§ 2.47 p.m.
§ Order of the Day for the Second Reading read.
§ THE JOINT PARLIAMENTARY UNDER-SECRETARY OF STATE, HOME OFFICE (LORD STONHAM)
My Lords, I beg to move that this Bill be now read a second time. It is a year since the noble Viscount, Lord Amory, initiated a valuable general debate about 1270 drugs. That debate underlined our awareness that the problem was growing and your Lordships expressed concern that the situation should not get out of hand. In my remarks at the end of the debate I said:… the length of my speech will, I hope, be taken as an earnest of the great seriousness with which the Government view this situation or, perhaps, I should say the prospective situation."—[OFFICIAL REPORT, 30/6/66, col. 837.]Since then the situation has indeed become more serious. A few figures will make my point. In 1965 convictions for offences against the Dangerous Drugs Act totalled 767, including 626 for cannabis. Last year the total was 1,174 including 978 for cannabis offences, an increase of more than 50 per cent. in a single year. Under the Drugs (Prevention of Misuse) Act 1964 there were 958 convictions in the 14 months ending December, 1965, and 1,261 in 1966, including 676 in the last half of that year. The police, with an augmented force of specialist officers, have been still more active this year. Convictions still show an increasing trend and a sentence of ten years imprisonment was recently imposed for drug peddling.
I have no need to scare the House about the drug problem. The time to sound the alarm is past. To my mind one of the striking features of the past twelve months has been the speed with which Press and public comment has moved from dismay that drug-taking occurs in the United Kingdom, to constructive interest in why young people get involved in drug abuse and what can be done to stop it. An example of both the increase in the danger and willingness to take active steps to meet it, was the issue last month by the Chief Education Officer to the Greater London Council of a circular to the heads of 300 London schools giving advice and urging them to make sure their staffs can recognise that a boy or girl is taking drugs, and to report it.
To some people publicity about the drug problem has caused misgiving, but I believe that in the past year responsible journalists and other commentators have greatly helped in improving public awareness of the intricate difficulty of this social problem. The effects of different drugs, the dangers of "escalation", the problems of treatment—these and other matters naturally prompt questions. There are calls for "authoritative guidance". 1271 Most people, however, now understand that this guidance is very difficult to provide because—and here I quote the Brain Committee Report:the phenomena of habituation, dependence and addiction involve a complex variety of social, medical and psychological factors".Because of the publicity I have mentioned certain points are now taken for granted. It is understood, for example, that drug-taking cannot be prevented or addiction cured simply by legislation; that drug peddling and abuse cannot be controlled by police action alone; and that addiction or drug dependence threatens not the majority of sensible healthy young people but a susceptible minority difficult to identify and hard to protect—a minority which is subject to mental, physical and moral deterioration; to unquenchable craving and increasing misery.
I have begun with these general reflections because today we are concerned mainly with one part of the problem. As I deal with this part, I want your Lordships to understand that I am fully aware of the other parts and of the links between them all. I know of the increasing menace of the amphetamines, of cannabis and of LSD which can induce madness. I know that addiction to hard drugs often has its roots in general drug abuse, abuse which sometimes starts by youngsters copying the unhappy example of a few of their "pop" idols. The Government are concerned about the whole drug problem. They are striving to approach it with balance and discrimination. They believe that this Bill, short as it is, will nevertheless help considerably in containing the general problem and bringing compassionate but real help to those who need it.
The Bill is concerned with addiction to "hard" drugs and particularly with heroin and cocaine addiction. I need hardly remind the House how this problem has been growing. In 1960 the number of known addicts to "hard" drugs was 454; four years later it was 753. In 1965 it had risen to 927 and last year to 1,349. Thus in six years the number of known drug addicts has trebled. In 1960 the number of heroin addicts was 68; in 1964 the number had risen to 342, in 1965 to 521 but in 1966 it was 899. That means that in the last six years known heroin addicts have increased 1272 thirteenfold. Last year more than 90 per cent. of the known addicts, whose addiction was not therapeutic in origin, were addicted to heroin. And there were some 300 heroin addicts under the age of 20 in 1966, as against only one in 1960—one person, not 100; in other words, a three-hundred-fold increase.
These are the figures for known addicts identified by inquiries into the supplies of drugs recorded by doctors and pharmacists. How many more have not yet come to notice? I can offer the House little guidance. Some observers, relying upon what they assert to be the economic basis for the new addict's life, argue that each must find or make two or three other addicts who will pay for part of his legitimate supply. On the other hand, addicts arc free at any time to seek treatment, including, if the doctor thinks fit, a prescription for the drug of addiction. In 1960 the Brain Committee felt that, by and large, most addicts came to notice quickly. Although we do not know for how long—or indeed why—individual addicts delay before seeking treatment from a doctor or a hospital, the numerical trends are obvious and alarming. They led an American Research Institute early this year to estimate that there could be 11,000 or more heroin addicts in this country by 1972.
Why has this wave of heroin addiction occurred? I do not think anyone can say with authority. Our problem in this country is quite novel. The new addicts have come from all classes of society. There is no close parallel with American experience. The reasons for other trends of drug abuse in the past are equally obscure. I will not take up the time of the House to-day with speculation. This is a field where we need to make full and continuing inquiry.
If we do not know the reasons for the increase in addiction, at least we know the source. The Interdepartmental Committee, in its Second Report, was satisfied that the increase had been fed from a surplus of drugs prescribed for addicted patients by a handful of doctors. The Committee gave examples of over-prescribing, which I need not repeat to-day. I must, however, tell the House that there is still no evidence of significant supply to addicts, other than through doctors' prescriptions—which are at present legitimate—and perhaps thefts.
1273 As the House will know, the addiction problem was carefully studied in 1959 and in 1964 by the Interdepartmental Committee on Drug Addiction under the chairmanship of the late Lord Brain. I should like to pay particular tribute on behalf of the Government to the very great assistance which Lord Brain gave, both in his leadership of this Interdepartmental Committee and in the discussion of many other important problems. It was his Committee which recommended that a Standing Advisory Committee should survey and advise upon the whole field of misuse of drugs and we had hoped that he would have been able to launch it. His death has been a sad loss to us all.
The Brain Committee's 1961 Report, written when problems of control were not challenging, was largely concerned with questions of procedure and treatment. Its second Report, published late in 1965, examined the new wave of known addiction and recommended appropriate counter-measures for what it likened to an epidemic. The three main measures were: compulsory notification of addicts, the setting-up of panels to advise doctors whether a patient is an addict or not, and the provision of special treatment centres. After very full consideration the three proposals have been fully accepted by the medical profession and the Government.
There are very difficult dilemmas here and it is important that I should make clear the implications of the Bill. Where addiction is pervasive rather than passive there are three choices for counteraction. One is to treat the addict as a criminal and try by police action to eradicate all drug abuse and peddling. That has been the American approach to heroin addiction and it has shown no signs of final success. We reject it. The second approach is to regard the addict as a dangerous patient and detain him for compulsory treatment. This has been tried in one or two countries, and very recently the State of New York has passed legislation providing for the compulsory institutional treatment of addicts for periods up to three years. The price to be paid for any compulsory and restrictive régime is, of course, much the same: a massive black market and dire complication of the general problem of crime. We reject that also.
1274 The third approach is to regard the addict as a sick person and to try to win his co-operation on voluntary treatment. That has been the United Kingdom policy for many years: doctors being free under the law to supply dangerous drugs to addicts whilst making every effort to cure their addiction. I am sure that no one would want us to abandon this basic principle and, by a repressive policy, encourage criminal elements to establish and exploit a thorough-going illicit traffic. On the other hand, it is plain—and the Government recognise this—that the present British system has defects and weaknesses. We have a rapidly growing number of addicts to heroin and cocaine. Many of them are young, unstable and eager to enlarge the unhappy army of addiction. They represent a formidable challenge to the general practitioner. We have seen more than once that the problem is accentuated when an individual doctor feels unable to continue to help a large group of addicts. All of us have read in the Press of cases of this kind: of how, for example, some addicts are lost to view; how others approach inexperienced doctors (I mean inexperienced in the question of drug addiction) with urgent pleas for help.
In these circumstances, it is natural to ask whether the principles of treating addicts need to be changed. The present principles are broadly based on advice given by the Rolleston Committee in 1926. These principles presuppose, first of all, that the general practitioner will make every effort to cure the addiction. If those efforts fail, however, the doctor may continue to prescribe dangerous drugs—in the words of the Rolleston Committee:where complete withdrawal produces serious symptoms which cannot be treated under the ordinary conditions of general practice, or where the patient, while capable of leading a useful and fairly normal life so long as he takes certain non-progressive quantities, usually small, of the drug of addiction, ceases to be able to do so when the regulated allowance is withdrawn".Obviously, my Lords, if these principles were abandoned, or even thought by addicts to be abandoned, many would look to an illicit source for their drugs, and that is a development we must strive to avoid. Your Lordships will recognise that the doctor's dilemma—arising at every stage in his handling of the patient—is profound: whether to 1275 encourage withdrawal at the risk of driving the addict to the pedlar, the "pusher", or whether to give the addict just enough of his drug not to prejudice the hope of progress to a cure. It is this concept of "just enough" that is so difficult to evaluate. In their Report in 1961 the Brain Committee gave general support to the present principles. The Government believe that they continue to command general acceptance by the medical profession. Accordingly—and I should like to stress this—the Bill is based on the assumption that certain doctors will continue, subject to their professional judgment, to apply the Rolleston principles and give maintenance dosage.
It is to preserve these principles and create conditions in which their adoption can be more beneficial to addicts and to society that the Government propose to change the organisation of treatment on the lines recommended by the Brain Committee. I will leave it to my noble friend Lady Phillips to describe in more detail, when she comes to wind up the debate, our plans for a system of special treatment centres for addicts to heroin and cocaine. The case for confining the treatment of such addicts to special centres is, in the Government's view, fully made out on two considerations. Prescribing can be more effectively controlled by a comparatively small number of selected doctors in these centres than is possible under conditions of general practice; and, more positively, treatment centres closely linked to the resources of hospitals should be able to offer more comprehensive treatment. Noble Lords will recall that the Brain Committee, in both their Reports, expressed the view that satisfactory treatment of addiction is possible only in suitable institutions. The Government believe that addicts are likely to be more encouraged to seek institutional care if efficient out-patient facilities are available.
It will be obvious that to transfer addicts away from general practitioners to a limited number of treatment centres involves a difficult transition. The problem is complicated because we do not know how many addicts will be prepared to seek treatment from a centre. Nor do we know how many unknown addicts—that is, unknown at present—will in due 1276 course want to do so. Nevertheless, the Government are convinced that general practice is no longer the right or adequate means for dealing with the new type of young addict—and in saying that I fully appreciate the dedicated help that has been given in the past by a number of doctors to many difficult addict patients. The addict's first and most compelling purpose is to get his "fix", and it is reasonable to assume that he will go to a treatment centre where he can get it—but without a surplus which he could sell to others. It is equally reasonable to suppose that many who attend the centres can be persuaded to attempt a cure.
We must therefore make the best estimates we can of the provision to be made. We must try to provide facilities which will ensure a close and sympathetic relationship between the individual addict and skilled centre staff. We have got to build up the confidence, both of addicts and of treatment centre staff, in the merit of our proposed new arrangements. Above all, we have to phase the arrangements so that in the individual case there is no gap between the support now being given by a general practitioner and the help which can be obtained from a treatment centre. All these considerations are being kept in mind in the course of Government planning.
I turn now to the Bill itself. It is an enabling measure, with necessary provision for enforcement, concerned solely with drugs scheduled under the Dangerous Drugs Act 1965. It extends to Scotland and Northern Ireland. Clause 1 extends the powers to make regulations conferred on the Home Secretary by Section 11 of the 1965 Act. Under the extended powers he will be able to make regulations to require the notification of addicts by medical practitioners and to prohibit medical practitioners, except under licence, from providing addicts with specified drugs. As I have indicated, the initention, initially, is to specify heroin and cocaine; but other drugs will be specified if it becomes necessary. The medical profession will be fully consulted in the preparation of these regulations.
As regards notification, the regulations will have to define addiction, lay down the circumstances in which notification will be required, specify the central authority (this will be the Chief Medical Officer of the Home Department) and prescribe the procedure for notification. Our aim, 1277 however, will be to keep the administrative burden on doctors to a minimum. I would emphasise that notification will have no legal consequences of any kind for the addict. It will merely indicate to the central authority that a particular doctor has attended upon a patient whom he considers or suspects to be addicted. It will not give that patient any continuing status as an addict as if he had been registered. As the House will know, the Brain Committee were firmly opposed to any system of registration. The central records of notification will simply enable the inquiring doctor to be put in touch with any doctor who previously notified that patient. Information provided by doctors under the regulations will be subject to the safeguards of the Official Secrets Acts. It is not contemplated that there will be disclosure of notification except to doctors with a professional interest in the individual case, and to the police.
The police have a special interest which I would explain. At present the Home Office obtains its information about prescriptions to dangerous drugs from routine police examination of records kept by pharmacists. The Brain Committee envisaged that this routine scrutiny would be continued to provide a means of ascertaining addicts who had not been notified. The police need to be informed therefore, as at present, when a case of addiction is made known and confirmed to the Home Office, so that the relevant prescriptions can be taken into account in the routine police scrutiny of the Pharmacists Registers.
As to licensing, the intention is that in selected National Health Service hospitals the doctors who receive licences will be consultant psychiatrists, in charge of the treatment of persons addicted to heroin and cocaine, and certain other medical staff under their supervision. The question of criteria to be applied for licensing doctors in approved centres, outside the National Health Service is under consideration. In the exercise of his licensing power my right honourable friend, the Home Secretary, will be advised by the Chief Medical Officer of his Department. He will, of course, take into account the requirements and plans of hospital authorities and any advice thereon which my right honourable friends, the Minister of Health and the 1278 Secretary of State for Scotland, may wish to offer.
As to prescribing for ordinary medical purposes, the Bill makes no provision for change. Regulations will allow doctors to continue, without restriction, to prescribe any dangerous drug in the course of medical treatment, provided it is not related to addicts. I remember the noble Lord, Lord Saltoun, sometime ago asking me whether our proposals might preclude the possibility of his continuing his prescription for laryngitis. I am glad to assure him that our proposals will not interfere with him in any way. The regulations will not prevent a doctor from prescribing heroin or cocaine to an addict where that drug is needed for a medical purpose, other than treatment for addiction.
The larger part of the Bill is concerned with enforcement. The Brain Committee felt that since notification of addicts and prescribing for addicts closely involve the exercise of professional judgment it would he inappropriate for a court of law to deal with breaches of the new obligations on doctors. They suggested that a more appropriate tribunal would be the Disciplinary Committee of the General Medical Council, but they did not take evidence from the General Medical Council on this proposition. Behind this, no doubt, was the thought that the medical profession should, if possible, discipline itself, especially where the issue turned on matters involving an assessment of a doctor's professional judgment. When the matter was discussed with the Council, the latter explained that the Committee's proposal did not fit in with the Council's established functions. It is not the Council's responsibility to deal with contravention of statutory obligations or offences; or to intervene in matters of professional judgment on medical treatment.
The conduct of a doctor, acting sincerely, who gives a generous supply to an addict would not necessarily be infamous conduct in a professional sense of the kind with which the Council deals, even though it might help to complicate and magnify the general addiction problem. Accordingly, the Government accepted that neither the Council nor its Disciplinary Committee were ready-made bodies for tackling the enforcement of regulations under the Bill. In devising 1279 alternative machinery the Government have tried to give effect to the wish of the profession for a suitably qualified tribunal and for the opportunity of representations against a tribunal's recommendation. The relevant provisions may appear somewhat involved, but the Government believe that by elaborating the substantive provisions in Clauses 2 and 3 and in the Schedule they are properly protecting the interests of the individual doctor, and of any other persons who may be involved in an inquiry into his professional conduct. The medical bodies have fully accepted the proposals in the Bill. The Council on Tribunals has also been fully consulted and has expressed agreement with what is proposed about the tribunal.
In this context I ought to say a word about Clause 4. This enables regulations under the 1965 Act to provide that contravention of particular regulations shall not constitute a criminal offence under Section 13 of the Act. It will also allow the Secretary of State to apply the safeguards of the tribunal and advisory body procedure in cases in which a court has found a doctor guilty of an offence under the Act and consideration is being given to withdrawing the doctor's authority. In this way it will be possible to deal with all withdrawals by a common procedure.
There are some other points I should mention. First, the Bill does not provide for implementing the Brain Committee recommendation for detaining addicts during treatment. The Committee did not favour compulsory detention as a principle. It had no belief in the success of this approach. It felt, however, that when a patient entered hospital voluntarily for treatment it might in certain circumstances he useful if the staff could detain him for a very limited period during a crisis in his recovery. The proposal was discussed later with Lord Brain who came to the view that initially it should not be proceeded with. As your Lordships will appreciate, any element of compulsion would materially affect the transition from one régime to another. The Government are convinced that the wisest course is to exclude compulsory detention at this stage.
Again, the Bill does not deal with the problem of dependence on "soft" drugs. The Government are, of course, very much 1280 concerned about this question, but although facilities for treatment are available there is no consensus that the same controls are necessary for amphetamines and barbiturates. Indeed knowledge about dependence on these drugs is very limited. We need to assess this area of the general problem by much further study and inquiry before considering statutory provision for notification or other measures. The Government propose, however, to make certain important aditions to the Bill at the Committee stage, and I shall be tabling Amendments in due course. This will be of particular interest to the noble Lord, Lord Derwent, whose continuing interest in this problem and whose knowledge and pursuit of it are greatly appreciated by Her Majesty's Government.
The first of these Amendments relates to the safe keeping of drugs, the second to the powers of search. My right honourable friend the Home Secretary has for some time felt concern about the inadequacy of present arrangements for the safe keeping of drugs in the premises of manufacturers, wholesalers and pharmacists. When addiction is increasing and abuse of "soft" drugs appears to be widespread, the need for effective security becomes vitally important. My right honourable friend has recently consulted the representative bodies of the pharmaceutical industry and pharmacists, with a view to strengthening his powers of requiring safe keeping, record keeping and packaging of "hard" and "soft" drugs. I am glad to tell the House that the representative bodies have fully endorsed the principle of my right honourable friend's proposals for wider enabling powers. As with the regulations on notification and prescribing, the effect will be to allow my right honourable friend the opportunity to impose or modify controls as the situation develops. It will be understood that the requirements which it may be appropriate to introduce will be the subject of detailed discussion with the interests affected.
As to police powers of search, Section 14 of the Dangerous Drugs Act 1965, and Section 3 of the Drugs (Prevention of Misuse) Act 1964 (the creation of the noble Lord, Lord Brooke of Cumnor, and the favourite of his assistant, the noble Lord, Lord Derwent) required that the names of the individual police officers 1281 should be endorsed upon the search warrant. This has been found to cause difficulty when police action is required at short notice. The requirement originated many years ago. It is an anachronism and serves no useful purpose to-day in the changed conditions, and the Government therefore propose that it should be repealed.
Apart from this, the police have been hampered in detecting offences of unauthorised possession by the present limits on their power to search on suspicion. It is noteworthy that a very high proportion of the convictions obtained under the 1964 Act have been made in the Metropolitan Police area where police powers arc more extensive. The Government therefore propose to sek your Lordships' approval of an Amendment which will give the police power to stop and search without warrant any person suspected of being in unlawful possession of a drug controlled under the Acts of 1964 and 1965. My Lords, we mean to stop the "pushers" and the pedlars of drugs by all means in our power, and we look confidently for the support of your Lordships in the measures that we shall introduce.
My Lords, I have spoken at some length because, although this Bill is short and its substance mainly concerned with the conduct of doctors, it foreshadows great changes in the organisation and treatment for addicts. No doubt much of our discussion on the Bill will be about differences of view on the planning of that treatment and related matters. The Bill, I would remind your Lordships, was passed by another place without amendment. The Government believe its provisions are sound and they have the full support of the interested bodies. For this reason, I hope that your Lordships will welcome the Bill and give it a unanimous Second Reading. My Lords, I beg to move.
§ Moved. That the Bill be now read 2a.—(Lord Stonham.)
§ 3.23 p.m.
§ LORD SANDFORD
My Lords, at last we have something. We welcome this Bill now it is here, so far as it goes, but it is nearly two years since the Brain Committee on Drug Addiction rendered its Second Report, and it has taken Her Majesty's Government 18 1282 months to set up the Standing Advisory Committee on Drug Dependence which, as the noble Lord, Lord Stonham, has pointed out, is so obviously needed to give continuous attention and authoritative advice on the whole rapidly changing and extremely anxious problem. And it has taken Her Majesty's Government 20 months to bring forward this very modest piece of legislation, most of which was spelt out for them by the Committee in its Report.
Not only has there been this really regrettable delay; there has, I submit, been a failure by Her Majesty's Government to grasp the nature, and particularly the urgency, of this problem. I do not want to exaggerate the size of the problem—the noble Lord has spelt that out admirably, and it is sombre enough reading on its own—but I do want to stress the extreme urgency (the figures given by the noble Lord speak for themselves) and the need to get to grips with this problem quickly, before it gets out of hand. One measure of Her Majesty's Government's failure to grasp the problem is the fact that it was left to the Lord Chief Justice to brine forward the Private Places of Entertainments Bill in January of this year, a vital weapon in the fight against this menace. At any rate, my Lords, here at last is the Bill, and I now turn to it.
The noble Lord, Lord Stonham, called it an enabling Bill, and it is indeed an enabling Bill, with a vengeance. We have the noble Lord's description of what is to happen under it, and we can accept that. We are glad to know that this is how it is to work. But little of that is in the Bill. Everything of substance is still to come under regulations which are not yet before us. Here we have a Bill dealing with addicts, yet to be defined, covering—and I quote from Clause 1(1)(a)—"drugs of any description" but yet to be specified, which no doctors, except those yet to be licensed by the Home Office, will be allowed to prescribe to addicts. We understand that licences will be granted only to doctors on the staffs of treatment centres yet to be provided.
Clause 2 indicates that all this is going to involve tribunals and advisory panels which have yet to be set up; so there is quite a long way to go yet. Incidentally, there are going to be more people on each set of tribunals and advisory 1283 panels than there were doctors (only six) who were the original cause of this particular mischief of over-prescribing heroin. I wonder, do the doctors know what is happening to them? Presumably they do. It is not for me, a member of another profession, to offer any advice to the doctors about how they should run theirs. But, my Lords, the clergy of the Church of England have long experience of nationalisation—we were nationalised by Henry VIII—and I think that the right reverend Prelate the Bishop of Worcester would agree that if we had been put in the position in which the medical profession was put by the Brain Committee Report, we should certainly have followed the advice of the noble Lord, Lord Brain, and tried very hard to keep the disciplinary procedures required under this Bill under the control of the profession itself—in this case, under the control of the General Medical Council.
§ LORD STONHAM
My Lords, is the noble Lord suggesting, first, that we did not try very hard, and secondly, that the B.M.A. were willing to accept this responsibility? I hope I made it clear that they were not.
§ LORD SANDFORD
My Lords, I was just coming to that. I believe that the doctors themselves will come to regret their decision to do otherwise than the Brain Committee recommended, and I think it is our duty in this House to-day to make quite clear (I shall be interested to hear what the noble Lord, Lord Amulree, and the noble Lord, Lord Segal, have to say about this) that it is not the decision of Parliament or of Her Majesty's Government, and it is certainly not the wish of the Opposition, but the decision of the medical profession which will bring down upon them all this paraphernalia of tribunals referred to in Clauses 2 and 3 and in the Schedule. It is not the Government who brought this about, and I am sure that noble Lords on these Benches would have sought to do as the Brain Committee recommended. However, be that as it may.
I now turn to the hospitals and what they have to say and do under this Bill. They are not mentioned in the Bill, but, as the noble Lord, Lord Stonham, made quite clear and explained, the whole object 1284 of the Bill is to shift the treatment of addicts into the centres to be established, primarily in the London and Metropolitan hospitals. But nothing can happen under this Bill, as the noble Lord's friend the Minister of Health made quite clear in another place, until these centres are provided, staffed, equipped and ready to function. No extra money is to be provided for this purpose. Very few doctors working in hospitals have much experience of treating addiction, and I do not believe (though noble Lords who are doctors and who hope to follow me in this debate will correct me if I am wrong) that the treatment of addiction figures to a great extent in the training of doctors. It is therefore, I submit, highly relevant for us to know how the hospitals are getting on with this task.
The Minister of Health set out what he wanted of the hospitals in his Memorandum H.M. 6716 of March 7, and asked for a report from them within a month—that is to say, by April 7—of what they had done and were planning to do in order to implement their part of this programme. So by now he must know, the noble Baroness must know, and I think that we should know, too, exactly how they are getting on. The noble Lord, has so far told us nothing. I hope that the noble Baroness, when she winds up the debate, will tell us a great deal. If she does not, I fear that our suspicions will be greatly increased.
My information, admittedly incomplete and unverified—and, I hope, incorrect—is that the hospitals are far from satisfied about the arrangements for these centres. They have not been given any extra money to bring them into practice. They are far from clear about how the centres are to operate, and they are far from being ready to take the steps without which the provisions of this Bill cannot possibly be brought into operation. As I say, the noble Baroness must have available the replies from the hospitals to this Memorandum of March 7, and the House should be given an accurate summary of them before giving its final approval to this Bill. I hope therefore that she can do that for us.
It is not quite accurate to say that the Bill implements the whole of the Brain Report—and I do not think that the noble Lord, Lord Stonham, said so. It implements part of it. In particular, it 1285 does not implement recommendation No. 7, as the noble Lord mentioned, in which power for detaining addicts in centres was recommended. I agree entirely with him that we should be unwise to copy the approach of the United States of America to this problem. Unfortunately for them, they have a far more extensive experience than we have in this matter. To treat the addict as a criminal would be disastrous, but I am not yet convinced that the modest measure of compulsion which the Brain Committee asked for would not be helpful in a number of cases. I know that it is the experience of the Convent of Spelthorne St. Mary, which has dealt with drug addicts on a voluntary basis for some number of years, that a court order applied to a voluntary patient is extremely helpful in keeping him at the centre until his cure has been successfully completed. Perhaps the noble Baroness can deal with this matter further. That is all I have to say on the Bill itself.
I should like now to follow the noble Lord, Lord Stonham, and for just a few moments turn to the problem of drug addiction as a whole. It could he said—and I know that my noble friend Lord Brooke of Cumnor, who was Home Secretary at the time, would readily admit—that the terms of reference given to the Brain Committee when it was reconvened were somewhat narrowly drawn. But this had the great advantage of enabling the Committee to deal with the comparatively narrow matter of the over-subscribing of drugs for heroin addicts and to report quickly. That is an advantage which, I submit, by their dilatoriness Her Majesty's Government have now largely thrown away. That decision to ask for a report on a narrow front now means that we find an urgent need for much fuller information and authoritative guidance covering the whole of this disturbing and rapidly changing programme. For example, the illicit sources of supply of heroin are now thought to be quite different from those discovered by Lord Brain's Committee. As well as the over-prescription of herion, we now face, as the noble Lord mentioned, the smuggling of drugs out of factories, raids on pharmacies and the forging of prescriptions. These are now outstripping the over-prescribing of drugs by a handful of doctors.
§ LORD STONHAM
My Lords, I made it quite clear that we have no evidence of any substantial supplies of heroin and cocaine other than those arising from prescriptions. The references which the noble Lord is now making to my speech are references to the other field of amphetamines and so on. He should make this clear distinction.
§ LORD SANDFORD
My Lords, I am most grateful to the noble Lord. I thought I had made it clear that I am now dealing with the whole problem, and that these remarks cover all drugs. I fully accept what he says about heroin. It is good to know that the regulations tightening the security over all drugs that may be harmful are having some success.
Another matter which the Brain Committee were not asked to report upon and did not report upon was cannabis and all its derivatives. This is a dangerous drug within the terms of the 1965 Act. Last April there were suggestions and letters to The Times, not at first particularly authoritative, that reefer smoking, the smoking of marijuana and hashish, was not too bad, no worse than the drinking of alcohol. A letter by Mr. Manfred Mann, who started the correspondence, was followed eventually by two long articles by Dr. David Stafford Clark, a well-known psychiatrist, in which he spoke of the "relative innocence" of marijuana by comparison with alcohol. If that is a good expression of our experience in this country, it is only because marijuana has not been smoked long enough by a sufficient number of people to reveal anything else. My information is that not only is marijuana with amphetamines one of the many roads leading eventually to heroin addiction but—and here I am relying on information in the latest edition of British Journal of Addiction—in time marijuana on its own leads to incurable insanity. It would be helpful to the House and to the public at large if the noble Baroness could give us some authoritative guidance on this point, because, if I am right, it is important that this is spelled out.
Perhaps she could deal also with the question of soft drugs, on which the noble Lord has touched. This Bill deals only with those people who have reached the end of the road; it does not touch those who are just starting on it or under 1287 temptation to start. I think that the House could well hear a little more than it has had already on what Her Majesty's Government have in mind for this part of the problem. Can the medical profession, for instance, justify the continued production of so many addictive stimulants in such large quantities for quasi-medical purposes, like slimming, when other non-addictive drugs, I am told, are available as alternatives? I understand that this matter is under consideration. If so, I suggest that it ought to be considered with dispatch, as the matter is urgent.
Finally, I come to the rehabilitation of addicts, a matter I raised in a Question last March, the answer to which I fear revealed remarkably little forward-thinking or planning in Government circles. I understand that there have been further consultations early last month, but I do not believe that the light has yet fully dawned. Ail the time and the money and the effort that is being expended on making provision for medical treatment in such centres is going to be wasted, unless adequate long-term social support for addicts who have been withdrawn from their drug is also provided to see them through, right to the end of a successful cure.
Rehabilitation and the provision of rehabilitation hospitals is supremely a job for a partnership between statutory and voluntary bodies. But the position in this respect is not, so far, an encouraging one. With a few notable exceptions, such as the long-standing contribution of the Covent of Spelthorne St. Mary, I see only a few struggling pioneers, grappling with very daunting problems of finance, with little positive contribution from medical officers of health in this field—though I should be the first to acknowledge their contribution with education officers in the field of education—and great uncertainty in the Ministry itself as to what to do next.
Further guidance on rehabilitation was foreshadowed in the hospital memorandum which I have already quoted. We should like to hear from the noble Baroness whether it has been given, and if so, in what terms. If the noble Baroness who replies can say anything to dispel the rather anxious and gloomy view that I at present take about this 1288 subject, no one will be more pleased than I shall. Meanwhile, while hoping for considerably more from the Government, and soon, we on this side of the House welcome and support the Bill.
§ 3.42 p.m.
§ LORD AMULREE
My Lords, I am sure that anyone would give support to a Bill which made some attempt to deal with this very serious moral, social and physical problem, and I feel certain that your Lordships will give this Bill an unopposed Second Reading. The state of the law regarding medicines has been unsatisfactory for quite a long time, and one has been promised—or it has been suggested—that by now more comprehensive legislation would come out dealing with more drugs than this Bill deals with. That principle was accepted by all. But such legislation has not come, and we must be content with this little ad hoc Bill, which deals purely with the dangerous drugs of addiction, the so-called "hard" drugs.
There is a good deal of evidence that the use of the so-called "soft" drugs, which I think might be called the dependent drugs, as opposed to the addictive drugs, does lead to increasing dependence upon hard drugs and to becoming addictive. It is claimed by some people that soft drugs when taken in reasonable quantities do no harm; some people even claim that they may have a beneficial effect. But this, I think, is a point of view which should not be encouraged, because I am sure that, fundamentally speaking, they are dangerous to all people. One has seen in the Press from time to time remarks by people who think themselves prominently important encouraging the use of these drugs, and who say that they take them themselves. This is something that is greatly to be deplored.
A great deal of what I should like to say has already been said by the noble Lord, Lord Sandford, and I am in general agreement with everything he said. I should like to say, in passing, that I was a friend of the late Lord Brain, and I am not a member of the General Medical Council. I would rather not pursue this matter further.
One agrees entirely that an addict should be regarded as a sick person rather than as a criminal. One has seen 1289 that the opposite attitude did not work in the United States. But because of that, and because the Home Office is the Department which deals with drugs, it will need a close co-operation and working together between the two Departments. The Home Office does a great and good work in all sorts of ways, and although at present it is one of the kindest and most humane of the Departments of State, the fact remains that in the minds of the public a certain penal quality attaches to it. That, I think, is inevitable. But I am sure that the Government will do what they can to ensure that the Ministry of Health, via the National Health Service, are given a proper part to play in the treatment of these unfortunate people.
There are one or two points to which I should like to refer. I gave the noble Baroness who is to reply notice of some questions, and I will ask a certain number of them. Clause 1(1)(a) of the Bill says that the doctor shall furnish particulars of a patient hehas reasonable grounds to suspect …is addicted, and so on. This is something about which I am a little worried, because my profession is not accustomed to being turned into detectives of crime. I do not know whether this provision has any particular sinister connotation. I do not think it has, but I was rather surprised and sorry to see it in the Bill.
Then, although there is not going to be any register of addicts, the names of such people are to be recorded somewhere: there will be some information centre. I should like to ask whether the addict will be told that his name has gone to that information centre. And supposing the man says that he is not an addict, will he have any appeal against his name being sent? And supposing he is successfully cured, will his name be expunged from the record at the centre? Then, what will be the position supposing an addict is taken to hospital suffering from some other disease, and the hospital happens to be situated some distance from where he lives and where his treatment centre is? Will the doctor at the hospital, although he is not the registered doctor, be able to give the addict his supporting drug, or will it be necessary for the doctor with whom the addict is registered to 1290 come and give the drug? And supposing the addict himself, due to his current complaint—a broken leg, or whatever it may be—cannot travel to the centre, will it be possible for the doctor treating him in hospital to give him his dose of drugs?
There is to be an information centre where all this information will be collected together. Will that centre be open for the whole of the 24 hours of the day? I ask this because addicts are "cagey" people, who do not keep regular working hours and if the addict comes to a centre and one cannot ring up to check from the information centre at any time whether he is already registered with somebody else, that can lead to some kind of abuse of the powers. What kind of steps will be taken to ensure that one addict—as I say, they can be cunning and clever people—does not register with more than one doctor, or with more than one treatment centre? That is all I have to say on Clause 1 of the Bill.
I should like to turn now to Clause 5, where subsection (3) seems to me to be extremely wide. I am not quite sure what it means. It seems to me to give the Minister enormous powers, but I cannot think that this is intended. I assume that this covers merely drugs in the Schedule to the principal Act. Suppose that there were further drugs to be added by the International Convention to the drugs in that Schedule: would it mean that this Bill, when it becomes an Act, would fall and that we should need to start again, or would this Bill then apply to Schedule 1 to the amended principal Act? I trust that I have made myself clear.
§ LORD STONHAM
My Lords, may I answer now? The answer is, Yes, of course; we could add the other drugs in Part I of the Schedule to the 1965 Act.
§ LORD AMULREE
I thank the noble Lord. That has cleared up that point. I was going to ask whether provision was going to he made whereby pharmacists and chemists and drug houses could protect the drugs but the noble Lord said that he would move an Amendment on that question, so I shall not proceed with that any more. That is all I have to say about the Bill itself.
I should like to add just one of two remarks before I sit down. First, I hope that the old machinery, such as it is, will 1291 not be taken away before the new machinery is absolutely ready. Drug addicts are curious people and it is not easy to move them from one place to another from the point of view of getting treatment; and, furthermore, they like to feel that they are going to have the same person treating them for a long time. So I trust that that will be borne in mind and that we shall not see any danger of the general practitioner being banned from prescribing drugs to addicts until the network of treatment centres over the country is completely finished and is working properly. If that does not occur, it will make a black market, and illicit sales of drugs will occur immediately. So although I consider the matter to be urgent, I trust that we shall not proceed too quickly and take away the old system, such as it is, before we have evolved a new and complete one in its place.
I do not know a great deal about the new centres. I have seen that there are to be two in London teaching hospitals, and four more are proposed. What I should like an assurance about is this. These new centres will cost money. Further premises may need to be provided; it will be necessary to provide extra staff to work them. That will cost money. The Minister in another place was closely questioned about that matter, and I thought he was rather cagey in what he said. I should like from the noble Baroness an assurance that extra money will be found for the establishment of these clinics and staff and, if necessary, premises; and not only that it will be found for the first year but that it will go on being found for subsequent years, for as long as the centres are in existence. One has observed in the past that money has been given for the first year of a new project, and in the second year it has been said, "This must come out of your budget. You will have to rearrange your internal affairs." One would like some guarantee that that is not going to happen in this case, because if it did I think it would go a long way to negative the value of the Bill. In conclusion, I would say that I trust that this Bill will succeed in the object it sets out to achieve. But I should like to say again that a drug addict is a curious and elusive creature, and it may be very difficult to pin him down.
§ 3.56 p.m.
THE LORD BISHOP OF WORCESTER
My Lords, I imagine that every right-minded person will give his support to this Bill, which I see as part of a plan to tackle the problem of drug addiction. And here it might be well to remind ourselves of the wise words of Edmund Burke:In all forms of government the people is the true legislator.This Bill, like any other Bill which deals with a matter of reformation, however well conceived, depends in the final analysis for its implementation on the good will and support of the people.
In order to have this community support it is necessary to have three things. First, people must have faith in the legal and administrative machinery that is being set up. Secondly, they must appreciate the fact that there are limits to what legislation can achieve; and, thirdly, in the particular case of this Bill, they must realise that we are all involved, that drug-taking is an inevitable by-product of a technically advanced society such as our own. Drugs are now used extensively in medical practice. Most of us have benefited from this, and there can be only a few fanatics who would think it wrong to do so.
Without wishing to weary your Lordships, I should like briefly to develop these three points. First, people must have faith in the proposals of this Bill and see their point. This is important, because I imagine that many people, old or young, are ill-informed and prejudiced about drug-taking. At one extreme there are those who make sweeping condemnation of "the teenage drug menace", and demand action to "stamp out this vice". At the other extreme there are a lot of young people who defend drug-taking in extravagant language and, one suspects, are more ignorant than they will admit about the dangers involved. There is, of course, between these groups a complete lack of communication. Someone has indeed said that the:gap between the generations yawns wider at this point than anywhere else".But there is also a third group, made up of many young people, parents, teachers and just ordinary everyday decent folk, who are prepared to ask questions about the use of drugs, to examine the 1293 facts objectively and to take part in intelligent and rational discussion of the problem involved. I support the Government most heartily in the promotion of this Bill. But I should also be glad to have the assurance that they will produce the material necessary for such discussion as I have suggested on, say, the teacher/pupil level, or by youth club leaders and club members, or parents' associations.
This brings me to my second point. If people are to be aware of what legislation can or cannot do in this matter, they must be told what are the medical facts about dangerous drugs; why some young people experiment in drug-taking; what are the social and personal pressures which make a person liable to addiction, and how society ought to tackle this problem. I should have thought that education and discussion on these lines is essential if the Title of this Bill is to be fulfilled. It is described as:An Act to provide for the control of drug addiction and to make further provision with respect to drugs.It is this "further provision" which to me seems so important.
My third point is that once people are aware of the problem they are usually prepared to be involved in its solution. And I must confess that I feel that a better Title for the Bill would have been, "Potent Drugs (Prevention of Abuses) Bill". The World Health Organisation now discourages the use of the word "addiction" and prefers the word "dependence", for basically drug dependence is the abuse and misuse of something which in its proper use is a great blessing and power for good. Countless thousands have reason to be grateful for morphine and cocaine, and other drugs, after accidents or major surgery. They have removed pain, or made it easier to bear, and for many people their passing from this life has been made an easier and less fearful experience. The tragedy is that, human nature being what it is, in this case as in many others it tends to change what should be a blessing into a source of evil.
Here, young people are peculiarly vulnerable, for, because they lack experience, the drug pedlar and those who support him have found them easy targets for making vast profits in their diabolical 1294 trade. These young people, like adults, gradually develop a state of mind called "psychic dependence", and it is to help such people that the various clauses of this Bill are designed. The Bill enables the Secretary of State to take certain action where it seems advisable, but behind the Bill are the causes which have made such a Bill necessary. The Bill deals with ends. It is the community who must deal with the causes, because, as I have suggested, the whole community—that is, all of us—share responsibility for the anxiety, the negative attitude to life, that drives some people to the extremes of escapism in the use of such self-destructive drugs. Therefore the whole community shares a great responsibility for dealing with the situation.
The ordinary citizen will no doubt discharge his duty in this regard with a certain amount of grumbling; will shoulder the higher taxation, if that is necessary for the new out-patient facilities for supplying drug dependents and inpatient facilities for withdrawal treatment. But this is not enough. Experience has proved that a great deal of personal voluntary effort is required to supplement what I would call the "professional case-work curing technique". The Salvation Army and the Church Army, to mention only two of many organisations thus involved, have shown, on the one hand, what can be done for the "incurables", and, on the other, how voluntary effort can help in the rehabilitation and resettlement of those who have successfully undergone treatment.
I believe that to-day there is an enormous potential of individual voluntary workers who cannot find any outlet for their urge to serve. They are not just "do-gooders"; they are anxious to be trained and equipped for the job, and it is a situation for an incisive national lead to be taken by the three Ministries responsible for coping with the abuse of dangerous drugs, in the co-ordination of these voluntary resources. At national level let there now be a complete frankness about what is required of such voluntary effort. Is it redistribution of wealth without tears? Is it collecting money for the new social service which cannot be obtained from increased taxation? Is it the creation of a community spirit so that the known drug dependent is not driven away to 1295 sleazy hidey-holes? Or is it really the provision of lodgings, sitting-in for overworked staff of hospitals, or finding and equipping and setting up hostels financed from statutory services? I very much hope that the ministerial statement in another place that:there is scope for valuable contributions by voluntary bodiesmeans that we are soon to have a comprehensive statement as to precisely what personal contributions ordinary people of good will can offer towards the success of the plans to be built upon this Bill.
Let me presume to conclude by quoting some words of Ralph Waldo Emerson, uttered in a speech in Manchester in 1847—and I feel that the situation which he then envisaged, applies to-day:I feel in regard to this aged England … I see her not dispirited, not weak, but well remembering that she has seen dark days before—indeed, with a kind of instinct that she sees a little better in a cloudy day, and that in storm of battle and calamity, she has a secret vigour and a pulse like a cannon".I believe that this is true to-day. Let the Government tell the people that this is a great challenge, in which the whole nation is involved, for it is nothing less than the opportunity to use, for once, the great benefits of scientific research and discovery for the benefit and not the destruction of humanity. The response will, I am convinced, be such that when the history of these times comes to be written, this Bill debated here to-day will be seen to have marked a great step forward in our national life.
§ 4.5 p.m.
§ LORD SEGAL
My Lords, I should like, if I may, to preface my speech by one or two comments on the remarks made by the noble Lord, Lord Sandford, who opened up from the Opposition Front Bench. He accused the Government of undue delay in bringing forward this Bill. If I may say so, I am inclined to think that this criticism of culpable delay is somewhat unwarranted. Eighteen months of discussion with professional medical bodies is, in the light of my experience, not an unduly long time, and, as the whole House will realise, the working of this Bill must depend on the active co-operation of the medical profession, who in themselves are not by any means agreed upon its machinery. Another point on which the noble Lord spoke was that 1296 of exercising some pressure on the medical profession in order to get, as he said, certain professional bodies to co-operate more actively. My own feeling is that if we cannot exercise compulsion upon the addicts themselves, by what right can we hope to exercise compulsion upon the medical profession? The noble Lord went on to say that the medical profession may yet have some cause to regret their decision in this matter. I am inclined to think otherwise. I think the decision was reached after long and careful discussion, and if the General Medical Council's Disciplinary Committee had assumed full responsibility for the disciplinary aspect of this Bill I think they would have been abrogating from the medical profession as a whole a good deal of their inalienable rights, which they would reluctantly yield to any Government.
Perhaps I may be allowed also to venture one slight criticism of one of the remarks made by the right reverend Prelate. He suggested a change in the title of the Bill and thought it might be improved if it were described as the Potent Drugs (Prevention of Abuse) Bill. To my mind every drug in the Pharmacopœia is in itself, if it were prescribed in sufficiently large doses, a potent drug. In fact, so far as my knowledge is concerned, I am totally unaware of any drug which can be described as an "impotent" drug.
I think we can all agree that this is not only a necessary Bill but also a measure of extreme urgency. To me, the most welcome part of the Bill is the provision that the regular prescribing of dangerous drugs should be taken out of the hands of the general practitioner and devolve upon licensed consultants who will be able to keep a strict control over the patient. It is highly important that the element of financial gain to the general practitioner by his prescribing of dangerous drugs to an addict should be entirely removed.
In discussing this measure, we are conscious to-day of the absence from our midst of Lord Brain, whose untimely death leaves a painful gap, not only in the profession which he adorned, but also in the membership of this House. His wisdom and kindliness and, above all, his quite unique knowledge of the subject we are discussing this afternoon, 1297 leave us not only greatly enriched by his life, but sadly the poorer for his passing.
The Brain Committee's Second Report, in paragraph 11, quotes the notorious case of one doctor who in 1962 alone prescribed 600,000 tablets or 6-kg of heroin to addicts, but that in all only six doctors, out of more than 20,000 on the Medical Register, prescribed very large amounts of dangerous drugs to individual patients. Whether they were well remunerated the Brain Report does not say, but I suspect that some financial gain must have accrued to the doctors concerned. I can recall a case of straightforward prescribing by an elderly ex-Army doctor, living mainly on his Army pension, who started giving a weekly prescription of heroin to a confirmed addict and for only a very nominal fee. But the weekly amount gradually became used up in less than three days and the patient kept coming more and more frequently for his prescriptions. In the end, the doctor had to issue him with a daily prescription, so that his fees from this one patient soon became increased sevenfold. And even this soon got out of control. With the date carefully inserted in the prescription, the patient was found standing on the pavement outside an "open-all-night" chemist, waiting for his day's supply of heroin to be dispensed on the stroke of midnight. So his daily supply became used up long before the next 24 hours were over, and the doctor had to insert on his prescription, "Not to be dispensed before noon".
At this Second Reading stage, I would express some of my anxieties about this Bill. Can the Minister give the House an assurance that, on the Bill's vesting day, there will not be a vast increase in the overall amount of heroin dispensed? What I fear may happen is this. If patient "A" is now receiving from a doctor a given amount of heroin and is able promiscuously to dispose of part of it to addict "B", with whom he may even be living, or to peddle part of it on the black market, it may well be that on vesting day addict "B", who until now has drawn all his heroin from an illegal source, will come forward to a doctor and ask for his case to be notified to the specified authority. Once notified, he will then presumably receive his required amount of heroin from a properly legal 1298 source. But would patient "A" then receive from the doctor licensed to prescribe only a half, or a third, or a quarter of his former prescription, to be used exclusively for his own requirements? I can foresee a very real danger on vesting day, not only of a large increase in the number of addicts now known, but also a vast increase in the overall quantity of heroin prescribed.
§ LORD STONHAM
My Lords, may I interrupt my noble friend? He may well be right; perhaps there is some reason to hope for a vast increase in our knowledge of known addicts, and he may well be right in regard to the total amount prescribed. Where he cannot be right is in thinking that the individual addict will receive more than he properly needs for the treatment of his addiction. He will not get enough to supply to other addicts.
§ LORD SEGAL
My Lords, I fully accept my noble friend's statement that he will not receive more, but there are certain cases where the people to whom he has been passing his excess heroin will be entitled then to have their own supply, and the original addict "A" should properly receive less than he formerly received. I think the Minister should be forewarned of the trap he may be laying for himself under the Bill. Does he propose that no doctor, not even a specially licensed doctor, should be allowed to prescribe any dangerous drug for a new patient on vesting day? If so, would not this be an unwarranted interference with a doctor's freedom to prescribe? What exactly are his plans in this matter?
May I add another warning? Great stress was laid in another place upon the provision of adequate facilities for treatment, and it has also been referred to in your Lordships' House this afternoon. I shall come to this aspect later on. But cases have occurred not infrequently of patients undergoing treatment at a treatment centre who peddle heroin secretly among themselves, thus undoing all the good work of the doctors and nurses who are trying so assiduously to effect their cure. These cases are sometimes so persistent that the doctor treating them is left only with the hope that they may eventually be convicted of a criminal offence, such as forging the quantity of dangerous drugs on a prescription, and receive a prison sentence. Then there is 1299 a good chance of a cure being effected. For on admission to prison their clothing is searched for dangerous drugs and they are admitted at once to the prison hospital, where attempts at cure can be strictly controlled. But even then the chances of a cure are not absolute, for cases have occurred in the past where, on their discharge from prison, all their property has been returned to them, including the heroin and syringes found on them at the time of their admission. Such cases of immediate relapse after cure, I believe, cannot occur to-day.
§ LORD STONHAM
My Lords, I am sorry to interrupt again. I do not think there have in fact been instances of heroin actually being returned. There have been instances of syringes being returned, but action is now being taken to ensure that there is no possibility of a recurrence of that.
§ LORD SEGAL
My Lords, I am glad to be able to confirm from my own knowledge what my noble friend has said. But I should like to draw the attention of the House to the fact that, without question, abuses have been known to occur in the past.
There is a third point which I should like to bring to the notice of the Minister. Till recently, I have always felt that our approach to this problem was far more humane and considerate than that of America. In this country we have always regarded the drug addict as a sick person, as much in need of treatment as the rheumatic patient or the diabetic. But during the last six years the increase in known cases of heroin addiction has been so great, as has been said, from 68 in 1960 to 749 in 1966, and so much crime and suffering is being caused as a result, that I feel the prescribing of heroin to any new patient should now be prohibited altogether. It would be utterly wrong to deprive a known confirmed heroin addict of his controlled access to the drug he needs. Once addiction has set in, no substitute for heroin can, I believe, be truly effective. But in a case where no addition to heroin as yet exists, a vast number of alternative synthetic drugs, highly efficient as pain-killers, are available to a doctor, and all of them far less habit-forming than heroin. So, while the banning of heroin to confirmed addicts would be wrong and inhuman, I feel that 1300 legislation to prohibit altogether the prescribing of heroin to any new patient is now long overdue.
One of the terrible pitfalls that face a doctor confronted for the first time by a new patient asking for heroin is that lying is one of the patient's main symptons. It is an axiom of English law that a man must be presumed innocent until he is proved guilty. But with a drug addict I have come round to believe, contrary to my own sense of fairness and from long and bitter experience, that it is always safer to assume that the patient is lying until it can be proved that he is telling the truth. Few doctors in general practice, I believe, would willingly undertake the treatment of an unlimited number of addicts unless they had some financial interest in the proceeds. I know of one doctor who did so purely in the interests of medical research. He said he would treat all-comers for a period of one year and register them on his National Health Service list. During that year he collected, thanks to the underground "grape vine", no fewer than 24 heroin addicts.
Then he decided to give them up and have them removed from his list: they were so demanding of his time and energy at all hours of the day and night that he refused to take them on any more. But he soon found that he could not give them up. The doctor/patient relationship with the 24 had become so complex that he felt he would be letting them down if he handed them over to the care of another doctor. But he also felt that all his other patients were being affected by this relationship and receiving less of his care than they needed. Under this Bill he can transfer all those addicts to a specially licensed consultant, far better able to give them the time and care they need, and far better able to exercise a strict control over their dosage and to initiate their treatment. The comment of this doctor to me was "Any general practitioner who would willingly take drug addicts on to his list ought to have his head examined".
Take the case of another doctor. He was prescribing for a heroin addict, an artist, living in circumstances of abject poverty. Suddenly the doctor was surprised to find the patient's house beautifully decorated, fitted with luxurious new furniture, and the patient himself was seen driving about in a large American 1301 car, far more expensive than the doctor himself could ever afford. The addict explains this by saying that he has sold a few more of his paintings. The doctor has his suspicions. What does he do? Quite rightly, he phones up the Dangerous Drugs branch of the Home Office and reports his suspicions. But the addicts' parents, who are also beneficiaries in their son's new-found prosperity, go off this doctor's list. The addict's wife and children also ask to be transferred to another doctor. The whole street may come to hear of it and the doctor's practice may suffer. This Bill, by transferring the care of this addict automatically to a specially licensed doctor, will effectively protect a conscientious practitioner from these pressures, and enable him to continue doing his good work with a tranquil mind.
Reference was made in another place to the cost of this Bill. I firmly believe that the cost will be negligible compared with the wastage in manpower, in human material, often of valuable human material, some of it highly gifted, intelligent and creative, of enormous potential value to the community, desperately in need of help and now being thrown aside on the scrap heap. The urgent need of the moment, however, is for strict control. The genuine addict must be granted, in the first instance, the right of access to his drugs, free of all cost to himself and under the National Health Service. But prescribing must be kept under the strictest control to ensure that the whole amount of the drug prescribed is used only by the patient himself. By this means we may eventually hope to destroy the black market in these drugs.
But before we start to condemn any addict, and accuse him of lying and of deceit, let us remember that under the present system an addict is sorely tempted to ask a doctor for far more heroin than he really needs. He is often unfit for work; he may have little inclination to go out and work. He knows that he can always readily dispose of any surplus heroin and effect an easy living by this means. I imagine that many heroin addicts, if not all, who desire to go straight and always to tell the truth about the amount of heroin they need for themselves must find this temptation hard to resist. So that if at any time an increase 1302 in quantities is required, that should be the signal to recommend a course of treatment to the patient in his own interest.
The strictest control can, I believe, be achieved under this Bill. That is why I welcome the Bill wholeheartedly and with but few reservations. But again I would emphasise that, while research is important and urgent, and treatment even more important and urgent, by far the greatest urgency of all is that the consumption of these drugs must be brought fully out into the open and kept under the severest control. Let us remember that research takes time; and this problem cannot wait. Let us also remember that in treatment the rate of relapse is appalling, and that months and years of patient treatment can often be destroyed in a single week. But control can be stringent and absolute.
Many addicts will have to be allowed to live with their addiction, as a rheumatic with his rheumatism. We may not be able to cure his rheumatism, but we can prevent it from getting worse. That is often the most humane and understanding approach to the problem of drug addiction, and I believe in many cases the only true medical one. I once heard of a large employer of labour, the head of a prosperous business, who travelled to his office each day in his Rolls-Royce, under the constant care of a trained nurse, and who was daily injected with more than 30 times the maximum official dose of heroin. Why was that? Simply because he had developed an abnormal tolerance to the drug, which was originally prescribed for him 16 years previously after a major surgical operation. Yet that man was able to run his business efficiently and to look after more than 2,000 employees.
He lived to well beyond the allotted span. Would anyone be so foolish as to suggest that this man should submit himself voluntarily to undergo a course of treatment? He was happy and efficient, left as he was after 16 years under the strictest and medical nursing control. Yet he was able to render a useful service to the community, far more useful than if, at the age of 75, he had been induced to undergo a course of treatment.
But in bringing the consumption of dangerous drugs under control, let us be 1303 careful at this stage not to change the present machinery. I believe that it works well now, and can be made to work even better under this Bill. There is the closest working collaboration in these matters between the Ministry of Health and the Home Office. The machinery is well established. The personnel is excellent. Some modification may indeed prove necessary in the near future and in the light of working experience under this Bill. But now, at all costs, let us avoid a leap in the dark, only to find later on that we may have created a pedlar's paradise.
I also believe that on balance the General Medical Council were right to remain outside the disciplinary machinery required for this Bill. But this is a matter perhaps more suitable for discussion during the Committee stage. Let us also ask ourselves: why should there be a sudden rush for in-patient treatment under this Bill? Do addicts rush to get cured? I greatly doubt it. A taste of "cold turkey" or treatment by means of gradual withdrawal of the drug may well tend to put some of them off. I rather think that as regards the provision of in-patient treatment things will go on for a while much as before. I only hope that as the need for in-patient treatment steadily increases facilities may gradually be made available.
But do not let us delude ourselves with fantasies of vast new hospitals, with special wards for specialised treatment, suddenly springing up overnight. Nor about millions of pounds having to be diverted from other pressing needs of the National Health Service for the treatment of drug addicts. Such ideas, I believe, are a delusion, and a cruel delusion at that. We are dealing here with human material, humans who are desperately in need of medical help, and who have the right to receive that help at the hands of our community. May I say, finally, that I believe this to be a good Bill. It is a highly necessary Bill. It is a Bill which should command approval from every quarter of this House.
§ 4.30 p.m.
§ BARONESS HORSBRUGH
My Lords, I had not intended to speak on this Bill, although for some time I have been extremely interested in the problem. In 1304 the days of the League of Nations I was one of those working with the Narcotics Committee and was well instructed by Sir Malcolm Delevingne of the Home Office. I realised then how certain measures that had been taken had brought about a wonderful improvement in the problem of the appalling traffic in illicit drugs that had been going on throughout the world. The basis of this was that a complete record was kept of the drugs from the raw state. The Committee discussed and examined how many acres were used in the cultivation of the opium poppy. They kept records of the raw materials which were taken into a country and manufactured into certain drugs to be administered. Records were kept of amounts taken in by retailers and sent out by retailers. They had complete records and could know at once when and where there was a leakage into the illicit traffic.
I know that the noble Lord, Lord Stonham, has told us to-day that the illicit traffic, or the illicit source of drugs in this country, is very slight and that addiction has come from over-prescribing by a certain number of doctors. It seems to me that if—which I hope will occur as a result of this Bill—over-prescribing is stopped, we shall have to watch very carefully to see that those who are dealing with this traffic do not find other ways of circulating these drugs. We have only to look at the history of this terrible trade to see how clever people are, to what extremes they will go. and what trouble they will take to get the material they want on which they will make large sums of money by peddling it to the poor victims.
What sort of records are we keeping in this country? I know, sadly enough, that during the war the world-wide records were destroyed. The Narcotics Committee moved to Canada, and I saw some of the records then. They are now, I think, attached to the United Nations. A great deal was lost during the war and I doubt very much whether it has been possible to build up again the scheme we had before the war. I should like to know what is the system now. Do we know the amount of raw material that comes into this country? Do we know the manufacturers to whom it goes? Do we know the amount that is manufactured by them, and have we a record of the amount that goes to the various retailers 1305 and pharmacists? Do we know how much goes to the doctors who have the right to prescribe, and do we know—if we have those records—the amount of leakage, and can we trace it? We know, of course, that other stuff will be brought in. I do not think we can evaluate what the problem is and what the illicit problem will become unless we have those records.
I did not wish to detain your Lordships for any length of time, but I was so impressed with what I learnt and with the speech of the noble Lord, Lord Segal, who showed us how complex this problem is. It is no good thinking that when we have passed this Bill, that instead of people being over-prescribed by a doctor, they will just go off to the right place where we should like them to be that they will be willing to go in and to give up this addiction, and that there will be no thought of trying to get more of the stuff and peddling it one from the other. I wish that were true. Those of us who know anything about this appalling difficulty will know the problems: how much we shall have to deal with deceit; how much we shall have to deal with the appalling craving, and how much we shall have to deal with people who, at the beginning, do not think it matters, and find later that it matters more than they can possibly express.
§ 4.36 p.m.
LORD ST. JUST
My Lords, may I have the presumption to say to Lord Stonham, who I know is not present in the Chamber at the moment, that his speech, and the speech of the noble Lord, Lord Sandford, who followed him, were so clear that I have thrown away my prepared speech and am working entirely from a few notes. Everything I was about to say has already been covered. I am certain that the Government are correct in treating the drug addict as a sick person. This is an important, fundamental point from which to work. One point, also, that I think is important is that when the time comes for an addict to go into a hospital or treatment centre his treatment should at that time be entirely on a voluntary basis. I think everybody will accept this, and I am certain it is the right way to approach the matter. There is difficulty, however, when the treatment of withdrawal has started, and then in some cases some form of limited 1306 compulsion must, I think, be held over the patient's head. I think it is impossible that when a man has gone into hospital and started a cure, having been, let us say, a serious addict for a number of years, and with withdrawal symptoms having started, he should be in a position to say: "I have had enough; I am now going out." This may be an extremely dangerous thing for a patient to do.
May I go on to another point connected with a subject already spoken about on many sides of the House to-day—the staffing of these centres? It is a question not only of doctors, but also of finding staff, psychiatric staff, to man these centres. This is a very important and serious problem in many of the psychiatric clinics attached to teaching hospitals at the present time. The clinics have some doctors, but they cannot get the psychiatric staff. After all, a great deal of work—especially in this branch of medicine—falls on the heads of staff nurses and even on junior nurses. This is a very difficult point to deal with, and I am certain it must be gone into in great detail.
I have a suggestion to make which the noble Baroness may throw out with the greatest of pleasure if she does not agree with it. When efforts are being made to persuade these addicts to go to centres and undergo treatment of withdrawal, I am wondering whether it is possible for people who have been cured to be present and argue with those patients the reasons why they must take a cure. It is the same idea as with Alcoholics Anonymous. A patient comes voluntarily into a psychiatric hospital to take a cure and when the psychiatrist or doctor sees him the patient turns round and says, "But you do not understand what it is like". However clever a doctor or psychiatrist, or anybody, may be, this is a true fact: the doctors do not know. I believe there may be something in this argument. I think it is exceedingly difficult to send a person who has been cured as a drug addict out again into the wide world to face these people, because there is a terrible danger that he will become an addict again. But if some people who have been cured could be present at the centres, where the staff could keep an eye on them, they might be able to help enormously in persuading addicts to take the cure and, when started, to go on with it.
1307 I have little more to say, except that I am certain that by this Bill the Government are moving in the right direction. As we know, drug addiction is a vast problem, but the country itself is now moving forward in its awareness of what has to be faced in dealing with it. As I said, this Bill is a step in the right direction.
§ 4.41 p.m.
§ VISCOUNT ADDISON
My Lords, I did not mean to intervene in the debate, and I shall not keep your Lordships more than a couple of moments; but there are two or three points on which I should like to touch. First of all, I think this is a good Bill and deserves all support, and I have no doubt that your Lordships will give it a Second Reading. Also, it is a Bill which may work out well in practice. I could not help agreeing very much with the noble Lord, Lord Sandford, when he said he felt that the legislation had come later rather than earlier. But my noble friend Lord Segal seemed to think that that was because of the rather protracted nature of the deliberations of members of his own profession, so I suppose we must accept that and give the Government credit for the Bill.
I should just like to make two points. First, I share the view, which was also expressed by the noble Lord, Lord Sandford, that it is a pity that recommendation 7 of the Brain Report was not incorporated in the Bill—though I can see that there would be grave difficulties in doing so. I also agree with the noble Lord. Lord St. Just, about how helpful it might be if we could produce cured addicts. But I wish I knew of any who had been cured of addiction to heroin. I wish it could be established that people can be cured, perhaps by detaining them long enough to get over the habit. This is a very vital aspect of the need for work on this subject, but I do not think it can be done without implementing recommendation 7 of the Brain Report.
On the question of the constitution of the tribunals and the advisory bodies set up under Clause 2, I should like to think that there was some lay representation. There will be a barrister chairman and four 'doctors on the tribunals, and two doctors on the advisory bodies. But I feel (I am speaking only for myself, and 1308 not for the hospital board which I represent) that we should have some experienced lay representation on those bodies. I do not wish to put down an Amendment, but I hope that the Government will look at this point before the next stage of the Bill.
§ 4.44 p.m.
§ LORD SOMERS
My Lords, before the noble Baroness replies, I wonder whether I may ask one or two questions. I was most interested in what the noble Lord, Lord Stonham, said, and I entirely agree with him that the guilty person is not the addict but the person who peddles the drug, and it is on him that the full weight of guilt should fall. Of course, the addict must presumably have a moment of weakness when he first starts, but he is not always responsible for that.
The noble Lord, Lord Stonham, spoke of the doctor's dilemma in knowing how much of these drugs to prescribe, and for whom they are necessary. But I should like to know, if the noble Baroness can give me an answer, whether there are ever cases in which these habit-forming drugs must be prescribed. After all, there are plenty of sedatives which are not habit-forming, and I should have thought that the use of drugs as sedatives could be confined only to any essential cases. Also, I wonder whether there could be some system by which there is complete anonymity for an addict receiving treatment at a hospital. Unfortunately, as with alcoholism, these patients are apt to bear the stain of what they have been suffering from, even though they may be entirely cured. In addition, it is not always known whether they are entirely cured or will go back again to drugs. But if it were possible for them to get treatment anonymously it would be much better if they want employment afterwards.
§ 4.46 p.m.
§ BARONESS PHILLIPS
My Lords, your Lordships have indeed set me a task in replying, or attempting to reply, to the many questions that have been raised during the Second Reading of this Bill. At the outset. I would say to those noble Lords who do not receive a reply this afternoon that it is not because Her Majesty's Government are unable to provide it, but probably because on this occasion I, as their mouthpiece. do not have the necessary information. But those of your Lordships who know me can 1309 accept my assurance that I will see that replies are sent to those questions which were raised later in the debate.
The discussion has ranged widely and has covered the problem of addiction over the whole range of drugs—the so-called "hard" drugs, the narcotics and the "soft" drugs—the prevention of addiction, including controls and their enforcement, and the extending of treatment and rehabilitation to those who become addicted. The Government are fully aware that the Bill we are discussing this afternoon does not set out to tackle all these problems. I was very heartened when the noble Lord, Lord Segal, told the noble Lord, Lord Sandford, that the allegation of unwarranted delay was not perhaps justified, and that in the opinion of a member of the medical profession 18 months was not long to consult with, and secure the agreement of, the medical profession. I hope that the noble Lord, Lord Sandford, will accept those words as coming not from me but from a member of the medical profession. I was heartened, too, by the fact that the noble Lord said that had the Opposition been in the position of the Government they also would have acted on the recommendations of the Brain Committee.
The noble Lord put several questions to the Government to which I shall endeavour to give him replies. He asked, as indeed did several other noble Lords, whether the Government were going to give some guidance about rehabilitation. My reply is that the Minister proposes to issue guidance about rehabilitation and the co-ordination of the services of hospitals, of local health authorities and of voluntary bodies. This guidance will be issued on the advice of the Advisory Committee on Drug Dependence, which is urgently considering the question of how best to provide effective rehabilitation. In other words, certain further measures will rest on the recommendations of this Advisory Committee.
Because of our mutual interest in the National Council for Social Service, I know that the noble Lord, Lord Sandford, will be aware that it is very active in this field, and that the Bristol Council for Social Service is hoping to provide a hostel for drug addicts. He will also be glad to know what other voluntary organisations have set up hostels for addicts. They are the Hill Farm Enterprise, near Birmingham; 1310 Narcotics Anonymous, in London, and the Crossroads Trust, in Watford. Others which are working on setting up hostels include the Birmingham Midland Committee for the Prevention of Drug Addiction, the Life for the World, in Gloucestershire, and the Manchester and Salford Methodist Mission. I should like to assure the noble Lord, Lord Sandford, that my own very warm feelings for the voluntary bodies will enable me to press their case strongly with my right honourable friend when it comes to a discussion about assistance for the voluntary bodies in this field.
The noble Lord also inquired (or, rather, I think that here he made a more definite statement) about the fact that hospitals were not happy about the proposals in a certain memorandum, and he asked what response there had been to this. I am not sure that my information entirely agrees with that of the noble Lord, but the Minister feels that the hospitals, after full discussion of the memorandum, are quite happy about the proposals and that the response has, in fact, been most satisfactory. Where, in the case of some teaching hospitals, additional funds are required, the Minister has informed them—and I know this will please the noble Lord—that these will be forthcoming. Some hospitals have particular problems to overcome, as has been mentioned by, I think, the noble Lord, Lord St. Just, such as the appointment of additional staff, and these are being urgently looked at in conjunction with my right honourable friend.
The noble Lord, Lord Sandford, also raised a question which I should prefer to discuss with him privately. That was the question of authoritative guidance on cannabis. I should prefer to do that privately partly because it is slightly outside the scope of the Bill that we are discussing this afternoon; but I have some facts which I should be happy to let him have. Naturally, they are not in any way private, so they could be mentioned at later stages of the Bill if it is desired that they should be on the record. I was indeed delighted to hear the noble Baroness, Lady Horsbrugh. I am sorry I cannot give a direct reply to her question on the record of drugs. A voice behind me, from the noble Lord, Lord Stonham, tells me that this reply will be available in a moment. If the noble Lady will accept that somewhat 1311 unorthodox voice of Her Majesty's Government I will see whether before the end of the debate we can satisfy her.
Having had a doctor in the house, as it were—my son-in-law, who has been a general practitioner for many years and with whom I have discussed this question on many occasions—I should be the first to agree with the noble Lord, Lord Segal, and with other noble Lords who have mentioned this fact, that the drug addict is very difficult. It is perhaps more truthfully said that he is amoral rather than immoral, and in his attempt to secure what he feels to be a necessity he will not always stick to the truth. I believe all general practitioners will agree with this. I should guess, with the noble Lord, Lord Segal, that most general practitioners will welcome this Bill for that reason, if for no other. I felt that the noble Lord, Lord Segal, gave us a great deal of help, as he always does, not only by way of the valuable medical information with which he supplied us but also by way of the suggestions which he made. These, I am quite sure, will be looked at carefully by my right honourable friend, because those who have been concerned in the treatment of patients of this kind are always those best able to give practical advice.
There is only one point on which I would attempt to reply to the noble Lord, and that is on the question of vesting day for the suggested prohibition of heroin for new patients. I believe my noble friend Lord Stonham has already dealt with this point most admirably, but I add this as a further comment. Heroin is regarded as the best drug for use in certain cases of intractable pain, and it is certain that the medical profession would not accept a prohibition on the prescription of heroin for the treatment of new patients. This in some way rather cuts across the point which the noble Lord, Lord Somers, made, and as to which I felt I was going to say I agreed with him, because I know that there are doctors who claim that heroin is no longer necessary. Perhaps this is a point upon which the medical profession themselves must come to some agreement and those of us who have been on the receiving end of medical attention will know that, as a profession, they are rather like the legal profession—not always unanimous 1312 in their acceptance of various recommendations.
The right reverend Prelate the Bishop of Worcester, of course, echoed again the sentiments that we should all express namely, that prevention is always better than cure. I shall certainly pass on to my right honourable friend his admirable suggestions for the involvement of more voluntary people. I know from my own work in the voluntary social service field that there is a vast, untapped source of real good will available, not only in this field but also in many others. I agree wholeheartedly with him that this must also be a very real part of our work that the Bill alone is far too narrow if we leave it merely to the treatment of the known addict.
The noble Lord, Lord Amulree, was kind enough to give notice of his questions, and I therefore hope that I can give him slightly fuller replies than I have been able to give to some other noble Lords. I should first of all like to reassure him (and my noble friend Lord Stonham will repeat this, I am sure, during the passage of this Bill) that the old machinery will certainly not be removed before the new machinery is established. I should like to give him a quite categoric assurance that this will be so.
I feel that the questions which the noble Lord raised on the subject of notification perhaps need a little general comment from me. First of all, we are, of course, referring always to notification, and not to registration. The noble Lord did not in fact use this phrase, but the layman may be a little misled if we do not keep strictly to the fact that we are talking always about notification. The basic task is to identify the addict at the time he presents himself to a doctor for treatment, and that need, which arises when first prescribing for the addict, is in most cases a difficult matter for clinical judgment. Also, under the new regulations, a general practitioner will commit a breach if he prescribes heroin or cocaine to an addict for the treatment of his addiction.
Broadly speaking, there are two possible approaches to the problem of identification. One would be to rely on the addict identifying himself—for example, by an identity card, a registered number, or some other symbol of his continuing con 1313 dition. This would require a number of formalities. There would have to be a formal assessment, a provision for appeal, continuing reports and formalities for denotification. Procedures of this kind would be elaborate and cumbersome, in order to keep the addict's recognised status up to date. In addition—and this will be quite obvious to all your Lordships—it would be open to evasion. The Brain Committee rejected this kind of approach on the ground that registration—and I quote:might seem to imply that the addict is officially recognised as having a right to an approved quantity of a dangerous drug".The other approach is to leave to doctors the task of identifying the addict, and to help by making that task as easy as possible. This was the approach recommended by the Brain Committee. That is why they recommended, and the Government accepted, that there should be an advisory panel to help the doctor who is in doubt about whether a patient is an addict.
The other help that can be given is by a central reference system, run on quite different lines from registration. The scheme of notification planned by the Government will simply indicate to the central authority that a particular doctor has attended a patient whom he considers or suspects to be an addict. Notification will allow the central authority to put in touch with the notifying doctor any other doctor who has cause to inquire about the patient he notified. Provided the central authority can identify each notified person from its records, and is in a position to refer any doctor inquiring about an identifiable addict to the doctor or doctors who last notified him, it can be left to the doctors concerned to exchange information without the central records being encumbered with details which might be medically important.
I should now like to answer the first specific question asked by the noble Lord—namely, will an addict be notified that he is being put on to the register? As I have already said, there will be no register, in the strict sense of the word, but only a list of notified names. On the question of whether to tell the patient, we believe that it is better to leave this to the doctor to decide. There are obvious dangers, of which the noble Lord will be only too well aware. If the doctor were 1314 to tell the patient that he intended to make such a notification the patient might be scared into thinking that it meant more than it does. This would have the effect of sending the patient "underground".
The doctor is the person in the best position to judge the implications and value of any disclosure to the patient and the need to protect both the patient and himself in the immediate circumstances. The Bill will not prevent an addict from asking the doctor whether his name has been or will be notified; nor will it prevent a doctor from giving the information to the addict. Will it be possible for the addict to appeal against his name being put on the register? As I have tried to explain, the inclusion of the name in the list maintained by the central authority will have no lasting significance and the fact of notification will be safeguarded (and this, I think, is the answer to a point raised by several noble Lords) by the Official Secrets Act.
Notification will not mean that the patient is in fact an addict: all it will signify is that a particular doctor has found, or thought, that he was an addict at a given date. If, subsequently, another doctor is in doubt about that patient and asks the central authority about him, the central authority will not say—indeed will not be able to say—that he is an addict; but will refer that doctor to the doctor who had previously notified him. There will be no need, therefore, for any appeal procedure. I wondered, as a layman, whether there is any comparable procedure in the case of notifiable diseases. If so, I feel certain that I must be registered on many lists, for I have had almost every notifiable disease there is—with a few exceptions.
The third question was: Will an addict's name be removed from the list when he is cured; and will he be so informed? As noble Lords are aware, the Home Office have maintained for many years a list of known addicts. The information is obtained from examination of the records of prescriptions kept by pharmacists and by subsequent inquiries made by the regional medical officers of the Ministry of Health. The Home Office list is constructed annually and includes the names of all addicts who have come to notice in a given year.
1315 The Government hope that it will be possible under the notification scheme to confine the particulars required to a minimum and to keep records uncluttered by the names of patients notified too long ago. It may be that it will be possible to construct the list on much the same annual basis as at present. This will mean that automatically the names of addicts who are cured will be dropped. The treatment centres will maintain their own records and we should hope to keep the central records up to date as regards the cures by information from that source. There will be no need to tell an addict that his name has been removed from the central list; because since its inclusion on the list in the first place is of no significance, its removal from it will equally be of no significance.
I was also asked whether the central authority register would be open for information 24 hours a day, and whether there is any danger that an addict's name will appear on more than one register. We shall be having further discussions with the medical profession about the operation of the central reference service; but our present feelings are that it will be unnecessary to maintain a 24-hour service for this purpose. But this is a matter for further study.
There will be only one central record maintained by the Chief Medical Officer at the Home Office, and we shall try to organise this so that doctors will be put to the minimum trouble in submitting notifications. The noble Lord, Lord Amulree, also inquired whether an addict who was admitted to hospital suffering, say, from gallstones (I am not sure that the noble Lord actually mentioned gallstones) would still be able to get drugs from the doctor with whom he was registered. The straightforward answer to that question is, Yes.
§ LORD AMULREE
My Lords, may I interrupt the noble Baroness? What I meant was, supposing that he was admitted to a hospital a long way away from where he was registered, could the doctor at that hospital give the drug, so as to avoid the patient's own doctor having to travel a long distance; or would he get into trouble if he did so?
§ BARONESS PHILLIPS
As I understand it—and I am subject to correction—the answer is Yes; because for medical 1316 reasons this patient would be in need of the drug.
I noticed that the noble Lord, Lord Sandford, inevitably and very sensibly, inquired whether extra money would be made available for opening the new treatment centres. I should like to tell him that all hospital boards are given additional money each year for development, and in general the Minister expects them to be able to finance the treatment centres from this money. It may be more difficult for the teaching hospitals whose budgets are smaller than those of the Regional Hospital Boards; but the Minister has said that if necessary extra money will be made available from a small contingency fund. The Government do not expect the provision of treatment centres to be held up by financial considerations. It will be obvious to noble Lords that, the treatment centres having once been involved as part of the service, they will then form a continuing part of the estimates submitted yearly. I hope that this will satisfy the noble Lord, Lord Sandford. If he is not satisfied I am sure that at a later stage of the Bill he will tell me so.
I was asked to tell the House something about the treatment centres. I am not certain at this stage that it would be something your Lordships would particularly wish to know. I feel—though it may not be very humble of me to say this—that often we talk too long on one subject in this House. I would therefore suggest, that at this stage of the Bill, I should confine myself to replying to questions. The noble Baroness, Lady Horsbrugh, asked about illegal sources of heroin. As it may be for my right honourable friend to note, my noble friend Lord Stonham emphasised in his speech that we have no evidence that the black market in heroin contains drugs smuggled in from abroad or manufactured illegally, as is the case in many other parts of the world. The illicit supplies are, so far as we know, derived wholly from the legitimate supplies and prescriptions and, perhaps, from forged prescriptions. This ends the note I have, but does not give the reply that the noble Baroness sought. This I will endeavour to do.
My Lords, apart from some rather minor points of criticism, I feel that there has been a general welcome to this 1317 Bill. There has been a wealth of professional advice tendered this afternoon. If any noble Lord is not happy with my rather inadequate replies, I am certain that during the passage of the Bill there will be ample opportunity for raising again the various points which have been raised to-day. I hope that the House will appreciate that Her Majesty's Government in this narrowly-drawn Bill are endeavouring to deal with what was rightly described by one noble Lord as a terrible trade. With that in mind, I would ask your Lordships now to give this Bill a Second Reading.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House.