THE QUESTION OF RESTRICTING THE SALE OF DRUGS.
[To THE EDITOR Or TUN "SPECTATOR."] SIR,—My attention having been drawn to an interesting-sug- gestion which appeared in a recent number of the Spectator with regardto the sale of drugs likely to prove injurious if used without proper caution, I venture to hope that the enclosed description of the regnlatinne in force in.-Germany will prove of interest to you.—I am, Sir, &c.,
GEORGE P. FORRESTER, 69 Beck Straw, Darmstadt, Germany.
'The evils. resulting from the unrestricted. repetition of a pre- scription, written by the physician to meet the requirements of
a certain aspect of the case under treatment, have for some time formed the subject of discussion:3 in medical and in pharmaceutical circles. The importance of this question in relation to the public health and welfare has found due recognition in several countries, and legislation tending to prevent the abuse of certain heroic drags is in existence, the last country to enact a regulation to this effect being the State of New York.
In most countries this object is effected by prohibiting the pharmacist from repeating prescriptiona containing any powerful or habit-forming drugs, thus necessitating the patient to consult a physician each tilde. The regulations recently passed in New York are aimed against the abuse of cocaine, morphine, and opium. A prescription calling for any preparation of these drugs may not be repeated ; however, if it contains less than one-half a grain of opium or the equivalent of its alkaloids, or if the pre- scription calls for an ointment or liniment containing any of the above,: it may be refilled without further formality. The absolute prohibition of repeating every prescription contang even minute quantities of a powerful drug would entail considerable hardship, upon many chronic sufferers, and in order to avoid going to a physician in every instance to have a prescription of this kind endorsed recourse might too easily be had to some patent medicine. This consideration is expressed in the German regula- tions for repeating prescriptions ; a brief summary will show that the paternal government for which our Teuton cousins are famous is fully alive to the dangers of self-drugging.
In the first place no prescription may be repeated which con- tains any of the following drugs : choral hydrate, chloral forma- hide, morphine, heroin, cocaine, prepaiations of ethylene, amylene hydrate, paraldehyde, sulphonal, trional, veronal, or urethane. It will be seen from this list that the unrestricted sale of drugs likely to create a habit in certain sufferers is forbidden—the above are all well-known analgesics and hypnotics. A single, but very important, exception is made in the case of prescriptions calling for morphine or heroin. Provided that either is present in com- bination with other remedies, and does not itself present the most active ingredient, it is permitted to refill a prescription containing in all not more than half a grain of morphine, or a quarter of a grain of heroin. This exemption does not hold good in the case of solutions for hypodermic use—another wise restriction. Otherwise, the refilling of a prescription is limited by two con- siderations. In the first place the physician may indicate the number of times a prescription•may be repeated, or he may forbid any repetition by a remark to this effect on the prescription. This is binding on the pharmacist, inasmuch as it does not come in conflict with the following regulations. A list of potent drugs and preparations has been elaborated, and against each is indicated the maximum dose which may be repeated without formality. If a prescription containing any of the substances named in this list is presented for repetition, the pharmacist first sees whether the single dose of this agent is apparent, and, if so, whether it exceeds the amount stated in the list. In the latter cage it may not be refilled unless again signed and dated by a qualified practitioner, and this formality would have to be repeated each time before having this prescription made np. An example will best illustrate the position. The following substances are included in this list, and against each is stated the maximum repetition dose: Acetanilide '74 grains. • Caffeine ... 75 Opium ... ... 2 1/3 „ Phenacetin ... 15 „ Silver nitrate .. I grain. Tincture of opium ... 25 minims. Tincture of aconite ... 10 Sodium salicylate ... 30 grains. A prescription calling for six acetanilkle powders of 5 grains each may be repeated without formality ; if each powder contains a dose of 10 grains, the prescription must be signed and dated by a medical man before the pharmacist is able to dispense it again. Or, a mixture contains some tincture of opium, but the label reads : Td be taken as directed. This may not be repeated, as the dose of the potent preparation is not apparent. The above restrictions apply, not merely to the use of certain potent drugs in mixtures or powders, but also when prescribed in the form of eye lotions, -inhalations, hypodermic injections, and for rectal administration. The utility of the list in question is not yet exhausted, it has to fulfil another important duty. As the preparations on this list are only used for medical purposes, it follows that any person ask- ing for one of these can only intend to apply it for the treatment of some complaint ; and as they are potent preparations their use in the hands of the uninitiated may not be unattended with danger. Therefore the sale of all preparations included in this list is forbidden (even in the shape of patent medicines) except upon a duly qualified practitioner's prescription. This means that in Germany such well-known remedies as phenacetin, antippine calomel, ipecacuanha wine, to quote but a few, may only be obtained upon a prescription. The restrictions in force in Germany not only safeguard the public from indiscriminate self-drugging, they materially assist the doctor in his task.
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