A historical primary source puzzle: Letter from H.J. Anslinger, US Representative to the Commission on Narcotic Drugs, to Dr Leon Steinig, Director of the Division of Narcotic Drugs, 18 January 1950, File: A2-112-M9 Drug Control – Methadone, WHO Archives, Geneva.
The substance under question is Levorphanol (trade name: Dromoran), which was, among other opiate pharmacology candidates, undergoing research at Harris Isbell’s Lexington Addiction Research Center in the 1950s. Clinical study results (on animals and humans/prisoners/addicts) were initially conflicting, but Isbell ultimately concluded that substance produces effects similar to morphine. Levorphanol later becomes a legitimate opioid used in treating moderate to severe pain in the US, though tightly controlled in its uses for other reasons.
In terms of international control, US through representative Anslinger (prohibitionist) promotes opiate pharmacology to find the perfect morphine substitute (powerful non-addictive painkiller–Caroline Jean Acker, Creating the American Junkie and David Courtwright, Addicts who Survived). For most administrators at this time, a legitimate powerful non-addictive painkiller was ok, but not a legitimate addiction withdrawal-symptom mitigating drug, even though chemically, they are usually the same thing. The context for international control in Jan 1950: the 1948 Paris Synthetics Protocol comes into force in 1949, stating that WHO is empowered to decide on a substance if it is proven to have addiction-liability or is chemically convertible into an already controlled narcotic under 1931 Convention. Article 11 of the 1931 Convention specifies a procedure of how trade in opiates should be tightly restricted to medical and scientific purposes.
Why is Anslinger communicating Isbell’s study results to WHO in 1950? In terms of the administration of international control, according to Article 11 of the 1931 Convention, he needs to communicate to UN when/how much morphine is being imported for research purposes, which he is then supplying to Isbell in Lexington (as Acker showed). However, under the new Synthetics Protocol, levorphanol is convertible to morphine through chemical synthesis, and should be subject to control. So I would guess he’s saying to WHO: before you decide to control Levorphanol because it is convertible to morphine, please consider that this might be our miracle painkiller to replace morphine, heroin, opium.
Is this anecdote historically significant? What is the need for Anslinger (who is not directly concerned with the operations of WHO Expert Committees) to transmit Isbell’s reports? As a leading addiction researcher, Isbell himself presents his findings to the WHO Expert Committees. My take is that it illustrates that Anslinger was adamant that if prohibition and tight control over new synthetics was to be achieved, there would need to be a legitimate painkiller to replace opium, heroin, morphine, etc. otherwise there would be serious cases of people undergoing treatment suddenly without a painkiller. So he’s kind of signalling or reinforcing to WHO that the Synthetics Protocol should not restrict a potentially successful non-addicting analgesic, nor should it override domestic policy, as earlier in the letter he states that this drug will be tightly controlled in federal narcotics law.
In any case, many of these controlled synthetic analgesics start to become legitimate maintenance treatments in the mid-1960s with Dole and Nyswander’s work, further backed by Nixon and Jerome Jaffe’s federal policy promoting methadone maintenance clinics in 1971 in the US. I’m guessing the clinical research of Isbell and others could have been used to argue both cases. WHO does not officially back maintenance treatment in the 1960s and really not with any enthusiasm until the 1990s with the Swiss trials and HIV through injecting drugs. I wonder when methadone and substitution medicines were added to WHO’s Essential Medicines list? Puzzled also as to why this interaction concerning Levorphanol is in a file labelled ‘Drug Control: Methadone’ – misfiled perhaps?
Apologies for the abruptness – as you can see, knee deep in book revision and enjoying it. On another category of drugs, antivirals, my article ‘Pricing Retrovir’ came out in July 2022, please see free access link below! Last days of summer - autumn is just around the corner :)