries where no affordable alternative anaesthetic is available. Finally, the Expert Committee did not recommend ketamine under international control.
Section 4 on Pre-review of psychoactive substances discusses the nine substances. Sub-section 4.1 on dextromethorphan (PINN) which is the d- isomer of the codeine analogue methorphan. It does not act through opioid receptors. It is widely used as an antitussive agent. Keeping in view its therapeutic usefulness, rare intoxications, relatively low abuse potential and infrequent reports of dependence, the Expert Committee concluded that a critical review is not warranted at this stage.
Sub-section 4.2 is on tapentadol (INN), 3- [ (1R,2R)-3-(dimethylamino)-1-ethyl-2-methylpropyl]-phenol hydrochloride, which is a novel analgesic agent with activity at the μ-opioid receptor and norepinephrine reuptake inhibition. Together with some evidence of abuse, the Expert Committee recommended that a critical review would be undertaken.
Under sub-section 4.3 on piperazines, four of its derivatives are discussed. N-Benzylpiperazine (BZP) is a piperazine derivative with stimulant properties (including euphoric). Based on the reported psychostimulant effects, evidence of abuse, and adverse effects, the Expert Committee concluded that a critical review of N-Benzylpiperazine (BZP) was warranted. 1-(3-Trifluromethylfluoromethylphenyl) piperazine is a piperazine derivative with mild stimulant effects and hallucinogenic properties. Due to lack of animal and human clinical data on the abuse or dependence potential, the Expert Committee concluded that a critical review was not warranted at this time. 1-(3-Chlorophenyl) piperazine (mCPP) is a piperazine derivative with stimulant (including euphoric) and hallucinogenic properties. Its abuse and dependence potential in humans remains unclear. On this basis, the Expert committee decided that a critical review was not warranted at this time. 1-(4-Methoxyphenyl) piperazine (MeOPP) is a piperazine derivative with mild stimulant (including euphoric) and hallucinogenic properties. There is a paucity of data on this substance. No specific studies have been performed to determine the abuse or dependence potential.
Section 4.4 is on gamma-butyrolactone (GBL). During the pre-review of GBL, the committee noted information relating to the abuse of GBL itself (convertible to GHB in the body) and suggested this substance for future pre-review. During the pre-review of 1,4-Butanediol (1,4-BD), the Committee noted information relating to the abuse of 1,4-butanediol itself (convertible to GHB in the body) and recommended that a critical review of 1, 4- BD be undertaken.
The final section of the Report discusses issues identified for consideration at future ECDD meetings and considers other matters like the use of terms, the use of pharmacovigilance data for the assessment of abuse and dependence potential, balancing medical availability and prevention of abuse of medicines manufactured from controlled substances, and improving the process for substance evaluation. The Report is supported by 28 references and has an annexure in which terms such as drug abuse, drug dependence, dependence potential, abuse potential, etc. are defined. Overall, the Report is very informative for the readers.
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