§ 10.2 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 (Supply to Addicts) Regulations 1968 (S.I. 1968, No. 416), dated 18th March 1968, a copy of which was laid before this House on 25th March, be annulled.It goes without saying that we are moving to annul these Regulations to give ourselves and the Minister another chance to survey this anxious problem. I have never felt it was much contribution to our problem to cry wolf too loudly or too often. Indeed, it might be said that to some extent the spread of addiction is in inverse ratio to the amount of publicity given to it.
Since 16th April we have embarked on a difficult experiment, and its success or failure will go some way towards determining the future course of narcotics addiction in this country. It follows, therefore, that it is critically important to watch the early stages of this new system.
I judge that we have got off to a better start than many expected or feared—at least in London. The Minister may say that some of the earlier fears expressed have now been displaced. Equally had those fears not been expressed—not only by hon. Members here, but by hospitals and members of the medical profession—it is possible that we would be in more trouble than we are.
About a month ago we discussed Regulations under the Bill requiring notification. In the light of these Regulations, will the Minister tell us the results up to date? He told me, in answer to a Question, that by mid-March 682, mostly heroin takers, had been notified. I judge the total to be about double that now, and I think the numbers are still coming in. I hope that the Minister will be able to indicate what view his Department takes about this.
Does it feel that it is approaching a final total? Has it formed any impression of those addicts who are, as yet not going to a doctor to avoid being notified? I have a feeling that there are still a fair number left to be accounted for. It is 154 disturbingly clear that a fair proportion of former heroin addicts have switched over to methedrine, about which I will have something to say in a moment.
Again, are we reconciling the numbers notified centrally with the numbers reporting to hospitals? This seems an important relationship. If those who start treatment at hospitals under these Regulations drop out, have we any way of discovering that this has happened and of keeping a check on their whereabouts?
I think that we might all wish that London lent itself to a system which Birmingham enjoys, by which all agencies—police, chemists, social workers and the hospitals—co-operate sympathetically to get addicts into the right hands to pool their information. That is beyond us in a capital of this size. Without wishing to sound in the least inhuman, it may be that the reconciliation of these various complex statistics will have to be assisted by a computer. I hope that the Minister will keep his mind open to that. Rapid assessments and calculations will be important.
As far as the hospitals go, I accept that it is early days to pass judgment on operations since 16th April, but perhaps I might make one or two observations on how they may be expected to operate. First, I think that they will find it very difficult to do a satisfactory job without disciplinary powers. I know that there are two views about this. One is that addicts must be wooed. That is true, but there is a balance to be struck. The addict is a patient, not a privileged person. I think that the Minister has shown awareness of the need for this balance by limiting—I think to one, but he can confirm this—the centres open for 24 hours in London. I have come round to see that this is probably right. If London's 16 or so hospital clinics were expected to gear themselves to the vagaries of the addicts, the lives of the staffs would become intolerable.
There must be discipline to a degree, and I should like to see this discipline extended to one thing, namely, admission for 48 hours for preliminary assessment of need. This view is supported by a number of people in the medical profession who know the problems well. 155 Without that assessment, how are we to avoid over-prescribing, or under-prescribing, either of which can lead to illicit traffic outside the hospitals, the one thing that we want to avoid? I cannot see that these addicts will arrive with any reliable guide of what their former needs have been. I cannot see how their needs can be scientifically ascertained without powers to ask them to submit to a more detailed examination than is now possible.
All the information which I respect stresses how important it is to draw local social workers into the work of these centres. It is imperative that social workers in the field and the National Health hospitals should work together on an equal footing. Someone has to establish a domestic relationship, as opposed to an institutional one, with these people. Under this system the addict will not always see the same houseman, as he saw his private doctor on private premises.
Whether the system remains simply a source of maintenance—which for the State has a questionable aspect—or whether it paves the way for some, even a few, cures, will depend an enormous amount on the social worker background. In some respects the social worker is more important than medical treatment if we bear in mind that the problem in many cases is not simply the detoxification of the addict, but, some form of social rehabilitation.
The Minister will say—and I know this to be true—that hospitals are short of social workers of that kind. That being, so, it seems all the more important to make the best use of the social workers that we have in the field outside the hospitals. I very much wish that the right hon. Gentleman had kept a slightly more open door for those medico-social units and centres which had been doing good work in this field——
§ Mr. Speaker
I hesitate to interrupt the right hon. Gentleman, but we are not discussing the parent Act. He must not go too wide of the Regulations.
§ Mr. Deedes
I appreciate that, Mr. Speaker, and I think that you will find that what I am saying comes within the terms of the Regulations.
The right hon. Gentleman will be aware that, as a result of these Regula- 156 tions, a decision has had to be taken to close the Chelsea Centre and that a good deal of feeling has been aroused on that score. I think that he will say that it has been done because, under the Regulations, it has been necessary to withdraw the right to prescribe heroin for all medical practitioners. That would be more convincing if we did not know that Dr. Chapple, one of the principal figures at the centre, is, under these Regulations, enabled, in another hat, to prescribe at Chelsea Hospital, as he is now doing. No doubt the decision can be justified by the letter of the Regulations, but I question its wisdom for several reasons.
According to a Written Answer in another place, 545 medical practitioners have been licensed to prescribe these drugs under the Dangerous Drugs Act, 529 of them on the staff of National Health hospitals. With all respect to those practitioners, how many of them know as much about this subject as either Dr. Chapple or Dr. Gray of the Chelsea Centre and, to be fair, how many want to know as much? Goodness knows, we are not over-endowed with reputable enthusiasts in this field and I might ask, why are they there anyway? They have been filling for some time an essential gap while we have been deciding rather slowly what to do.
It is imprudent that, under these Regulations, these people should be driven out of this business and we should then have to draft 500 or so doctors, the work of few of whom has lain regularly in this field and most of whom are reluctant soldiers, into the business.
There seems to be one more reason for not closing the door, under the Regulations, to the voluntary organisations which have been operating in the field. I accept that the present system is an emergency measure and we must accept it, but I doubt its permanence. We may well have to move towards less formal arrangements as time goes on, in a year or so—away from the National Health hospitals, into which the Regulations would put the system, and towards more ad hoc institutions able to integrate the social background and, of course, approved and supervised by the Minister.
I hope that the Minister will not close his mind to the possibility of this system 157 being a transitional stage. If that is so, it follows that we should not too quickly discourage reliable enthusiasts who may well be the nucleus of a new system which the addicts will eventually have to have. All experience has shown that, whatever arrangements we may try to dispose of here, ultimately, professional personality is decisive. This is particularly so in a place like All Saints, Birmingham and also, I think, in Bristol, under Dr. Wood, and in a number of other places.
I want now to turn to a different and rather more serious aspect which, I think, falls within the Regulations. We are confronted with a rapidly changing scene. It has changed a great deal since the Act went through and is changing continuously. There has been one particularly important change in the relationship, or perhaps in our conception of the relationship, between hard drugs, the narcotics of which the Regulations treat, and soft drugs. Hitherto, I think, most people put the drug problem in roughly three fields—first, narcotics, with which the Regulations deal, second the hallucinogens, which have nothing to do with the Regulations, L.S.D. and cannabis, for example, and, third, the barbiturates and amphetamines, the soft drugs, with which I think we may deal under the Regulations.
The Minister knows that it is on the last of these drugs, the amphetamines, that most anxiety arises at present in the medical profession because we have incontrovertible evidence of widespread abuse of one amphetamine, namely, methedrine or methylamphetamine. This is not included in the Regulations and I cannot ask that it should be. It cannot have been included because it was not even under discussion when we were talking about the Bill.
As, with these Regulations, we establish our arrangements for heroin and its immediate associates, we are left in no doubt that the intravenous use of methedrine has become almost as widespread—and no less serious in the eyes of the profession—as the use of heroin. There is no doubt that this is a nasty problem. I have sent the right hon. Gentleman some figures today, which I will not publicise and which would not be relevant to these Regulations. Nor, 158 will I enlarge on the medical use or the social misuse of amphetamines: that would also be without the scope of the Regulations.
It is long overdue for serious question whether 3½ million annual prescriptions for amphetamines, with the consequent large overspill of illicit use, is medically necessary or socially sense, but I know that the Minister has taken care of that with a letter to medical practitioners. What troubles me is that I do not think that a caution to the medical profession will prevent that kind of minority which was prescribing heroin excessively and was the direct cause of these Regulations from prescribing methedrine excessively now.
We have one example of how this is being done and I will not advertise him or his whereabouts, since he has had enough publicity, but, unfortunately, he is not the only one prescribing methedrine and knowing full well the uses to which it is being put.
I do not believe that, in this sphere of amphetamines, and methedrine in particular, we will be able to control the situation by Regulations of this kind from here. It is a course which, as we see tonight, has two obvious drawbacks. First, we shall always be a little too late, however hard we try, and that is no reflection on the Ministry. Through the workings of Parliament, we shall always be a little too late.
I have no doubt that, sooner or later, we will have to add methedrine to the list. By that time we will have another drug to contend with. I could already name one, but I will not. There will be other possibilities, and one will follow another. We will be required to add these drugs to the list and then, if necessary, pray against them to discuss them. This is not the way to handle the situation.
Parliament is not an effective instrument for the sort of control that is needed. We are dealing with something that Parliament cannot control effectively and I believe that these Regulations are almost the last thing that we here will be able to do. In my view, only the medical profession can now exercise control. The Minister knows that I wish—and perhaps he wishes, too—that it was the profession which was exercising control tonight and not we through these 159 Regulations. Only the profession can make, as professional bodies should, value judgments on the prescribing of particular drugs like methedrine for particular persons or purposes.
I put the matter as moderately as I can. The medical profession must pause here now and see where it is going. Unless a concerted effort is made to curb an irresponsible minority, we will be drawn inexorably and, I fear, unwisely and against the profession's interest, into more and more Regulations of this kind. For reasons which the Minister knows, the General Medical Council felt unable to accept a recommendation that heroin should be dealt with by the profession. Therefore, these Regulations have become necessary; and that is what the Regulations are about. It has become necessary for us, by Statute, to take away an important part of the medical profession's rights—the right to prescribe—and this is an extremely serious matter.
The Regulations say that doctors may not prescribe certain drugs. This is a big and important deprivation, of which the medical profession should have taken more note than it has. If we go on, as it seems we may, attempting to limit by Statute the prescribing of certain amphetamines, the medical profession will face a big invasion, begun with heroin, of its prescribing authority. This is an extremely serious matter. Indeed, speaking with moderation, I only hope that the profession is aware of its importance.
I am not saying that everything can be left entirely to the profession's own established standards—"conduct unbecoming", "infamous conduct", and so on—but that it should accept the need to play a bigger part; otherwise, its freedom will be steadily eroded by Regulations of this kind. I hope that we are aware of the limitations here. We are dealing not with 1,200 or so heroin addicts, but with a larger number of a sub-culture who, for one reason or an-other, resort to any extreme, even to self-destruction; and this we will never eliminate. Unfortunately, they are apt to enlarge their circle, and that is our concern and the reason behind the Regulations.
Eventually, it may be that this permissive society of ours will have to be 160 permissive enough to establish micro-communities where these people who want to contract out of life can live in a world which accepts them. Until then, we must simply contain them, and that will depend heavily not just on our overworked hospitals but on a wide diversity of social agencies. I hope that the Minister will acknowledge and emphasise that now because it is something which should have very heavy emphasis indeed.
§ 10.23 p.m.
§ Mr. Mark Carlisle (Runcorn)
Hon. Members will be grateful to my right hon. Friend the Member for Ashford (Mr. Deedes), for initiating this debate on what the Minister will agree is an extremely important set of Regulations. It prevents the power of doctors to administer certain named drugs. As my right hon. Friend said, probably for the first time Parliament is interfering with the doctor's normal right to administer drugs to his patients.
When we are considering the question of hard drugs, the vital thing is to ensure that their supply is properly controlled. If it is not, then we know, from what we have seen over the years, will happen; that they find their way on to the black market and into illegal sales. These sales seem to have two very worrying social effects. First, they are supplied to the addict at prices which require him to gain money by various means to pay for their supply. Secondly, they encourage other people to go onto drugs or encourage the possessors of drugs to persuade others to take them, thus increasing the outlets for his sales on the black market.
Therefore, to the extent that these Regulations, by controlling the supply of drugs, will limit the supply that might get into the wrong hands, they are to be welcomed. I must admit that, like my right hon. Friend, in many ways I regret its necessity. It is indeed unfortunate that we could not have left this control to the good sense and professional discipline of the medical profession. It is an unfortunate fact that we find it necessary to legislate in this way.
I say this particularly for the reason that it is highly questionable where one stops when one starts on this type of Regulation. As my right hon. Friend mentioned, there is an alarming increase 161 in the supply of methedrine at the moment. We cannot expect Parliament persistently to bring forward Regulations laying down prohibitions on doctors against prescribing particular named medicines. I hope that we shall not have to see other similar Regulations produced, but that we can rely on the profession to take the necessary disciplinary measures which will make such Regulations unnecessary.
I say that mindful of the fact that I am a member of a profession which prides itself on having high professional standards, all of which are laid down internally and upheld internally and do not require or need legislation to control those high professional standards. The medical profession is equally a high and honourable profession. I hope very much that it will be able itself to continue to lay down and require members of the profession to behave in accordance with such high standards and that further orders of this kind will not be necessary.
Just as if we are to prevent drugs being sold illegally we must curtail resources of supply, we must see that those pathetic people who are genuine addicts are able to get their supplies from registered or licensed sources. Some of us are not so well versed in this subject as my right hon. Friend. I ask the Minister to say something about the geographical location of the number of doctors licensed under the Regulations. I have the impression that to a large extent this is still a London problem. I hope and believe that I am right, but is the Minister satisfied that, for the few addicts there, there are enough licensed doctors in the Liverpol and Manchester area?
I am a member of a Home Office advisory committee concerned with a wholly different subject, detention centres for youths. In that capacity I have visited various detention centres in recent weeks. What concerns me immensely is that over recent months—I believe it is only over recent months—there have suddenly come into those detention centres, people convicted of possession of drugs. I have the impression that the number is increasing as against the number of those convicted for other offences. They may be there not for possession of hard drugs so much as soft drugs. They are not addicts and are not directly affected by 162 these Regulations, but what was said to me today is worth repeating.
A man in a position of responsibility in one of the centres said that the very publicity given today by the Press and other mass media to the use of drugs is creating a phase among young addicts which leads them to try drugs, to be in possession of drugs and experiment with drugs, and eventually, if they start taking soft drugs regularly, possibly to move on to hard drugs and to become addicted.
In considering the Regulations we should bear that problem in mind and try to ensure that we discuss drugs responsibly and avoid the glamorisation which sometimes occurs and point out that it is for many a very sad and tragic downward path. Although these Regulations relate only to hard drugs, in so far as they show the control that is to be taken over the supply of drugs I welcome them and hope that, without any Regulations, due to the good sense of the medical profession itself similar control will be exercised over the supply of soft drugs.
§ 10.31 p.m.
§ Mr. Paul Dean (Somerset, North)
The House is grateful to my right hon. Friend the Member for Ashford (Mr. Deedes) for drawing attention to this extremely important subject. Although I do not claim to have one-tenth of the knowledge that he and my hon. Friend the Member for Runcorn (Mr. Carlisle) have of this difficult problem, I want to underline one or two of the points which they have made.
My right hon. Friend made the interesting point that the Regulations make provision for treatment in hospital for those who previously were, in many cases, treated within the community. I am not saying that that is the wrong procedure at this moment, but it is interesting to reflect that, at a time when all the emphasis is on care within the community, in this particular case we appear to be moving in the opposite direction. I hope that the Minister will pay great attention to the plea which my right hon. Friend made that we should not close the door on the ad hoc institution in the community which tries to deal with this problem. The problem is changing. It is very much in a transitional stage. It would be a pity, bad from the point of view of obtaining 163 deeper knowledge of the subject, and bad from the point of view of the care and treatment of those concerned, were we to try to narrow the base too much.
My right hon. Friend said that this is inevitably a transitional stage. These are inevitably transitional Regulations. Since they were tabled, we have the new problem concerned with methedrine coming to the fore. Only the other day I read in a newspaper expressions of concern over teen-age parties at which cider and pills were taken. This is another example. These two points emphasise the case which my right hon. Friend made that it is virtually impossible to try to deal with this problem through legislation or Statutory Instruments, because the character of the problem is changing so much. As soon as we succeed in plugging one loophole, another will almost certainly open up.
There is a real risk that, under these Regulations, we may fall between two stools. We cannot hope by legislation to block the holes fast enough unless the law is so wide and so flexible that drugs can be put very quickly on the banned list. But were the powers to be so wide, we should run into the other real danger that we should substantially undermine the right and duty of doctors to prescribe for their patients what they think best. That is why I say that, with the approach represented by these Regulations, we could well find ourselves falling between two stools.
It is not my purpose to oppose the Regulations, but I hope that the Minister will recognise the deep experience and knowledge of my right hon. Friend on this subject and accept that the questions which he put go not only to the heart of the most effective treatment for the people about whom we are speaking, but also to the heart of the freedom and professional judgment of medical men to do what they feel is best for their patients.
§ 10.36 p.m.
§ The Minister of Health (Mr. Kenneth Robinson)
The Prayer moved by the right hon. Member for Ashford (Mr. Deedes) enables the House to discuss those aspects of drug addiction which form the subject of these Regulations and also, perhaps, some related aspects of addiction to heroin and cocaine. The 164 Government welcome this opportunity to discuss their measures to tackle the spread of addiction to these drugs, and the right hon. Gentleman has, as usual, made a helpful and constructive speech on this subject, as did the hon. Members for Runcorn (Mr. Carlisle) and for Somerset, North (Mr. Dean). I fully accept that this Prayer has been tabled for purposes of elucidation and discussion.
The Regulations complete the scheme of measures on drug addiction recommended by the Brain Committee and accepted by the Government. I think it right to remind the House of the scheme as a whole, and its objectives. First, we now have a Standing Advisory Committee on Drug Dependence under the chairmanship of Sir Edward Wayne, which keeps the whole field of drug dependence—both the so-called "hard" and "soft" drugs—under review. Second, research effort has been substantially increased by the establishment of the Addiction Research Unit at the Institute of Psychiatry.
Third, Regulations laid before Parliament in February require doctors to notify particulars of addicts to the Chief Medical Officer. Fourth, an advisory panel has been set up to help doctors who are in doubt about whether a patient is addicted within the meaning of the Regulations and should, therefore, be notified.
Fifth, the Regulations now before the House restrict to licensed doctors authority to prescribe heroin or cocaine to addicts. Sixth, and certainly not least, hospital treatment facilities have been developed to meet the estimated demand for treatment following these Regulations.
These Regulations prohibit doctors from prescribing or administering heroin or cocaine to addicts except under a licence issued by the Home Secretary or where the drugs are needed for the relief of pain due to organic disease or injury, thus giving effect to one of the major recommendations of the Brain Committee.
As indicated by Government spokesmen during the debates on the Dangerous Drugs Bill last year, the Home Secretary is advised in the exercise of his licensing powers by the Chief Medical Officer and takes account of the facilities of the institution in which the licence is to be 165 used as well as the personal qualifications of the doctor himself. In the National Health Service, doctors who have been considered for a licence are consultants who treat, or who may be called upon to treat, heroin addiction in psychiatric hospitals or units and have been nominated by a hospital board, and doctors in other specified grades who have been nominated by, and are under the supervision of, those licensed consultants.
Applications for licences from doctors outside the National Health Service are considered on the basis of similar criteria. For example, the doctors should be of comparable rank or status and the institution should have facilities comparable with those of National Health Service hospitals which treat heroin addicts. All doctors were informed of the Regulations towards the end of March, and an explanatory memorandum was issued setting out the procedure for licensing.
I understand that the Home Secretary has issued over 500 licences. Almost all are to medical staff in National Health Service hospitals; there have been a few applications from doctors outside the Health Service and a very few licences have been issued to doctors in private hospitals. Many of the licences issued to Health Service hospitals may be only rarely used, but it is sensible to ensure that there are licensed doctors in all parts of the country, although in many there are believed to be no heroin addicts. I think that this answers the point of the hon. Member for Runcorn (Mr. Carlisle). The main criteria for licensing seem to be well understood by doctors and I understand that my right hon. Friend has had to reject very few applications.
The effect of licensing is to transfer the treatment of heroin addicts from general practitioners to hospitals. The House will recall that this accords with the Brain Committee's view of the most hopeful way of organising treatment and that this view has the general support of the medical profession. It would not be surprising if some addicts and perhaps a few general practitioners preferred the old arrangements under which any doctor was free to prescribe for addicts. But, quite clearly, these arrangements could not be allowed to continue in view of the Brain Committee's advice.
166 I think it worth emphasising that we are changing the basis of the system and that the Regulations do not reflect adversely on those general practitioners who have undertaken the difficult and unrewarding task of treating heroin addicts, and discharged it in a responsible manner. It also follows that we shall not issue any licences for use in general practice. The new system must be applied without exception. This does not, of course, imply that any doctor who has an interest in the treatment of addiction will be prevented from treating his patients. It is only where he considers it necessary to prescribe heroin that he would need to secure for that purpose a suitable hospital post.
The right hon. Gentleman questioned the decision to withhold licences from two doctors at the Chelsea Addiction and Research Centre. I understand that these doctors treat addicts in the course of general practice; the centre is not a hospital, the doctors are not consultants, and there is no consultant supervision. One of the doctors is, however, licensed for the purpose of his part-time hospital appointment, where he will be under consultant supervision.
The Chelsea centre will be able to continue to treat addicts by methods other than prescribing of heroin, and I hope that it will do so. There is certainly no necessity for the centre to close because of the decision not to license the two doctors for this limited purpose.
The House will naturally wish to view the Regulations against the background of our current information on the scale of addiction to heroin and cocaine, about which the right hon. Gentleman asked particularly, the sources of the drugs and the provision for treatment. First, under the new system of notification which began on 22nd February, 877 heroin addicts had been notified up to 3rd May. Of these, 764 were in the Greater London and Home Counties areas.
The majority of notifications were made by hospital medical staff. There is no sign yet that notifications are falling off sharply. It would be rash to make any deductions yet from the pattern of the daily receipt of notifications. I shall certainly consider the right hon. Gentleman's suggestion about the possible use of computers in this 167 connection. Some use is already being made of the Home Office Statistical Branch services, but it would be as well not to take decisions too quickly about the type of information to be collected or the methods to be used. As I am sure the right hon. Gentlemen will know, the notification programme in New York City took several years to develop.
Second, although the Home Office has evidence that a small quantity of heroin has been imported illegally into this country, the main source of supply is still believed to be prescriptions by doctors. Third, treatment facilities which should be capable of dealing with up to 1,000 addicts in London, were ready by 16th April. The details were given to my hon. Friend the Member for Wandsworth, Central (Dr. David Kerr) in reply to a Question on 26th March.
In the Government's view, nothing has happened to invalidate the case for restricting the prescribing of heroin and cocaine; and the information about the numbers of addicts does not cast doubt on the adequacy of the hospital facilities to meet the foreseeable demand for treatment. These considerations were, of course, carefully weighed by my right hon. Friend the Home Secretary and myself before the regulations were made and their operative date decided upon.
Arrangements for the transfer of addicts from general practitioners to hospital clinics were well advanced before the regulations were made, and in the interval before they became operative arrangements were made for the transfer of those who were still being treated by general practitioners. I am very pleased to inform the House that this operation has gone off smoothly and that hospital clinics have now take over the major responsibility for the treatment and supervision of heroin addicts. At the present time in the London area, these clinics have more than 700 addicts on their books.
The object of the operation and of the other measures taken is, of course, to check the spread of heroin addiction by reducing and, if possible, eliminating the over-prescribing of heroin, and by providing more effective treatment facilities than are possible within general practice. 168 Both considerations require that the hospital service should not provide facilities for an addict to obtain heroin at any time of day or night.
It will be obvious to the House that it would be difficult, if not impossible, to control the supply of heroin available to addicts if they could obtain this drug at any time, merely by visiting a hospital or perhaps a series of hospitals. Fortunately, there is no clinical need to provide facilities of this kind. On the contrary, I am advised that the consensus amongst psychiatrists is that a 24-hour out-patient treatment service is unnecessary and, indeed, undesirable, in that the attendance of an addict at regular times in a clinic's usual working hours is part of the process of rehabilitation. Experience in the London clinics has already confirmed that addicts are capable of attending at regular hours, and this is perhaps not altogether surprising when one recalls the punctual attendance of addicts at midnight at certain all-night chemists in order to get their prescriptions for the following day's supply dispensed.
I expect incidentally that this particular concentration, which is so undesirable, will disappear or be greatly reduced under the new regime partly because prescriptions will be dispensed by chemists near to the addicts' homes, thus spreading the dispensing points, and partly because the hospital doctor may specify on the prescription the hours during which it may be dispensed; and these will be during chemists' normal opening hours.
The possibility of tampering with prescriptions to obtain extra supplies is being prevented by sending prescriptions direct to the chemists, and the risk of an addict prematurely using up, or perhaps selling, a whole week's prescription, and in consequence suffering withdrawal symptoms, is being reduced by arranging for supplies to be dispensed daily. Even so, emergency treatment for addicts in distress is available at all times in accident and emergency departments and in casualty departments. I am advised that withdrawal symptoms may be relieved by a substitute drug, and do not necessitate the use of heroin.
The Chief Medical Officer has issued clinical advice to doctors, including 169 casualty officers, on the treatment of "emergencies". This advice says among other things, that most addicts exaggerate or fabricate withdrawal symptoms. This was borne out by my inquiries into the case reported in the Sunday Times of 28th April, which said that an addict in pitiful condition was refused emergency treatment. In fact, the addict—who, despite the name he goes under, is not a peer of the realm—was correctly receiving drugs prescribed by one hospital, and could have returned there if he had been in genuine difficulty. Instead, he arrived by ambulance at another hospital, where he was examined by a doctor, found to be clinically fit, and discharged. He returned by ambulance to this hospital later in the day and demanded a "fix"; when this request was refused by the doctor who saw him, the patient promptly walked out, I emphasise "walked out". It is quite untrue to say that the patient was refused any necessary emergency treatment. I may add that the voluntary organisation who wrote to me making these allegations was given the facts as I have recounted them before 28th April when the story appeared in the newspaper. Perhaps I may also add that the incident took place five weeks before that story appeared.
The right hon. Member for Ashford referred to the problem of assessing the right dosage of drugs. This is a medical matter of which the clinicians responsible for treating addicts are fully aware. I understand that it is difficult to make a precise assessment without requiring the patient to enter hospital for a short period, which might well deter some addicts from further attendance at the clinic. The clinicians have held several conferences at the Ministry which included discussion of the assessment of dosage, the scope for laboratory testing and the development of laboratory services for this purpose. I understand that at present laboratories can provide qualitative, but not quantitive tests, of drugs taken by a patient, and the experts are continuing to tackle the technical problems involved in assessment of this kind.
The out-patient clinics are not concerned only with the right assessment of drugs. The intention is that rehabilitation should begin as soon as the addict enters the clinic.
§ Mr. Deedes
Before the right hon. Gentleman leaves the question of assessment, if the profession come back with a feeling that some form of compulsory admission will be necessary I hope that the right hon. Gentleman will not resist it, although I realise the difficulties that can arise.
§ Mr. Robinson
This is a difficult matter. Of course I would consider it. I would not dream of dismissing it out of hand. We decided, and this was the final view of Lord Brain, that we would go ahead without the power to detain, in the hope that the system would work well.
§ Mr. Deedes
I am not talking of the permanent admission for treatment, but temporary admission, for not more than 48 hours, for this critical matter of assessment.
§ Mr. Robinson
I was not thinking of permanent detention. I take the hon. Gentleman's point. We shall just have to see how we go. I was saying that the out-patient clinics are not only concerned with the assessment of drugs.
I have recently received interim advice from the Advisory Committee on Drug Dependence, which I have commended to hospital authorities in the London area. The Committee emphasises the importance of clinics having the services of social workers who would, for example, maintain contact with addicts and their families and where possible follow-up patients who have entered hospital or who need after-care on discharge. I fully accept the importance of social workers in this context, but they are in short supply.
The measures that the Government have taken are based on the best professional advice, and we shall watch closely their effects. If it appears necessary to supplement them, we shall not hesitate to do so. Even if heroin addiction is checked, there will remain as the right hon. Gentleman said, and as the Government recognises, the problem of dependence on the so-called "soft" drugs, including the particularly worrying problem of methedrine, on which expert advice is awaited.
The Advisory Committee on Drug Dependence has been asked to study the problem urgently. The present difficulty is to get the real facts about the 171 phenomena of methedrine abuse and dependence. It is not yet clear—and I think this point was accepted in the debates we had on the Bill last year—that the Brain solution which is enshrined in the Regulations and associated Measures would serve a useful purpose here. As I say, we shall have to await the expert advice.
This whole exercise of organising hospital facilities for the treatment of heroin addicts, and of transferring addicts from their general practitioners to the hospital clinics for treatment has been anything but easy. That it has been carried out with such a marked degree of success reflects credit on many people, including psychiatrists, administrators and others in the hospital service and a small group of officials in my Department who worked closely with them throughout.
There has, understandably, been considerable public interest in drug addiction, and constructive discussion of the problem, and the way it is being tackled, is both proper and helpful. The House will no doubt continue to review this problem. On the whole, public comment is becoming more informed and responsible, but there have been some unfortunate exceptions. The difficulties we have had to contend with have been in no way diminished by the attitude of certain newspapers, and of a few people concerned with the addiction problem in a mainly voluntary capacity, who have found a ready forum for their views in those newspapers.
From the first, this small group seems to have been hostile to the whole concept of hospital treatment for addicts; when the facilities were established they denied their existence—"Minister's addict clinics are just a myth" ran one Sunday Times headline of 18th February, and they consistently predicted chaos when the general practitioners prescribing ban came into operation, the very chaos that they, no doubt unintentionally, were doing something to bring about. For this consistent campaign of denigration of the Government"s efforts had one inevitable side effect—it could only damage the addicts' confidence in hospital treatment, and make them less inclined to seek it.
Happily, there was no chaos on 16th April when these prescribing Regulations 172 came into force. As I have said the transfer has been effected in a remarkably orderly fashion. It was too much to expect this to be publicly acknowledged in those journals which had confidently predicted chaos, and one must be grateful for their relative silence on the subject in the last week or two.
But, here again, there has been one regrettable exception at least. I have recently seen reported an extraordinary statement that hospital doctors are cutting down supplies of drugs to addicts so severely that their lives are threatened. Since it may discourage addicts from coming forward for treatment, I would like to say now that this allegation, like so many publicised utterances from the same source, is complete nonsense. It is also dangerously irresponsible. The increasing numbers of addicts who attend the hospital clinics are finding—and will continue to find—that they are treated by doctors and nurses who understand their problems.
Addicts are not necessarily receiving all the drugs they would like—this might well mean over-prescribing—but they are receiving all the drugs that the consultant who is responsible for their treatment, and who is skilled in these matters, judges that they need.
In case hon. Members may think that I have been a little unfair to the Press, may I mention one other example. There have been occasions where newspapers have arranged for an addict or a person presenting himself as an addict to tour hospitals, pretending to be in need of treatment, apparently to test the readiness of hospitals to provide treatment. I am sure that the House will deplore, as I do, activities of this kind, which waste the time of busy hospital staff and are, naturally, resented by them, and I sincerely hope that their work will not again be impeded in this way.
The 16th April marked the beginning of a new era in the control of drug addiction in this country. It is much too early to say how far these Regulations, together with the other measures taken by the Government, will succeed in securing our objective, the containment of heroin addiction here in Britain. But I am fortified by the knowledge confirmed by this debate that we have the 173 support of all sides of the House for what we are trying to do and the way in which we are setting about the task.
§ Question put and negatived.