The Harrison Act strictly banned the non-non-refillable prescription sale of products containing any amount of cocaine, but exempted those containing small amounts of opiates- which this 1915 JAMA editorial insisted should not.
INTERPRETATIONS UNDER THE HARRISON NARCOTIC LAW
Treasury decision 2213, issued June 7 by the commissioner of internal revenue, establishes a new ruling on Section 6 of the Harrison Narcotic Law, the section exempting certain proprietary preparations from the operations of the law. The section provides that preparations and remedies which do not contain more than 2 grains of opium or more than one-fourth grain of morphin or more than one-eighth grain of heroin or more than one-eighth grain of codein, etc., shall be exempt from the provisions of the act. The decision discusses the question as to whether or not "prescriptions" come within the definition of "preparations" or "remedies" as given in the act. The commissioner says:
The word "preparation" as generally used and understood means ready-made or prepared medicines, and the word "remedies" means that which cures or is efficacious in a specific disease or diseases under all conditions, while the term "prescription" is the written directions or recipe of a physician for the compounding or preparing of a medicine and directions for its use to meet the existing conditions in the case of a particular patient.
Under this interpretation, the commissioner holds that the exemptions in Section 6 do not apply to prescriptions written by registered physicians unless such a prescription is written for a preparation or remedy prepared in accordance with the U. S. Pharmacopeia, National Formulary or other formula, or for a "remedy or preparation" prepared under private or proprietary formula, carried in stock by a dealer, which may be dispensed without a "prescription." Accordingly, the commissioner directs that every prescription containing a narcotic drug in any quantity, unless it is for a preparation prepared in accordance with the U. S. P. or National Formulary, must have indicated on the prescription the name and address of the client, the date, the name and address of the physician and his registry number. Such prescriptions cannot be refilled, and must be kept on file by the druggist filling them for a period of two years.
This ruling draws exactly the same line in medicinal preparations that exists between ready-made clothing and clothes made to order. A preparation which is put up in accordance with a distinct formula and which is recognized as a definite preparation is exempt, provided it contains less than the minimum quantity of drugs. A physician's prescription, being written to order for an individual patient for a specific purpose, is not exempt, no matter how small an amount of the prescribed drugs it may contain. The practical effect of this decision is, that under it, physicians must include, in all prescriptions containing any opium or cocain or any of their derivatives, the name and address of the patient, the date, and the name, address and registry number of the physician.
At first glance, this decision will doubtless impress physicians as being a discrimination against them and in favor of proprietary preparations. This is true, but it is because the law, as it passed Congress, discriminated against physicians and in favor of "patent medicine." Section 6 of the Harrison law represents the political influence of the "patent medicine" manufacturer in Congress. It should never have been included in the law. Its insertion weakened the law and was due solely to the inability of the members of Congress to resist the pressure from "patent medicine" interests. This section must be repealed; so long as it stands, the Treasury Department has no choice but to enforce it. To use an exemption clause drafted at the dictation of the "patent medicine" interests to exempt physicians' legitimate prescriptions would be an absurdity. There should be no exemptions of any kind under this law. Every preparation of any kind, containing any amount of opium or cocain or any of their derivatives, should be subject to the operation of the law. Physicians have never asked that their prescriptions should be exempt. The demand for such exemption comes solely from the proprietary and "patent medicine"' interests; to satisfy these interests, the special exemption was made.
It has often been said that the best way to repeal unwise laws is to enforce them, rigidly and impartially. Section 6 of the Harrison law should be repealed at the earliest opportunity. Until this is done, it should be enforced. Physicians certainly do not wish to have their prescriptions put in the same category as "patent medicine" fakes and frauds. Let the dope-containing "patent medicine" stand on its own merits, if it has any, and let it be distinctly separated from the prescriptions of reputable physicians. With this understanding of the recent decision, the position of the Treasury Department should receive the approval of all physicians.
Another Treasury Decision (T. D. 2414, June 10, 1915), giving the interpretation of the Internal Revenue Bureau on another portion of the Harrison law, has just been made public. This decision has reference to the limitation on the professional prescription and distribution of narcotics by persons whether registered or not. The decision states that registration is limited to certain named persons, and that persons not legitimately engaged in the exercise of their trade or profession cannot legally register under the terms of the act, and has special reference to the prescription and distribution of narcotics on mail orders.
According to the decision, a party must be a legitimate producer, importer, manufacturer, seller or distributor of the mentioned drugs; likewise, a physician, dentist or veterinary surgeon can register under the act and dispense these drugs "in the course of his professional practice only." Such physician, dentist or veterinary surgeon can prescribe these drugs "when he has been employed to prescribe for the particular patient receiving such drugs" and on whom "he shall personally attend in his professional practice only," and then only "when employed to prescribe for the particular person receiving such drugs."
The decision further states that it has special application to those persons not registered as physicians who prescribe or distribute narcotic drugs or preparations on mail orders received from so-called patients or who, under the laws of the state or municipal regulations, are not permitted to practice medicine. This and the decision first referred to constitute two of the most important and far-reaching regulations in regard to the curbing of the indiscriminate sale and use of "patent" or proprietary medicines containing narcotics or habit-forming drugs. The extent of the so-called mail-order prescription cannot be estimated, but this recent treasury decision will undoubtedly have a tremendous effect on lessening this growing evil.