Comments on the Reported Statistics on Psychotropic Substances

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Part two Deuxième partie Segunda parte statistic onPychotropic Substances Germany (4percent). followed byHungary(9percent), Denmark(8percent),theUnitedStates(5cent)and all combinedbarbituratescontinued tobeChina(accounting for 70percentofglobal output), accounted for 1,4,9and 7 percentofthetotal,respectively. Theleading manufacturer of for amobarbital,barbital,butobarbital andpentobarbital,theothermainbarbiturates,which increase inmanufacturewasreported reported byHungaryandtheRussianFederation.Asmall of loweroutput compared with2009asaresult manufacture ofthatsubstancedeclinedslightly accounted for 78per cent ofthetotalmanufacture,asinpreviousyears,although of themostwidelyusedpsychotropicsubstances. increased during thelastdecade and, in 2010,thesubstance became one as ananti-epileptic, the total.Manufactureofand international trade in clonazepam, the only benzodiazepine classified and China were the leading manufacturers of this group, accounting for 60 and 14 per cent of in2010amountedto5.5billionS-DDD. Inthatyear, sedative-hypnotics benzodiazepine-type Italy Reportedmanufactureof purposes (S-DDD). of defineddailydosesforstatistical in terms anxiolytics diazepam and alprazolam remained the mostmanufactured psychotropic substances, and the resultinganalysis of thedata on benzodiazepines. In 2010, the benzodiazepine-type manufacturing countries,inparticular India, affected the comprehensiveness of theinformation medication and the inductionofgeneralanaesthesia. Lack of data for 2010fromsomemajor medical practiceforpre- andareusedin and sedative-hypnotics 34 areclassifiedasanxiolytics some majormanufacturingand consumer countriesaremissingorincomplete. buprenorphine increasedmarkedly2009. For2010,datafrom the 1990suntil andsteadilyfrom treatment programmes for heroinaddicts. International trade in and global consumption of that is used in about 80 countries worldwide to treatpain and in detoxificationand substitution and Australia. United Statesremainedthelargestconsumerofamphetaminesin2010,followedbyCanada this group of substances in 2010,response to decreasing demand. Inabsolute terms, the France,the key traditionally output of manufacturerofamphetamines,continuedtoreduceits substances and substances not under international control,as well as for direct medical purposes. inSchedule system stimulants II,arecommonlyused for themanufactureofotherpsychotropic Canada, Iceland, the Netherlands and the UnitedStates.Amphetamines,othercentralnervous in 2010.Thecalculatedpercapitaconsumptionofmethyphenidatethatyearwas highest in substance, althoughitsshareinglobalmanufacturecontinuedtodecline,reaching82percent to increaseworldwide.TheUnitedStatesofAmericaremainsthemainmanufacturer disorder(ADD)continue of attention-deficit manufacture andmedicaluseforthetreatment Its mainly byGermany, Austriaand Switzerland (indescending order). recent years,and so hastheuseofdronabinol. For 2010,useofdelta-9-THC hasbeen reported cal variantsofdelta-9-tetrahydrocannabinol (delta-9-THC)has declinedin Schedule II, in listed schedules. Theuseofdelta-8-tetrahydrocannabinoltoobtaindronabinol,onethestereochemi- scientific researchand, in certaincases, to themanufacture of psychotropic substances in other statistical datafurnishedbyGovernments.Thequalityoftheanalysisdependsonprovided. Summary

Of the 12 barbiturates listed in the 1971 Convention, phenobarbital, an anti-epileptic, Of the 12 barbiturates listedinthe1971 Convention, phenobarbital, an anti-epileptic, A totalof35benzodiazepines arecurrentlyunder international control.Ofthem, Buprenorphine isanopioid analgesic listedinSchedule III ofthe1971Convention listed inScheduleII. stimulant Methylphenidate isthemaincentralnervoussystem Use of substances included in Schedule I of the 1971 Convention should be limited to The analysiscontainedinthepresentsectionoftechnicalpublicationisbasedon comments on the eported r

English The 14 stimulants listed in Schedule IV of the 1971 Convention are mainly used as anorectics or for the treatment of ADD. Total reported manufacture of this group of substances amounted to 1.8 billion S-DDD in 2010. Phentermine continues to be the most used substance in this group. In 2010, the substance accounted for 74 per cent of global manufacture; it was followed by mazindol (8 per cent) and phendimetrazine and amfepramone (6 per cent each). Calculated consumption of the stimulants listed in Schedule IV decreased in 2010 but continued to be highest in the Americas. In Africa, Asia and Oceania, consumption of stimulants in Schedule IV increased markedly in certain countries.

34 the manufacturethe of 3,4-methylenedioxymetamphetamine 3. At endthe atof stood 2010 they 141 g. stocks ofglobal DMA depleted became by end the of 2008. manufacture reported after has been 2007 and, as a result, manufacture inthe decrease of photographic film. No As of 2002,manufacture to started decline, owing to a for manufacture inthe use of anon-controlled film dye. tons several exceeded years inthe prior to 2002,exclusively annual manufacture of 2,5-dimethoxyamphetamine (DMA) or products. However, United inthe States of America, for manufacture the try of non-psychotropic substances psychotropic substances included Iby inSchedule indus- 2. exceptions noted in followingthe paragraphs. substancesin, those have, therefore, limited, been with the use. The manufacturemedical and stocks of, as trade well as central system nervous stimulants limited or with very no that substances all Iare inSchedule hallucinogens and/or by Governments. their This restriction resultsfrom the fact that are directly under controlthe of or specifically approved authorized personsor inmedical scientific establishments for limited scientific by purposes duly andmedical very provisionsthe of article7of 1971Convention, the except of use substances those should prohibited, be pursuant to 1. Twenty-eight substances are listed I.The inSchedule Israel, Switzerland and United the States reported The 1971 ConventionThe 1971 not does foresee theuse of Substances listed in Schedule

stocks at stood held all inUnited114 the kg, States. declined, reaching 53kgin2010.By end the of 2010,global kg in2005,manufacture of isomers of THC I inSchedule factured inUnitedthe States. After reachingpeak of 326 a main substance among isomers the Imanu inSchedule - listed II.delta inSchedule drocannabinol (delta I areSchedule manufacture in the used of delta country, isomers of tetrahydrocannabinol (THC) listed in psychotropic substances inother schedules. In that ofuse asubstance Ifor inSchedule manufacture the of 5. 27.5 kg of PMA. or no manufacture of PMA,in2010Denmark manufactured use. In contrast to 2008and there 2009,when was limited manufactured an average of 40kgof PMAannually for such international control. 2005-2007,Denmark In period the an active pharmaceutical ingredient that is not under inDenmark used forbeen manufacture the of tamsulosin, 4. stocks were held in Switzerland and Unitedthe States. endthe of 2010amounted toof 454g;almost all those countries in research projects. stocks Global of MDMA at 2006-2010. MDMA (MDMA) in those is used in period the The United Statesthe is that only country has reported para -Methoxy-alpha -9-THC), apsychotropic substance I -methylphenethylamine (PMA) has -8-Tetrahydro cannabinol is the -9-tetrahy- 35

English Substances listed in Schedule II

6. Listed in Schedule II are 17 substances that have little Amphetamines to moderate therapeutic usefulness and whose liability to abuse constitutes a substantial risk to public health. The 8. Both optical isomers of amfetamine (levamfeta- substances belong to the following groups: central nervous mine and dexamfetamine) and their racemic mixture system stimulants; anti-emetics; hallucinogens; sedative- (amfetamine), as well as both optical isomers of hypnotics; antitussives; and antidepressants. In addition to metamfetamine (levomethamphetamine and metam- their various applications in human and/or veterinary fetamine) and their racemic mixture (metamfetamine medicine, some of these substances are used in industry racemate), are listed in Schedule II. Statistical reports for the manufacture of other psychotropic substances or on amfetamine, dexamfetamine and metamfetamine for conversion into non-psychotropic substances. have been received by the International Narcotics Control Board from Governments since the 1970s. Statistics for levamfetamine and levomethamphetamine have been available since 1986, and statistics for Central nervous system stimulants metamfetamine racemate since 1988, owing to the different dates on which those substances were 7. Total manufacture of central nervous system stimulants brought under the control of the 1971 Convention. in Schedule II fluctuated in the period 2001-2010, as can be seen in figure 1. In 2010, total reported manufacture of this 9. In 2010, the quantity of amphetamines listed in group of substances continued to decrease and amounted to Schedule II that were manufactured worldwide 2.4 billion S-DDD. Of the group, methylphenidate grew continued to decline, to 16 tons (1.1 billion S-DDD), fastest, its share of total output of stimulants in Schedule II as a result of the decreased manufacture by the two rising from 22.5 per cent in 2001 to 56 per cent in 2010. main manufacturers, France and the United States, By contrast, manufacture of amphetamines decreased over which reported output of 10 and 5 tons respectively the decade. In 2010, dexamfetamine and amfetamine each in 2010, compared to a yearly average of 12 and accounted for 12 per cent of total output. Together with 14 tons respectively during the period 2007-2009 (see methylphenidate, these substances accounted for 80 per cent figure 2). In 2010, dexamfetamine, amfetamine and of the total combined output in 2010. metamfetamine racemate had almost the same share

Figure 1. Stimulants in Schedule II: total reported Figure 2. amphetamines: total reported manufacture, manufacture, by substance, 2001-2010 selected countries, 2001-2010

Millions of S-DDD 7RQV 4 500 4 000 3 500 3 000 2 500 2 000 1 500 1 000 500 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Amfetamine Dexamfetamine Year

36 into amphetamines. turer of levamfetamine, for was which used reconversion 2001-2010,France manufac sole the period was virtually - and Hungary for remainder. the Throughoutthe 10-year facture of amphetamines, United the States for cent 29per 2010, France accounted for cent 62 per of totalthe manu- respectively), followed by levamfetamine cent). (18per In of total output of amphetamines (28,27and cent 26per nian drugs (selegiline). (selegiline). nian drugs fenpro substances as anorectics used (benzfetamine, clobenzorex, addition, amphetamines have mainlyconverted been to treatmentin the of attention-deficit disorder (ADD). In amphetamine), aprodrug of dexamfetamine, is which used synthesis inthe used of lisdexamfetamine (L-lysine-d- Convention. In United the States, amfetamine is also other amphetamines included IIof inSchedule 1971 the IIareSchedule for in industry widely used conversion into France and United inthe States, amphetamines in substances not controlled under 1971Convention. the In arewhich optical isomers of substance; original the and groups: other psychotropic substances, including those manufactured from amphetamines may divided into be two other substances figure (see 3).newThe substances products as intermediary industry for manufacture the of 10. substances intermediate as Use Amphetamines Precursors narcolepsy Levamfetamine obesity or (Has nouse) ADD (Mixture ofdexamfetamineand Amphetamines IIare inSchedule frequently in used porex and levopropylhexedrine) and antiparkinso-

Direct medical use Amfetamine racemate amphetamines: use inindustry Figure 3. levamfetamine) 1-Phenyl-2-propanone lisdexamfetamine or fenproporex Dexamfetamine Clobenzorex (P-2-P) Manufacture

ADD Direct medical use

Metamfetamine or fenproporex Benzfetamine (Mixture ofmetamfetamineand Norephedrine Manufacture Metamfetamine racemate levomethamphetamine) benzfetamine Selegiline or Levomethamphetamine

Manufacture Over-the- Over-the-

inhalant counter counter nasal nasal use medical Direct

inhabitants day) per rate calculated their of (expressed use inS-DDD 1,000 per in these calculationsin these is presented intable IIIof present the publication. present publication. tropic substances is explained explanatory inthe note to table IVof the Country Country provided for 2010) tion of amphetamines on (calculated basis of the statistics (i.e. by furnished Governments) and consump calculated - 12. there are destined for export. country, amphetamines the as almost all manufactured of limited use there amphetamines medical is very inthat traditionally amajor been manufacturer of amphetamines, discontinued inmost countries. Although France has treatment of considerably obesity has been reduced or although widespread the of substances use those for the addition, are they to treat used narcolepsy and obesity, mainly for treatment the of ADD United inthe States. In 11. use medical Direct Kuwait 0.01 Croatia Belgium 0.11 Norway 0.39 Netherlands Australia 1.48 Canada Austria 0.02 Germany 0.04 Israel 0.03 Denmark 0.04 Finland 0.08 Sweden 0.28 Chile States United 2 1

T The list of defined daily doses (S-DDD)statisticalfor used purposes for Theused calculating levelsmethod of consumption of psycho- T amphetamines: calculated consumption rate, able 2. The countrieswiththe highest levels of reported For amphetamines purposes, direct medical are used amphetamines: reported consumption rate, able 1. selected countries, 2010 selected countries, 2010 1 are listed intables 1and 2inorder of 2 in 2010.

(S-DDD per 1,000 inhabitants perday) per1,000 (S-DDD (S-DDD per 1,000 inhabitants perday) per1,000 (S-DDD

Consumption rate Consumption rate 14.93 0.05 0.85 1.73 2.78 37

English Comments on amphetamines, by substance which are exempted in that country from certain control measures, in accordance with article 3 of the 1971 Con- 13. The manufacture of amfetamine gradually increased vention. In 2010, about 600 kg of the substance were used until 1998, when it reached 30 tons. After 1998, it fell for that purpose. In the five-year period 2006-2010, gradually to less than 4.3 tons in 2010, mostly in France levomethamphetamine was also used in Italy, which had and the United States. The United States subsequently been the main importer of the substance until 2008, when replaced France as the leading manufacturer, accounting it stopped importing the substance. on average for 66 per cent of global output during the period 2008-2010. For medical purposes, amfetamine is 17. Metamfetamine racemate is mainly manufactured for used mainly in combination with dexamfetamine in the export to the United States, where it is used for conversion United States. In 2010, about 81 per cent of global stocks into levomethamphetamine and metamfetamine. France (8.7 tons) of amfetamine were held in the United States; and Hungary were the main manufacturers of metamfeta- the rest was held in France. Total imports of amfetamine mine racemate in the last decade. In 2010, global in 2010 amounted to 148 kg, the main importers being, in manufacture of metamfetamine amounted to 4.3 tons, of descending order, Canada, Chile, Sweden and Germany. which France and Hungary accounted for 68 and 32 per cent respectively. Global stocks in 2010 stood at 3 tons. 14. While the manufacture of dexamfetamine was stable International trade averaged 1.3 tons in the five-year period during the 1980s, at a level of approximately 350 kg 2006-2010; most of the imports were accounted for by the annually, it rose, with fluctuations, after 1991, reaching United States. 11 tons in 2009. In 2010, it decreased sharply to less than half (4.4 tons), owing to the drastic fall of output in the Fenetylline United States, which was the only manufacturer of the substance apart from France. Although, in 2010, the United 18. During the decade leading up to 2010, the States remained the main user of dexamfetamine for Netherlands held most of the stocks of fenetylline; those medical purposes, such use was also reported in a number stocks were gradually exported to Belgium and from there of other countries, including, in descending order, Canada, to other countries in Europe. Belgium, France, Germany Australia, the Netherlands, Sweden, Norway, Belgium, and Luxembourg are the only countries to have reported Finland, Germany, Switzerland and Denmark. Global use of fenetylline for medical purposes after 2003. In 2010, stocks of dexamfetamine increased from 1 ton in 1995 to Canada and Switzerland were the only countries holding 11 tons in 2010. More than 20 countries reported imports small stocks of fenetylline (1 and 7 g respectively). of the substance, amounting in total to 508 kg in 2010. Canada and Australia remained the main importers, accounting for 53 and 32 per cent of the total, respectively. Methylphenidate

15. Since 1999, when the total reported manufacture of 19. The use of methylphenidate3 for medical purposes has metamfetamine stood at 9.5 tons, global output has fluctu- increased significantly since the 1990s. Methylphenidate is ated. Since 2008, total manufacture decreased sharply, used for the treatment of ADD, primarily in reaching less than 500 g in 2010 after France and children. It is also prescribed for the treatment of narco- Switzerland had ceased manufacturing the substance. The lepsy. The increase in the manufacture and use of methyl- main regular user of metamfetamine (mainly for industrial phenidate is mainly the result of developments in the purposes) is the United States. International trade in United States, where the substance is heavily advertised, metamfetamine has been limited in volume, fluctuating including directly to potential consumers. During the on average at about 2 kg. Nine countries reported imports period 2001-2010, the use of methylphenidate for the treat- of metamfetamine in 2010, ranging from 1 to 81 g. ment of ADD rose sharply in many other countries, such as Canada, the Netherlands and Germany. The calculated 16. In the period 1999-2005, the total reported manufac- global consumption of the substance followed an upward ture of levomethamphetamine had fluctuated between trend and reached 43 tons (1.4 billion S-DDD) in 2010. 433 kg and 4.6 tons. From 2005, manufacture dropped sharply from 4.3 tons to no output in 2009 or 2010. In the 20. Global manufacture of methylphenidate started to past, Germany, France, the United States and the Czech increase rapidly in the first half of the 1990s, from 2.8 tons Republic (in descending order) were the main manufactur- in 1990 to 19.1 tons in 1999. As a result of increasing use ers of the substance. The main user of levomethampheta- of amphetamines for the treatment of ADD, methylpheni- mine for industrial purposes was Germany; it was followed date manufacture dropped to 16 tons in 2000. After that, by the United States, France and the Czech Republic. In 3 the United States, levomethamphetamine was mainly used See table IV for details of the consumption levels of methylpheni- for the manufacture of over-the-counter nasal inhalers, date.

38 and Switzerland. with sharply increasing reported use by Canada, Iceland Israel, Switzerland, Denmark, Sweden and Norway, 2006-2010were Canada,Iceland,period Netherlands, the The main period. users of methylphenidate theduring averaged about 453million S-DDD year per same inthe The level of methylphenidatethe in use rest the of world of worldwide calculated the of use methylphenidate. 2010, that accounted, country on average, for cent 66per United States figure (see 5). 2008- three-yearthe In period expressed inS-DDD, has traditionallyhighest inthe been 22. in amounts exceeding 10 kg. and reportedtries 1territory imports of methylphenidate 2001-2010. In Governments 2010,the period of 38 coun- ing methylphenidate continued gradually during to rise the and India. The number of countries and territories import- were, indescending order, Switzerland, Spain, Germany major Other total exports. countries exporting in2010 leading and exporter in2010accounted for cent 42 per of until 2006,inthat year United the States the became Switzerland was main the of exporter methylphenidate accounted for cent 77per ofimports. global Although main importersthey of methylphenidatetogether in2010; Switzerland, Canada,Spain and Netherlands the were the 1999-2010, from 6 to period the 21 tons.Germany, International in methylphenidate trade increased during United States continued mainly to be met by imports. requirements medical the for methylphenidate outside the 21. substance in stocks, or cent 80 per of stocks. global United States. In 2010,that held country 35tons of the in 2010as aresult of an increase instocks held inthe methylphenidate continued to increase, reaching 45tons that had increased country inrecent years. stocks Global of continued domestically, used to be although from exports methylphenidatethe manufactured in Unitedthe States accounted for cent 18 per of manufacture. global Most of (together totalling 1.2tons); combined their output (3.8 tons), Switzerland (2.4tons), and Spain and Japan amounts of methylphenidate in2010were Canada The countriesother manufacturereporting of considerable did notcountry report manufacture of substance.the about that level in2009(3.2tons); however, in2010,that in 2008compared with 2006and 2007and remained at manufactured United inthe Kingdom increased fourfold slightly, to 33tons. The quantity of methylphenidate 2009. In 2010, total manufacture in that decreased country increasing its output from 1.8tons in1990to 38tons in States was leading the manufacturer of methylphenidate, the 1991-2010, period figuretheDuring (see 4). United remained stable at about 42tons2008-2010 period inthe total reported manufacture of substance the fluctuated, but Thecalculated consumption of methylphenidate, Despite increases in manufacture countries, in several

expressed in defined daily doses for statistical purposes (S-DDD) purposes for statistical doses daily in defined expressed global consumption inagivenyear.approximate Theseconsumptionfiguresare a inhabitants day) per in 2010. leveltheir of consumption (expressed inS-DDD 1,000 per provided for 2010)are listed intables 3and 4inorder of tion of methylphenidate on (calculated basis of the statistics (i.e. by furnished Governments) and consump calculated - 23. 0LOOLRQVRI6 7 RQV methylphenidate: total reported manufacture, Figure 4.

Statistical data submitted by Governmentsareusedtocalculatethe data submitted Statistical The countrieswiththe highest level of reported methylphenidate: calculated medical Figure 5. 8QLWHG6WDWHV ''' *HUPDQ\ 7KH1HWKHUODQGV 8QLWHG6WDWHV selected countries, 2001-2010 consumption, 8QLWHG.LQJGRP &DQDGD 2WKHUV 8QLWHG.LQJGRP a 2001-2010 2WKHUV < HDU < HDU 39

English Table 3. methylphenidate: reported consumption rate, countries holding stocks of the substance were Germany 2010 (12 per cent of global stocks) and Switzerland (6 per cent).

25. International trade in delta-9-THC remained limited Consumption rate in 2010. A total of 7 kg of the substance were exported by (S-DDD per 1,000 inhabitants per day) the United States, Germany, Switzerland and France (in that Country order) to 15 countries, with Austria and Canada being the United States 15.05 main importers and users. Iceland 14.78 Israel 7.37 Denmark 5.10 Sweden 4.81 Hallucinogens Germany 2.00 Finland 1.23 Chile 1.08 Phencyclidine Austria 0.44 Singapore 0.20 26. Phencyclidine is primarily used as an anaesthetic agent in veterinary medicine. After 2006, manufacture and international trade in phencyclidine amounted to less than half a kilogram per year. Table 4. methylphenidate: calculated consumption rate, 2010

Consumption rate Sedative-hypnotics (S-DDD per 1,000 inhabitants per day) Country Mecloqualone

Canada 20.21 Netherlands 16.38 27. Mecloqualone stopped being manufactured after Switzerland 5.93 1980. In 2010, global stocks of the substance amounted to Norway 5.35 a few grams. New Zealand 3.19 Belgium 2.08 Methaqualone Andorra 2.05 Spain 2.01 Australia 1.97 28. The latest significant manufacture of methaqualone was reported in 1997 by Switzerland (340 kg) and the Czech Republic (43 kg). After that, only small quantities (amounts of just a few grams) were manufactured intermittently in the United States, mainly for domestic consumption. In Anti-emetics 2010, a total of 3 g were manufactured in the United States. Global stocks of methaqualone have fluctuated between delta-9-Tetrahydrocannabinol and its stereochemical 355 g and 575 g since 2006. In 2010, global stocks stood at about 400 g, with 86 per cent held by the United States. variants Germany and Malaysia imported a total of 2 g in 2010.

24. During the period 2001-2010, manufacture of delta- 9-THC fluctuated between 106 and 318 kg. In 2010, global Secobarbital manufacture was 106 kg (3.5 million S-DDD), a slight decrease compared with the figure for 2009 (114 kg). The 29. Since 2000, Germany has been the main manufac- United States remained the main manufacturer of delta-9- turer of secobarbital. Its annual output accounted for THC in 2010 (101 kg), accounting for 95 per cent of the between 54 and 99 per cent of the global total during the global total, while Germany (5 kg) accounted for the rest. period 2001-2010. In 2010, Germany (721 kg) and Japan The majority of the delta-9-THC manufactured in the (4.4 kg) reported manufacture of the substance. In 2010, United States was for domestic consumption. In 2010, global stocks of secobarbital stood at 845 kg, held mainly stocks of delta-9-THC held in the United States amounted by Germany (65 per cent) and the United Kingdom to 364 kg, accounting for 81 per cent of global stocks; other (26 per cent).

40 group of analgesics. substances, buprenorphine and pentazocine, belong to the glutethimide and flunitrazepam. The two remaining (amobarbital, butalbital, cyclobarbital and pentobarbital), to group the of sedative-hypnotics: four barbiturates of central system nervous stimulants. Six substances belong One substance,usefulness. cathine, belongs to group the andhealth have which moderate to great therapeutic liability to abuse constitutes asubstantial risk to public Organization, substances in III Schedule are whose those to scheduling the criteria adopted by World the Health 33. turing zipeprol in1999,resumed its manufacture in2008 31. Zipeprol Germany. in 2010;it was followed by United the States, Sweden and United Kingdom remained main the of user secobarbital substance, and Sweden was main the importer in2010.The Germany continued leading of the exporter to be the S-DDD) in2008to 618kg(6.2million S-DDD) in2010. secobarbital gradually declined from 776 kg (7.8 million 30. mainly in Germany and Mexico. cathine at stood 2.4tons stocks were in2010;those held of 300kgof cathine, mainly for stocks Global of export. manufactured For inChina. reported 2010,China output outputglobal fell of in2009to all was which 55kg, in2007(5.9 tons), 2005-2007.Afterpeak a period in the until 2003. manufactureGlobal averaged 4 tons year per levels of Germany, only the manufacturer of substance the the 2001-2010,reflecting manufacturingduring period the Manufacturepurposes. of cathine fluctuated considerably 34. Cathine Nine substances are listed III.According inSchedule TheRepublic of Korea,which had stopped manufac- 2008-2010, total volume trade period the During of Cathine as astimulant is used and for industrial Central nervoussystemstimulants Antitussives Substances listed in Schedule

ties ofties amineptine (9 g) from China. Switzerland reported having quanti small imported very - tion on its manufacture reported. has ever been In 2010, IIofSchedule 1971Convention the in 2003. No informa- antidepressants is amineptine, was which included in 32. Amineptine compared with 2009.Manufacture Denmark, inChina, 905 million S-DDD figure (see 6), an increase per centof 7 butalbital, cyclobarbital and pentobarbital amounted to 37. pentobarbital and cyclobarbital butalbital, Amobarbital, clandestine laboratories. diverted frombeen licit circuits rather than synthesized in barbiturates encountered on illicit the market have usually duration of actionand potency. benzodiazepines, Like vulsant property. Barbiturates differof in speed onset, mainly as anti-epileptics used or for anticon selective their - tions (ultra-short-acting substances). Nowadays, are they in someas anaesthetics cases, for short interven- surgery prescribed forbe treatment the of anxiety and stress and, 36. (23 kg, for(23 kg, domestic only). use zipeprol in2010was Plurinational the State of Bolivia ture was reported. The only country importsreporting of and 2009for domestic consumption. In 2010,no manufac- which had been the mainthe which had importersbeen of substance.the imports were reported by Italy, Mexico and South Africa, however, averaged total exports only 1.3tons, as lower 2009and 2005-2008;between 2010, during period the of exports Global substanceChina. the averaged 5.5tons were 2006-2010; they followed period in the by India and 35. The only substance representative groupthe of of In 2010,total reported manufacture of amobarbital, sedative-hypnotics, asClassified barbiturates to used Germany and Italy were main the exporters of cathine Sedative-hypnotics Antidepressants III 41

English stance increased to 5.8 tons, which were manufactured Figure 6. barbiturates listed in Schedule III: solely by China and Japan. China accounted for 86 per cent total reported manufacture, by substance, 2001-2010 (5 tons) of global manufacture, the majority of which was %LOOLRQVRI6''' for domestic use. The total calculated consumption of the substance reached 7 tons (70 million S-DDD) in 2010. Global imports of amobarbital declined from a peak of 10 tons in 2002 to 159 kg in 2010. Thailand and the Nether- lands continued to be the main importers of the substance in 2010. China, Germany and the Netherlands were the three main exporting countries in 2010.

39. Having declined during the period 2002-2007, global manufacture of butalbital gradually increased between 2008 and 2010, from 32 tons to 36 tons, mainly because of increased manufacture in Denmark, the leading manufacturer of the substance. Another major manufacturer of the substance during the period 2001-2010 was the United States. Other manufacturing countries in 2010 included

40. Cyclobarbital continued to be mainly manufactured and used in Europe, although the quantities manufactured decreased considerably after 1998. The sole manufacturer of cyclobarbital after 2004 was Poland (its manufacture of the substance was used mainly for export), after Germany and Latvia stopped manufacturing the substance in 2003. In 2010, Poland manufactured 150 kg of cyclobarbital (0.75 million S-DDD) and was the only country exporting the substance to other countries, including Georgia, Latvia and the Russian Federation, the three main users of the substance. The Russian Federation continued to be the main importer of cyclobarbital in 2010, accounting for 79 per cent of global imports of the substance. Global stocks of

42 2009 to 2010. of substance the declinedsignificantly (byper cent) 46from trading substance, inthe country reported that its imports of imports global of substance. the main Canada,the importing pentobarbital, together accounting for cent 68per Netherlands (1,905kg)remained main the countries Unitedthe States (2,383kg),Australia (2,366kg)and the substance in2010.France (4,141kg),Canada(3,922 accounted for about cent 91per of ofexports the global France and Denmark (indescending order) together Astons2010. 22.3 in in previous years, Germany, Canada, of substance the declinedfrom 27.3tons in2008to pentobarbital continued to decrease. Total reported exports 42. users of substance.the land, Switzerland and United the States were main the 2008-2010,Australia,period Canada,Ireland,- New Zea were held in Germany and Unitedthe States. the During that do not contain that substance. that are on sold illicit the market are counterfeit products of preparations the containing purportedly flunitrazepam tion with pharmaceutical the industry. Nowadays, most controlstrict for policies flunitrazepam,- coopera in close manufacturers and importers of substance, the adopted countries, IIIin1995.Several includingSchedule major abused, flunitrazepamtransferred was from Schedule IV to for such preparations. As it was frequently diverted and smuggled into countries there inwhich is an illicit demand diverted from licit the market inone and country Preparations containing flunitrazepam have been often diverted mainly from domestic distribution channels. frequently abused The benzodiazepines. substance is 44. Flunitrazepam reported 2006-2010. for period the 2002-2005. No international substance inthe trade was hundred1997-1998 to several kilograms during period the offrom about apeak 15tons year per during period the United States. Inter atstood 1.2kg; most of stocks were those held in the stocksin 2010.Global of glutethimide at end the of 2010 and (240kgin2005).No China manufacture was reported of substance the took place inHungary (700 kgin2001) and stopped in1998.Afterthat year, sporadic manufacture facture of glutethimide declinedsteadily during 1990s the substance as an used antineoplastic agent. manu Global - conversion into aminoglutethimide, anon-psychotropic glutethimide were manufactured annually, mainly for 43. Glutethimide During the period 2008-2010,international period the During in trade Flunitrazepam continues one to be of most the early dozen the During tons 1980s,several of national inglutethimide trade decreased

45. the substancethe in 2010. and accounted 45kg, for cent 17per ofimports global of Republic of Korea and Greece, eachranging 20 between epam imports of Brazil, Germany, Switzerland, Nigeria, the imports of flunitrazepam in 2010. The combined flunitraz- imports of substance. the About 40countries reported importing 870kgand accounting for cent 75per of global remained leading the importer of flunitrazepam in2010, ofexports 2008-2010. flunitrazepamperiod the in Japan countries together accounted for over cent 90per of global pam, 328kgof exporting substance the two in2010.Those pam. Italy was second the biggest of exporter flunitraze- 2010. In 2010,that 791kgof exported country flunitraze- of exports substance the global 2006- during period the ofexporter flunitrazepam, averaging per centover 65 of ofhigh 1.2 tons in 2010. Switzerland remained leadingthe 46. figures(see 22 and 23 andparagraph below). 91 dropped of to all was which 231kg, manufactured inItaly ever reported. In manufacture 2010,global of flunitrazepam epam increased, reaching 1.9tons largest in2009,the amount Despite fluctuations, those manufactureglobal of flunitraz- no manufacture of substance the took place inthat country. substance, fluctuatedsome in greatly; years, such as 2010, flunitrazepam in Switzerland,the main manufacturer the of 1997, reported its manufacture. The manufacture of Switzerland, to started which manufacture flunitrazepam in manufactured countries. inseveral After 1996, only Italy and general anaesthesia. Prior to 1996,flunitrazepam was insome countriesused for pre-medication and to induce buprenorphine reported that in2010,Belgium its However, of countries the that reported manufacture of to 1.8tons (228million S-DDD) figure in2010(see 8). total reported manufacture of buprenorphine amounted not report data on its manufacture for 2010.As aresult, of total reported manufacture of substance the in2009,did of buprenorphine, together accounting for over cent 86per Kingdom and Australia, once two the main manufacturers (4kg)and(147 kg),China Denmark (0.4kg).The United Germany (127kg),Switzerland United (49 kg), the States Czech Republic (1,098kg), the ing Belgium (397kg), countries reported manufacture of buprenorphine, includ - treatment of pain and opioid addiction.In 2010,seven for substancethe doses inhigher used the to started be manufacture of buprenorphine increased significantly, as mainly as analgesics. In late the 1990s,total reported 47. Buprenorphine In practice, flunitrazepam, medical like diazepam, is International influnitrazepam trade a reached record Buprenorphine belongs to family the of opioids used Analgesics 43

English manufacture of the substance significantly increased, by 77 per cent, over the figure reported for 2009 and the Figure 8. buprenorphine: total reported manufacture, stocks and calculated global consumption,a 2001-2010 Czech Republic reported an increase of nearly 70 per cent. Global stocks of the substance continued to increase 7RQV in 2010, reaching 3.8 tons, the highest level reported in 10 years. The majority of the stocks were held in the United Kingdom, the United States, Germany, France, the Czech Republic and Switzerland (in descending order). 48. Total exports of buprenorphine started to increase in 1996 and amounted to 3.4 tons in 2009, the highest amount ever reported. In 2010, the total volume of trade in the substance decreased to about 1.7 tons, mainly as a result of the significant decline in exports reported by the United Kingdom. The main exporting countries in 2010 included Belgium (575 kg), Germany (418 kg), the Czech Republic (371 kg), Australia (112 kg) and Switzerland (76 kg), which together accounted for 90 per cent of the global total. E The United Kingdom had been the main exporter of morphine. Total reported imports of the substance in 2009. Canada, Japan, Nigeria, Portugal and Switzerland together accounted for over 4 In recent years, calculated consumption of buprenorphine has been 57 per cent of global imports of pentazocine in 2010. Data less reliable than the calculated consumption of other substances, owing for 2010 from Pakistan, another major importer of the to the limited number of manufacturers of buprenorphine, lack of data substance, has not yet been received. The United Kingdom from some of those manufacturers in 2010 and inconsistent stock data reported by some major consumers. became the largest exporter of pentazocine in 2010, when

44 reported manufacture. benzfetamine accounted for less cent than 1per of total or cent) figures 5per (see 9 and 11). Pemoline and or cent 6per each)and fenproporex (88million S-DDD, amfepramone (109million S-DDD and 100million S-DDD, of total reported manufacture), phendimetrazine and followed by mazindol (143million S-DDD, or cent 8per mine (1.3billion S-DDD) accounted for cent; 74per it was 14 stimulants in IV Schedule (1.8 billion S-DDD), phenter 55. reaching 1.8 billion S-DDD figures in 2010 (see 9 and 10). averaging 2.07billion S-DDD. However, it dropped, then 2006-2008, total manufactureperiod was fairly stable, manufacturers of group this of substances. the During Brazil, Germany and United the States were main the Brazil, in Unitedthe in addition observed to those States. toued fluctuate, as a result of changes in manufacture in manufacture of central system nervous stimulants contin- United States. 2001-2010,total reported In period the developmentsthe of phentermine manufacture inthe unstable, IVwasin Schedule very primarily reflecting 54. as anorectics used tially or for treatmentthe of ADD. and pyrovalerone. The stimulantsSchedule IV in are- essen carb, pemoline, phendimetrazine, phentermine, pipradrol fencamfamin, fenproporex, mazindol, mefenorex,- meso amfepramone, aminorex, benzfetamine, etilamfetamine, 53. (5 substances); and analgesics (1 substance). and anti-epileptics (7substances); other sedative-hypnotics epileptics (1substance); barbiturate-type sedative-hypnotics hypnotics (11substances); anti- benzodiazepine-type anxiolytics (1substance); sedative- benzodiazepine-type anxiolyticsbenzodiazepine-type (22substances); other groups: central system nervous stimulants (14substances); icine are listed in IV.Schedule belong They theto following 52. remained amajor of exporter substance the in2010.The highest figure reported thatby since country 1999. Italy it reported having 1.2tons exported of substance, the the

Sixty-two substances with various applications- inmed In 2010, of total the reported manufacture of the In 1990s,total the reported manufacture of stimulants Fourteen stimulants are listed IV: inSchedule Central nervoussystemstimulants Substances listed in Schedule -

Portugal and Unitedthe States. years included Canada,India, Japan, Nigeria, Pakistan, main countries consuming over pentazocine past the three %LOOLRQVRI6 %LOOLRQVRI6 Schedule main central nervous systemstimulantsin Figure 10. main central nervous systemstimulantsin Figure 9. Schedule 3KHQGLPHWUD]LQH 0D]LQGRO $PIHSUDPRQH ,WDO\ %UD]LO $UJHQWLQD ''' ''' IV: total reported manufacture, bysubstance, IV: total reported manufacture, bycountry, IV 2001-2010 2001-2010 3KHQWHUPLQH 3 )HQSURSRUH[ *HUPDQ\ 8QLWHG6WDWHV %HOJLXP HPROLQH : RUOG7 RWDO < < HDU HDU 45

English 56. The fluctuations in the total calculated consumption (140 million S-DDD, or 8 per cent) and amfepramone of central nervous system stimulants listed in Schedule IV (107 million S-DDD or 6 per cent). (see figure 12) mainly reflect changes in the use of phentermine in the United States and the use of amfepra- 57. Consumption of Schedule IV stimulants in the mone and fenproporex in Brazil. A total of 1.75 billion Americas remained the highest worldwide. This is mainly S-DDD of central nervous stimulants listed in Schedule IV a result of high consumption levels in the United States were used in 2010. Of those, phentermine (1.2 billion and Argentina. Overall, an average of 9.53 S-DDD per S-DDD) accounted for 69 per cent; it was followed by fen- 1,000 inhabitants per day were consumed in the Americas proporex (190 million S-DDD or 11 per cent), mazindol during the period 2008-2010 (see figure 13). Levels of consumption decreased in the Americas, Asia and Europe during the three-year period 2008-2010 compared with the period 2005-2007, although they increased markedly in Figure 11. main central nervous system stimulants in Schedule IV: share of total reported manufacture, Africa and Oceania, mainly as a result of increased selected substances, 2010 consumption in South Africa and Australia. In 2010, )HQSURSRUH[ the highest calculated consumption rates expressed in 2WKHUV S-DDD per 1,000 inhabitants per day were observed in 0D]LQGRO $PIHSUDPRQH Australia (9.8), Argentina (9.2), the United States (9.0), 3KHQGLPHWUD]LQH the Republic of Korea (6.5), Brazil (3.9), the Hong Kong Special Administrative Region of China (2.9) and Singapore (2.8).

58. Phentermine has been the most manufactured substance in the group of stimulants in Schedule IV, although its share of total manufacture within this group fluctuated widely, between 0 and 70 per cent in the previous two decades. Total reported manufacture of the substance increased from an average of 9.5 tons annually during the period 1991-1995 to 50 tons in 1996, the highest level ever reported. Manufacture of the substance dropped in 1997 3KHQWHUPLQH and ceased in 1998. After 1999, global reported manufacture of the substance continued to fluctuate. It amounted

Figure 12. main central nervous system stimulants Figure 13. central nervous system stimulants listed in calculated global consumption,a by substance, 2001-2010 Schedule IV: average national consumption,a by region, 2002-2004, 2005-2007 and 2008-2010 %LOOLRQVRI6''' S-DDD per 1,000 inhabitants per day 12 11 10 9 8 7 6 5 4 3 2 1 0

aStatistical data submitted by Governments are used to calculate the approximate global consumption in a given year, which is expressed in defined daily aStatistical data submitted by Governments are used to calculate average doses for statistical purposes (S-DDD). annual consumption for a three-year period.

46 respectively). Canada and Italy imported also significant United560 kginthe States and Republic the of Korea substance in2010reached previous levels (3.5tons and zine imports countries, in2009both imports of the Republicthe of Korea. After in a phendimetrasharp fall - importers of substancethe have Unitedthe been States and 2008-2010.Traditionally,during period the main the substance, accounting for cent 88per ofexports global of substance. the Italy main the was of also exporter the cent.66 per Germany was second the largest manufacturer atstood 7.6tons, of Italy which accounted for more than 62. together accounting for cent 89 per of imports. global (485 kgeach)and four (170 kg),the Chile countries by United the States (1.5tons), Germany and Mexico Thelargest imports of amfepramone in2010 were reported in2010; itexports, was followed by Italy and Germany. 2.5 tons of substance,the or cent 78 per of global the of amfepramone 2001-2010, exporting period in the cent)(87 per and Italy. Switzerland was main the exporter 7.5 tons, most of waswhich manufactured in Brazil manufactureglobal of amfepramone further, decreased to substance; it was followed by Switzerland and Italy. In 2010, 2001-2010, Brazil was largest the manufacturer of the during 2007-2009.In three-year the period the period from 28tons in2005to an average of about 11tons 61. fell sharply from 5.9tons in2009to less than 1ton in2010. leading importer. Total reported imports of substance the year after 2006, exceptevery when the 2009, was Brazil Germany was leading the importer of substance the in 2010, Brazil wasmanufacturer sole the of fenproporex. manufacture of 2006-2009. In substancethe inperiod the ing fenproporex, accounting for about cent 99per of global andBelgium Brazil, two the main countries manufactur fluctuatedbetween 9.5 tons in2005 and 1.76 tons in2010. in 2003,total reported manufacture of fenproporex 60. and Republicthe of Korea (1.6 and 1.4 tons respectively). importer of substance the (5.6tons), followed by Australia 2008-2010. In United 2010,the States remained main the of phentermine at least once during three-year the period Australia and Switzerland. countries Thirty importsreported substance inthat year. major Other exporters in 2010were 9.5 tons, accounting for cent 87per of of total exports the exporters of phentermine; totalled in exports 2010, their and United the States, indescending order, were main the of in phentermine trade averaged 11 tons. Germany, Italy 59. order, were mainthe manufacturers of substance.the United States, Germany, Italy and India, indescending to nearly 20tons 2008-2010,the in2010.In period the During the three-year period 2008-2010, the volume 2008-2010,the three-year the During period Total reported manufacture of amfepramone decreased In manufacture 2010,global of phendimetrazine After steadygrowth, from 3 tons in1998 to 10 tons -

pyrovalerone. was reported for aminorex, etilamfetamine, or mesocarb mefenorex and pipradrol, no international while trade transactionstrade were reported for fencamfamine, ormesocarb pipradol was reported. and Small irregular No manufacture of aminorex, fencamfamin, mefenorex, reported manufacture of pyrovalerone was 5gin2010. ture of etilamfetamine was 6gin2009and only the in Canada(9kg).Since only 2003,the reported manufac- stocks of2007, all pipradol at end the of 2010 were held Following from exports France to Canadain2004and other stimulants sporadic. listed IVhas inSchedule been 66. average of 862 kg of substancethe year. per 2008-2010,consumingbenzfetamine period inthe an The United soletheStates consumer virtually also was of of substance the (16 kgin2010)from stocks held by Italy. was limited, with only United the States reporting imports 2001-2010, international period the inbenzfetamine trade turer, manufacturing on average year. 448 kg per During United2010, the States was once more manufac sole the - United States; subsequently, 2008- three-year inthe period manufactured inItaly and Switzerland, inaddition to the 2000-2004. In 2006, benzfetamine was period the ture of benzfetamine, averaging 1.1tons annually during 65. in Brazil, France, Mexico and Switzerland. endthe of 2010amounted stocks to were 175kg;those held stocks 2008-2010.Global ofthree-year mazindol period at from 707kgin1998to an annual average of 191kginthe extent, for of use Global substance the export. fell sharply, ing for that period, domestic consumption and, to alesser of mazindol was manufactured inArgentina eachyear dur tured almost exclusively inArgentina. An average of 157kg 64. treatmentthe of ADD. addition as astimulant, to used being for pemoline is used followed by (37 kg) and Chile Switzerland (23 kg).In were Japan, imported which atotal of 440kginthat period, ers of pemoline during 2008-2010 three-year the period pemoline amounted to 295kgin2010.The main import - were main the exporters of substance. the in trade Global facturer of pemoline. The Netherlands and Switzerland Netherlands the thatDuring period, was mainthe manu- 2001-2010 ranged from no manufacture to afew tons. 63. and Unitedthe States (0.26 S-DDD). 1,000 inhabitants day), per followed by Italy (0.35 S-DDD) were highest in Republicthe of Korea (0.56 S-DDD per ita consumption of substance this 2008-2010 for period the amounts of phendimetrazinecap per - in2010.Calculated During the period 2006-2010,mazindol was manufac period the During - The reporting of manufacture of the trade in and Until 2004,only United the States reported manufac - manufactureGlobal of pemoline during period the 47 -

English Benzodiazepines Figure 14. benzodiazepine-type anxiolytics: total reported manufacture, 2001-2010

67. Thirty-three benzodiazepines were included in %LOOLRQVRI6''' Schedule IV in 1984. Midazolam was added to Schedule IV in 1990 and brotizolam was added in 1995. Flunitraz- epam was transferred from Schedule IV to Schedule III in 1995. During the decade ending in 2010, practically all countries and territories that reported to the Board manufactured or traded in benzodiazepines in quantities of more than 1 kg at least once. Benzodiazepines are frequently diverted for subsequent smuggling and abuse. Benzodiazepine-type anxiolytics 68. Twenty-two benzodiazepines are generally classified D

69. In 2010, diazepam accounted for almost 32 per cent (6.3 billion S-DDD) of total reported manufacture of %URPD]HSDP benzodiazepine-type anxiolytics, alprazolam for 25 per cent (5 billion S-DDD), lorazepam for 20 per cent (3.9 billion S-DDD), bromazepam for 7 per cent, chlordiazepoxide for 2.8 per cent, oxazepam for 2.5 per cent and clorazepate for 2.4 per cent (see figure 15). Nordazepam accounted for 1.7 per cent of total reported manufacture of benzodiaze- &KORUGLD]HSR[LGH pine-type anxiolytics, tetrazepam for 1.5 per cent, clobazam for 1.1 per cent and ethyl loflazepate and prazepam for 'LD]HSDP &ORUD]HSDWH 1 per cent each. The remaining six substances in that group (clotiazepam, delorazepam, halazepam, ketazolam, medazepam and oxazolam) together accounted for 2 per cent of total reported manufacture of benzodiazepine-type anxiolytics, calculated in S-DDD. No manufacture of camazepam, fludiazepam or pinazepam was reported for 70. Total approximate consumption of benzodiazepine- 2010. As shown in figure 17, China, India and Italy were type anxiolytics calculated by the Board was more stable the leading manufacturers of benzodiazepine-type anxio than global manufacture, although it follows the same lytics in the period 2001-2009. In the absence of data overall trend. In the three-year period 2008-2010, total cal- from India, China and Italy together accounted for almost culated consumption of this group of substances gradually 59 per cent of global manufacture of that group of decreased, from 25.8 billion S-DDD in 2008 to 23.8 billion substances in 2010 (see figure 16). S-DDD in 2010 (see figure 18). The calculated consumption

48 for anxiolytics figure benzodiazepine-type (see 19). average highestthe calculated national consumption rates publication. Europe has consistently region the been with inhabitants day per is shown intable IV.3 of present the anxiolyticsof benzodiazepine-type inS-DDD 1,000 per %LOOLRQVRI6 a The data for 2010 are incomplete. for 2010are The data Figure 16. 2WKHUV reported manufacture, selected countries, 2001-2010 total reported manufacture, bycountry, 2010 Figure 17. ,WDO\ ,WDO\ ) &KLQD 6ZLW]HUODQG ''' UDQFH b enzodiazepine-type anxiolytics: share of enzodiazepine-type b 8QLWHG6WDWHV enzodiazepine-type anxiolytics: enzodiazepine-type 6ZLW]HUODQG *HUPDQ\ )LQODQG %UD]LO &KLQD 2WKHUV ,QGLD *HUPDQ\ )UDQFH

< HDU D

expressed in defined daily doses for statistical purposes (S-DDD). purposes for statistical doses daily in defined expressed global consumptioninagivenyear.approximate These consumptionfiguresare annual consumption for a three-year period. three-year annual consumptionfora

13.6 tons was in 2008,which result the of increased from about 1ton year per in1986 to of a one-time peak 71. Alprazolam 6

a a %LOOLRQVRI6 '''SHULQKDELWDQWVSHUGD\ Statistical data submitted by Governments are used to calculate the to calculate used are by Governments submitted data Statistical Statistical data submitted by Governmentsareusedtocalculatethe submitted data Statistical Figure 18. Figure 19. Total reported manufacture of alprazolam grew $IULFD 'LD]HSDP $OSUD]RODP ''' 2002-2004, 2005-2007 and 2005-2007 2008-2010 2002-2004, b national consumption, b global consumption, enzodiazepine-type anxiolytics: calculated enzodiazepine-type enzodiazepine-type anxiolytics: average enzodiazepine-type $PHULFDV /RUD]HSDP %URPD]HSDP $VLD a 2001-2010 a byregion, (XURSH 2WKHUV &KORUGLD]HSR[LGH

2FHDQLD < < HDU average HDU 49

English output by all manufacturing countries and unprecedented Switzerland (5.1 tons), Denmark (3.3 tons), Germany increases in Finland and India in that year. In 2009, total (2.6 tons) and India (2.6 tons), which together accounted manufacture dropped to 8.7 tons, as output declined across for 23 per cent of global exports. the board in all the major manufacturing countries. In 2010, total reported manufacture of alprazolam was 5 tons, 75. Practically all countries and territories imported diaz- as only eight countries reported manufacture of the sub- epam at least once in the period 2008-2010. About 115 stance (down from 12 countries in 2008) and no data were countries and territories reported imports of diazepam of submitted by India. The main manufacturers of alprazolam more than 2 kg for 2010. The main importers of diazepam in 2010 were Italy (1.9 tons), the United States (1.2 tons), in that year were Denmark (10.3 tons), the United States France (928 kg) and Finland (463 kg), which together (4.7 tons), Germany (3.4 tons), Switzerland (2.8 tons), accounted for almost 90 per cent of global manufacture. Brazil (2.7 tons), Ghana (2.5 tons), Spain (2.2 tons), the Democratic Republic of the Congo (1.9 tons), the Czech 72. International trade in alprazolam averaged 8.4 tons Republic (1.8 tons), Serbia (1.4 tons) and Thailand and during the period 2008-2010. In 2010, global imports of Bangladesh (1.2 tons each). Together, those countries alprazolam stood at 8.2 tons, with more than 140 countries accounted for 65 per cent of global imports. Global and territories in all regions reporting imports of the sub- calculated consumption of diazepam decreased from stance. The main importers of alprazolam continued to be 16.4 billion S-DDD in 2001 to 5.7 billion in 2010. China the United States (2.7 tons), Italy (907 kg) and Belgium (748 million S-DDD), Brazil (681 million S-DDD), (887 kg), which together accounted for 55 per cent of total the United States (640 million S-DDD) and the United imports of the substance. Global calculated consumption, Kingdom (273 million S-DDD) were the largest consumers which had averaged 4.8 billion S-DDD during the period of diazepam in that year. 2000-2005, reached an average of 9.7 billion S-DDD in the period 2008-2010. The largest consumers of alprazolam in absolute terms in 2010 continued to be the United States Lorazepam (3.6 billion S-DDD), followed by Canada (1.2 billion S-DDD) and Hungary (850 million S-DDD). 76. Total reported manufacture of lorazepam was fairly stable in recent years, averaging 10.7 tons per year in the Diazepam period 2004-2009. Italy and Germany were the two main manufacturers of the substance; they were followed by 73. Diazepam continued to be the most traded substance India. In 2010, total output of the substance was 9.9 tons, in the group of benzodiazepine-type anxiolytics. It is of which Italy accounted for 66 per cent and Germany consumed in all regions of the world. Together with 23 per cent. India had traditionally reported about 1.5 tons alprazolam, diazepam is among the benzodiazepines that of lorazepam manufacture every year, although no manu- are often diverted from domestic distribution channels to facture was reported for 2010. Other countries reporting be sold on unregulated markets and to be abused. Global manufacture of lorazepam in 2010 were Brazil, Canada, manufacture of diazepam declined from 162.6 tons in China, Israel, Poland, Spain and the United States. 2001 to 43.5 tons in 2009, reflecting declining use of the substance. In 2010, global reported manufacture increased 77. Between 2001 and 2009, total exports of lorazepam again, to 63 tons, owing to increased output in China had been between 9 and 11.6 tons. In 2010, total reported (31.3 tons, or almost 50 per cent of global manufacture) exports of lorazepam stood at 10.2 tons. The main export- and Italy (20.6 tons or 33 per cent), the leading manufac- ers of lorazepam in the decade up to 2010 had been Italy, turers of diazepam. The only other countries reporting Germany, Ireland and India (in that order), together manufacture of diazepam in quantities exceeding 1 ton accounting for 88 per cent of total exports of the substance. were Brazil (5.4 tons), Switzerland (3.6 tons) and the The main importers of lorazepam in 2010 remained the United States (1.5 tons). India, which had manufactured United States, Ireland, Spain, Germany, Italy, France and 7.9 tons of the substance in 2009, did not report any Canada, together accounting for 68 per cent of all imports manufacture for 2010. of the substance. About 55 other countries imported lorazepam in quantities exceeding 5 kg. During the 74. Exports of diazepam fluctuated between 51 and period 2001-2010, global calculated consumption averaged 60 tons during the five-year period 2006-2010, reflecting 3.9 billion S-DDD per year; in 2010 it amounted to varying levels of exports reported by China and Italy, 4.1 billion S-DDD. The largest consumers of lorazepam the world’s leading exporters of the substance. In in that year were the United States (906 million S-DDD), 2010, China exported 23.8 tons of diazepam and Italy Germany (587 million S-DDD), Spain (450 million exported 18.8 tons. About 45 other countries reported S-DDD), Canada (355 million S-DDD) and Italy (341 mil- exports of diazepam in excess of 1 kg in 2010, among them lion S-DDD).

50 in 2010. that, it slightly, decreased amounting to 1.2billion S-DDD 2001-2008, averaging period the 1.3billion S-DDD. After consumption of bromazepam was fairly stable during importsglobal of substance. the global Calculated together(795 kg),which accounted for cent 59per of (1.8 tons), Brazil (1.2tons), Germany (836kg)and Japan included France (2.5tons), Switzerland (2.2tons), Italy substance. The main importers of bromazepam in2010 23 of countries those imported more than 100kgof the 110 countries reported imports of bromazepam in2010; accounted for cent 89per About of exports. global Switzerland (7.3tons), Italy (5.5tons) and India (2.1tons) countries were leading the exporters of also substance: the In 2010,as inprevious years, main the manufacturing 2001-2010,averagingduring period the 16.3tons annually. 79. report any manufacturing data for 2010. manufacturer of bromazepam recent inthe past, didnot (420 kg)and Canada(86grams). India, other the major weretotal; they followed by Brazil (1.4tons), China cent34 per and cent, 53per respectively, of reported the manufacturers of substance the in2010,accounting for (4.4 tons) and Switzerland (6.9tons) remained leading the manufacture of bromazepam was 13.1tons in2010.Italy attaining of 18.3tons apeak in2008,total reported ated significantly 2001-2010. After period theduring 78. Bromazepam Iraq (1.1.tons) and (884kg).Together, Egypt those (2 tons), United the States (1.9tons), Switzerland (1.8tons), main importers of substancethe in 2010 were Cuba chlordiazepoxide up three-year to in the 2010. The period 81. 22 tons 2001-2003 to 15.8 tons in period the in 2010. ide fluctuated, but declined fromoverall, an average of ofthat2010. During exports chlordiazepox global decade, - exporters of chlordiazepoxide 2001- during period the India,China, Italy and Switzerland were largest the did not report any manufacture of substancethe for 2010. manufacturethe of 10.9tons of chlordiazepoxide for 2009, (149 kg)and Canada(15kg).India, had which reported substancethe in2010,namely Iraq (259kg),Poland together. Three countriesother manufacturereported of was accounted for by (8.5tons) China and Italy (7.6tons) output of that substance was 16.5tons, cent 98 per of which increased tothen 40tons in2009.In 2010, total reported fromdecreased 43tons in2000to 19tons in2007and 80. Chlordiazepoxide Global exports of exports Global bromazepam werestable very Total reported manufacture of bromazepam fluctu- More than 100countries reported imports of Total reported manufacture of chlordiazepoxide

largest consumers of oxazepam in 2010. Norway (inthat order). countries Those thewere also (6.6 tons), France, Netherlands, Canada,the Australia and imports global ofthe substance, the were Germany oxazepam in2010,together accounting for cent 64per of importedtries oxazepam in2010.The main importers of slightly in2010,reaching 24.6tons. More than 50coun- and it 2009,when dropped to 17.3tons. It picked up again between 2006 five-yearthe 2001-2005,declined period pam, had which averaged about 40tons annually during substancethe respectively. The volume trade in of oxaze- 2010, reporting manufacture of 18.3tons and 5.2tons of France remained main the manufacturers of oxazepam in which manufactures substancethe mainly for and export, 2010, owing to increased output reported by Italy. Italy, manufacture of substance the amounted to 25.3tons in After reaching alow of 20.7 tons global in2009, reported of oxazepam was fairly stable, averaging 27.3tons year. per 82. Oxazepam comprised of output from Germany (2.3tons) and France reported manufacture of substance the was almost entirely datathe on manufacture the of clobazam inIndia, total 2001-2009.Forduring period the absence 2010,inthe of and India were main the manufacturers of clobazam In 2010,total output at stood 4.2tons. France, Germany manufacture of clobazam fluctuatedbetween 3 and 6 tons. 84. Clobazam substance. the about 60other countries reported import the and of use France and Spain remained largest the users of clorazepate; International inclorazepate trade at stood 5.6tons in2010. over cent 98per ofmanufacture global of clorazepate. 2001-2010. In two countries 2010,those accounted for leadingthe manufacturers of clorazepate during period the dropping again to 9.4tons in2010.France and Italy were again, reaching of 11.3tons apeak in2009before 5 tons in2006and output 2007,global to started increase 8.4 tons 2000-2005.After declining during period to the 83. Clorazepate stood atstood 613 million S-DDD. In consumption global 2010,calculated of substance the S-DDD in2006,rose again in2009to 2.1billion S-DDD. fromdecreased 1.2billion S-DDD in2001to 715million consumption global Calculated of substance, the had which countries accounted for cent 58per ofimports. global In the period 1991-2010,total reportedIn manufacture period the During the decade leading up decade the During to 2010,total reported Total reported manufacture of clorazepate averaged 51

English (1.9 tons). International trade in clobazam fluctuated accounting for 80 per cent of total imports of the substance during the period 2001-2010, when it averaged 5 tons. Over in 2010. Other main importers of the substance in 2010 80 countries reported imports of the substance in 2010; included Hungary, Romania, Tunisia, Algeria, the France, India, Brazil, Bangladesh and Japan reported Democratic Republic of the Congo, Iraq and Switzerland having imported the largest quantities. (in descending order). In 2010, global calculated consumption of meprobamate amounted to 258 tons (215 million S-DDD). Hungary, France, Cuba and South Africa (in that order) had the highest calculated consumption of the Other anxiolytics substance in 2010.

85. Total reported manufacture of nordazepam fluctuated widely in the 10-year period up to 2010, reflecting Benzodiazepine-type sedative-hypnotics changing output reported by Switzerland. In 2010, global manufacture of the substance amounted to 4.9 tons 88. Twelve benzodiazepines are generally used as (328 million S-DDD), 94 per cent of which was manufac- sedative-hypnotics: brotizolam, estazolam, flunitrazepam, tured in Switzerland. Global output of tetrazepam stood at flurazepam, haloxazolam, loprazolam, lormetazepam, 305 million S-DDD, and total reported manufacture of midazolam, nimetazepam, nitrazepam, temazepam and ethyl loflazepate amounted to 190 million S-DDD. triazolam. Comments on flunitrazepam, a substance that Camazepam has not been manufactured since 1991; was transferred from Schedule IV to Schedule III in 1995, manufacture of fludiazepam was last reported by Japan are provided in paragraphs 44-46 above. for 2007. India was the only country that reported manufacture of pinazepam during the period 2007-2009; no 89. Total reported manufacture of the 12 substances in manufacture of the substance was reported in 2010. The the group gradually increased from 6.4 billion S-DDD in combined manufacture of the remaining eight substances 1999 to over 8.5 billion S-DDD in 2007 and subsequently in that group (clotiazepam, cloxazolam, delorazepam, fluctuated, mainly as a result of changes in manufacture in halazepam, ketazolam, medazepam, oxazolam and Germany and Switzerland. In 2002, Switzerland started prazepam) amounted to 619 million S-DDD in 2010. reporting to the Board on the manufacture of benzodiazepines. In 2010, total reported manufacture of this group Meprobamate of substances fell to 5.5 billion S-DDD, as a result of lower output reported by several manufacturing countries and 86. Meprobamate, the only non-benzodiazepine-type because of missing data on manufacture from India (see substance in Schedule IV that is used as an anxiolytic, has figure 20). Calculated consumption of this group of sub- gradually been replaced by benzodiazepines, leading to a substantial decline in manufacture from 750 tons in the Figure 20. benzodiazepine-type sedative-hypnotics: total late 1970s to an annual average of 290 tons during the reported manufacture, by substance, 2001-2010 1990s. After 2000, total manufacture of meprobamate %LOOLRQVRI6''' fluctuated around an annual average of 230 tons and the decreasing trend continued. In 2010, total reported manufacture of the substance amounted to 137 tons (114 million S-DDD). China, Denmark and India were the main countries manufacturing meprobamate, although the quantities manufactured declined. In 2010, Denmark reported having manufactured 71.9 tons of meprobamate, while China reported having manufactured 63.5 tons. India did not report any data on manufacture for 2010. Global stocks of meprobamate stood at 146 tons in 2010, 93 per cent of which was held in Denmark (59 tons), South Africa (34 tons), France (30 tons) and Hungary (12 tons). 87. International trade in meprobamate also continued to D decline. Global exports of the substance decreased from

52 expressed in defined daily doses for statistical purposes (S-DDD). purposes for statistical doses daily in defined expressed year.given in a global consumption imate are figures consumption These pam came second, with an output of 1.1billion S-DDD, manufactureglobal of group this of substances. Temaze- notics, accounting for 1.3billion S-DDD, or cent 24per of stance group inthe sedative-hyp of benzodiazepine-type - most the became manufactured2010, lormetazpem sub- inparticular,trazepam, showed significant fluctuations. In within year. the trends The in total manufacture of fluni- time, keeping quantities in stocks those that are not used turers tend to produce large quantities of asubstance at a groupthis has greatly varied over years, the as manufac- 91. IV.2 of presentthe publication. itants day per inindividual countries are shown intable azepine-type sedative-hypnotics inS-DDD 1,000inhab- per figureCalculated consumption(see 22). levels- benzodi of 1998-2000,butwith increased period again the in2010 stances other declinedinthe had regions, also compared 2010. Average levels of consumption of group this of sub - 2007-2009,didnot continue period inthe observed in consumptioncalculated levels inEurope, was which in Europe than inother regions. The markedthe decline in 1,000inhabitantsper day, per has traditionallyhigher been sedative-hypnotics,zodiazepine-type expressed inS-DDD 90. In 2010, it at stood 8.4 billion S-DDD figure (see 21). average of 7.9billion S-DDD 2001-2010. during period the stances was less volatile and fluctuated around an annual a %LOOLRQVRI6

Statistical data submitted by Governments are used to calculate the approx to calculate used are by Governments submitted data Statistical enzodiazepine-type sedative-hypnotics: sedative-hypnotics: benzodiazepine-type Figure 21. The manufacturereported of individual substances in Thecalculated average national consumption ben- of )OXQLWUD]HSDP %URWL]RODP 7 HPD]HSDP ''' calculated global consumption, 2001-2010 /RUPHWD]HSDP 7 (VWD]RODP ULD]RODP a 1LWUD]HSDP 2WKHUV

< HDU -

(see figure (see 23). substance group, inthis accounted for cent 4per of total the Flunitrazepam, in2009was which most the manufactured cent)15 per and brotizolam and cent (7per triazolam each). it was followed by estazolam (802 million S-DDD or was third inthat group (844million S-DDD or cent); 15per or cent 20 per of manufacture global in 2010. Nitrazepam annual consumption for a three-year period. three-year annual consumptionfora enzodiazepine-type sedative-hypnotics: share sedative-hypnotics: benzodiazepine-type Figure 23. 1LWUD]HSDP 6 a Statistical data submitted by Governments are used to calculate the average to calculate used are Governments by submitted data Statistical '''SHULQKDELWDQWVSHUGD\ average national consumption, enzodiazepine-type sedative-hypnotics: sedative-hypnotics: benzodiazepine-type Figure 22. of totalreported manufacture, bysubstance,2010 7HPD]HSDP $IULFD (VWD]RODP 2005-2007 and 2005-2007 2008-2010 $PHULFDV )OXQLWUD]HSDP $VLD a byregion,2002-2004, 2WKHUV (XURSH %URWL]RODP /RUPHWD]HSDP 7ULD]RODP 2FHDQLD < HDU 53

English 92. For the remaining substances, total reported manufacture amounted to 240 million S-DDD of midazolam, Figure 25. benzodiazepine-type sedative-hypnotics: total reported manufacture, selected countries, 2010 168 million S-DDD of flurazepam, 18 million S-DDD of loprazolam and 13 million S-DDD of both haloxazolam and nimetazepam. Together, those substances accounted 6ZLW]HUODQG 2WKHUV for 8 per cent of global reported manufacture of benzodi- -DSDQ azepine-type sedative-hypnotics in 2010. &KLQD 93. The main manufacturers of benzodiazepine-type )UDQFH sedative-hypnotics during the decade up to 2010 are shown in figure 24. Throughout that decade, Italy was the leading manufacturer of benzodiazepine-type sedative-hypnotics, *HUPDQ\ accounting in some years for more than half of global manufacture of such substances. In 2010, Italy manufactured benzodiazepine-type sedative-hypnotics amounting to 3.3 billion S-DDD, accounting for 60 per cent of global manufacture of such substances (see figure 25).

,WDO\ Figure 24. benzodiazepine-type sedative-hypnotics: reported total manufacture, selected countries, 2001-2010

%LOOLRQVRI6''' to be the main exporters of lormetazepam in 2010. The main importers of lormetazepam were Spain, France, and Belgium; in all of those countries, the substance was imported partly for re-export. Calculated global consumption of lormetazepam followed an increasing trend. In 2010 it amounted to 1.5 tons. The highest calculated rates of consumption in 2010, measured in S-DDD per 1,000 inhabitants per day, were recorded in Belgium (49.3), Spain (34.6), Italy (16.3) and the Netherlands (11.3). Temazepam 95. During the period 2001-2010, Italy was the leading D

54 the substance.the together accounted for cent 87per of total imports of Japan, Portugal and United the States (indescending order) 2008-2010.Inestazolam 2010,Poland, period inthe Italy, Fewerexport. than 20countries reportedof use the Italy and Japan manufactured substance the mainly for manufactured estazolam mainly for domestic use, whereas of estazolam 2001-2010.China during period the 2.4 tons remained in2010.China leading the manufacturer substance picked up again afterwards, amounting to recorded since 1994.However, manufacture global of the manufacture to drop to lowest 790kgin2007,the level stopped manufacturing estazolam aftercausing 2006, global Japan, Poland and United the States). The United States developments manufacturing inthe countries (China, manufacture of estazolam fluctuated, as a result of 97. Estazolam 2,465 kg and for Cuba, 625 kg). 2010 reached highest the values far reported so (for Japan, substance, 2001-2010and increased during in period the traditionally largest the importers and users of the Imports of nitrazpam reported by Japan and Cuba, of nitrazepam at 2008-2010. least once period inthe Aboutexports. 80countries reported importing over 1kg accounting for more cent than 80per of nitrazepam all order, were mainthe exporters of substance,the together to 4.4tons. As inprevious years, Italy and inthat China, in 2009and picked up slightly amounted they in2010,when annually 2000-2008,dropped during to period the 3.7tons ofExports nitrazepam, which had averaged about 5 tons not report any manufacture of substancethe for 2010. facturer of nitrazepam 2001-2009, did during period the manufacturing nitrazepam in2010.India, amajor manu- Federation (inthat order) were other the countries accounted for cent. 76per Canadaand China, Russian the In 2010,that figure stood at 4.2 tons, which of Italy ture of nitrazepam ranged 7and between 4tons year. per 96. Nitrazepam 98. Brotizolam facture of brotizolam reached 330kgin2009; in2010, did not manufacture brotizolam. reported Global manu- extent, by Italy and Japan. In 2008and 2010,Germany hundredseveral year kilograms per and, to a much lesser is usually manufactured by Germany inamounts of reported for first the time in1997, Germany.by Brotizolam substances (0.25mg). Manufacture of brotizolam was ittriazolam, has lowest the S-DDD of psychotropic all During the period 2001-2010, global reported 2001-2010,global period the During reported manufac 2001-2010,global In period the - Brotizolam is apotent hypnotic. Together with

accounted for cent. 61 per ofuser substance the 2001-2010, during period the amounted to 1.3billion S-DDD, of Japan, which main the consumption global Calculated of brotizolam in2010 reported having imported more than 1kgof brotizolam. substance for re-export. In 2010,only sixother countries it was followed by France and Italy, imported which the or(134 kg, cent 72per of total imports of substance); the vious years, Japan was largest the importer of brotizolam substance, amounted which to In 193kg. 2010,as inpre- 2010, accounting for cent 78per of of total exports the Germany remained main the of exporter brotizolam in substance,the total the reported manufacture was 99 kg. onlywhen Italy and Japan reported having manufactured followed by Japan (10.3 S-DDD). (over 30S-DDD 1,000inhabitants per day); per it was capita with highest the per country the of use triazolam cent of ofuse substance the global was in2010.Belgium substance for re-export. Japan accounted for almost 50 per andBelgium Italy imported also large quantities of the for over cent 50 per of imports global of substance.the Japan was largest the importer of accounting triazolam, 2008-2010.Throughout period inthe triazolam that period, MoreBelgium. than 40countries reported imports of of in triazolam 2010; it was followed by France, Italy and 100. substance. the accounted for over cent 99 per of manufacture global of not manufacture and triazolam, Italy and France together substancethe the in2009.Then, in2010, United States did accounting for over cent 90per ofmanufacture global of turer of throughout triazolam 2000-2009, period the S-DDD). The United Statesthe leading manufacbeen had - after 1990. thatIn 2010, figure millionstood at90kg(361 of 460kg(1.8billion S-DDD), largest the quantity reported of increased triazolam until it 2009,when reached apeak 99. Triazolam substance at stood 5.7tons. In 2010,Germany continued 2008-2010.In reported imports 2010, global period of the countries and was imported by about 140countries inthe cent),20 per Italy and Midazolam China. inmany is used (1.3 tons, or cent 29per of total), the Israel or (953kg, manufacturer of substance; the it was followed by Brazil cent) were accounted for by Switzerland, largest the figure stood at 4.8. tons, which 1.8 of tons (orper 37.5 it fluctuated at about 6.9 tonsper year. thatIn 2010, afew hundredexceeded kilograms until 1996.After 1997, 101. Midazolam In up decade the to 2010,total reported manufacture The United States continuedthe be main to exporter Total reported manufacture of midazolam had never 55

English to be the main importer of midazolam; it was followed by the United States, France, Switzerland, Brazil, Argentina, Figure 26. clonazepam: total reported manufacture, selected countries, 2001-2010 Spain, Portugal, Hungary, Mexico and Bangladesh. Together, those countries accounted for 71 per cent of global imports 0LOOLRQVRI6''' of midazolam. Flurazepam 102. Global reported manufacture of flurazepam, which had followed a declining trend, dropped in 2009 to 2.8 tons, the lowest level ever recorded. In 2010, it increased again, to 5.1 tons. Fluctuations in the reported manufacture of flurazepam reflected changes of manufacture in Italy, the largest manufacturer and exporter of the substance. In 2010, Italy accounted for 82 per cent of global reported manufacture of the substance, and Brazil and Canada accounted for the remainder. About 40 countries reported having imported flurazepam in the period D

56 of manufacture global 2008-2010.In during the period the phenobarbital, accounting, on average, for over cent 70 per continuedChina leading the to manufacturer be of phenobarbital amounted to 429tons (4.29 billion S-DDD). 2001-2010. In reported manufacture 2010,global of fluctuatedbetween 370 tons and 450 tons period theduring 109. 1,000 inhabitants day per are shown in table IV.4. consumptioncalculated levels by inS-DDD country per barbiturate-type anti-epileptics listed IV, inSchedule the 4.7 S-DDD 1,000inhabitants per day. per With to respect the Japan, had which consumption rates ranging 0.5and between order) Jordan, Hungary, Yemen, China, Lebanon, Israel and 2008-2010were IV during (indescending period the rates of barbiturate-type sedative-hypnotics listed inSchedule 108. manufacture of vinylbital was reported after 1996. was last reportedtal in2008(by 117kg).No Germany: vinylbital was reported in2010.Manufacture of butobarbi- for remainder. the No manufacture of butobarbital or Methylphenobarbital and secbutabarbital together accounted S-DDD); in barbital accounted for approximately cent. 5per manufacture of barbiturates the IV(expressed inSchedule phenobarbital accounted for over cent 94per of global 4.5 billion S-DDD. In 2010, as inprevious years, of 5.1billion S-DDD in2006before declining in2010to gradually rose 1999-2000, then to an average period in the non-psychotropic substances) fell below 4billion S-DDD rates (for and use manufacture directthe medical both of 107. barbital. by stance group inthe of barbiturates in2010;it was followed Phenobarbital continued most the to sub widely be - used are as anti-epileptics used also (long-acting barbiturates). nobarbital. barbital and phenobarbital, daytime sedatives. The two other substances, methylpheno hypnotics (to induce sleep). They are no longer as used intermediate-acting barbiturates and are mainly as used are vinylbital, and secbutabarbital butobarbital, barbital, III. Five of substances, seven the namely allobarbital, pharmacologically related included to those inSchedule 106. vinylbital and secbutabarbital phenobarbital, methylphenobarbital, butobarbital, barbital, Allobarbital, arbiturate-type sedative-hypnotics and sedative-hypnotics Barbiturate-type 5

See table IVforSee details of consumption calculated the levels of phe- The countrieswiththe calculatedconsumption highest Total reported manufacture of phenobarbital Total reported manufacture barbitu of seven those - The seven barbituratesseven The Schedule listed IV in are anti-epileptics 5 have additional properties and

substance. Atotal of 45countries reportedof exports accounted for over cent 72per of total imports of the (14.8 tons) and Japan (10tons). countries Those together (20.4 tons), Denmark (18.6tons), United the States Federation (36.9tons), Ukraine (20.6tons), Germany (67.6 tons), followed by Brazil (59tons), Russian the (3.4 billion S-DDD), largestthe importer being Switzerland total imports of phenobarbital amounted to 343 tons reported imports of year. substance the every In 2010, 2006-2010,an average period the During of 145 countries 2010, with aslight 2009and decline between 2010. inphenobarbitaltrade fluctuated 2008- period theduring volumetrade of over 300tons year. per International psychotropicwidely traded substances, with an average 110. 2010. phenobarbital, didnot report any data on manufacture for substance in2010.India, another major manufacturer of reported having manufactured quantities small of the (2.6 tons) and Brazil (2.1tons). Iraq and Canadaalso of phenobarbital in2010included Japan (7tons), Germany major 2001-2008.Other during manufacturers period the significantlythan less its average of 61 tonsper year having manufactured 11tons of substance the in2010, turer of phenobarbital, Russian the Federation, reported total of 51tons of substance. the Another major manufac- 2010 was Hungary, reported which having manufactured a second27). The largest manufacturer of phenobarbital in an increase of cent 21per over figure 2009level the (see increasedChina steadily. In 2010, it amounted to 355 tons, manufacture 2001-2010,the period of phenobarbital in a %LOOLRQVRI6 The data for 2010 are incomplete. for 2010are The data Figure 27. Phenobarbital continues one to be of most the 5XVVLDQ)HGHUDWLRQ &KLQD ''' selected countries, 2001-2010 Phenobarbital: total reported manufacture, +XQJDU\ -DSDQ 2WKHUV ,QGLD < HDU D 57

English phenobarbital in 2010. China, Switzerland, India, Hungary, order). Nine countries reported imports of methylpheno- Germany, Denmark, Singapore, France, Jordan and Ireland barbital in 2010. In 2010, the main importers of methyl- (in descending order) remained the main exporters of phenobarbital continued to be the United States, Croatia, phenobarbital, accounting for 99 per cent of global exports Germany (for re-export) and Italy (in descending order); of the substance. their imports together accounted for 96 per cent of global imports of the substance. 111. Global manufacture of barbital fluctuated during the period 2001-2010 around an annual average of 96 tons. 115. From 1996 to 2005, Germany was the sole manu- After 2008, global manufacture of barbital slowly increased, facturer of allobarbital, manufacturing between 393 kg from 79 tons (158 million S-DDD) to 116 tons (233 mil- and 4 tons of the substance each year. In 2006 and 2007, lion S-DDD) in 2010, mainly owing to increased manufac- Belgium started manufacturing the substance, reporting ture in China, the leading manufacturer of the substance. an output of 2.5 tons (25 million S-DDD) in 2006 and During the period 2008-2010, China accounted for 1.4 tons (14 million S-DDD) in 2007 (mainly for export). 98 per cent of global manufacture of barbital. Japan was While it reported no manufacture of allobarbital during the other key manufacturer; it manufactured barbital the period 2006-2008, Germany resumed its manufacture mainly for domestic consumption, including for use in of the substance in 2009 (1.1 tons, or 11.3 million S-DDD). the manufacture of non-psychotropic substances and In 2010, no manufacture of allobarbital was reported by preparations exempted from certain control measures in any country. As a result, global stocks of the substance accordance with article 3 of the 1971 Convention. Total decreased from 2.6 tons in 2009 to 1.2 tons in 2010; those calculated consumption of barbital averaged 94 tons stocks were held mainly in Germany, Switzerland and per year during the period 2008-2010. China, Japan, Turkey. During the period 2008-2010, Hungary, Israel, Italy, France, the United States and Thailand (in descend- Poland, Turkey and Yemen were the main consumers of ing order) remained the main users of barbital during the substance. that period. 116. International trade in allobarbital decreased signifi- 112. International trade in barbital grew significantly cantly, from 1.6 tons in 2008 to 825 kg in 2010. Germany from approximately 10 tons (20 million S-DDD) in 2008 was the leading exporter of the substance in 2010 (475 kg); to 17 tons (34 million S-DDD) in 2010. In 2010, as in it was followed by Switzerland (200 kg) and Jordan previous years, China (11.5 tons) and Germany (3.9 tons) (149 kg). The major importers of allobarbital in 2010 were were the main exporters of barbital; they were followed by Switzerland (400 kg), Turkey (200 kg) and Yemen (149 kg). Japan (1.2 tons). Together, those three countries accounted for 97 per cent of global exports of barbital. Exports of 117. Secbutabarbital was manufactured intermittently barbital from China increased considerably, by 130 per cent, during the period 2001-2010. No manufacture of the between 2009 and 2010. Germany and Japan were the substance was reported for 2000, 2004 or 2005. After leading importers of barbital in 2010; they were followed Germany stopped manufacturing the substance in 2003, by Italy, Thailand, France and the United States. the United States became the sole manufacturer, reporting an output of 31 kg in 2010. Lebanon continued to be the 113. Manufacture of methylphenobarbital fluctuated main importer of secbutabarbital, and it reported imports between 0.8 and 22 tons during the period 2001-2010. of 25 kg of the substance in 2010. Those fluctuations were the result of significant changes in output reported by the manufacturing countries, namely 118. Manufacture of butobarbital was last reported by India, Switzerland and the United States. For instance, Denmark in 1998 (1.3 tons) and by Germany in 2008 India manufactured 21.7 tons of methylphenobarbital in (117 kg). No manufacture of that substance was reported 2008, but reported no data on manufacture for 2010. In after 2009. About 21 kg of butobarbital were traded in 2010; 2010, global manufacture of methylphenobarbital amounted Jordan, the Netherlands and Belgium (in descending order) to 3.4 tons, all of which was reported by Switzerland. were the importing countries. Germany and the Netherlands Switzerland also accounted for over 95 per cent of global were the major exporters of the substance in 2010. stocks of methylphenobarbital at the end of 2010. Croatia, Switzerland, Slovenia and Italy (in descending order) were the main users of the substance in 2010. Barbiturates in Schedules II, III and IV 114. International trade in methylphenobarbital also fluctuated during the period 2001-2010, averaging about 119. Of the 12 barbiturates listed in Schedules II, III and 2.9 tons per year between 2008 and 2010. The main export- IV of the 1971 Convention, the following five substances ers of methylphenobarbital in 2010 included Switzerland, accounted, on average, for 99 per cent of the total reported the United States, Germany and India (in descending manufacture of those barbiturates in the five-year

58 ture of entirethe group of barbiturates figure (see 29). together accounted for cent 98 per of total the manufac- cent),(5 per Germany cent) (4per and Japan cent) (2per cent),(9 per Denmark cent), (8per United the States sented infigure 28. per cent),China (70 In 2010, Hungary of total manufacture of substances those in2010are pre- cent)(3.4 per and amobarbital cent). (1.6per The shares cent),(9.4 per pentobarbital cent), (7.8per barbital 2006-2010:phenobarbitalperiod cent), (77per butalbital barbiturates in Schedules Figure 28. barbiturates in Schedules Figure 29. %XWDOELWDO of totalreported manufacture, bysubstance,2010 reported manufacture, selected countries, 2010 &KLQD $PREDUELWDO 3HQWREDUELWDO 2WKHUV 'HQPDUN 2WKHUV %DUELWDO *HUPDQ\ II, II, III and III and +XQJDU\ 3KHQREDUELWDO -DSDQ 8QLWHG 6WDWHV IV: share IV: total

of ethinamate was last reported by Germany in1988 by Unitedthe States in 1999 (1.3 tons). The manufacture 123. Spain, Hungary and Germany in 2010. ers of substance the were in2010; they followed by Japan, France and United the States were largest the also consum- for about cent 52per of ofexports substance. the global twothe main exporters of zolpidem in2010,accounting 2008-2010.Francesubstance period inthe and India were with more than 100countries reporting imports of the morethe widelyand psychotropic traded used substances, manufacture of zolpidem in 2010.Zolpidem is one of Brazil and (in descending China order), reported also countries, including Japan, Italy, United the States, Canada, Czech Republic (3.2tons) and Argentina (2.8tons). Other majorOther manufacturers of substance the were the accounted for by France (31.5tons) and Israel (8tons). to 46tons (4.6billion S-DDD), cent 86per of was which In 2010, total reported manufacture of zolpidem amounted output of France, main the manufacturer of substance. the the 2001-2010,reflecting changingduring period the ture of zolpidem fluctuatedbetween 24.2 and 51 tons 122. est consumption calculated of GHB in 2010. Unitedthe Kingdomdescending (in order)- hadhigh the in 2010.United States, Italy, Russian the Federation and (in descending order) were leading the exporters of GHB of substance. the Germany, Ukraine and United the States Kingdom (indescending order) main the being importers with Italy, France, Russian the Federation and United the 30 countries reported imports of GHBtotalling 15.8tons, national increased. In inGHBalso trade 2010,about countries in2010included Germany and Ukraine. Inter ture of substance the major in2010.Other manufacturing GHB, accounted for cent almost 80 per of manufac global - (36.9 tons). The United States, a major manufacturer of cant increase of over cent 60per compared with 2009 2006-2010, reaching of 59tons apeak - in2010,asignifi manufacture of GHBincreased steadily during period the nationalall control measures to substance. this Reported incomplete, although most countries have now extended and, more rarely, alcoholism. Data for GHBmay be still 121. in 2001. acid (GHB)and zolpidem were to IV added Schedule adoption of 1971Convention, the gamma methyprylon have listed IVsince inSchedule the been ethinamate Whilebenzodiazepines. ethchlorvynol, and listed IVare inSchedule neither barbiturates nor 120. The manufacture waslast reported of ethchlorvynol Zolpidem to induce is used sleep. manufac Global - GHB is mainly treatment inthe used of narcolepsy Five substances group inthe of sedative-hypnotics Other sedative-hypnotics -hydroxybutyric 59 -

English (500 kg), and the manufacture of methyprylon was last Analgesics reported by the United States in 1990 (2.1 tons). Very small stocks of ethinamate and methyprylon were reported by Canada and the United States in 2010. There were no 124. Lefetamine is the only analgesic included in Sched- reports of international trade in ethchlorvynol, ethinamate ule IV. No manufacture of or trade in the substance was or methyprylon after 1991. reported after 1996.