SLEEPLESSNESS AND DRUGS

Waipa Post, Volume 48, Issue 3471, 26 May 1934, Page 10

SLEEPLESSNESS AND DRUGS

DOCTORS DIFFER

(By a Medical Correspondent to a

London Paper.)

Disagreement among leading menubers of the medical profession is not a new thing, but the topics about which doctors argue amongst themselves are not always of great imt portance to the general public. At present, however, there is proceeding a controversy which has considerable interest, for patients, and since both leading medical weekly journals are now devoting columns to the subject (it. seems an appropriate moment to set out the two sides to the qase. The argument has been termed “ the battle of the barbiturates,” since it is taking place round the proper place in medicine of the group of drugs derived from barbituric acid. The immediate trouble dates from a discussion held at the Royal Society of Medicine last December, but the difference of opinion occurred long before that, and, indeed, the affair has been smouldering- for many years. On the one hand stand the physicians concerned more especially with disorders of the nervous system, who hold that the powers of the barbiturites in promoting sleep and in calming down over-activity of the nervous system (that is, stopping convulsions) cannot be rivalled by any other drugs, and that their use is essential and should be carefully taught to all medical students.

On the other side—consideraly less in numbers, but holding, so to speak, certain key positions—it is held that these drugs are so dangerous that they are such frequent weapons in suicide, that addiction is so comimon that their use should be hedged round with the most stringent legislation. The doctors who are in daily touch with patients suffering from psychological troubles are very keen to have the use of the barbiturates under proper control, but they do not wish to have a new set of irksome regulations for limiting their use. All will agree that it is probably undesirable that drugs which are certainly potentially dangerous should be sold over the counter in chemists’ shops—as is done in defiance of the existing law. The fact that there have been moi*e suicides recently due to this group of drugs is only to be expected since twould-be suicides usually adopt a popular method.

As far as can be ascertained from the figures, less than 1 per cent of all suicides can be in any way attributed to these drugs. The whole point of the matter lies in the margin of safety between the dose of a barbiturate derivative which is effective and a dose which is dangerous. For some of the drugs this margin is small, for others it is reasonably large in comparison with other sedative drugs. Self-dosage with these drugs is certainly one aspect of the controversy about which there is agreement—it is a dangerous practice. It would also be agreed that as far as possible the total amount of the drug ordered at any one time should be kept below the fatal dose. It has also been argued that the prescription for such drugs should always be marked “Not to be repeated.” It is with reference to the lastnamed suggestions that the interests of the public come into the arena. The Poisons Board, set up under the Pharmacy and Poisons Act of 1933, is said to be considering the matter, and while it is hoped that something Avill be done to lessen the risks of accidents and suicides from these drugs, it is also important that it is not made too difficult for the patient who cannot sleep to secure relief. Probably a-s much harm is done from not. giving such drugs early enough to such sufferers as from giving them too early.