§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Concannon.]
§ 10.49 p.m.
§ Mr. Leslie Huckfield (Nuneaton)
I am glad to b; able to thank you. Mr. Speaker, for the opportunity I have been given to raise what I think is rather an important subject. At the same time, I should point out that I do not wish to sound scare-mongering in any way. I am merely trying to bring to the attention of this House, and particularly of my hon. Friend, something which has already been brought to the attention of Governments and Houses of Parliament in other countries.
I am not asking for the introduction of a new breathalyser to combat drug-taking; I am not even asking for the introduction of legislation. I am asking my hon. Friend to look into the various points that I shall raise, and I hope, also, that he will have the opportunity at an early stage to bring them to the attention of his right hon. Friend the Minister of Transport.
Today, we are living in an increasingly drug-taking society where the number of prescriptions for drugs are increasing every year. From the latest figures which I have before me, in England and Wales, in 1967, family doctors wrote out more than 271 million National Health Service prescriptions for drugs, including over 20 million for sleeping tablets, 16 million for barbiturates, 14 million for tranquillisers, almost 5 million for antidepressants, nearly 5 million for stimulants and appetite suppressants, and over 5 million for antihistamines.
These are round figures, but they give some indication of the increasing number of drags which can have psychological or psycho-active effects which are being prescribed in the National Health Service.
I want to draw attention to a problem which which scant attention has been drawn so far in this country. We have had a great deal of concentration over the past two years, particularly since the introduction by the previous Minister of Transport of the 1967 Road Safety 1520 Act, of the influence of alcohol on drivers' capability. I want to extend that to talk about the influence of drugs on drivers' capabilities, and I take as my starting point an excellent article in the latest edition of the Automobile Association publication called Drive.
In this article, done in an exemplary manner by Miss Paulette Pratt, we have a good and comprehensive selection of statistics which I should like to bring to the attention of the House tonight. My interest in this has also been stimulated by one or two leader columns recently, particularly in The Guardian, and by some rather unsatisfactory replies I have received from the Minister to Questions which I have put down.
According to the survey carried out by Drive—and I congratulate the Automobile Association on the pioneering work that it has done in this field—945 drivers of private cars and commercial vehicles were asked if they had taken pills or medicine of any kind during the 24 hours before the interview. One hundred and forty said that they had. If this 14 per cent. is extended over the motoring population as a whole, we come to the figure of 2 million motorists who, at any time—bearing in mind the size of our motoring population—are driving under the influence of medicines or drugs.
These figures—particularly the 14 per cent.—are backed up by a recent survey by the Californian State Highway Patrol, in the United States, which produced the very similar figure of 13.2 per cent. We can also have some figures given in a paper read before an international symposium on drug addiction at Brussels by Dr. J. D. J. Havard, of the British Medical Association, in which he points out that various surveys have been made and that in these we find that 10 to 16 per cent. of those examined or questioned had been taking some kind of drugs. But other surveys indicate that only 3 or 4 per cent. were involved. One random survey in the United State of 100 alcoholic patients showed that 38 per cent. had been taking tranquillisers or barbiturates, although only 9 per cent. admitted the fact. So here we have some facts to back up the conclusions drawn in the survey by Drive.
I stress that tonight I am not only or even particularly talking about the drugs about which we have heard a great deal 1521 over the past two years. I am not concerned only with the obvious, drugs that are supposed to be controlled, like heroin, cocaine and even cannabis. I am talking about ordinary everyday medicines and drugs like anti-depressants, antihistamines, amphetamines and the kind of thing that in many cases it is possible for the general practitioner to prescribe, and in even more cases can be bought over the chemist's counter.
To back up my concern, I would like to quote some figures from a World Health Organisation report, "Psychoactive Drugs and Road Safety", a paper produced before the United Nations Commission on Narcotic Drugs. It has some rather revealing figures on the influence of various types of psycho-active drugs on people's psychological and other capabilities.
On page 9, a section headed "Barbiturates" states that a research team called Smith and Beecher, in their double-blind study on the effects of barbiturates on skilled performances, found that 100 mg. of seco-barbital per 70 kg. of body weight can produce a profound distortion of judgment under certain circumstances. They concluded that this is particularly important in regard to road safety.
In the section dealing with tranquillisers it is stated that the depressant effects of this group of drugs are reported to be qualitatively different from those of other central nervous system depressants, such as barbiturates. Kornetsky and others compared the effects of chlorpromazine in quantities varying from 100 to 200 mg. and 200 mg of secobarbital and placebo given orally to normal subjects at bed time. Both drugs produced a significant increase in sleeping time and significantly impaired performance of various psychological tests the following morning.
Even more alarming is the conclusion of the report on what happens if a person taking a sedative happens to combine this with alcohol. For instance, Goldberg, in his study on the effects and after-effects of alcohol, tranquillisers and fatigue on nystagmus, found that moderate doses of alcohol in conjunction with tranquillisers may induce a marked intoxication, while the same dose of alcohol alone might bring about no apparent intoxication.
1522 In the section of the report on stimulants we find that, in Australia, Swanton has reported that some inter-State transport drivers have found amphetamine useful, not realising the dangers, and this has been a factor in some traffic accidents. Some drivers confessed that they had been taking up to 500 milligrammes of dexedrin over 48 hours. What I am trying to show is that we have done sufficient research to prove that these drugs have some kind of psycho-active or psychological effects. The difficulty is that it has not been proved, because the research has not been done, that these psychoactive or psychological effects directly affect driving.
To quote again from Havard's paper:The conclusion to be drawn from the reported surveys is that there is no statistical evidence, as yet, of increased risk of accident involvement among drivers taking drugs. However, many psychological and physiological tests of the effects of drugs on skills resembling driving and on driving performance, including simulators, point to a serious deterioration in those aspects of driving performance which are believed to be important in influencing risk of accident".Though we have not yet done the extensive research which I believe is vital and necessary to prove that there is a direct correlation between those taking drugs and their driving performance, we have shown that there is sufficient evidence to be concerned about the numbers of people who take drugs and drive at the same time.
The Havard paper also says:For these and other reasons it has been said, with some justification, that research on the effects of drugs on driver behaviour is in its infancy and that we are in a position similar to that which existed in the case of alcohol 50 years ago.It is even more illuminating when we look at what other countries have done on the basis of the experience and research they have gathered. In Norway, for example, legislation forbids driving a motor vehicle under the influence of alcohol or of intoxicating or tranquillising substances.
§ Mr. Huckfield
We find other examples in America, in Texas and Tennessee, for example, where penal codes actually mention tranquillisers and depressants. We have not got to that precise stage of 1523 definition, but I want to bring these general examples to my hon. Friend's attention. Again, in other countries, particularly some North American States, one frequently finds newspaper advertisements and television commercials—particularly in Pennsylvania—drawing attention night after night to the rather dangerous consequences that can occur with a combination of drugs and driving.
A great deal of preliminary research is already being done outside this country, particularly in North America and also by the O.E.C.D. The World Health Organisation report gives the example of Germany, where a study was made of 2,060 traffic participants under the influence of alcohol. When questioned on whether they had taken drugs within the previous 24 hours, 11 per cent. answered affirmatively, so a precise relationship has been established there.
In France, the Academy of Medicine was requested by the Ministry of Health to study the matter. In New York, the Committee on Public Health of the New York Academy of Medicine recommended that persons should not drive under the influence of drugs such as barbiturates, tranquillisers, and amphetamines in conditions which might induce mental drowsiness or inattention.
In this country, the Board of Trade also gives a similar warning to airline pilots. One drug company gives a leaflet to doctors prescribing its product instructing them that they should warn patients that some of these products may have effects on driving. Again, we have one or two examples where the manufacturers of antihistamines warn that they should not be used if the patients intend to operate a machine or drive a vehicle.
General awareness has been shown by the Medical Research Council and the B.M.A. Unfortunately, however, the Dunlop Committee said that consideration of the subject was really outside its terms of reference. Professor Payne, of the Royal College of Surgeons, has said that it could escalate into a serious public health problem. He is doing research into gas liquid chromotography as a means of measuring effects. Professor Beckett, of the Chelsea College of Science and Technology, who did pioneering work at the Mexico Olympics, has started 1524 on the problem of measurement, which is the big problem here because, although it is comparatively easy to measure alcohol as part of the blood stream, it is more difficult with drugs.
We have some preliminary research going on, but it is on a somewhat haphazard basis. I understand that the Road Research Laboratory has started some research into the matter, but it seems to me that the status of that research, particularly as I have been informed by my right hon. Friend in reply to Questions, is not on the basis I would like to see. There is also the whole question of what happens to insurance policies in relation to this matter.
Finally, I have five basic points. I do not think that there is need to go around scaremongering, or to glorify statistics, because they do not amount to all that much. What is wanted, first, is some tighter medical control over the prescription of psycho-active drugs. That has to be done by the medical profession, because at the moment there is a great deal of difference on what doctors advise their patients. Some will go so far as to ring the Medical Defence Union before prescribing and ask what would be the come-backs from patients if patients were aggrieved. Doctors should far more frequently, as part of prescription practice, advise patients that everyday drugs can be dangerous and lead to accidents or impair a driver's capabilities. More manufacturers should follow the advice of Abbotts, which has already informed doctors and is extending its labelling of product scheme.
We must do far more research into the medical aspect and into the effect of legislation in other countries. Above all, we should draw the attention of the public on a far wider scale than hitherto, to what can be a growing problem. I submit to my hon. Friend and to my right hon. Friend the Member for Greenwich (Mr. Marsh), who has just joined him, that what we have to do is to elevate research into this matter to the status which is accorded to it in other countries.
There is no need for alarm or scare, but we should be concerned. My hon. Friend may think that this does not, as yet, appear to be a significant problem, but I differ. It is becoming a significant problem.
§ 11.7 p.m.
The Joint Parliamentary Secretary to the Ministry of Transport (Mr. Bob Brown)
I am sure that the House appreciates the concern for road safety which has led my hon. Friend the Member for Nuneaton (Mr. Leslie Huckfield) to raise this subject tonight. Last week, my right hon. Friend the Minister of Transport announced the number of deaths and injuries in road accidents during 1968. There were 6,800 deaths, 89,000 serious injuries and 254,000 slight injuries. Although these figures are the lowest since 1962, they are still appalling. And it is just because we know that we can bring them down—as we have done during each of the last two years—that we must keep on studying the causes of road accidents, and look out for new ways to reduce them still further.
One reason why I particularly welcome this debate is that the influence of drugs on driving and their effect on road safety has until quite recently received comparatively little attention. The effect of alcohol on a driver has, of course, been studied exhaustively, and our experience following the Road Safety Act has confirmed that alcohol can be a significant cause of accidents. Other drugs are being prescribed and many others, quite legal, are bought privately—quite apart from those taken illegally—on a rapidly increasing scale as new drugs are discovered and as advances in medical knowledge allow us to make more and more use of this method of treatment. We need, therefore, to know whether this also presents a major road safety problem.
Many different factors can lead to a road accident and, indeed, in most accidents different factors interact. It would be foolish to imagine that every factor which may conceivably contribute towards an accident is equally important, or that all can be remedied. This is a subject in which there is an overwhelming need for a planned approach, so that resources are not dissipated in attempting to deal with those things which receive a lot of publicity but are not responsible for a significant number of accidents, or which are not within our power to correct.
The first question we must ask ourselves, therefore, is how large a problem is this, and how amenable to treatment is it likely to be. When we have answered these questions we can decide what proportion 1526 of our resources should be devoted to tackling it.
The first question to be answered is how many accidents appear to be due to drugs? This is not an easy subject on which to conduct research. Research into the effect of alcohol on driving is comparatively straightforward because one is concerned with only one substance, because people tend to react similarly when they have consumed a given quantity of it, and because it is comparatively easy to measure its presence in the body. With other drugs we are dealing with a wide range of different substances which have different effects on different people, some of which are much harder to detect and quantify.
Yet another difficulty is that drugs which affect the central nervous system, which are the ones we are primarily concerned about, are frequently prescribed for people suffering from depression or similar mental conditions which might in themselves affect accident risk, without taking drugs into account. Yet a further difficulty is that experience from overseas is only of limited value.
Reference was made to a study in California of the number of drivers killed in single-vehicle accidents, who were found to have been taking some form of drug. This information, though interesting, does not give any indication about how many accidents in this country can be attributed to drugs, since the pattern of drug-taking in the United States may be very different from what it is here. This we could only know after supporting studies of the kind which were carried out by the Road Research Laboratory in connection with differing blood-alcohol levels.
My hon. Friend made a lengthy mention of the study carried out recently on behalf of the Automobile Association. On the basis of this, it was suggested that there might be as many as 2 million drivers on the roads who might be under the influence of drugs. That study was based on the result of a series of interviews in which drivers were asked whether they had been taking any pills or medicines during the previous 24 hours.
It did not, however, attempt to discover how many of the drivers who answered "Yes" had been taking the kind of drug which might have affected their driving, 1527 and how many had been taking some which could be regarded as harmless in this context. Furthermore, the nature of the survey did not allow any indication of how many accidents might be caused by drugs, or the extent to which a driver's accident risk can increase with drugs.
The figures quoted in the A.A. study are in distinct contrast to the results of a limited pilot study done on this subject by the Road Research Laboratory. The laboratoiy maintains a team of medically qualified research workers who visit hospitals to study the injuries received by victims of road accidents, and the extent to which medical factors contribute towards accidents. One of the aspects of accidents which this team has been studying is drugs. Its work is still at an early stage, so I obviously cannot anticipate the full results. I can say, however, that the preliminary indications are that the number of accidents which can be attributed to drugs is negligible. This work is being pursued, but it seems most unlikely that some of the more extreme estimates will be substantiated.
But because we have no evidence that this is a major road safety problem, this does not mean that we are sitting back and ignoring it. We recognise that certain drugs can produce drowsiness or otherwise affect driving, particularly if taken with or shortly before alcohol. The 1962 Road Traffic Act makes it an offence to drive while the ability to drive properly is for the time being impaired by alcohol or drugs. "Drugs" is a broad enough definition without going into details of types.
§ Mr. Leslie Huckfield
Is my hon. Friend aware that the police would prefer to prosecute, in the case of drugs, under the 1967 Act, because the 1962 Act is not sufficiently precise?
I am coming to that.
Not the least of the objections to introducing more precise legislation about drugs and driving is that many drugs are known by different names, and new types of drugs are continually becoming available. A patient who is given a prescription by his doctor may very well have little or no idea what drug is being prescribed, let alone whether it is likely to affect his driving. In our view, the most promising way of approaching the problem is for the manufacturers who 1528 produce the drugs and the doctors who prescribe them to see to it that patients are given due warning of possible side effects.
For our part, we in the Ministry of Transport are doing what we can to help in this. We are in touch with the Department of Health and Social Security both on the question of the marking of drugs and on the need for doctors to give patients due warning if driving is likely to be affected. I have promised my hon. Friend that I will bring to the attention of my right hon. Friend the Secretary of State for Social Services the suggestion that he has made on this point.
My hon. Friend also raised the question of the marking of drugs. I understand that there are already rules which require that containers containing certain types of drug should be marked with the warning "Caution. This may cause drowsiness. If affected do not drive or operate machinery". This covers antihistamines, which are one of the most important groups in this connection. I know this, because I am a regular drug addict, on antihistamines, for the treatment of a nasal condition.
I understand that it may be possible to extend this sort of arrangement for marking to other drugs: This will be a natural subject for consideration by the expert committees which are to be set up under the Medicines Act. But we understand that this will not be without its problems, not the least of which is that the effect of a drug can vary from patient to patient, depending on the patient's general condition, and whether any other drugs are being prescribed at the same time. Again, I assure my hon. Friend that I will draw the attention of my right hon. Friend the Secretary of State for the Home Department to his concern in this matter.
With drugs obtainable only on prescription, I am sure that the real need is for the doctor to give the patient a warning at the point at which he makes out the prescription. My hon. Friend and I are at one on this. The Medical Commission for Accident Prevention has recently distributed a very comprehensive code of advice to doctors contained in a booklet, "Medical Aspects of Fitness to drive Vehicles". This, very helpfully, contains a section on drugs and describes which drugs are the most likely to affect driving.
1529 In addition, the Dunlop Committee, which advises the Health Ministers on questions relating to drugs and their use, has recently sent a circular to all doctors reminding them to warn patients who are taking drugs which should not be combined with alcohol. We are considering with the Department of Health and Social Security what further advice ought to be issued to doctors to remind them of the problem. For our own part, we are proposing to supplement this with some publicity directed at the patients themselves, urging them to remind their doctors if they drive. This will go part of the way to meet my hon. Friend's point on the education of the public, but I will consider this when I have received the results of the Road Research Laboratory study.
I would not wish to give the impression that this is a subject on which we know all the answers. It is generally accepted throughout the world that this is a subject on which very little research has been done. In the United Kingdom, the R.R.L. is continuing the work that I 1530 have described. On an international level, the subject is to be studied further by a group set up under the auspices of the Organisation for Economic Cooperation and Development. The United Kingdom is participating in this, through the British Medical Association, which is also providing the secretariat of the group.
As I said at the beginning, it is absolutely essential to get this sort of problem into perspective. In a subject like road safety it is vitally necessary to devote our resources where they are likely to repay the greatest return in terms of accidents saved: It would be the height of folly to allow our resources, particularly research resources, to be dissipated uneconomically——
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at nineteen minutes past Eleven o'clock.