Foreign Relations of the United States, 1969–1976, Volume E–3, Documents on Global Issues, 1973–1976
143. Memorandum From the Director of the Special Action Office for Drug Abuse Prevention (Jaffe) to the Associate Director of the Domestic Council (Shepard)1 2
SUBJECT:
- SUMMARY OF ATTACHED MEMORANDUM
Goal of worldwide elimination of opium poppy and substitution of synthetic substitutes.
PART I:
United States policy must be clarified to reflect that the goal of the elimination of the opium poppy is still not immediately attainable, but that a limited availability of opiates will be required for the next few years’ legitimate medical needs.
PART II:
The policy of the complete elimination of the opium poppy as an absolute goal should be reviewed by the Strategy Council in order to determine the validity of the policy, clarify its goals, and define the most reasonable means of attaining those goals.
[Page 2]Attachment
Memorandum From the Director of the Special Action
Office for Drug Abuse Prevention (Jaffe) to the Associate Director of the Domestic
Council (Shepard)
SUBJECT:
- Goal of worldwide elimination of opium poppy and substitution of synthetic substitutes.
Problems: Part I—Clarification of policy in reference to medical and scientific capabilities.
Part II—Review of policy as an absolute goal.
PART I
BACKGROUND
In June Of 1971, President Nixon stated in a Message to Congress:
“It is clear that the only really effective way to end heroin production is to end opium production and the growing of poppies. I will propose that as an international goal. It is essential to recognize that opium is, at present, a legitimate source of income to many of those nations which produce it. Morphine and codeine both have legitimate medical applications. It is the production of morphine and codeine for medical purposes which justifies the maintenance of opium production, and it this production which in turn contributes to the world’s heroin supply. The development of effective substitutes for these derivatives would eliminate any valid reason for opium production. While modern medicine has developed effective and broadly-used substitutes for morphine, it has yet to provide a fully acceptable substitute for codeine. Therefore, I am directing that Federal research efforts in the United States be intensified with the aim of developing at the earliest possible date synthetic substitutes for all opium derivatives.”
CURRENT SITUATION
Numerous developments have accelerated the substitution of synthetic substitutes for opium derivatives in the United States, such as increased prescription control over opium derivatives and growing acceptance by the medical community of a number of improved synthetic substitutes. Some progress has been made in the international and foreign medical communities, primarily through the efforts and resolutions of the World Health Organization and the U.N. Commission on Narcotic Drugs. And, of course, Turkey has decided to cease the cultivation of the opium poppy, and several other nations are moving to reduce their legitimate cultivation.
However, partially because of these significant reductions in the cultivation of legitimate opium, a severe worldwide shortage of opium for medical use has developed. Increasingly severe criticism of the United States policy may be expected in the near future because of the medical shortage. In view of these facts, the United States policy concerning this matter must be clarified and up-dated, especially for the use of our Delegation to the Commission on Narcotic Drugs and other officials charged with implementing the policy.
POLICY CLARIFICATION
The ultimate goal of the policy is to seek the total elimination of the cultivation and production of the opium poppy and its derivatives. However, based on current knowledge, the immediate elimination of all natural opiates would have a serious detrimental effect on worldwide medical practice. The available synthetic substitutes fail to adequately meet medical health standards in all cases, and are neither universally accepted by the medial community nor readily available for use or experimentation in every nation. Ninety percent of the synthetic substitutes for opium derivatives are used by the ten most developed nations. The majority of the world’s medical community relies almost exclusively on opium derivatives for treating pain. Therefore, we believe that the goal of complete elimination of opium poppy cultivation must remain a “long range” goal, and that, the limited availability of opiates will be required for the next few years. Consequently, an easing of pressure for the reduction of legitimate sources where there has been little diversion is not an inconsistent policy, and, at least at this time, is essential in order to ensure adequate opium for legitimate medical needs.
[Page 4]IMPLEMENTATION OF POLICY MEDICAL USE
In order to achieve our long-range goal and eliminate the common use of opium derivatives in medical practice, the United States Government should:
- 1.
- Continue our policy of reducing the use of opium derivatives by the United States medical community. This can be achieved by continuing educational efforts, increased control of the availability of opium such as further restricting prescription controls and perhaps reducing the domestic opium quota.
- 2.
- Further efforts should be made to encourage the pharmaceutical industry to develop improved synthetic substitutes and to make them available at prices more comparable to the opium derivatives. A careful review should be made of the Government’s own purchases and uses of opium derivatives, with an eye toward switching to the synthetic substitutes.
- 3.
- A feasibility study should be made in a test hospital or other appropriate location of the absolute replacement of opium derivatives with synthetics currently available, to test both doctor and patient reaction.
- 4.
- A careful study should be made of the necessity for the continuing use of codeine in cough preparations, or other medications not intended for treatment of medium to severe pain.
- 5.
- Continuing efforts should be made to educate the international medical community as well as encourage both international and foreign initiatives in moving, toward the more extensive use of the synthetic substitutes.
PART II
BACKGROUND
Since the Presidential, statement in June of 1971, the official policy goal of the United States has been to seek the complete elimination of the opium poppy. The policy has been implemented as part of our foreign policy by increased pressure on foreign governments who permit legitimate cultivation of the poppy to reduce or eliminate that production. Turkey, of course, has removed itself completely as a legitimate producer [Page 5] and exporter, and other nations are reducing their legitimate production. The World Health Organization has conducted a study of the synthetic substitutes for opium derivatives and is continuing in its efforts to encourage the use of medically acceptable substitutes. Domestically, some efforts have been made to reduce the use of opium derivatives, as reviewed in Part I of this paper.
CURRENT SITUATION
From the beginning it was clear that there would be two types of problems related to efforts to suppress growth of the opium poppy: those related to achieving the stated goal and those that would arise if we could achieve it, some of which might vitiate all of the benefits of suppressing poppy production.
The opium poppy can be grown in many parts of the world. Presently, only India grows for legitimate export, at least eight other nations grow for their domestic medical use, and, in over fifteen others, illicit cultivation occurs. It is a labor intensive crop, and theoretically the farmers should be willing to raise other cash crops requiring less labor.
However, there are few agricultural products that are as easy to store or cost so little to transport pound for pound. The farmers are not paid large sums for the opium by illicit traffickers but even this amount is in excess of the amount they get by selling their opium through legitimate outlets where such outlets exist. As opium growth is suppressed, those farmers who take the risks involved in illegal production will find their risk handsomely rewarded, for the price of illicit opium is now about $20/Kg (or $200/Kg heroin equivalent) while the retail price in New York is more than $100,000 per kilo; therefore the price for opium could rise by 600% (i.e. to $1200/Kg heroin equivalent) without raising the price to the consumer by more than a few pennies per dose.
It is probable that the closer we come to the goal of reducing the world’s opium supply, the more profitable it will be to produce that small fraction of the total that is needed to supply the illicit market in the U.S. At the same time, the supply for legitimate purposes will be totally [Page 6] eliminated or markedly diminished. Information available to us indicates that there is already a shortage of legitimate supplies, partially as a result of the decision of the Government of Turkey to cease opium production. If our present policy prevails, this shortage which is only moderately acute at present will become increasingly severe with each passing year. It is this shortage of legitimate opium for medical use that prompts this analytic review of the situation, as well as the need for a study of the effects of the policy to date and the anticipated results of continued policy implementation.
POLICY REVIEW
In assessing current policy, we must determine the advantages and disadvantages of the overall policy goal and the various means available to attain the ultimate goal or a modified version of the same. There are several alternatives to consider.
Alternative 1.
Continue present policy (revised to reflect current medical needs, as presented in Part I of this paper) and pressure India, Pakistan, Iran and other producer nations to phase out legitimate opium production and intensify efforts to replace opium-derived medicines with totally synthetic products. This would require:
- (a)
- substantial re-education efforts for physicians worldwide. They would be annoyed and skeptical, particularly if illicit narcotics continue to be available, and
- (b)
- increased capacity to manufacture, substitute synthetic to narcotics. This would pose only a minor problem for the pharmaceutical industry in the U.S., but supplying these products to the rest of the world could raise major political problems. First, they are likely to be more costly than the products they replace. Either these synthetics will be made by the developed nations and exported to less developed nations, or we will be obligated to set up manufacturing facilities in a number of countries that now have no manufacturing capacity.
Major difficulties with the latter approach are (1) the current capacity of these countries to operate such facilities is uncertain. (2) The major concern for the long-run would [Page 7] be the possibility that the manufacturing facilities might divert these or similar synthetics into illicit traffic directed toward the U.S. (3) The availability of synthetics both in U.S. and abroad would not substantially mute the criticism of the forced move from codeine and morphine by the medical profession which continues to be skeptical, believing that suppression of poppy growth will adversely effect medical care long before it has any substantial effect on illicit narcotics traffic. In the U.S. the annoyance of the medical profession might be transmitted to patients, thereby resulting in the U.S. Government policy of suppression of codeine (for pain and cough) and substitution of higher priced synthetic becoming a major political problem. (4) This approach creates no incentive at all for countries where illicit opium is produced to allocate their own resources for its elimination or control of diversion. (5) Underdeveloped nations may well allege that the U.S. Government effort is prompted by economic and profit motivations.
Indeed, the major disadvantage of this policy as a whole is that many analysts believe that it is doomed to failure. As the world supply of opium shrinks, its value will rise and the difficulty in producing further curtailment will increase. At some point well before we have suppressed more than 90% of the supply, the value of the product will result in corruption of enforcement officials and leave sufficient areas in production to adequately fill the requirements of the illicit traffic.
Alternative 2.
Hold to present policy with respect to opium poppy, but begin intensive investigation and experimentation with a different poppy - Papaver Bracteatum. This poppy variety contains thebaine, but not morphine. Thebaine can be converted into codeine which is the major medical use of opium products. Thebaine cannot be converted into heroin. It can conceivably serve as a substitute crop for the opium poppy since it grows wild under similar agricultural conditions.
The major problems with this approach are the potential illicit uses of thebaine. Thebaine can be subjected to a chemical process that yields a narcotic (etorphine) that is at least 300 times as potent as heroin (on basis of weight). Thus 2Kg of etorphine might replace 600 Kg of heroin. If the synthesis of illicit narcotics from thebaine were to be developed [Page 8] by criminal elements, the United States could be held accountable for unleashing of new plague. This would occur in spite of the fact that several hundred kilograms of thebaine are already produced annually as a by-product of obtaining morphine from opium, and only 10 kilograms of thebaine is needed to provide sufficient etorphine to supply all the addicts in the United States for one year.
Alternative 3.
Revise the policy, preferably quietly and over a long period of time, to continue to permit limited legitimate production, perhaps indefinitely, for medical use in circumstances where synthetic substitutes are not medically acceptable, but continue intense pressure against illicit cultivation and production, primarily through diplomatic and law enforcement efforts to destroy the illicit manufacturing and distribution systems.
The advantage of this alternative is that it will slowly relieve us from some of the intense foreign pressure to deal realistically with legitimate medical needs and acknowledge that complete elimination of the opium poppy from the world, barring cooperation of the vast majority of the people of the world, is probably an impossible task.
The disadvantages would be primarily political (i.e. we “forced” Turkey out of a legitimate business and are now backing down) and possibly realistic (i.e. total, elimination of the poppy is possible and would help solve the heroin problem).
Alternative 4.
Abandon the basic policy entirely. Although for obvious political and diplomatic reasons we could probably never adopt this alternative, we might point out that the policy of complete elimination of the opium poppy has not proved cost beneficial to date, since the reductions in supply felt during the past two years are too premature to be credited to the elimination of cultivation and production in Turkey. The recent impact in reducing the flow of opium and heroin has resulted from increased law enforcement efforts (both domestic and foreign) on the manufacture and delivery systems.
[Page 9]RECOMMENDATIONS
Undoubtedly other alternatives and policy considerations can be suggested by members of the Strategy Council and their staff. The essential need is for the policy to be reexamined to determine its validity and the most appropriate means be determined for expressing and implementing the policy.
Certainly enforcement efforts should continue to be applied to abolish all illicit cultivation and distribution of opium, but it must be accepted that the ultimate goal of total abolition of the use of opium based medicine is at least two to five years away, and until the slow process of education in the use of synthetics and development of improved synthetics is completed, the legitimate medical demands must be met.
It is not inconsistent with this policy to soften the pressure which may be brought against India to reduce their illicit production, so long as there are no major problems with diversion, in order to ensure adequate production for world medical needs for the next few years. At the same time, it might be entirely appropriate to take more affirmative action to reduce U.S. demand, perhaps, among other means, by reduction of the domestic import quota.
The pros and cons of the alternatives available to the United States should be reconsidered as soon as possible, in light of the advances made during the few years and the changes in the problem and our approach to its solutions.