§ 2.52 p.m.
§ EARL JELLICOE rose to draw attention to the problems and dangers of drug dependence and misuse in contemporary Britain; and to move for Papers. The noble Earl said: My Lords, this House yesterday spent many hours discussing a grave matter of life and death. To-day I should like to direct your Lordships' attention to a grave condition in our society: dependence on and misuse of drugs, a condition which can only too often mean a sort of death-in-life—which can indeed mean death itself—for a growing number of our fellow citizens. I can, I fear, bring no special expertise, unlike some of the speakers who are to follow me in this debate, to this matter. I did once, I must confess, try my hand at hashish when. I was in the Middle East, but the experiment was a total failure, like my other and earlier experiment in cigar smoking as a small boy at 1266 Winchester. I derived no pleasure from it; only intense nausea.
§ Be that as it may, this is, I believe, a great and growing problem within the doors of our society, and it is right that this House should from time to time take stock of it. That is my simple purpose in proposing this Motion. I do not in fact propose to discuss those drugs, the old familiar friends and killers, like smoking and alcohol, with which most of us are probably fairly well acquainted. I shall concentrate rather on the less familiar area of the opiates and cocaine, the amphetamines and the barbiturates, cannabis and the hallucinogens, about which perhaps we should all, whether we be Parliamentarians or private citizens, or just plain parents, try to learn a little more.
§ First of all, the very hard drugs, cocaine and heroin, whose treatment is covered by the Dangerous Drugs Act 1967. I suppose that this is the area where the cost of drug dependence, in social waste and in intense personal suffering, is the greatest. In this area, heroin is perhaps the gravest menace. It is of course literally a killer and as often as not it kills indirectly via septicæmia caused by infected syringes. It is only eight years ago. I think in 1961, that we read in the first Report of the distinguished Committee presided over by the late Lord Brain that we had no cause to fear that any real increase in addiction in this area was occurring. I wish that that could be said to-day, in 1969. We can now read in the text of a formidable address delivered by Professor Paton to the British Association last summer that we are now "dealing with a major medical emergency" in this sphere.
§ And so, my Lords, we are; or so the grim escalation of the statistics would suggest. In 1960 there were only 68 known heroin addicts in this country. By 1966 that figure had become 899. By 1967 it had risen to 1,299; and by last year it had climbed to 2,096—a 30-fold increase in a bare eight years. That may be bad enough, my Lords, but the worst of it is that a new element has recently crept into the national picture of heroin addiction. In 1960 only one known heroin addict in this country was under 20 years of age. By 1964 that one had become 40; by 1966 that 40 had become 300, and by 1968 that 300 had become 785. Thus, heroin addiction is not only searing the lives of 1267 the old and the middle-aged; it is now starting to wreck the lives of young people who have never had a real shot at living.
§ We should, of course, keep these figures in perspective, By our standards they are beginning to look pretty frightening, but not of course by North American standards. In the United States there are some 60,000 heroin addicts in one city alone—New York. All the same, our national acceleration rate, which suggests that the number of our addicts is doubling about every 18 months, cannot be ignored. Mr. Jeffery, one of the admirable Home Office inspectors for drugs, recently told us that there could be 10,000 or so registered heroin addicts in Britain by 1972. If heroin addiction continues to spread like myxomatosis he may well be right. And what thereafter, if this acceleration rate of doubling every 18 months goes on?
§ I do not wish to be alarmist and I hope that the noble Lord, Lord Stonham, will be able to confirm the very tentative impression which I have formed, that the action which has followed from the 1967 Act may be serving to arrest this grim upward spiral. From the figures with which I have been kindly provided by the Department concerned, there seem to be some hopeful trends. The increase in the number of out-patients at the hospital treatment centres seems to be levelling out; the amount of heroin prescribed by hospital doctors seems to be falling. And we can take some comfort from the apparent fact that about one in seven of a sample of out-patients seem to have withdrawn, maybe only temporarily, from all narcotics.
It is now almost a year since the new system of treatment for these dangerous drugs was started. I hope that the noble Lord will be able to tell us more about that first year's experience and to indicate to us what comfort—and, more important, what lessons—for the future can be drawn from it. Specifically, could he assure me on two particular points? First, I have been struck by the relatively small number—less than 10 per cent.—of in-patients among those addicts attending treatment centres. In our debate on the 1967 Act the noble Lord expressed the view that it is:
reasonable to suppose that many who attend the centres can be persuaded to attempt a
cure."—[OFFICIAL REPORT; 20/6/67, col. 1276.]
Is this hope being realised? My second question is this. If I am right (I hope I am), in assuming that the road which leads via over-addiction to heroin addiction is being blocked, are the other, alternative, routes also closed? What can the noble Lord tell us, for example, about the very disturbing report, which I read to-day on the left-hand front column of The Times, that heroin is now being imported, smuggled, into this country? And are there not incipient signs that the flank of the 1967 defences may be being turned by another route?
§ I wish to tread warily and responsibly in this area, but my information is that in the last few months there has been a sharp but significant increase in the number of persons suffering from addiction to morphia and another narcotic, a synthetic called physeptone. Both these drugs have the same effect as heroin; both are just as dangerous, and both, I understand, are now being prescribed, with a total lack of responsibility, by certain doctors. It would seem that we may still have the Swans and Petros of our outrageous society with us. In this sensitive area I do not wish to press the noble Lord who is to reply for over-much information, but I do wish to press the Government for action.
I now turn briefly to my second chosen area, the amphetamines. I am inclined to think this could be the area which may well present us with the greatest difficulty in the coming years. Of course many of the amphetamines are household names—benzedrine, dexedrine, methedrine, and so on—and have legitimate medical uses. But, like other drugs, they are double-edged weapons; they can only too easily be misused or abused, and such abuse can well involve intense psychic dependence—to use the technical term. To quote the sober words of a World Health Organisation study, referring to amphetamines:
Although an individual may survive the oral administration of very large quantities, such ingestion may produce profound behavioural changes that are often of a psychotic nature, including hallucinations, illusions, etc.
§ Given those properties in amphetamines, I was glad to learn (and I hope the noble Lord can confirm that this is so) that the Advisory Committee of which the noble Baroness, Lady Wootton of 1269 Abinger, is the Chairman—and I am very glad that she is able to take part in this debate to-day—are now seized of the amphetamine problem. It is, of course, a large one. Nearly 4 million prescriptions for amphetamines were made out in this country in 1965, comprising a total of some 100 million tablets. Here again, American experience can show us what we may be in for. There, some 10,000 million amphetamines and barbiturates are manufactured each year, and it is estimated that of this total perhaps 5.000 million tablets are sold illegally. That, my Lords, is quite a lot of tablets. And there is a major security problem here. In London alone, in 1966, over 650,000 tablets were stolen, 800 prescription forms were forged and 500 blank prescription forms were stolen. I understand that regulations covering the security of these supplies in factories and wholesale depots and chemists' shops are now being drafted. I hope that the noble Lord will be able to confirm that those regulations will soon be laid before Parliament.
§ Amphetamines, of course, cover a wide spectrum. But I am particularly concerned at what I have learned about the increasing tendency for amphetamine tablets not only to be swallowed orally but also to be dissolved in water and to be injected intravenously. This gives a far greater and quicker "kick" to the human brain and the human body. I understand that the problem here centres largely on methedrine. In Sweden something of a cult surrounds the intravenous injection of this drug. Methedrine absorbed in this way can, I understand, lead to a psychotic condition with very dangerous paranoic tendencies. I am glad to say that, from what I have learned, this mad craze has not really caught on in this country. I am also glad to learn that last autumn the pharmacological industry reached an understanding with the Government, by voluntary agreement, to restrict the supplies of methedrine exclusively to hospitals. This seems to me to be a wholly admirable piece of common sense and self-discipline on behalf of those concerned, and I hope the noble Lord will be able to confirm that this arrangement is watertight and working well.
§ The other area of drug dependence on which I want to touch is that of the hallucinogens—the drugs which alter the 1270 senses: marajuana, cannabis, pot—call it what you will—LSD, STP, and so on. Cannabis, as your Lordships well know, has recently been the subject of—I was going to say a controversial Report, but I will say a Report which has aroused some controversy, by the Home Secretary's Advisory Committee on Drug Dependence, of which the Chairman is Sir Edward Wayne. The sub-committee which did the donkey work was presided over by the noble Baroness, Lady Wootton of Abinger. I should like first to say that those who wish to criticise the Report—and I shall voice some criticisms of it—should first read it. Personally, I have found it quite absorbing, not least the review by Sir Aubrey Lewis, who is, I suppose, the most distinguished neurologist of his generation in this country, of the vast literature on the subject. This review is attached as an Appendix to the Report.
§ Given the emotion which surrounds this subject, it was perhaps inevitable that this Report should have aroused controversy. What I find less excusable and less inevitable is that the Committee's carefully considered and carefully weighed views should have been so distorted in certain instances. I am glad that the noble Baroness, Lady Wootton, who has only just returned to this country, will be speaking in this debate. She is well able to defend herself and her committee. I am not saving that she is necessarily méchante, although I think at times she can be, but in any case, "cette animale se defend bien". However, some of the comment on this Report has been so distorted that I feel, even though the noble Baroness is here, I must just say a word on it. For example, it has been claimed that the Committee stated that cannabis consumption was not dangerous. A glance at paragraph 71 of the Report will show that that is not the case.
Then it has been claimed that the Report recommends the legalisation of cannabis. Once again, a glance at paragraph 71 demonstrates the falsehood of that assertion. To quote the Committee's words:
We conclude, therefore, that in the interests of public health it is necessary to maintain restrictions on the availability and use of this drug.
I personally cordially agree. More surprisingly—and I must confess thought just a little unworthily—the Home Sec-
retary himself has suggested that the authors of the Report may have been unduly influenced by the pro-pot lobby.
The Committee's central recommendations—or at least those on which comment has fastened—concern the penalties for the possession of, and trafficking in, cannabis. At present, as I would remind your Lordships, the maximum penalties are: on summary conviction a £250 fine or 12 months' imprisonment, or both; and on conviction on indictment, £1,000 or 10 years, or both. These are also the penalties which apply to heroin and the other opiates, and the Committee's central recommendation was that:
the association in legislation of cannabis with heroin and other opiates is inappropriate and new legislation to deal specially and separately with cannabis.
should soon be introduced. They then went on to recommend that the existing penalties for cannabis should be lowered.
§ I frankly say that I have found myself torn on this question. Much of the Committee's argument I have found compelling. It seems to me to be a nonsense to lump heroin and cannabis together in our legislation—their effects are so utterly different. It seems all the more a nonsense when one reflects that we rightly regard and treat the wretched heroin addict as a patient and not as a criminal. Moreover, if this seems a bit of a nonsense to me—a 50-year old "square" Peer—how much more of a nonsense is it likely to seem to some of the younger generation? If we allow too large a gap to appear between legality and what they hold to be reality we are only too liable to encourage an element of sheer defiance among the young. My feelings on all this are reinforced by paragraph 80 of the Report, where one reads that 17 per cent. of cannabis first offenders are sent to prison.
Yet, my Lords, I have my doubts. In the first place, it is obvious that we are still groping in the dark. We do not even fully understand the chemistry of cannabis itself. Nor do we know very much about the interaction between cannabis smoking and other forms of drug taking. The Committee state quite categorically that:
it can clearly be argued on the world picture that cannabis does not lead to heroin addiction".
But can it, my Lords? Sir Aubrey Lewis himself confirms in his survey which is attached to the Report that there is support for
the view that marijuana users are more likely than non-users to progress to opiate addiction".
And in his address to the British Association, from which I have already quoted, Professor Paton quite firmly states—and again I quote his words:
I think one is bound to conclude that there is, at least for our culture, a far closer connection between cannabis and the opiates than is generally recognised".
§ If one accepts this view, that there may well be a progression from relatively harmless cannabis (if one may so describe it) to the highly lethal and dangerous drugs, then surely there is a strong case for proceeding cautiously. But at the end of the clay, one has to declare one's stance on these matters. I have considerable sympathy with the Home Secretary's view that unless we are faced by some emergency we should not legislate for one drug alone. I would not therefore myself—and here I am speaking quite personally—favour an immediate change in the law relating to cannabis. Nevertheless the equivalence of pot and its penalties with heroin and its penalties, I must confess sticks in my gullet. So does the equivalence of penalties in this field for the trafficker and the consumer. I should myself hope that we could introduce a separate offence in this area for possession with intent to supply compared with possession with intent merely to consume—with the former offence attracting far more stringent penalties. When we legislate—and I hope that the Government will soon legislate in this area—I would go some way with Wootton. I would personally accept her lower penalties or something like them for mere possession. But I would opt for a separate offence for trafficking in cannabis, if this can be devised, and the higher penalty for that suggested by Mr. Brodie, the Chief Inspector of Constabulary, in his note of reservation to the Report.
§ So much for the drugs themselves. May I, as I come to the end of my remarks, offer one or two more general observations? First of all, there is the Government machinery. Some doubts have been expressed before about the adequacy of the Government machine 1273 to tackle this growing problem. Both here and in another place there has been pressure for a more powerful focus of Government authority. I understand that although other Ministries and Departments are deeply engaged, the commander-in-chief on this front is the Home Secretary. Is there under the Home Secretary sufficiently powerful machinery—I should have thought there was a case for something like a standing inter-departmental Committee under a Minister of State—co-ordinating and driving forward the work of the various Ministries? One reason why I ask this question is my understanding that even at the Home Office there is no Assistant Secretary engaged full time on this grave and infinitely complex problem.
§ Next, there is legislation. I am glad that the Home Secretary has foreshadowed new and comprehensive legislation in this field. The present law here is complex and scattered. We need, I believe, to codify. New drugs and new ways of taking old drugs, sometimes just as important, spread with the speed of a prairie fire. We need to introduce a quicker and more flexible procedure. We also need to close some obvious loopholes. All that I can accept. Where I am less certain is whether in framing new legislation the Government should pursue the 1967 Drugs Act route or whether they should pursue the Brain route, if I may so term it; namely, to try, as recommended by Lord Brain in his Second Report, to secure a far greater measure of quick response from and self-discipline by the medical profession and the pharmacological industry. I personally believe that there is a lot to be said for going the Brain way if we possibly can. In any event, the Government would be wise to encourage public discussion of these issues—they are very difficult ones indeed—before they seek to legislate. I hope the noble Lord will therefore be able to confirm that there will be legislation next Session and that it will be preceded by a White Paper.
§ My Lords, this is a vast field. There is so much else that I could ventilate: the absolute necessity for more research; the relationship between drugs and delinquency; the problem of drugs and school education; the police powers of search and arrest—and I am glad that there is a sub-committee of the Advisory Com- 1274 mittee under my right honourable friend, Mr. Deedes, looking into this matter; the relationship between road safety and drug dependence; the crying need for greater public understanding and information, and so on. But I shall confine my concluding remarks to one need on which I personally feel very strongly, the absolutely crying need to put more drive behind the rehabilitation of the drug addict.
§ I must ask the noble Lord to tell us what the Government's plans in this field are. I understand that a sub-committee of the Advisory Committee under Mr. Blenkinsop have drawn attention to the need for more hostels. Some months ago the Ministry of Health issued a slim memorandum on rehabilitation, calling for more hostels and suggesting that this was a good area for voluntary endeavour. Extrapolating my experience in other fields, I am sure that Blenkinsop and the Ministry of Health are right. But where are the hostels—where? I was talking last night to a very distinguished practitioner in this field. He told me that if he wished to get one ex-addict into a hostel in the London area this would simply not be possible for him.
§ This is a very serious matter and a very serious deficiency. There are now over 1,000 people attending treatment centres in London alone. This has been going on for nearly a year. Some have been cured; some will be cured. But all will need support—many, I suspect, in hostels. Without that support they will relapse, and then the whole dreary cycle of relapse and infection will start again. But the problem is not only a problem of bricks and mortar—that is the easiest side of it to remedy: it is a deficiency in skills as well. I am sure that there is a real part for the voluntary worker to play here, but there is also a need for specialised skills. It is not as if something could not be done here. I am convinced it can. New York, for example, with the Phoenix House Organisation working under the New York City Agency, have shown what can be done, given the impulse and support from above, given the resources and given the right leadership. But what is happening here in this country and in this city? I understand that the London Boroughs Committee of the G.L.C. is looking favourably at the idea. I know that there 1275 are splendid organisations like the Richmond Fellowship, eager to help. But can the noble Lord tell us when all this is going to get off the ground? Above all, can he tell us what the Government propose to do?
§ Before I quit this field and leave it for other more informed speakers, may I say just this? As I have tried to learn a little more about this taxing problem—one of the most demanding and difficult with which our society has to cope—I have become more and more conscious not only how little I understand about it but also how baffling it is even to the experts. But one thing I have learned We may approach this matter of drug dependence and abuse from a moral standpoint. That I can very readily appreciate. Nevertheless, unless we recognise that we are also faced with an infectious disease, and one which could all too readily assume epidemic proportions, we are likely as a society to find ourselves in very deep water indeed. There really is here a need for speed and a need for speedy action. I beg to move for Papers.
§ 3.19 p.m.
§ THE MINISTER OF STATE, HOME OFFICE (LORD STONHAM)
My Lords, I am sure that your Lordships will all be as grateful as I am to the noble Earl, Lord Jellicoe, for raising the very important drugs issue at a time when the Report on Cannabis is still very fresh in our minds. We are grateful to him also for the wide terms in which his Motion is drawn, and, if I may say so, for the very objective and helpful speech which he has just made, although, as he will appreciate, he has posed to me rather more questions than it would be tolerable for me to attempt to answer. I will do my best with as many as possible, and my noble friend Lady Scrota, who is to wind up the debate, will deal with some of the other points.
I would assure your Lordships that we regard this as an extremely important debate and that every word said here will be most carefully studied. I should like in the course of answering the noble Earl's points to single out, as it were, some features of the general position and try to put them, as he himself said, in perspective, and I hope helpful perspective.
1276 I would first stress the need for a sense of proportion and a realistic attitude. The other day I was present at the opening of a conference in Westminster about addictions. The agenda covered drugs, alcoholism, smoking and gambling, all serious social problems. But the newspapers reported only the speeches on drug-taking and its dangers. They seem to think that the drug problem is special, even though fewer people are affected by misuse of drugs than misuse of alcohol, or indeed by the other addictions I mentioned. Perhaps it is because it is a new problem in the Western world and therefore alien and malign and a direct indictment of our way of life. One finds the drug problem described as a "scourge" or "menace" which should be "stamped out". I am quite sure that the noble Earl will agree with me that stamping is least likely to do any good. We live in a drug-using society and are subject to intense personal pressures and conditions for which drugs are an immediate relief. Drugs have come to stay. Our task is to come to terms with them.
I am glad that my noble friend Baroness Wootton of Abinger has returned to us from the Far East like a lion refreshed. After shedding her light over Asia she is in time to favour us with pearls of wisdom. After a lifetime devoted to social reform in this country my noble friend is no stranger to controversy or the roughness of the stony path trodden by reformers. Even so, my noble friend must, unfortunately, have been sorely tried by some of the more personal attacks for her part in producing the Report on Cannabis. It was understandable, if scarcely necessary, that the Advisory Committee at their last meeting should have declared their complete confidence in her and in their Chairman. The Advisory Committee have come to know, as we have long known, my noble friend's honesty, humanity of purpose, and outstanding intellectual gifts. We can be more confident of successfully dealing with the drug problem while we have her at our side.
My Lords, it is fitting that I should begin as did the noble Earl, with some remarks about the Advisory Committee's Report on Cannabis. It was the first appraisal of its kind. We are all most 1277 grateful to my noble friend and her colleagues for producing such an informative, clear and readable analysis (I stress "readable" because I think one can detect my noble friend's hand in it) even though, as the Committee explained, the Report could not be regarded as either final or definitive. It is unfortunate that controversy over penalties overshadowed much of great and continuing value in the Report. In my personal view the most notable feature was the declaration by this distinguished Committee including eminent doctors, that whilst cannabis is a "potent" and "dangerous" drug, it is, in terms of physical harmfulness very much less dangerous than the opiates, amphetamines and barbiturates, and also less dangerous than alcohol. It may comfort some noble Lords in view of those last words, that the Report also says,that alcohol, with all its problems, is in some sense the 'devil we know'; cannabis, in Western society, is still an unknown quantity".It was the Committee's own decision to look first at this subject, but their initiative proved particularly timely when public interest was stimulated by The Times advertisement in 1967, and by controversy abroad about the dangers of the drug.
It is easy to underestimate the difficulties which faced the Committee. Cannabis is a drug whose active principles have yet to be fully understood and made readily detectable. It has no medical value. It comes from abroad where it is also prohibited. The literature about it is vast and confusing. We do not yet know its effects upon our own society, or what long-term effects it may produce on individuals. It is to the credit of the Committee that the Report went beyond stating these negatives. Instead, for the first time in the United Kingdom, an attempt was made to measure the apparent harmfulness of a drug from a wider frame of reference; to translate that measurement into the terms of the criminal law; and, as it were, to make "the punishment fit the crime". This constructive approach led the Committee to recommend recasting of the general drugs law, further inquiry into police powers and further study of possible refinements in the nature of the offence of unauthorised possession. The Report makes clear beyond dispute that there 1278 must be co-ordination of policy and a common frame of purpose for dealing with individual drugs. Where my right honourable friends and I differ from the Committee is which should have first priority, alteration of cannabis penalties, or general recasting of the law.
I do not want to go into detail about the Committee's views about the use of penalties by the courts. Since the Report was published, there has been further controversy about whether, and if so to what extent, there is a link between cannabis-taking and subsequent heroin addiction. There has also been some comment in the Journal of the Probation Service seeking to show that the courts in disposing of cannabis offenders have been less severe than the Committee asserted.
The two crucial issues to which want to draw your Lordships' attention are these. The Committee forecast wider use of cannabis and recommended recasting of the law, further research, further inquiry into police powers, and further study of the offence of possession. Would it, in the face of these recommendations, be sensible to make immediate drastic reductions in maximum penalties? Would it be desirable to do so without assessing or preparing public opinion? In my view the answer must surely be, "No". The primary objective of even reduced penalties which the Committee still recommend—to deter and discourage use and trafficking of the drug—would be defeated if the public were not properly prepared to understand the meaning of such a move.
So long as misuse of drugs is subject to the criminal law, penalties must have a special significance. No doubt they must and will be changed from time to time. But multiple drug use and scientific, social and political factors will always make it difficult to relate the penalties simply and directly to the accepted harmfulness of an individual drug. I am sure that my noble friend Lady Wootton and her colleagues fully appreciate these points, and accept the Government's view that their recommendations on penalties would be best reviewed in a general revision of the law.
I turn now from, as it were, opinion, to the facts of what has been achieved by our legislation on hard drugs. As I 1279 think the noble Earl, Lord Jellicoe, mentioned, a year ago we were understandably impatient and perhaps sceptical about what would be achieved by the hospital treatment centres. It is the more pleasing that I am able to report that the work of these centres has already made a significant contribution to the battle against drug addiction. Two major problems faced us: how many heroin addicts would there prove to be, and under what conditions would they be prepared to attend, and continue to attend, hospital clinics? On the first point, we made the best estimate possible from such information as was known; this was that there would be about 1,200 in the whole country of whom about 1,000 would be in London. On December 31 last there were 1,252 of whom 985 were in the London area. We made a remarkably accurate estimate. That figure has remained fairly constant in the most recent months after the expected high rate of increase in the early months. Thus, once the hospital facilities were fully developed, they have been able to cope with the demand made on them.
The second problem of persuading addicts to attend hospital clinics regularly was the more difficult. The object was to halt the upward trend in heroin addiction. But could this be achieved by a tough policy of cutting down dosages drastically, perhaps refusing heroin, and offering only a substitute drug? It certainly could not be achieved by continuing the high level of prescribing which had been criticised by the Brain Committee, so we followed the middle way of a gradual reduction in individual doses—in many cases complete withdrawal has been possible—with the overall object of reducing the total pool of heroin available from which excess supplies could be obtained and silently traded.
In this we are succeeding. Last August the average total amount of heroin supplied to addicts was 145 grammes per working day—that was the size of the heroin pool, about 5 oz. per day. By January the daily heroin pool had fallen to 111 grammes, about 4 oz., a drop of over 23 per cent. Let me illustrate what this means to individual patients. In December we made a survey of 702 patients under treatment for heroin addiction. It was not the lot, but a very sub- 1280 stantial number. This showed that out of that 702, 214 were receiving heroin on a non-reducing basis (but also on a non-increasing basis); 217 were on reducing doses; and 271 had been weaned from heroin altogether. Of this last group as many as 111 were off all narcotics. The noble Earl asked me if I could give any indication of whether our hopes of cures were being realised. I know it is early days, but that begins to give real hope.
The noble Earl also asked me about the in-patient figures. The position is that at any one time there are about 100 heroin addicts undergoing in-patient treatment, and they represent, as I think he said, one in twelve of those undergoing hospital treatment of one kind or another. But, as I have already indicated, out-patient treatment has led to this significant number of withdrawals from heroin, and in-patient treatment alone is no indication of the extent to which patients are being weaned from heroin. I think that this success in so short a time not only shows a very hopeful trend but reflects very great credit on the hospital staffs concerned.
The noble Earl spoke about a forecast, a somewhat alarming forecast, of the possible continued escalation in numbers, and made reference to Mr. Jeffery of the Home Office. I am glad he raised this point because it gives me the opportunity of telling your Lordships that Mr. Jeffery was not expressing a Home Office conjecture; he was referring to an estimate made by a Research Institute in New York which was based on a simple projection of the early trend, and his words were taken out of context.
No one can be certain about the future in this subject, and I am not saying that we can yet draw any firm conclusions about the future, but certainly we reject the forecast that the noble Earl mentioned and we direct attention to this and to other encouraging pointers to a diminution of the heroin problem. The number of new cases notified by hospitals has fallen from the rate of over 38 a week when the legislation first became operative, to less than eight a week in January. Set against the upward curve which was noted by the Brain Committee, that is very significant. It is also not without significance, as the noble Earl himself said, that problems with other 1281 drugs have arisen—serious problems which we are facing. So far as his mention of morphia was concerned, I have no evidence to confirm the suggestion that has been made to him about a transfer to and increase in use of morphia. Because I have no evidence, it does not mean that it is not happening; I am merely saying that we are not aware of it at present. But this change is another indication that at least to that extent we are beginning to be successful in the campaign on the heroin front which he said is the killer, the worst of all.
§ LORD O'HAGAN
My Lords, if the noble Lord will excuse my interrupting, could he tell me, in taking into account these figures as far as the new centres are concerned, how many heroin addicts formerly unknown to the Home Office have now declared themselves and therefore swelled the numbers? This would have been likely to happen, particularly at the beginning, when the new centres were starting to operate. Could he say, therefore, whether the decline in new known heroin addicts is a real figure or somewhat illusory?
§ LORD STONHAM
My Lords, I quite follow my noble friend's point, but I would ask him to let me deal with these figures—they are difficult to grasp—in the course of my speech, when I will answer the point that he has raised. I first wanted to deal with the matter the noble Earl raised: that medical treatment is not adequate by itself; that drug dependence is as much a social as a medical problem, and patients need support. All the hospital clinics dealing with significant numbers of heroin addicts have the services of social workers, who have a vital role to play in the patients' rehabilitation. The recommendations made a year ago from the Advisory Committee were very valuable to us in pointing to this need in out-patient clinics where the process of rehabilitation begins.
When the patient is off drugs, often after a spell of in-patient treatment, his social needs assume even greater importance. Many drug addicts have told me personally, when I have seen them in clinics, "We must have support when we go outside; otherwise we have no confidence that we shall not be back again", and all the good work of the hospital 1282 can be undone if the patient does not get the support he needs. This support is in the form of counselling from social workers, and in some cases, as the noble Earl indicated, special accommodation will be required for those who, for one reason or another, cannot be discharged to a suitable home. This is a responsibility of local authorities. Advice has already been passed to them on these aspects, and I look forward to the publication shortly of the Advisory Committee's final Report on this subject which my right honourable friends will be commending to all the statutory authorities concerned. I know that the noble Earl is perfectly well aware of my own anxieties on this particular point and the pressures which are needed.
I want now to deal with the subject which was just raised in an intervention by my noble friend, namely, the number of heroin addicts. I said just new that on December 31 1,252 addicts were receiving treatment at approved centres. But on the same date, as the noble Earl mentioned, the Home Office had received 2,096 first notifications of persons found or suspected to be addicted to heroin. At first sight it would appear that mote than 700 are not being treated at approved centres. Fortunately, there are reasons for believing that this large gap is more apparent than real. Before 1968, our information about individual cases of addiction was obtained from routine police examination of records kept by pharmacists of prescriptions for dangerous drugs and by other means, and from this information the Home Office established each year an index of individual persons known to be regularly receiving supplies of dangerous drugs without therapeutic justification. These figures did not purport to represent a current addict population at any given date. They simply indicated the numbers of persons coming to notice in a given year who were described as addicts.
Since February 22, 1968, when the Notification Regulations came into operation, every doctor has been under a duty to notify particulars of any patient found or suspected to be addicted. Since April 16 last, when the Addicts Regulations came into force, the supply of heroin to addicts has been confined to licensed doctors at hospital treatment centres. These changes have introduced two new 1283 sources of information from which I want to give a provisional assessment of the position as it appeared at December 31 last. I stress the word "provisional", because the "numbers game" with drug users is notoriously difficult, and it is easy to gain, and to give, false impressions. Of the 2,096 first notifications, 1,562 were made by hospitals. 295 came from other institutions and 239 from general practitioners; but 149 notifications from these sources were subsequently repeated by hospitals. That is one duplication.
I would make three general comments. First, the Regulations do not require a doctor submitting a notification to declare whether he is convinced of the patient's addiction or to confirm or deny suspicions about addiction. Second, the doctor is not required to "de-notify"—for example, if the patient dies, moves away or transfers to a non-narcotic drug. Third, a doctor is not required to notify changes regarding the particular drug prescribed or administered. A general practitioner may notify addiction to heroin and then treat the patient by a substitute drug without reporting this. There are a number of possible reasons why some people did not present themselves at a hospital by December 31—for instance, death, emigration, serving a prison sentence, reversion to illicit heroin, transfer to a drug other than heroin, and of course not being truly addicted to heroin. It is significant that some 612 second and subsequent notifications were received from prison doctors among 1,612 such notifications received by December 31. All these facts account for the difference.
In any case, my Lords, I do not think that the picture needs more elaboration. The notification scheme brought to light more than 1,000 possibly addicted persons previously unknown, most of whom have been seen by the treatment centres. The number who remain unnotified is anyone's guess, but it does not appear likely to be substantial. The weekly rate of notification has been steadily dropping for some time. Allowing for the unknowns, the doubtful diagnoses, the dropouts, the experimenters, and the addicts withdrawn from the drug by treatment, the current number of addicts seems to be rather smaller than some of the estimates freely made before the new 1284 measures came into force. Of course it is too early to say whether the spread of heroin addiction has been checked or is petering out. But it is certainly our view that the measures recommended by the Brain Committee are proving to be of great value.
The noble Earl, Lord Jellicoe, mentioned the report in The Times to-day of heroin being smuggled into this country. So far, the seizures have been few and the amounts very small. The information so far available is too meagre for us to speculate about likely trends or implications for the treatment centre system. There is no evidence as yet that organised traffickers are trying to exploit heroin addiction in this country. Everyone knows the risks of such a development and the Department and enforcement authorities will continue to watch the situation very closely.
I turn to some recent problems. It is a feature of drug addiction that as fast as one problem appears to be near solution another takes its place. When the restrictions were applied to the prescribing of heroin and cocaine certain doctors began to prescribe large amounts of injectable methylamphetamine, better known as methedrine. Abuse of this drug, considered by many experts to be potentially more dangerous than heroin, started to spread rapidly. As an indication of what one evilly disposed doctor can do, Dr. Petro, in the month of May last year, was know to have prescribed 24,000 ampoules of methedrine to 110 patients. That is an average of over 200 per patient in a single month. That was just one doctor. It gives some idea of the kind of problem which we are up against when one has a few rotten apples like that in the barrel.
Unfortunately, we had no suitable powers of statutory control available to us in respect of methedrine, but with the ready support of the medical and pharmaceutical professions my right honourable friend, the then Minister of Health, introduced last October a scheme for the voluntary restriction of supplies of injectable methedrine to hospital pharmacies only. These arrangements have satisfactorily resolved the methedrine problem, at least for the time being. But we must watch it. But "one down t'other come up"; and we then began to see the prescribing of powdered amphetamine, 1285 clearly for intravenous injection in solutions. Again, no suitable statutory powers were available to check it. My right honourable friend, the then Minister of Health took prompt action to check this development, and after consultation with the medical profession the Pharmaceutical Society recently issued a warning to its members against dispensing any prescription for powdered amphetamine. We believe that this will be similarly successful, particularly as the B.M.A. have just made the welcome statement that there is no justification for prescribing amphetamine in powdered form.
It would be wrong, my Lords, to conclude from these recent experiences that over-prescribing by doctors is the beginning and end of the drug problem. The matter is much larger than that. The doctor has as important a part to play as the drugs industry, but his problem is one of particular difficulty. In, I believe rightly, regarding the heroin addict and other drug dependent persons as patients, and offering treatment, we expose the doctor to the pressure of his patient's craving. If all doctors prescribe responsibly and cautiously the challenge can be withstood. But once drug users find a compliant doctor, not only is there a risk that he will create the nucleus of an epidemic, but other doctors are put under special pressure to conform, so as to keep their patients. There is a very delicate balance here of which the staff in the treatment centres already have much experience, and about which they inevitably feel concern when prescribing by general practitioners seems to threaten their own dedicated efforts. I will leave it to my noble friend Lady Serota to say more about this aspect. But it is clear that as more and more stimulants, sedatives and tranquillisers are developed, new abuses and new dangers will threaten the delicate balance to which I have referred. For this reason it is particularly heartening that the B.M.A. have decided to set up a working party to explore with my right honourable friend ways of preventing the misuse of potentially dangerous drugs.
That brings me to the much-needed revision of the law. Our present drugs law was mainly constructed before the United Kingdom had a drug abuse problem, and we have added to it piecemeal. It is plainly unsatisfactory. First, it is 1286 fragmentary. We have restrictions of sale to prescription only: that is under the Pharmacy and Poisons Act 1935. The Dangerous Drugs Acts 1965 deals only with substances controlled under the international Single Convention on Narcotic Drugs 1961; the Drugs (Prevention of Misuse) Act 1964 is available for yet other drugs, such as amphetamines, LSD. The Dangerous Drugs Act 1967 gives power to regulate the notification of, and the prescribing to, addicts of 1965 Act Single Convention drugs. Secondly, the law is inadequate. The 1965 Act contains absolute prohibitions on opium prepared for smoking, but it does not allow for total prohibition of other substances controlled internationally and scheduled in the Act—for example heroin. The 1967 Act does not provide for control of over-prescribing of all drugs liable to abuse, or for reporting all forms of drug dependence. The 1964 Act authorises possession for a variety of professional purposes, but gives no power to control either manufacture, supply or export.
Thirdly, the law is inflexible. If the international authorities decide to schedule a drug under the Single Convention, Section 12 of the Dangerous Drugs Act 1965 obliges us to schedule it under that Act. But Section 12 does not conversely allow us to schedule a substance in the Act on our own initiative. The controls under the 1965 Act are largely applied by regulations which have stood without much change for many years. New drugs are subject to this common code. The 1964 Act does not allow the Home Secretary to limit authorised possession; and although it requires manufacturers and dealers to be registered, it does not allow him to limit the numbers on the register. If a new drug is scheduled, all those given authority to possess under the Act, and all those already on the register, have their authority automatically enlarged.
In the light of recent experience and the challenges ahead, there is a clear risk that each new fashion of drug abuse will find new gaps in the defences which can be plugged only by voluntary steps or by ad hoc legislation like the 1967 Act. There is great temptation to plug the holes with more ad hoc legislation. We must resist it. What is needed is a single comprehensive code covering the 1287 whole field of drug abuse; a code which would rationalise and strengthen the Government's powers and enable us to deal selectively and flexibly (flexibly above all) with individual substances whether produced by the industry or by the "underground".
The Home Secretary has made clear that he will be looking to the Advisory Committee for their full help and advice in preparing this legislation. A subcommittee has been working for several weeks now reviewing police powers of arrest and search as recommended in the Cannabis Report. Another sub-committee under the chairmanship of my noble friend Lady Wootton is studying the problem of central nervous stimulants and the hallucinogens. We hope that conclusions from these studies will be available for consideration in the legislative programme.
The Home Secretary is also continuing his consultations with the Law Commission about the desirability of modifying the drugs law to exclude absolute liability and will take account of the Advisory Committee's recommendations in this regard. We intend to consider further the recommendations in the Cannabis Report for possible redefinition of the offence of possession. Much careful consultation will be needed if new legislation is to be soundly based, but my right honourable friend is determined to bring forward proposals without delay and we are working on them with this object in view. I cannot be more definite than that. I can only hope that "soon" will be soon. The noble Earl asked whether it might be a good idea for the Government to issue a White Paper outlining their proposals for new legislation. I assure him that his suggestion will be carefully considered, though of course I cannot commit myself this afternoon.
The law is important, but legislation alone cannot solve the drugs problem. There is one important field, however, in which sensible precautions can do much to protect the public, and in particular young people, from "exposure" to drugs. That is the safe keeping of drugs. I do not wish to exaggerate the threat from that source, but there is continuing evidence that retail chemist shops are vulnerable to attack by break- 1288 ing and entering, and that wholesale manufacturing chemists continue to lose substantial quantities of tablets through pilfering, and from the occasional large-scale robbery. We have worked out a specification, in consultation with the police and other experts, for constructional standards for safes, cabinets and stores. There are points still to be settled; for example, about the value of alarm systems, particularly in the larger premises.
It must be remembered that in dealing with drugs scheduled under the 1964 Act, we are dealing with much larger quantities than with the so-called dangerous drugs. Some requirements will have to be determined according to the circumstances of the individual premises and this will be done through the Home Office Inspectors. Consultations with the various interests have been going forward and we hope to be in a position soon to prepare a draft set of regulations for agreement with them. But I cannot, for reasons which the noble Earl will appreciate, yet say when the regulations will be laid.
I turn, finally, to the important subject of research. Behind all our concern about the drug problem and its future resources lies the basic question: why people misuse drugs and fall victim to dependence. If we knew the answer to that we should be a long way on the road to understanding what we should do. Our ignorance is enormous, and it is no comfort that it is shared by the international bodies and other communities overseas. We cannot assume that better knowledge will be quickly available. I assure your Lordships, however, that we fully appreciate the importance of research and will do all we can to encourage and promote promising lines of inquiry. One difficulty is the vast range of relevant material to be explored. Another is to avoid waste of effort by selecting the significant fields for study.
The noble Lord, Lord Sandford, will no doubt have something to say on this subject. He is a member of the Council of the Institute for the Study of Drug Dependence, which is holding a reception in your Lordships' House on April 1 to celebrate its first anniversary, and next month has arranged a scientific symposium on the chemistry and botany of 1289 cannabis. The Government warmly welcome the establishment of this body and look forward to co-operating with its programme of studies and other activities. Noble Lords will have noted from the professional journals that the momentum of drugs research is increasing. The Advisory Committee's Report on Cannabis made some important recommendations which have been brought to the attention of the Medical Research Council and the Social Science Research Council. Meanwhile the Addiction Research Unit, established by my right honourable friend the former Minister of Health in 1967, has been extending its range of activities. Plans have been made to exploit information collected by the treatment centres.
We have learned a good deal in the past few years, particularly about the value of the inter-disciplinary approach. Much, however, has still to be done to harness effort from official sources and voluntary organisations of all kinds. It is tempting to think that we could do better if control and responsibility were placed in some specialist central body. There are precedents overseas for this, though constitutional and other circumstances are very different in those cases. We do not have closed minds towards such a possibility, but the problems need very careful study in the context of our administrative and other arrangements. At the present time we think that our machinery is working effectively enough and my right honourable friends are satisfied that no changes are called for at present. I am confident that at the end of the day, although we may differ on details, we shall be at one in our concern about the dangers to which the noble Earl, Lord Jellicoe, has drawn attention, and I hope I have convinced your Lordships that the Government have demonstrated, and will increasingly demonstrate, their resolve to meet them with realism and resource.