1924 _ TREASURY DEPARTMENT. UNITED STATES PUBLIC HEALTH SERVICE HUGH.S. CUMMING, SURGEON GENERAL . PER. CAPITA MEDICINAL. REQUIRE- ef MENTS OF NARCOTICS | DATA SECURED IN A NARCOTIC SURVEY OF _ ALLEGANY COUNTY, MARYLAND BY A. G. DuMEZ Pharmacologist Division of Pharmacology, Hygienic Laboratory . United States Public Health Service REPRINT No. 956 FROM THE PUBLIC HEALTH REPORTS SEPTEMBER 12, 1924 ( Pages 2358-2360) | WASHINGTON - GOVERNMENT PRINTING OFFICE 1924 PER CAPITA MEDICINAL REQUIREMENTS OF NARCOTICS. Data Secured in a N: arcotic Survey of Allegany County, Maryland. By A. G. DUMEz, Pharmacologist, Division of Pharmacology, Hygienic Laboratory, United States Public Health Service. _ In connection with the drug-addiction studies baine carried out . by the United States Public Health Service, a narcotic survey of ‘ Allegany County, Md., was made during the period May 8 to 28, 1924. The object of this survey was to secure accurate data on the quantities of narcotics used annually for medicinal purposes in a - restricted area, so that a reliable basis might be obtained for com- puting the requirements of the country as a whole. Allegany County, Md., was selected for this purpose for an reasons, namely, (1) pone of its remoteness from the sea coast and boundary lines, where the greater possibility of obtaining narcotics might tend to vitiate the results; (2) because the county is fairly distant from and contains no large cities in which it is thought that abnormal conditions are more likely to prevail; (3) because the occu- pations of its inhabitants are quite diversified—farming, mining, rail- roading, and manufacturing being represented; (4) because the county is easily accessible from Washington. In other words, it was thought that Allegany County represents as nearly as possible a normal unit within easy reach of Washington where conditions prevail which can be taken as typical of the country as a whole. The actual work of the survey consisted in visiting all of the narcotic registrants in the county and compiling from their records the amounts of narcotics dispensed or used during the period of one year. In all there were visited 69 physicians, 12 dentists, 20 retailers (pharma- cists), 3 wholesalers (pharmacists), 1 veterinarian, and 5 hospitals and sanitoria. The records of each were examined in detail. These records showed that for the period July 1, 1922, to June 30, 1923, the © following quantities of narcotics were dispensed or used: Taste 1.—Total quantities of opiates dispensed or used. Grains (Rak ore aka a wewas cea INEM ALG Poe ace pee Sons re 38, 937 Codeine stiiphate and phosphate... 22.6 Inc Ee ee bs ow on ok ec ee een ne nace wees 29, 410 Morphine sulphate and hydrochloride... «cts. -.2 aera ee fe sos 2 heen bee lee 22, 284 Hthylmorphine hydrochloride (dionin) _...A.3. . oS 2s 5 nn ln cn eeceseccuwsnles 4, 724 Hincotylmorphine hydrochloride: (herein). con Ss te a 2. ce eee ee eS 1, 940 E@abaniine hycrochoride (Sty purclit).s 42: eS eee ee a eee 788 BAMOnIONB Mineriy cto] Onide sa co as aoe ccm oo eee eee eet oe set woe he Sees see trnee 93 Fl. oz. Exempt preparations (paregoric, Bateman’ s drops, Godfrey’s cordial, ote. NYE Se ae ie eas ee Ste 10, 366 Total cocaine dispensed or used. PELoe atic ur hOGMlLorilit se Sa ae sod Maia SO ot ie tea G Rade 8 Gee pane R ee oa ak ony: 11,485 - 1 Reprint from the Public Health Reports, vol. 39, No. 37, Sept. 12, 1924, pp. 2358-2360. 2 j 12889—24f MEDICINAL ' NARCOTIC REQUIREMENTS. _ 3 The equivalents of the foregoing quantities in terms of crude drugs are given in Table 2..:In computing these equivalents the amount’ of anhydrous pieanduike present in opium has been taken as 10 per cent, of anhydrous codeine as 0.3..per cent; and of narcotine as 5 per cent. In computing the opium aqaifalent of the total quantity of opiates 855 grains of codeine sulphate have been subtracted from the 29,410 grains of codeine sulphate and phosphate, as this quantity can - be extracted (on the 0.3 per cent basis) from the opium required to manufacture the stated quantities of morphine sulphate and hydro- chloride, ethylmorphine hydrochloride, diacetylmorphine hydro- chloride, and apomorphine hydrochloride. Likewise, the 788. grains of cotarnine hydrochloride have been omitted, as the quantity of narcotine which can be extracted from the opium required to manu- facture the foregoing alkaloids and their derivatives is more than sufficient (on the 5 per cent basis) to yield this amount. In com- puting the coca leaf equivalent of the quantity of cocaine hydro- chloride used, the yield of anhydrous cocaine has been taken as 0.5 per cent. ; TABLE 2.—Opium equivalents of opiates. Grains of opium. 88, 987 grains of opium = 38, 937 28, 555 grains (29,410—855) codeine sulphate = 213,219 22, 284 grains morphine sulphate = 167,130 4,724 grains ethylmorphine hydrochloride = 36, 560 1,940 grains diacetylmorphine hydrochloride = 13, 060 93 grains apomorphine hydrochloride = - $50 10, 366 fluid ounces exempt preparations == 18, 906 otal loa 3 ee eck yeas echoes 2 eer of eet eee ealete d's ee ee aes 488, 662 = 69. 81 potmnds Coca leaf equivalent of cocaine. Grains of coca leaves. 11, 485 grains of cocaine hydrochloride ; = 2,051, 220 = 293. 03 pounds The per capita consumption of opium for Allegany County on the basis of a population of 69,938 as found for 1920 by the Bureau of the Census, United States Department of Commerce, would there- fore be 6.98 grains. In the case of coca leaves, it would be 29.32 _grains. To supply the entire United States on this basis, taking the population to be 106,000,000, would require the annual importation of approximately 105,697 pounds of opium and 443,988 pounds of coca leaves. It is thought that the quantities of narcotics dispensed or used in this county represent fairly accurately the medicinal requirements at present, except in the case of cocaine and the exempt preparations. A census taken for the year July 1, 1923, to June 30, 1924, would no doubt show a much smaller quantity of cocaine used, as most of the dentists who used cocaine in 1922 to 1923 reported that they had since discontinued its use in favor of the synthetic local anesthetics. In the case of exempt preparations (paregoric), it is thought that, al- 4 _ MEDICINAL NARCOTIC: REQUIREMENTS. though ae were sold only in smallamounts (in quantities not exceed- ing 2 fluid ounces), they were dispensed too frequently in some cases to the'same individuals. It is also realized that some of the residents of the county may have purchased narcotics outside of the county (in near-by counties forinstance); butitis thought that any error in the total amounts:resulting from this cause would be counterbalanced by that introduced through the puPonaee made within the county by non-residents. Acknowledgments.—It is desired here to thank the officials of the Maryland State board of health for their cooperation in making this survey, and especially for the loan of one of their drug inspectors, Mr. Henry Bernhardt, who assisted in the work throughout. -ADDITIONAL COPIES OF THIS PUBLICATION MAY BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT 5 CENTS PER COPY V