HC Deb 20 February 1968 vol 759 cc367-88

10.11 p.m.

Mr. W. F. Deedes (Ashford)

I beg to move, That an humble Address be presented to Her Majesty, praying that the Dangerous Drugs (Notification of Addicts) Regulations 1968 (S.I., 1968, No. 136), dated 1st February 1968, a copy of which was laid before this House on 8th February, be annulled. When the Dangerous Drugs Act was in Committee, some of my hon. Friends and I entered one plea. We urged that the Regulations, of which these are the first to appear, should exceptionally be approved by Resolution and not be subject to this procedure. Otherwise, I foresaw that we would have to go through this gambit of seeking to annul the Regulations which, like the Act, we support in principle. For reasons which did not convince the predecessor of the hon. and learned Gentleman the Member for Lincoln (Mr. Taverne), the Home Office felt unable to meet this request, so here we are doing what I feared. I can only hope that the medical profession and others concerned with the Regulations will understand why we are doing it in this way.

These Regulations are the first of a number that will be needed to put the Act into operation, and they are not the least important. I find it depressing that these Regulations should reach us about a thousand days after the Committee, presided over by Lord Brain, first recommended that something of this kind should be done. Making all allowances for the difficulties which we know occur, a thousand days is a long time to deal with a problem of this urgency. However, they now implement one of the Act's two main legs; that is to say, Section 1 (1,a) requiring all medical practitioners to notify a central authority of those whom they have reasonable grounds for suspending are addicted to specified dangerous drugs. This will come into force this week. As from Thursday, all doctors will be required to make this notification.

I see certain advantages in making this the first step. At the same time, it also appears that the timing of the Regulations, envisaged when we were discussing the Act, has gone somewhat awry.

I am subject to correction, but it would appear that at least two conditions attached to these Regulations have not yet been fulfilled. First, we have no fresh definition of the word "addiction". In the Regulations is a slight adaptation of the definition given by Lord Brain nearly three years ago. Is this the last word on the subject? It may be adequate, but we were told by the Minister in Committee on 20th April that something different might be drafted. He said: There is no definition of an addict in existing law, but the Regulations which we shall make under this Clause will include a definition. There was a suggested definition in the Brain Report. Our definition will probably be based on that, but I should be surprised if it followed it exactly. To be fair, it does not follow it exactly, but it is very close, and I wonder whether we should regard it as the final version.

Much more important, we were promised at the time that a panel of experts would assist general practitioners in determining whether patients who came to them fell within this or some other definition of addiction. At the same meeting of the Committee, the Minister said: Our present intention is that there should be at least four panel members in each hospital region, and that the doctor should consult an individual panel member rather than the whole panel. In our view, the panel ought to be set up and publicised, certainly to the profession, before the regulations under this Clause come into operation, so that doctors know exactly where they stand before this obligation falls upon them."—[OFFICIAL REPORT, Standing Committee G, 20th April, 1967; c. 7–8.] This obligation falls upon them on Thursday. My second question is, how far have the panels been established and how far do doctors know of their existence?

It is important that they should exist in some form, however rudimentary—and not simply in London, where good advice on this difficult subject is not hard to come by, but in other regions where there may be few addicts and general practitioners may have little first-hand knowledge of patients of this kind. Perhaps we may have some up-to-date picture of these panels. I do not know what members of the profession have been advised about by publicity. I doubt whether they have heard much about these panels, at least up to today.

I turn now to a development since the Brain Committee's Report and since our Committee discussions last year, which bears on the Regulations. We now know—it is no secret—that there has been introduced into this complex field of hard drug taking a new element, that of the occasional taker of heroin, the "experimenter". He is not, at least for the time being, necessarily addicted to heroin as defined in the Regulations, but he uses the drug once a week or perhaps more or less.

Surely it is important that we should know who these people are, where they live and something about them. If we are to build up any picture of the geography of hard drug addiction, this is invaluable information. I accept that not all these people are likely to come the way of general practitioners, even after Thursday, but, if they do, surely they should be notified. Should not some central record of those addicted to heroin also include those who may be taking it but are not necessarily addicted? In this sense, the Regulations are incomplete.

Are they being supplemented with specific advice to general practitioners? It is important to know this. In any case, even if they are being given additional advice or guidance, under the Regulations as they stand they are not required to notify anyone but an addict. Therefore, this point should be cleared up.

There is another kindred complication here, and there is no secret about this either. Certain drugs, which were not taken into account at the time of the Dangerous Drugs Act, 1965, or the Dangerous Drugs Act, 1967, are now coming into use. One or two of them are hardly less dangerous than the drugs covered by these Regulations, but they are not in the Schedule to the principal Act of 1965, nor are they as yet on the United Nations list. I suppose the best examples of these are methedrine—and there has been a certain amount written about this in the Press—and amphetamine which there seems no doubt is being taken intravenously to an unknown extent. The medical profession find it extremely diffi- cult to judge what is happening here, and we ought to take the earliest steps to find out. I think that something of a switch by a certain number of people from heroin to cocaine to methedrine is possible. I appreciate—

Mr. Speaker

With all the sympathy in the world, I must remind the right hon. Gentleman that he cannot amend on this Order the parent Act and the Schedule to the parent Act.

Mr. Deedes

I appreciate that, Mr. Speaker, and I am not continuing the point for very long. I was only going to say that the Regulations offer us a chance to find out what we want to know. I do not press the hon. Gentleman for a firm answer on this, but we ought to be prepared to extend the scope of Regulations such as this as quickly as possible if developments suggest that is necessary. I hope the hon. Gentleman will be able to assure us that this is possible.

Finally, the Regulations provide for a certain course of action which is eminently fair and has been approved by the medical profession, but which will not necessarily be swift, against any doctor who refuses to comply with these Regulations and does not after Thursday notify an addict who comes to his notice. Some months ago I should have thought the likelihood of any doctor refusing to comply with these Regulations was really too unlikely to bother about. But since a recent case which has achieved some prominence I feel less sure.

When we have Regulations dealing with the prohibition of the supply of drugs, it will not be difficult to catch up with any doctor who refuses to conform with these Regulations, though it may take a little time to bring him to book. He will, of course, be traced through the pharmacy records. But if a doctor chooses to ignore these Regulations before the prohibition on prescribing drugs comes into force and continues to treat but not to notify as he is now required to do, it will not be very easy to bring him to book.

It may be that—and I think I am just within the bounds of order here—that the interval between these Regulations and those dealing with the prescription of drugs will be short one, and I hope the Under-Secretary will be able to say something about this. The distance between this and the next set of Regulations seems very important indeed, and in the light of recent events I hope the Home Office will look again at the interval which could elapse between starting the machinery of those Regulations against a doctor refusing to conform with them and actually bringing him to book. I repeat that six months ago this was an unthinkable contingency, but it is not quite unthinkable now. For those reasons I thought it right to raise the matter of these Regulations and to repeat what we must do.

It goes without saying that we hope they are going to succeed, as a great deal depends on their success. If they work we should, within a matter of weeks, be able to repair at least one major weakness in our scheme for combatting drug addiction, which is—I must not say our ignorance, but our very vague idea about the real numbers involved—a very big advance. Perhaps even more important, the Regulations will enable us—I shall be interested to hear the Under-Secretary's observations—to discover addicts who by one means or another have been resorting to more than one doctor. If every doctor is required to notify, certain names may appear twice on the list held by the Home Office. This would indeed be a very remarkable advance.

We must not under-rate the difficulties—I am sure that the Under-Secretary does not—which will confront a very large number of practitioners in implementing these Regulations. The majority of them have little or no experience of handling addicts, because most addicts have been channelled into the hands of a relatively few doctors and practitioners may now encounter them for the first time. These doctors will look for guidance. I should like to think that the guidance is available. During the passage of the Bill we discussed pretty thoroughly the use of the information which will be derived from these Regulations, and I do not want to go over all that ground again.

However, it is relevant to ask two questions. First, when under these Regulations names have been notified to the central authority, who I understand will be the Chief Medical Officer at the Home Office, what action will be taken to follow up the information? After all, these will be the names of people notified by doctors as being addicts who will for an un- known period be continuing to receive their prescriptions from doctors as opposed to treatment centres. It is very important that some kind of follow-up by some agency should be undertaken so that we know what these people are up to. This is a question on which I should be glad of a little more guidance.

One other question on the central point has concerned a number of my hon. Friends. It is fair to quote what the Minister of State, Home Office, said some months ago about these Regulations: Once the new system has been established on a statutory basis, it is possible that inquiries will be received from other sources, but, as I say, the whole of the list will be safeguarded by the Official Secrets Act, and it will have to be determined administratively where the information can be passed. We know that marriage partners, persons with whom addicts are living, employers, and others may ask questions, but I think we should have to say quite clearly that this information could not be given to the majority of these people."—[OFFICIAL REPORT, Standing Committee G, 20th April, 1967; c. 20.] This is an important point, because it relates to the use that will be made of the information derived from these Regulations. Anything that the hon. and learned Gentleman can say on that would be of great interest to my hon. Friends and myself.

In raising the matter now we shall not delay or impede what the Home Office has in mind. On the contrary, in view of the amount of doubt and uncertainty which have prevailed about these and certain other Regulations which it would be out of order to discuss, some of it stimulated by people who do not want the Act to work, I hope that this will give the Under-Secretary an opportunity to say some of the things which need to be said.

10.28 p.m.

Mr. Arthur Blenkinsop (South Shields)

I rise only to welcome the speech of the right hon. Member for Ashford (Mr. Deedes) and the opportunity it gives us to secure as full a reply as possible from the Home Office on the nature and implication of these Regulations. I share the right hon. Gentleman's anxiety that the Regulations should be effective and that the consequent actions of the Government should follow as rapidly as possible. Can my hon. and learned Friend say anything further about the sequence of events which is likely to follow from the Regulations, although I appreciate that this is a matter on which we cannot go into detail now? It would help many of us to know something of the timetable that the Home Office and the Ministry of Health have in mind.

I have sympathy with my hon. Friends on the Front Bench on the question of timing. While we all would have wished to see much more rapid action in many of these matters, we appreciate many of the problems involved and the difficulties of ensuring the full co-operation of, for example, the medical profession in this matter. I assume that this would be one of the problems which has had to be faced concerning the time when the Regulations have been brought forward.

Like others, I would be extremely interested if we could hear a little more about the nature of any central register which may be developed from the basis of information provided as a result of the Regulations. I hope very much that we will not be too seriously limited in the information that we can provide, which could be of the utmost importance in regard to the emergency treatment, for example, of cases which might arise by the natural problems of secrecy and the like. Anything that can be said about this I would welcome.

There is also the point, which the right hon. Member for Ashford has raised, concerning the deep anxieties which many of us have about the wider range of drugs and the new developments which are taking place which make our ideas on the matter out of date within a few weeks. Many of us are concerned about whether the provisions in the Regulations will prove adequate to deal with some of the new developments of which we are beginning to be well aware, which may prove to be just as anxious a matter to the whole of the community as the problem of heroin.

Therefore, I do no more than welcome the fact that this opportunity is being given to my hon. Friend the Under-Secretary of State to reply to this brief debate and assure him that there is deep concern on both sides of the House on the matter and a deep anxiety that the Regulations and other Measures which succeed them should be successful.

10.33 p.m.

Dr. M. P. Winstanley (Cheadle)

The whole House will be grateful to the right hon. Member for Ashford (Mr. Deedes) for giving us an opportunity to debate this important matter and for giving the Under-Secretary of State an opportunity to explain, within the limits of the Rules of Order, the use to which he will put the Regulations and the sequence of events in the campaign in a matter which is of the greatest importance to us all.

In general, I welcome the Regulations. All that they really do is to make a reality of what many people have believed to be the situation for a long time. There seems to have been a general impression that there was already a sort of register of addicts and that all general practitioners were required to furnish this information. That, however, was not the case.

The Minister of Health and the Home Secretary had opportunities of obtaining that information but by rather devious means, and without the Regulations they have had to rely on the drugs register. When a chemist's register was produced and showed that a general practitioner was persistently issuing National Health Service prescriptions, because it would be those transactions that the chemist would have to enter if the general practitioner himself did not do the dispensing—the entry would be recorded not in his register, but in the pharmacist's register—the fact would be brought to the attention of the Home Secretary and in due course one of his medical officers would call on the general practitioner to find why it was necessary regularly for him to prescribe heroin or morphia for a certain individual. That was a long and tortuous process, however, and it is necessary to have a system of the kind which is now intended.

It is also necessary, as soon as possible, for the Home Secretary and the Minister of Health to have all the information which is available on a subject about which we all talk a great deal but about which we do not know everything by a long way. There are all sorts of guesses about the size of the problem, and nobody really knows.

These Regulations will assist. They will be very necessary indeed, not only to the Home Secretary but also to the Minister of Health, in enabling them to assess what will be their next steps and where they will take them. Obviously it will be impossible for the Minister of Health to decide what resources will be needed in terms of the availability of treatment centres and so on, till he has this information and knows where the addicts are and what their number is in any locality.

I would urge one point on him which I hope he will answer, namely, the question of timing. The right hon. Gentleman referred to it and I wish to refer to it, too. In our previous debate, whilst I supported all the measures which were being taken—and I still do, and I support these Regulations—I stressed what I am sure every doctor would stress, that the whole question of the timing of these various operations is absolutely crucial. If things are done in the wrong sequence or with too much haste, then the whole thing could collapse about our heads and we could be in a desperate situation. If, for example, any kind of restrictive regulations were introduced or appeared to be introduced before the Minister of Health was in a position to cope with the problem, we should be doing precisely what we want to avoid doing, namely, encouraging the creation of a black market. Therefore, I hope we shall hear tonight from the Government something about the timing of what is to happen.

I accept that it is necessary to have these kinds of Regulations in order to establish the size of the problem and certain details about it. I am not minimising this problem. I regard it as desperately serious and of desperate significance, but nevertheless I think that from the purely quantitative point of view it is still not large. I think the Minister will find that is so when the Regulations work and he gets the figures. There are many general practitioners who are never approached by an addict at all. I think it is necessary to say this, because so many people seem to think that general practitioners throughout the country are inundated with requests from people for prescriptions for drugs in circumstances in which it would be necessary for them to take action under these Regulations, but it is not the case. In my nineteen years' of general practice the occasions on which I have been approached for drugs as specified here have been very rare, so rare that they stand out and one remembers them. However, if once a doctor gets a reputation for being sympathetic to applicants, and of being prepared to spend time with an addict and prepared to give special consideration to these cases, it may be that that individual practitioner will get a great many applications.

If that number were taken as a statistical basis, the total position would be unreal. There would be a tendency to multiply the figure and to say that that is the size of the problem. It is not. Some addicts approach doctor after doctor in their efforts to get adequate supplies and, theoretically, could appear over and over again in the returns from different doctors. These Regulations will provide information more widely and enable the Ministers to know more about the true size of the problem.

I would like an answer to a question on Regulation 1(3,b,iv): if the attendance is at a hospital, by a medical practitioner on the staff of that hospital. This exempts a doctor from the requirement to notify if notification has already been carried out by somebody on the staff of that hospital. There is a point of some importance here. The vital factor in the management of the addict, if it is to be done successfully, is continuity. The Minister of Health agreed, and I am sure that the Home Secretary agrees, that continuity of care is vital. There are addicts at present under the care of specific practitioners at certain hospitals. I am sure that it will be helpful to the Minister to know the names and identities of the doctors, not the hospitals, and for how many addicts they are prescribing.

There is a danger that, when the Regulations come into force and there are the new treatment centres, if a patient is suddenly cut off from, say, the psychiatrist under whose care he has been and he is made to go somewhere else, he will break the treatment off. I do not for a moment suggest that he will have inferior treatment elsewhere. The danger is that his treatment will cease altogether. The requirement for purely hospital notification does not take account of the important personal relationship between an individual patient and a specific doctor. The patient's relationship is not with a hospital; it is with a doctor. The Minister may well find it helpful to have that information, but, under paragraph (3,b,iv), it is envisaged that he will not have it. I should like to hear from the hon. and learned Gentleman about that.

In general, I welcome the Regulations, and I hope that they will work.

10.41 p.m.

Mr. John Brewis (Galloway)

The form o: the Prayer, to annul the Regulations, should not be taken as an indication that we oppose them. We are very much in favour of the Regulations and feel that the delay has been too long already. They ought to have come into force much sooner. There is delay, also, in bringing in the other regulations which are needed to control the prescribing of drugs. When will they be laid before the House?

I wish, first, to refer to the important question to which my right hon. Friend the Member for Ashford (Mr. Deedes) stressed, namely, the co-operation of the medical profession. There is a very small minority of medical men who are not playing the game by drug addicts. I mention in particular the name of Dr. Petro, which has figured in the popular Press in the last week or two. What is to happen—

Mr. Deputy Speaker (Sir Eric Fletcher)

Order. It is difficult to see how that can arise on Regulations which provide merely for the notification of drug addicts.

Mr. Brewis

I was leading up to the question of what the sanction would be in the event of a doctor not complying with the Regulations, Mr. Deputy Speaker. Under Section 2 of the Dangerous Drugs Act, 1967, a direction may be given to a doctor that he shall not in future prescribe drugs at all, but this is hedged about with a requirement that the matter may go to a tribunal, which will take a considerable time. This, surely, is wrong, when we have the flagrant and scandalous evidence of over-prescribing by doctors which is associated with the name of Dr. Petro. How quickly will that sort of abuse we put right?

Second, how far will the system of notification deal with another loophole in our drugs law? Where are addicts at present getting their drugs? As far as I can see, the Home Office and the police are not proceeding nearly actively enough against the vendors of drugs simply because they are not getting the information on which they could take action against "Big Jim", "Long Tom", or whoever it may be who is peddling drugs. I hope that these Regulations will give the Government a chance to bring these people to book. It is not being done sufficiently at present. Will the hon. and learned Gentleman tell us how the Regulations will help on that side of the matter?

I want thirdly to deal with the definition of drugs in Regulation 3(1). The Dangerous Drugs Act, 1965, contains a list of many drugs—a whole page of them—but, curiously enough, at the moment only three drugs are of any importance, although the Schedule to that Act lists about 40, giving their chemical names. Surprisingly, I do not see heroin mentioned. Is it included under another name? More important, methedrine does not seem to be included. When these Regulations come into force, will doctors like Dr. Petro be able to continue to prescribe methedrine, which in many ways is much more dangerous than heroin? An answer to that question is urgent.

10.46 p.m.

Mr. Mark Carlisle (Runcorn)

As other hon. Members have said, these are important Regulations which in many ways are far-reaching, because, by requiring doctors to notify particulars of people attending them as patients, it largely cuts across the normally accepted doctor-patient relationship

. I have three comments to make about the Regulations. The first concerns that of timing, a subject which other hon. Members have mentioned. It appears that something has gone wrong with the timing of the legislation. We are tonight dealing with Regulations motivating Section 1(1,a) of the Dangerous Drugs Act, 1965, and yet it is clear from the debate in Committee that it was undoubtedly the intention that both parts of the Act, both notification by doctors and the control of prescription, should come into operation at the same time.

The Minister of Health himself said: I hope that treatment facilities will be ready on this scale by the time the Regulations are made. It might well be decided then that the Regulations under paragraphs (a) and (b) should have a common operative date. It is desirable, if possible, that these two sets of provisions should come into force simultaneously."—[OFFICIAL REPORT, Standing Committee G, 20th April, 1967.] He said very much the same thing at the Committee's second meeting.

We must therefore ask why it is that we have only these Regulations tonight. Does the Parliamentary Secretary consider that it is wise to bring this legislation into force in this piecemeal way? Notification and the control of prescriptions go together, and it is important that at the time of the notification of addicts there should be control of prescribing by the general practitioner and that there should be treatment centres where prescriptions can be given. The Minister himself said that the whole purpose of notification was that treatment could be given.

If there is notification, are treatment clinics available so that people notified as addicts can go to clinics? There was a somewhat alarming report—I use the word generally—in a Sunday newspaper on Sunday about the situation in London, and I should be grateful if the Parliamentary Secretary would say whether that was a true assessment of the position, or whether, as the Minister of Health has suggested, there are already 15 clinics in existence.

Mr. Deputy Speaker

I do not think we can pursue that in any detail. It is in order to inquire when some other Regulation may be made, but it is not permissible in discussing these Regulations to speculate as to whether reports in Sunday newspapers about the availability of treatment are correct.

Mr. Carlisle

I am most grateful, Mr. Deputy Speaker. I was leaving that point, and shall do so with the comment that bringing in the Regulations to notify without clearing up the undoubted dangers of loopholes may mean that people unwilling to go to a doctor, with the danger of notification, may be driven into the undesirable black market.

My second point is that which my right hon. Friend has already raised about the panel. Do panels now exist of doctors to whom the doctor can go if he is not sure whether a person is an addict and should be notified under the Regulations?

Clearly, that was envisaged by the Brain Committee and throughout the whole debate on the Dangerous Drugs Act, and we should know if the panels now exist, and it not what is being done about them.

My third point is more general. Does either the Home Department or the Ministry of Health intend to give any advice to doctors as to how the Regulations apply, and in particular as to whether they should inform the patient that they propose to notify the chief medical officer that he is a drug addict or a suspected drug addict? This question was raised in Committee and was left somewhat in the air. It is a difficult question, because as I understand it the important thing is the confidence between the patient who is a drug addict and the doctor. It is a question of balance whether that confidence is more likely to be shattered by telling the man that he will be reported, or by not telling him and his finding out in another way.

10.53 p.m.

Mr. Maurice Macmillan (Farnham)

I do not want to detain the House for very long, and I should be out of order if I made anything but the most passing reference to problems of treatment. But I hope that it will be all right to say that we are discussing not only the Regulations but, by implication, the rather miserable lives of a number of people.

We should be grateful to the hon. Member for Cheadle (Dr. Winstanley) for pointing out that in some aspects this is not a large problem, and that perhaps the most important part of the Regulations is concerned not only with the treatment and method of handling existing addicts, although this is important enough, but hopes to confine addiction to as small a number of people as possible, especially young people. I hope that we can be given Home Department's figures for 1967. I think that the total for 1966 was 1,349, of whom about 329 were under 20.

My right hon. Friend the Member for Ashford (Mr. Deedes) and my hon. Friend the Member for Runcorn (Mr. Carlisle) pointed out that it was originally hoped to bring in two sets of Regulations together, those we are now discussing and those which are yet to come on the control of prescriptions. I wonder how much the apparent slowness in getting the new treatment facilities going is likely to delay the second leg of the Regulations controlling prescriptions. The new treatment facilities were announced by the Minister a week or so ago, and the very wide interest in this aspect—indeed, in all aspects of the problem—is demonstrated by the number of Questions put to him and by the Adjournment debate last July. That interest, which is on both sides of the House. is rather greater than might be implied from the numbers present tonight to discuss this somewhat narrow point of notification, but it is well that it should be known outside the House that this is not a problem which the House takes lightly.

I do not make too much of the newspaper articles in this connection, except to say that I think they express a sense of unease and a feeling that perhaps the Ministry is not as in control of the situation as it would like to be. We are, therefore, worried about the further delays involved in splitting the operation of the Act into two legs. I hope we can be told how long it will be before the next set of Regulations is brought forward.

On these Regulations, I reinforce what my right hon. Friend said on the question of definition of addiction and the allied problem of the drugs to which these Regulations will eventually have reference. In the Adjournment debate last July, the Minister said: I should explain that I shall be using the term drug addicts ' in this debate to mean addicts to heroin and cocaine, since it is to the treatment of these forms of addiction that the present measures are being directed."—[OFFICIAL REPORT, 25th July, 1967; Vol. 733, c. 634.] I think that my right hon. Friend made the point clearly that perhaps the Minister should consider whether other forms of drugs should not now be included.

I want to ask, too, about the whole question of the definition of addiction as opposed to habituation, which my right hon. Friend touched upon in referring to what he called the occasional addict—the person who takes heroin from time to time but cannot be said to be addicted within the meaning of these Regulations. This is important, both from the point of view of trying to help someone who might be on the point of becoming an addict but is not one yet in terms of the Regulations, and also from the point of view of dealing with those who are ex- ploiting addicts and potential addicts, changing their liability to come under these Regulations by switching their drug to one which is not or may not be covered by the Regulations.

Then there is the whole question of confidence. Is there any possibility that the confidence between doctor and patient—and, although we may talk of addicts and treatment centres, this basically is still a relationship between doctor and patient about which we are making Regulations—will in any way be disrupted more if there is a feeling that the centres are not fully operational, so that doctors who would not normally treat an addict but would report him feel that it may be difficult to get the addict the attention which should go with notification?

Another aspect is the difficulty which may or may not arise through delays, involving the question of people receiving maintenance doses and addicts seeking genuine treatment and cure being mixed up together. There are considerable dangers involved in this. Do these Regulations have any effect on this aspect?

To sum up, there seems to be some uncertainties, more than any of us on either side would like. These include the question of panels, the definition of addiction, new drugs, the list of drugs, the problem of the experimental taker, the occasional taker, or the addict who is not under these Regulations, and the major problem of the interval between these two sets of Regulations.

I hope that the Under-Secretary can give us much more information and I am sure that he is anxious to do so. I trust that he will be able to allay some of the anxieties clearly felt in many quarters and expressed by some hon. Members. Perhaps he can clarify a point which I suspect is causing a little unease, and that is the boundary of responsibility between his right hon. Friend the Home Secretary and the Minister of Health. There is always a great danger when questions of health and law come together, and I hope we can have some clarification.

Mr. Deputy Speaker

Order. There is nothing about the Minister of Health in the Regulations.

Mr. Macmillan

I hope that I can show that I was not out of order. I was referring to the definitions which come within the Regulations. There is a number of references to medical practitioners, those in hospitals and so on. Apart from the fact that these are Home Office Regulations, one may think that this was the responsibility of the Minister of Health, and it is on this point of slight uncertainty that I was speaking. I hope that the hon. and learned Gentleman can give us information about this.

The problem is extremely difficult, and I hope that those concerned, and those who may not be so deeply concerned but read about the problem in the newspapers and so, realise that although the debate is initiated by a Prayer against the Regulations, it carries no implication of disapproval. I hope it will be realised that, in seeking this debate, my right hon. Friend was also putting forward evidence of our desire to make the Act work effectively.

11.2 p.m.

The Under-Secretary of State for the Home Department (Mr. Dick Taverne)

I am sure that everyone, not only in the House but outside, will fully understand why this Prayer has been moved. It is not only that the right hon. Member for Ashford (Mr. Deedes) is entitled to move it, but he has performed a service in doing so, enabling a number of points to be cleared up. Some of the points I cannot answer at once because I do not have the figures, while I cannot answer others because I would be out of order in trying to do so. I must tell the hon. Member for Farnham (Mr. Maurice Macmillan) that the figure for 1967 is not yet available. The last figures are for 1966, which show an overall number of addicts of 1,349, of which 899 were heroin addicts.

The first question of the right hon. Member for Ashford dealt with the timing of the Regulations, a point raised by others. As the hon. Member for Cheadle (Dr. Winstanley) said, timing is very important, but I am not sure that the question of the definition is at all relevant to timing. Since the definition has been mentioned, I shall deal with it first. All that my right hon. Friend the Minister of Health said in Committee was that the definition would probably be based on the Brain Report, but he would be surprised if it followed it exactly. That is more or less the present position.

Of the four limbs of the definition contained in the Brain Committee formula—repeated administration, dependence, over-powering desire for continuance, and no medical need—the first three are in paragraph (2) of Regulation 1, and the fourth appears in paragraph (3) of the same Regulation. There are some very slight modifications, but, basically it is the Brain Committee formula. There is a slight difference in the new words "so dependent that", but it is not really a substantial departure from the Brain Committee formula.

However, the really important point is that the medical profession has been consulted on this definition, and the medical bodies are satisfied that the present wording is a realistic test to apply in clinical practice. That is an assurance which the House needs and can be given. If it should turn out in practice that this is not a satisfactory definition, it can be altered in the future.

As for addiction as opposed to habituation or dependence, about which the hon. Member for Farnham asked, this is a difficult question. The terms are somewhat loosely used in international parlance, and it would be a mistake now to try to clarify the point. We should be concerned solely with the definition contained in the Regulation.

The next question that I was asked was the obviously very important one about the Advisory Panel of Experts. I am glad to inform the House that this Panel is now in being. A leaflet was sent to all National Health Service doctors a few days ago (which is why right hon. and hon. Gentlemen may not yet be aware of it), which not only tells them about the effect of the Regulations but refers specifically to the doctors on the panels in all the different regional hospital board areas over the country.

I cannot say that in every single case there are four doctors, but in the majority of cases there are at least four doctors on such a panel. I think that the whole country is covered. It is not intended that these doctors should operate as a panel but that each doctor on the panel can be consulted by another doctor who needs advice. The list has been made available for doctors in private practice, and it has been made known in the medical Press that it is available for them. The very important feature of the panel has been seen to and, from that point of view, nothing has gone awry in the timing of the Regulations.

I was then asked about the occasional taker, and I agree with the right hon. Member for Ashford that it is desirable to know about these occasional takers. One has the recent rather unfortunate case in Crawley where there seems to be a number of people who are not yet properly addicted but have become occasional takers of heroin. The full details of those are not yet available, but we know that the speed of addiction varies in each case. However it is difficult to build up a geography of the kind that the right hon. Gentleman wanted to see, because we are not dealing with addiction but with misuse.

Obviously there are certain difficulties about making the misuse of drugs a subject for the notification procedure. Even if there were no ethical difficulty about notification, where it is simply a case of quasi misuse, it would be hard to force doctors to report all the cases of suspected misuse if no clinical condition was likely to be presented. It would be impractical for the central authority to confirm the large number of doubtful diagnoses that might come forward. A mass of formal reports based on suspicion might be more confusing than helpful. There is a difficulty about it, but any doctor who is in doubt about a case can consult either the central authority to see if an individual has been notified before or consult a member of the panel in his area.

Mr. Deedes

I assume that the doctor will be immune from any action that might be taken through inadvertently notifying someone who could prove subsequently that he was not an addict?

Mr. Taverne

Certainly.

Mr. Brewis

Is it not an offence to take cannabis, marijuana? Surely it should equally be an offence to take heroin without the question of addiction coming into force?

Mr. Taverne

I think the hon. Member is straying a long way from the Regulations. The offence is the possession of cannabis. It would be extremely unwise if we followed what, in a sense, is the American pattern of making the taking of certain kinds of drugs an offence. That would give no hope for the addict for treatment, and it would be going in the wrong direction.

Dr. Winstanley

On the same point—

Mr. Taverne

I will not give way, because I think we are straying from the Regulations if we move into that area.

I was next asked about the dangerous drug, methedrine. I must ask the House to await the advice which we are given by the Standing Advisory Committee on Drug Dependence. That Committee is considering this urgently, as the right hon. Gentleman the Member for Ashford knows. It is right that we should wait to see what advice it gives, because on this question advice differs. There are many people who think that to use the Brain Committee procedure, if I may so describe it, would be the wrong way to deal with methedrine. I do not know whether that is right or wrong, but I am sure this is a matter on which we must have expert advice. If amendment of the law is needed to deal with methedrine on the lines of heroin, obviously we would gladly consider an amendment of the law. However, we must wait for the experts to make up their minds first.

I was asked several times about the difficulties of enforcement. This is intimately tied up with the prescribing regulations. I cannot commit the Government to a definite date, but I can assure the House that these further prescribing regulations will be produced fairly soon.

Treatment centres in their various forms will be available when the prescribing regulations are brought in in the near future.

The question of tribunal machinery is important. We are considering the preparation of this machinery for enforcing both sets of regulations.

I was asked about confidentiality both by the hon. Gentleman the Member for Farnham and the right hon. Gentleman the Member for Ashford. This point was gone into in some detail in Committee. There is no intention of giving information about notification except to two kinds of person: first, the doctor who inquires and who shows the central authority that he has a professional interest in the case; secondly, the police who will need to take this information into account in their scrutiny of the chemists' prescription records. They are given information for this purpose and they will be given the information which comes to light through the notifications. We will also collect what other information we have about addicts from other sources for the purpose of research, but any access to records for research will be carefully controlled on undertakings to comply with the Official Secrets Act.

I was asked how far the patient will be told that he has been notified, as it were. This must be a question for the individual doctor to judge. Only the doctor can assess whether it would be wise to notify the patient. This must be left to the doctor.

I was asked: what will be the follow up on addicts notified by general practitioners? This depends on the drug. If it is heroin, the central authority will hope to encourage the transition to treatment centres by suitable approach to the doctor concerned. Some heroin addicts will be notified initially by the treatment centres. If it is not heroin, the doctor will be free to go on prescribing, even under the new régime, but the Regional Medical Officers of the Ministry of Health will keep in touch with doctors as they do now.

I was then asked by the hon. Member for Cheadle about Regulation 1(3)(b)(iv). As I understand it, this means that if it is the same doctor who has made the notification within a period of 12 months, he will not have to notify again, but that if it is different doctor in the same hospital, he will be required to notify.

The hon. Member for Galloway (Mr. John Brewis) asked me about action against pedlars. The notification scheme is not designed to assist the police to catch pedlars, but if new pockets of addicts come to light in areas where drug taking had not been thought to be a problem, the police will be alerted to the possibility of trafficking, but doctors would have professional objections against notification being used against trafficking whether by addicts or pedlars. We shall be in a better position to know, through notification, where some addicts are getting their drugs. The definition covers heroin and not methedrine, but the question of methedrine is now being considered.

I was asked by the hon. Member for Runcorn (Mr. Carlisle)—

Mr. Brewis

Before he leaves that point, may I ask the Under-Secretary whether methedrine could not be added very easily to the Schedule if the Committee recommended it?

Mr. Taverne

It would require a change in the law and could not be covered by Regulations. Only drugs covered by the Single Convention can be covered by these Regulations. Since the Single Convention of 1961 does not at the moment cover methedrine, it will require another change in the law.

I was asked by the hon. Member for Runcorn why the two Regulations could not be made at the same time, but these Regulations will be useful in providing us with much information even before the prescribing Regulations are ready.

I have already dealt with the question of whether a doctor will tell his patient. This is entirely a matter for the doctor.

I would like to agree with the final remarks by the right hon. Member for Ashford. These Regulations and the notification procedure will be extremely valuable to us because they will give us a lot of extra information which we do not have now. I can confirm that one benefit we hope to see is in cases where patients are going to different doctors. This will give us an extra means of control because it means that the patient who plays off one doctor against another will find that he cannot do so in future, in all likelihood. The moment one doctor notifies, he will be able to get information which a previous doctor has notified, and also the central authority will know.

The Regulations have been welcomed and represent a major step forward. They will shortly be followed by another set of Regulations which will make the general scheme effective.

Question put and negatived.