§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. McBride.]
§ 7.22 p.m.
§ Mr. W. F. Deedes (Ashford)
The House and, the Minister will, I hope, welcome this opportunity to discuss in a short time—even shorter than we had hoped—the exceedingly difficult social problem of drug addiction and the misuse of drugs. As hon. Members know well enough, there is increasing public disquiet about this, and among many social workers—teachers, doctors, parents and others who are already at grips with this subject—there is something akin to dismay.
Not the least cause of public anxiety is the difficulty we have in measuring the extent of the problem. Perhaps the first thing to make clear, therefore, is that we do not know the facts. This has one very unfortunate result. It leads to a tendency for opinion to polarise. Without the facts, there is inevitably alarming talk about the tip of the iceberg and some generalised exaggerations resulting from particular tragedies and scandals, others are provoked into taking hysterical attitudes, while others declare that a mountain has been made out of a molehill and that it is no more than a passing manifestation of the youth revolution. I hope that this debate will, if nothing else, enable us to establish some perspective.
In my view, none of these extremes reflects the real position. I do not believe that addiction or the misuse of drugs in this country is yet out of hand. However, both have moved against us very rapidly, particularly in the last year or two, and we are now going to have to move very fast to catch up. The situation can no longer be met by a well-intentioned conspiracy to ignore it.
Although the facts are hard to establish, we have some ominous indications. We have the evidence of the courts, where almost every day—and no longer simply in London—we have evidence of misuse and some evidence of trafficking. We also have the recent prognosis of the Vera Institute of New York. Of course, it is prudent to treat with reserve a survey which suggests as far ahead as 122 1972 that there will be 11,000 heroin addicts in Great Britain. However, anyone familiar with the quality of work of the Vera Institute—as I am sure the Minister must be—and its close association with our drug problem would be imprudent to dismiss this prognosis entirely as nonsense. As I will show, there may be reason to think that the Vera Institute's forecast for the immediate future could be, if anything, an underestimate. As well as this, some of us have talked to the police and others who are involved and have formed our own estimates of the problem generally. We can no longer doubt that we face a formidable situation.
Certainly a sharp deterioration has taken place even since the Report of the Inter-departmental Committee under the late Lord Brain in July, 1965. Those who speak of an epidemic may be accused of exaggeration, but they may not be wide of the mark. I am not unconscious of the Government's difficulties in meeting some of the problems and I am not going to under-rate them.
The long illness and widely lamented death of Lord Brain, who was to have been Chairman of the Advisory Committee on Drug Dependence—the body which he recommended—has meant that this Committee has only just been able to start its work. Some of his other proposals confront the medical profession with a new and difficult situation. The Minister of Health has not found it difficult to resolve them, but the whole of our law enforcement machinery faces a new and unfamiliar situation. Nevertheless, and making every allowance, I do not believe that the Government have measured up to the situation adequately. This is not a political opinion but a view which is widely held by those who have been already at grips with this problem.
There has been inexcusable tardiness, and it has not altogether been disguised by the flurry of activity which many of us have noted during the weekend, with speeches, statements and so on. I am anxious, for my part, to avoid recriminations, for we should be concerned with the future. If we are to get out of this mess and get on terms with the problem, we must note past mistakes and face up to certain weaknesses. I mention four such weaknesses. The first is the lack of information and what appears to have 123 been the lack of a proper system for getting it. The second is the conflict of opinion about how much or how little it is wise to say about this menace—which has left public opinion up to now largely without authoritative guidance from the quarter from which it should have come. The third is the fact that there has been a failure to appreciate the serious part which clubs and resorts for young people have played in many cities, not just in London, and a failure to take the right steps on this score quickly enough. The fourth is the fact that we have not yet got one Minister who is clearly in charge of the whole sphere, which strikes me as a marked weakness, which I will deal with straight away.
The Minister has resisted pleas from myself and the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short) for a co-ordinating Minister to co-ordinate the work of the principal Ministeries concerned, the Home Office, Ministry of Health and the Department of Education and Science. I accept that all three must be involved, but it is imperative that one of these Ministers should assume prime responsibility for the whole matter. As the senior and principally concerned, it should be the Home Secretary. I am very glad to see him here. I nope that his presence may mark a fresh approach on the question of Ministerial responsibility.
There is perhaps a fifth and more general weakness which I wish to stress. There has been a damaging tendency, which was reflected in the interdepartmental report, to underrate the importance of the part played in this matter by so-called "soft" drugs—the barbiturates and amphetamines—and, in a different category, cannabis, or marijuana, to which we have to add the form of hallusinogens, LSD25.
Beyond question, the misuse of amphetamine in the first group, and to some extent cannabis in the second, is rife, and it cannot be dissociated from the smaller but far more serious problem of addiction to narcotics. We have to face the fact that the Act of 1964 which was designed to make unauthorised possession of these drugs an offence—cannabis and LSD have since been added to the Schedule—notwithstanding 2,000 124 prosecutions, has not proved adequate. There is a particular reason for this to which I shall come. When we consider the facts—and we have some facts here—this is hardly surprising.
In the first six months of 1966, not fewer than 10 million National Health Service prescriptions for barbiturate-type drugs and other hypnotics were issued. These are called depressants. If they are abused they are both dangerous and addictive but otherwise they are not the principal cause of social trouble among young people. Amphetamine-type drugs, on the other hand, the "pep" pills, form the bulk of the illicit traffic. Although they are not physically addictive, they can be habit-forming and gross misuse of them can seriously damage mental health. They are perscribed on a smaller scale. I think there were about 3 million prescriptions for them in the last year.
To complete this corner of the picture, we have the third kind of drug, of which Drinamyl, the best known—the "Purple Heart"—has a two-way action. This includes amphetamine and barbiturate and might be said to depress fears on the one hand and to elevate hopes on the other. Thus it has become a most valued and sought-after form of illicit booty. There is reason to think that in addition to the supply lawfully produced by Smith, Kline & French Laboratories, increasing quantities of Drinamyl are being copied—which is not difficult—and made elsewhere.
The social implications of a nation lawfully absorbing this quantity of depressants, stimulants and tranquillisers is outside my scope tonight. I am concerned only with their illicit use. This, I think the Minister will agree, is now on a scale which causes widespread concern. I cannot guess the figure; I only hope that it is below the American figure. Ten billion—10,000 million in their language—capsules and tablets were traded in America last year, and it is believed that more than half of these found their way into the hands of drug abusers through illegal channels.
In this country there are four sources of illicit supplies. First there are drugs smuggled out of factories by employees. I know that the inspectorate are doing what they can, but I question whether even now if really adequate security will be achieved without stronger penalties. 125 The second source is raids on factories, warehouses, chemists' shops and the interception of supplies. Beyond doubt this is a major factor by which very large quantities are being stolen in bulk. The third source is by theft and forgery of National Health prescription forms, and the fourth cause—which I think is diminishing—is over-subscribing and repeaters by overworked doctors. I know that there has been some tightening up here, but I also know, and so does the Minister, that there are some doctors who are writing "blank cheques" in this respect.
In all these fields, it is imperative to apply stricter vigilance and sharper penalties. We would be very stupid to underrate the social dangers arising from misuse of these drugs. I add a word about cannabis or marijuana. I cannot say that it has not medical uses—there may be medical opinion which would contradict me, but I think those uses are very limited—and supplies of this drug are almost certainly obtained through illicit sources, principally smuggling. I shall not argue about its properties, which seem very hard to defend. I hope that the Minister does not take the tolerant view of cannabis which is expressed by an authoritative minority, nor did those with whom I discussed it in America. Both the amphetamine type drugs and cannabis can induce a state of excitement and recklessness or euphoria in which the user may be more easily persuaded to try something stronger and deadlier. That is not fancy; it is fact.
In America between 80 per cent. and 90 per cent. of those addicted to heroin, when questioned on the subject, admitted that their associations began with cannabis or marijuana. I think Dr. P. A. L. Chappell, who has worked on the problem, has said that 70 out of 80 young addicts first used marijuana. I do not make much of this, but there is the argument that if we outlaw this drug we stimulate an appetite for it and for illicit trafficking and experiment. That can be said of many drugs, but it is not a counsel which appeals to me. It certainly does not follow that the right course is to countenance it.
Although admittedly not addictive, marijuana used only once or twice experimentally by the young is a thoroughly dangerous substance. I hope that the 126 Government will accept that and propagate it, because it is high time that an authoritative voice was heard among the conflict of opinion and public argument about this drug.
Before leaving the subject of amphetamine drugs and cannabis, I have two other things to say. I have been at pains to find from the police how far these drugs can be linked with crime and violent crime. There is no doubt that some young criminals, usually amateurs, before undertaking a raid calling for resource and risk, will use a stimulant drug. When weapons are carried a mood of recklessness is thus induced which may have very grim consequences. In the autumn I asked six senior policemen in different parts of the country whether they thought that the misuse of amphetamines had a bearing on violent crime. Five unhesitatingly said, "Yes". The sixth was not sure. I asked the same question in the United States of four police chiefs. All four unhesitatingly said, "Yes".
For the same reason, the House will accept that misuse of these drugs has a serious bearing on road safety. It is well known that an admixture of alcohol to these drugs can have damaging consequences. We are about to measure alcohol in terms of road safety. Neither here nor in America is there any known way of quantitatively assessing the amount of barbiturate or amphetamine which a person may have inside him. This seems to me to be one more reason, since it cannot be added to any road safety Measure, for taking this illicit traffic very seriously inded.
Of L.S.D. I would only say that it is not very difficult to manufacture. It is, perhaps, the best illustration of a drug which I do not believe the Government will be able to defeat entirely by inforcement. I am sure that there will also have to be education. I am aware of the dilemma which confronts Ministers here. One half of the dilemma was put at the Conference of the National Union of Teachers—not unreasonably—where it was said:The sensational publicity given to drug taking by young people has not only created a false impression of the extent of this problem but has tended to intensify it.I do not dismiss that as negligible.
127 The pros and cons of education in schools must be weighed, but, after discussing this point here and in the United States, I am left in no doubt that we must plump for more education. I think that the young are entitled to know the grievous physical consequences of misuse, nearly always begun in ignorance. I fear that our present approach is getting us the worst of both worlds. It is stimulating an appetite for experiment and it is not explaining to young people the consequences that such experiments can lead them into. If it is right to instruct on the subject of sex—and some will argue about that—it seems to me imperative to instruct on the subject of drugs.
Beyond any doubt, certain of the resorts for young people which have sprung up like mushrooms in recent years are prime sources of infection. This is not merely a London problem. In Brighton there are 20 to 30 such clubs. I have seen some of them. All cities and big towns now have them. Most hon. Members will be familiar—or perhaps I should say will know of—at least one in their constituency.
Here I must take the Government to task. It is now at least six months since the Lord Chief Justice, despairing of action by anyone else, drafted some proposals of his own. We are now to hear more about them. I am aware that I must not trespass on the rules of order here. I agree that the Home Secretary has said from time to time that the Lord Chief Justice will receive ail assistance. I am not going to enter into the nuts and bolts of it. The House must be aware that a Measure to regulate these establishments is something which the police and others have been calling for urgently for more than two years. They still have not got it. I find that very difficult to defend.
I would now add only one postscript without trespassing on the rules of order. If we are to license and register clubs, as the Lord Chief Justice does not propose at the moment, we must also register proprietors. Benches must be frankly advised that men with criminal convictions should not be granted licences.
As things are, the enforcement of the 1964 Act, which I have admitted to be a partial failure in these places, has become 128 impossible for the police. They raid club premises licensed for about 60 people in which they find about 200. Before the police, even if they are policewomen wearing suitable disguise, go through the door all the pills are on the floor. Therefore, I regard the Lord Chief Justice's proposals as really urgent. I hope that the Home Secretary will take note of this.
With apologies for detaining the House, I turn finally to the smaller and infinitely more serious field of narcotics addiction. Here we have more figures. I am not sure that this means that we have a reliable guide on the extent of the problem. We are familiar by now with official returns which show that addicts to dangerous drugs increased from 753 in 1964 to 927 in 1965, a rise of 25 per cent. Of these, 521 used heroin, a rise of 52 per cent. in a year. In that period, the number of addicts under 20—this is something which we must note very seriously—rose from 40 to 145. The Home Secretary told us in his speech at the weekend that the number of addicts—I think I am quoting him correctly—in the first nine months of 1966 was 1,036. It would not surprise me if the total of addicts for 1966 was in the region of 1,300, half of them, or perhaps a little more, on heroin.
These, it must be stressed, are known addicts. Some authorities will assert that the real figure may be three or four times as high. Without accepting that, because I am most anxious to be cautious here, let me simply double the figure. That would give us a total of 2,600 addicts. I may be wide of the mark, but I do not think I am all that wide. That means possibly 1,300 or 1,400 on heroin. We must note that the Vera Institute figures, to which I referred earlier, mentioned 1,202 on heroin in Great Britain in 1967. That is why I say that the Vera Institute figures in the years immediately ahead could conceivably be an underestimate.
Even more ominous, as the right hon. Gentleman knows, 77 persons in 1965 drew supplies from unknown sources. That figure will certainly be higher now. I regard this as a new and very serious development. Lord Brain could say in July, 1965, in his Inter-departmental Report:we are satisfied from our enquiries of the Home Office, the Metropolitan Police and our129witnesses that there is at present no evidence of any significant traffic, organised or otherwise in dangerous drugs that have been stolen or smuggled into this country.For reasons which the Minister will know, but which I think should be explained to the House, there are certain factors at work which will almost certainly increase this dark figure. Lord Brain reported also:From the evidence before us we have been led to the conclusion that the major source of supply has been the activity of a very few doctors who have prescribed excessively for addicts.I judge—I hope that the right hon. Gentleman will deal with this point—that a number of doctors who were previously treating addicts have ceased to do so. There is a marked tendency for doctors to withdraw from this field. That compels certain addicts—I will not say many, but some—to seek elsewhere. There are unfortunately certain sources in this country which are, illicitly, most willing to meet that demand. Discounting all the wilder rumours about the activities of Mafia, and so on, these sources can be described only as criminal.
It therefore appears to me that the Minister of Health here is confronted with a very urgent situation. He must provide quickly from National Health Service sources institutional means of replacing supplies for which some general practitioners have hitherto been the major source before filling that gap becomes a major racket. That is a very grave situation.
In fairness, many in the United States referred to our system to me most enviously. It seemed to them that supplies were limited to doctors, that addicts went mainly to doctors, and that doctors were able to contain the problem by regular prescription. I no longer feel quite sure that this relatively tranquil state of affairs prevails. We are in a very difficult transitional period. There has been a change since Lord Brain reported 18 months ago, and not surprisingly. He advocated four important steps, among others—first, addicts to dangerous drugs to be notified to a central authority; secondly, special treatment centres, especially in London; thirdly, the prescribing of heroin and cocaine limited to doctors on the staff of those institutions; and, fourthly, dis 130 ciplinary steps against doctors who prescribed to addicts.
It is only to be expected that some doctors who were prescribing regularly should have acted in anticipation of those findings being implemented. But the Government have not yet implemented them, 18 months later. They have not supplied the treatment centres recommended, though some others have acted independently.
In my view—and it is not only my view—a very serious gap now exists and into that gap an element, certainly illicit, certainly non-medical, possibly criminal, has begun to enter. This is perhaps the most serious of all developments on narcotics since Lord Brain reported. I warn the Minister that I think that ground we lose here will be very hard to regain.
Lord Brain at that time recommended one other thing. He thought that there should be powers for the compulsory detention of addicts at these centres. I appreciate that this raises a very big question on which Lord Brain subsequently had second thoughts. I can follow the dilemma of the Government sympathetically. If they introduce such powers, some who ought to be treated at such centres will not come forward. I see that clearly enough. If they do not, what is accepted as being a protracted and painful course of treatment may be less effective.
I looked into this matter during a hurried visit to America and I am persuaded that, on balance, powers to detain—I will not say are absolutely essential, because I am not a professional—are very important. I shall need a lot of convincing that we do not need to have them. The American approach is that addiction is not a crime but a form of sickness. The approach, therefore, is non-punitive. That must be right. I am sure that it is right. It is essential and it should be stressed, but that does not remove the need for confinement.
Some hon. Members will know well enough that it is very difficult permanently to cure a narcotics addict. It demands not just skill but infinite patience. To detoxify with methadone and other drugs to remove physical dependence is not difficult. To remove psychological dependence is quite different. I can only say that at Corona, which is one 131 of the first and largest institutions of its kind in South California, it has been found necessary to keep addicts for a minimum period of six months and for an average period of 15 months, and then there is after-care for three years. During the first of these three years—and we know what is involved in this—all must attend the clinic regularly for nalline tests. If there is a relapse or a failure to report, the patient must return to Corona. Relapses are frequent and have to be treated not punitively but with infinite patience.
This is a world of repeated failure, quite outside any other world in the sphere of penology with which we have to deal. An account in The Times of experiences at Birmingham makes this clear. Dr. John Owens, the head of the drug addiction unit at All Saints Hospital, is on record as saying:It is difficult to be precise, but at the present time I believe that 90 to 95 per cent. of the addicts being cured in this country go back to drugs.That illustrates the problem. There is a big difference between keeping a small number of addicts "ticking over" by doctors' prescriptions and an attempt such as we are about to make, I hope, to cure a larger number at in-patient institutions and out-patient centres. I accept that we must keep this matter in perspective. In California alone there are upwards of 20,000 addicts. In Britain at the moment we have no more than 2,000. None the less, even for that number the administrative machine will be taking on a load to reckon with.
I also accept that the right hon. Gentleman will not find it easy to reach a complete understanding with the medical profession. I know the difficulties well enough. Naturally, the medical profession does not relish the limitations of its inherent rights to prescribe as it sees fit. Nor will the profession concur readily to machinery proposed by Lord Brain for disciplining its members. I want to say nothing here to make the Minister's task more difficult, but, in my view, it would be best, based on experience elsewhere, if the medical profession could be persuaded to assume principal responsibility for disciplining its members. Enforcement is for the Government. Checks with chemists and other sources will trace what is to become illicit prescribing. In 132 the United States the information is then passed to the medical profession on a regional basis, and it is invited to deal with offenders. I think that is wise.
I have already taken more of the time of die House than I intended, and I do not wish to conclude with a grisly or fanciful portrait of what might lie before us. What I have seen of this problem in other countries has led me to think that no nation can try too hard or can go to too much trouble to prevent this sort of epidemic from getting out of hand or into crime. Here and in America we know terribly little about it. We need a great deal more research in depth, and that we must have. Some of the drugs that I have spoken of tonight are only the inventions of the last decade and we can be quite sure that they will not be the last. Medical science has a lot more in store for us and we must get our administration in shape to meet the challenge. I suggest that aggressive research is essential, and I hope that the Minister will say something about that tonight.
The main impression left on my mind, looking at this in America, was not the human misery engendered by this problem. That goes without saying. It was the enormous demand on skill, care and expertise that addiction, even on a small scale, will make. Drug addiction is prodigal of skilled human resources—resources which we have not got in this country in superabundance. We must do all we can administratively and in other ways to reduce that demand. I do not say that we can beat this thing. That would be a loose and misleading expression. H. L. Mencken has called it "intrinsically and eternally insoluble". But at least perhaps we can contain it, if we properly use the help of social workers, teachers, police, doctors, church and other services. But it will call for a main effort. It will call for a bigger and more costly effort than many now realise. It will call for more clearly-defined Ministerial responsibility, for a sharper sense of urgency and for much clearer directions from the Government than any that we have yet had.
§ 7.57 p.m.
§ The Minister of Health (Mr. Kenneth Robinson)
The public is justifiably concerned about the growing misuse of dangerous drugs, and the Government welcome this opportunity for a discussion 133 of the problems and of our policy for tackling them. We have listened to a thoughtful and reasoned speech from the right hon. Member for Ashford (Mr. Deedes) who has, I know, a special interest in this subject and who, as the House will know, has been appointed a member of the new Advisory Committee on Drug Dependence.
It may be helpful if I stress at the outset that when I refer to dangerous drugs I am doing so in the statutory context, meaning drugs such as morphine, cocaine and heroin. This carries no implication that other drugs addictive to a greater or lesser degree such as the amphetamines and barbiturates, are free from danger for those who habitually take them. Indeed, I would not dissent from much that the right hon. Gentleman said on this subject. I should mention that my right hon. Friend the Minister of State, Home Office will be dealing in greater detail with the problems of control of amphetamines and the like, in winding up the debate.
Although there are no reliable figures of the total incidence in this country of the addiction to dangerous drugs, it appears to be small, but recent trends have been disturbing particularly in relation to the number of young addicts. In 1959 the total number of dangerous drug addicts known to the Home Office was 454. In 1965 the total had risen to 927. In 1959 there were no known addicts under the age of 20. In 1964 there were 40, and in the following year 145, all but 11 being addicted to heroin or cocaine.
The increase in addiction is a matter for deep concern but, as the right hon. Gentleman fairly said, it is a problem which we must try to keep in the right perspective. The figures are small compared with those in some other countries. For example, there is an estimated total of more than 3,000 addicts in Canada, with a population one-quarter of ours, and in the United States there are between 40,000 and 60,000 in New York City alone. Nevertheless, the marked increase in addiction, especially among the young, has properly given rise to serious public concern.
My right hon. Friend the Minister of State will deal with arrangements for the control of dangerous drugs and with related matters which may arise in the 134 debate. I propose to confine myself to outlining the action taken or proposed by the Government to implement the recommendations of the Inter-Departmental Committee on Drug Addiction. This Committee was reconvened in 1964 to consider whether its earlier advice in relation to the prescribing of dangerous drugs needed revision. As hon. Members know, the late Lord Brain, of whose recent death we all learned with so much regret, was the chairman not only of the Inter-Departmental Committee but also of the new Advisory Committee on Drug Dependence. Lord Brain enjoyed an international reputation as one of the most distinguished neurologists this country has produced, and his death is a serious loss to medicine. It is appropriate in this debate that I should acknowledge the debt we owe to Lord Brain for his great interest and careful examination of the problem of drug addiction and for his guidance [HON. MEMBERS: "Hear, hear."]
The House will know that the findings of the Brain Committee were, in brief, that there had been a disturbing rise in the incidence of addiction to heroin and cocaine and that the main source of supply was over-prescribing of these drugs by a small number of doctors who were nevertheless acting within the law. The Government have accepted this finding. The Committee recommended measures designed, on the one hand, to prevent over-prescribing of heroin to addicts and, on the other, to avoid such restriction of lawful supplies of drugs to addicts as would encourage the introduction of a new illicit market in drugs. To strike this kind of balance is, perhaps, the crux of the problem. Clearly, we cannot allow the spread of addiction to go unchecked, but the steps we take must not encourage the establishment of a black market in heroin which would tend not only to accelerate the increase in addiction but to spread criminal activities.
Perhaps I can just remind the House of the major recommendations of the Committee. First, there should be a system of compulsory notification of persons addicted to dangerous drugs. Second, only doctors at recognised treatment centres should be allowed to prescribe or supply certain drugs to addicts. These drugs—initially heroin and cocaine 135 —were termed restricted drugs. I should make clear, however, that it was the Committee's view, and it remains the Government's view, that all doctors should remain free to use restricted drugs when they judge it necessary for the treatment of organic disease.
The Committee's third recommendation was that hospital treatment facilites should be available for all addicts to dangerous drugs, not only those addicts who are willing to accept withdrawal treatment but those who are not for the time being willing who nevertheless need drugs and so require medical supervision. Fourth, an advisory committee should be set up to keep under review the misuse of narcotic and other drugs. Fifth, the need for more research. Sixth, the staff of treatment centres should have a new statutory power to detain patients during crises in which they wished to break off treatment.
The Government recognised at once the need for speedy decisions and urgent action to implement these recommendations, but we recognised also that drug addiction poses complex problems and that it is most important that our action should be carefully prepared and soundly based. It would have been all too easy to act hastily and make matters worse. These measures recommended by the Committee are the special concern of doctors, and it was essential to consult the medical profession fully in order that its professional experience should be brought to bear in devising a scheme of action and that doctors should co-operate willingly in its execution. I am pleased to say that this has been achieved, although it has taken rather longer than we expected.
The time spent in this preparatory work has, in the Government's view, been well spent, and I make no apology to the House for not acting sooner. I reject the charge of inexcusable tardiness levelled against us by the right hon. Gentleman. I assure him that the joint responsibility for these matters between my right hon. Friend the Home Secretary and myself has not in any way contributed to any delay in implementing the Committee's recommendations.
The right hon. Gentleman suggested that certain of the freely prescribing 136 doctors had anticipated action by the Government and had stopped prescribing for addicts. I am glad to tell him that my inquiries indicate that the problem, although it is not non-existent, was somewhat exaggerated by him. We believe that only one or two have either given up altogether or restricted the numbers treated and that most of those addicts who have, so to speak, been dropped by their normal practitioner have been accepted by other general practitioners. There are some of whom we have lost trace, I admit.
The House will know that the Advisory Committee on Drug Dependence was appointed last year. The first meeting took place earlier this month. It had, of course, been delayed on account of the unfortunate illness of the late Lord Brain. We attach the greatest importance to the work of this Committee, the chairmanship of which has recently been accepted, I am glad to tell the House, by Sir Edward Wayne. The Committee will keep under review the effectiveness of the measures being taken to check the misuse of narcotic drugs and the problems arising from the misuse of these and other drugs.
The problems of addiction are complex. The reasons why addiction spreads are not fully understood. It is not merely a matter of availability of supplies. For this reason, one or more units for research into the problems of drug dependence are needed. I am pleased to inform the House that later this year I shall set up a unit at the Institute of Psychiatry, the Maudsley Hospital, London. The broad aims of the unit will be to consider, first, the social causes of spread of addiction and, second, the clinical aspects of treatment. The unit will, of course, be in close touch with the hospital treatment centres.
The measures which I have outlined are aimed fairly broadly at the problems of addiction. I turn now to measures to tackle the more specific and immediate problem of over-prescribing of heroin and cocaine to addicts. The proposals for compulsory notification and for the limitation of doctors' authority to prescribe or supply restricted drugs require legislation to amend the Dangerous Drugs Act. Both the principle of this legislation and a more detailed scheme were discussed with the medical profession, which has signified its support, and as my right hon. 137 Friend the Home Secretary announced in a speech on Saturday, the Government have now decided that a short Bill embodying these measures will be introduced during the current Session. The development of hospital treatment facilities does not require legislation. Although it has been pressed forward, considerable time and thought have been necessary. I stall now give the House a brief account of the position.
The Committee envisaged that treatment under the National Health Service would he provided in psychiatric hospitals or in psychiatric departments of general hospitals and that it would take two main forms: first, in-patient treatment for those willing to accept withdrawal of the drug, followed by a longer period of rehabilitation at the hospital or elsewhere; second, out-patient treatment and supervision of addicts who are unwilling for the time being to accept withdrawal treatment.
Treatment of the first kind is fairly widely available in hospitals, but hitherto there has been a very small demand for it from heroin addicts, partly because there have been few such addicts, and partly because fewer still have desired hospital treatment. Treatment of the second kind, supervision on an out-patient basis, represents a new rôle for the hospital service. That new rôle requires the hospital to strike a delicate balance—to supply heroin addicts with drugs that they need, in the opinion of the hospital doctor, but with no more than they need.
I shall not delay the House by going into all the questions that arise—methods of assessment of dosage and supply of drugs, and the need for special precautions against over-prescribing, including a system of identification linked with the proposed new central records. The point is that these questions require attention from doctors with special experience in the treatment of addiction; they could not be solved by Government edict.
Three conferences were therefore organised to consider problems of this kind, and also to take a fresh look at the organisation of hospital in-patient and rehabilitation services for addicts. I am most grateful for the service of those doctors, and propose shortly to issue guidance to hospital authorities on the facilities required for the treatment, 138 supervision, and rehabilitation of persons addicted to heroin and cocaine. Final details are currently being discussed with representatives of the medical profession and of hospital authorities, but the House may like to know the kind of arrangements proposed.
Addiction is a socially infectious condition, and it is important to avoid any large concentration of addicts at treatment centres. On the other hand, if treatment is too dispersed, the medical and nursing staff will not have the opportunity to specialise and there will be insufficient patients to treat as a group, which is also desirable. We therefore propose that in-patient facilities at a hospital should cater for a small group of heroin addicts, probably not exceeding 12. In the London area, where there is a concentration of addicts, the expectation is that the main in-patient rôle will be shared among the psychiatric hospitals.
Out-patient supervision will also be spread, among psychiatric hospitals and psychiatric departments of general hospitals, so that large numbers of addicts do not attend together. There will be links between these out-patient clinics and in-patient services, where both are not provided at the same hospital, so that an addict who attends as an out-patient can be offered withdrawal treatment as soon as he is ready to accept it. Out-patient supervision will involve, among other things, a decision by a psychiatrist whether to supply an addict with drugs, or substitute drugs, and an assessment of dosage. I understand that where possible dosage will be determined by a short period of in-patient observation which the addict will be asked to accept. Continued treatment will not, however, be conditional on acceptance. If the psychiatrist decides that the addict should receive a regular supply of drugs, it is likely that they will be issued by hospital pharmarcies or retail chemists, and there will be special precautions against the misuse of prescriptions.
Because addiction to heroin and cocaine is largely concentrated in London, I have asked the London hospital authorities to take immediate action to deal with existing and potential demand for treatment on the lines suggested by the conferences. I expect that out-patient treatment will be mainly provided by the 139 psychiatric departments of the London teaching hospitals.
I now return to the in-patient rôle of the treatment centres, and to the recommendation of the Brain Committee, to which the right hon. Gentleman referred—
§ Mr. Deedes
What about the financing of the proposals? Will there be extra provision for hospitals, or will they be expected to finance them out of their current expenditure?
§ Mr. Robinson
The right hon. Gentleman knows the method of financing the National Health Service. All hospital authorities have extra money every year for developments. It has never been the practice to give them funds earmarked for a particular purpose. I do not consider that the cost of the treatment centres will be very large in relation to the total cost of the hospital provision.
I was about to refer to the recommendations of the Brain Committee, which the right hon. Gentleman mentioned, for a new, limited power to detain patients who wish to break off treatment entered into voluntarily. I accept the Committee's view that compulsory treatment meets with little success, and I have carefully considered the limited proposal which it made. I must tell the House and the right hon. Gentleman that it poses a practical difficulty, as well as the serious considerations that attach to any restriction of the liberty of the subject.
The practical difficulty is that although it is unfortunately true that addicts often break off treatment against the advice of their doctor there is no convenient way of identifying those occasions to which a limited power of compulsion could easily be attached. I am advised that it is common for addicts to complete withdrawal treatment successfully and then, at some stage during the rehabilitation period which succeeds withdrawal treatment to discharge themselves from hospital. If compulsion were to be applied to that situation, it would have to apply to the rehabilitation period and would seem to require a long-term power of detention. The Government's view is, therefore, that the case for the limited power of detention recommended by the Committee—about which Lord Brain had second thoughts, as the right hon. Gentle 140 man reminded us—has not been fully established, and that it would be right for us to proceed, at any rate initially, without it.
I should like to say a little more about the problem of the rehabilitation of addicts. The Brain Committee said, and this is generally recognised, that withdrawal is only the first stage of treatment. The problem is to prevent subsequent relapse, and that can be prevented to some extent by improving facilities for long-term rehabilitation. But once again the problems must not be over simplified. There is no ready-made system of rehabilitation which guarantees or even promises a high rate of success. To ask the Government to provide an effective system of rehabilitation is, in effect, to ask us to produce a cure for drug addiction—something that, unfortunately, medical science has not yet succeeded in doing.
I am anxious to build on existing services and try new methods. One possibility is the accommodation of addicts in hostels, where they can receive psychiatric supervision and support while in regular employment. In arrangements of that kind I feel sure that there is scope for voluntary bodies, and I certainly welcome their co-operation.
The object of these measures—the legislation and the new rôle for the hospital service—is to check the spread of addiction, but not to crush the addict. The addict is, as I am sure the House realises, a sick person deserving of compassion; addiction is a disease. That is and will remain the attitude of the hospital service, and persons who are addicted to heroin—or for that matter to other drugs—will find in the hospital to which they are referred doctors and nurses whose professional job it is to understand their problems. Addicts will not be compelled to undertake withdrawal against their will; but they will be given every opportunity to do so and we hope that more of them will be so persuaded.
Finally, I should try to sum up what the Government hopes to achieve by these various measures. I must first say frankly to the House that we do not expect to abolish drug addiction. The causes of this social phenomenon are insufficiently known; the extent to which it can be dealt with by legislation is as 141 yet uncertain; and we cannot ignore the fact that other countries have failed to solve these problems. We believe that the measures which I have outlined are the right ones at the present time to check the spread of addiction, and we fervently hope that they will succeed. But the Government have no monopoly of action in this field and there is scope for voluntary bodies to help both in the prevention of drug addiction and in the rehabilitation of addicts.
The Government's measures will be carefully watched by many people—for example, by the new Advisory Committee, by research units, doctors and others interested in addiction, and not least by the House. The problems of addiction are complex and changing, and it would be a mistake to think that a once-for-all solution is at hand. If experience shows that further steps or new methods are required, we shall be very ready to introduce them.
§ 8.20 p.m.
§ Dr. M. P. Winstanley (Cheadle)
I shall try to be very brief, because this is an extremely important matter on which I am sure many hon. Members wish to speak. Also, while I am anxious to put forward a professional point of view—incidentally, it is my own professional point of view—I nevertheless recognise that the non-professional point of view is every bit as important. However, the professional point of view is a slightly different one, and so it may be helpful to hon. Members to hear it.
I found myself in substantial agreement with almost everything that the right hon. Member for Ashford (Mr. Deedes) said, save that I would have laid a slightly different emphasis in different places. I depart from him to some extent in his criticism of the Government for tardiness. Perhaps there has been some tardiness, but I think it would be only right and fair for hon. Members to say that they can understand it. It must have been, and I am sure still is, an extremely difficult decision to make. When I first studied the proposals of the Brain Committee and the other recommendations that were put forward, I should not have liked to have had to make up my mind about them very quickly. I was conscious, as I think we all are, that certain of these decisions could rapidly take us down a route from which there 142 might be no return. In other words, it was very important that nothing irreversible should be done without all possible thought.
In my brief remarks I want to leave alone the question of the general dependency on drugs of patients in legitimate circumstances in society at the time when there is considerable stress in life generally. I agree that this is a big problem, and it is possibly a problem for the House to consider at some stage, but it is a totally different problem from that of addiction.
With respect to the arguments by the right hon. Member for Ashford I would leave, too, the question of addiction to the amphetamines, the barbiturates and marijuana. I am not what he called "part of a tolerant intellectual minority" in doing that—I regard this, too, as an extremely important and serious problem—but I would emphasise that it is a totally different problem. Although the basic causes may have the same roots, it is quite a different problem from that of addiction to such things as heroin.
§ Sir Keith Joseph (Leeds, North-East)
Yes, but would the hon. Gentleman tell the House whether, in his view, this is partly a medical problem as well as a social and a law and order problem?
§ Dr. Winstanley
I agree with that entirely. They are both medical problems and they are both social problems but what I want to make clear is that the kind of remedies that we may have to introduce to deal with addiction to drugs like heroin are not necessarily the right kind of remedies to introduce in a different field.
With that proviso, I would concentrate on what I regard as something extremely grave and, indeed, desperately worrying. There is no doubt that this country has some grounds for satisfaction and can congratulate itself on the low level of addiction to drugs of this kind in the past. At the same time, we should be very unwise to blind ourselves to the fact that the situation has changed, and once it changes at all, that change can accelerate at a terrifying rate. I think that it could be possible for us to make mistakes here, and that if we took certain steps we might start trends in motion which we might never be able to reverse.
143 There is something of a dilemma here. Whatever choice we make—the Government have to make a choice; indeed, they have already started making the choice—will not be altogether satisfactory, and certainly cannot be satisfactory for all parties. In a sense, what we have to do is either to tell certain doctors that they have the right virtually to destroy certain people—that is what giving drugs to an addict means—or to introduce types of punitive measures, regulations and controls in order to cure certain addicts and, thereby, run the risk of escalating the whole problem on the black market.
The House has to understand that once drugs of this kind come into short supply the addict will leave no stone unturned to find them, and that the usual method of his finding them and making sure that he can get them is for him to create further addicts. This is undoubtedly what has happened in the United States of America. Where there has been a shortage and a black market, the addict has found that in order to obtain finance for his own increasing supplies—let us remember that the amount required increases and increases extremely rapidly—he has to create further addicts whom he can supply, so that he can get the supplies that he himself needs.
I was very glad to hear—I was not surprised—the Minister of Health say that this is a problem of which the Government are fully seized. I expected them to understand this. But I appreciated the right hon. Gentleman's remarks, and I support almost everything he said. I am glad that the Government have taken what I regard as a very thoughtful view of an extremely difficult problem.
It may be attractive to think of introducing measures whereby one can suddenly control the whole problem, introducing compulsory treatment arrangements and setting up special clinics where one can put an addict under some kind of certification and keep him excluded from the community. Introducing all sorts of controls on the import of drugs and the traffic in drugs generally through what are at present legitimate channels may be attractive. It might be possible to stamp out addiction by an extremely vigorous attack of this 144 kind, although I very much doubt it. But, if it failed, the results would be utterly devastating.
That is why I think the Government are right to take the course which they are adopting. But I think it is extremely important to consider the timing of all the operations that have been announced. It is extremely important that the Government should think all the time—if I used the word "permissive" in this context it might be misleading—about the way in which the various regulations are operating. If it should turn out that the new centres are the sort of places to which the addicts would not go, that somehow or other addicts were escaping or finding the arrangements unacceptable, it would be a matter of extreme urgency that the Government should take other steps. Otherwise they may be hoist with the danger to which I referred—that of the addict having to create further addicts, and thus the problem escalating. A great deal of thought will have to be given to the various measures, and that undoubtedly will be done. I am sure that they are the sort of measures that we all welcome, but I would like to see some further steps taken.
I am glad that the Home Secretary recently paid tribute to the steps which have been taken in Manchester for the inspection of certain clubs and other places. This is important. It is extremely important that every possible attempt should be made to identify the kind of people liable to become drug addicts at an early stage so that they can rapidly be brought under supervision. I am sure that the Government will be considering these points and I hope that they will take steps on them as they arise.
But I would emphasise particularly the importance of seeing to it that the various measures are properly phased. It will be catastrophic if the regulations controlling the prescribing of drugs to addicts precede those making avaliable alternative sources.
The right hon. Member for Ashford, in an intervention, put to the Minister a point regarding the financing of these centres. I accept from the Minister that money awarded to hospitals is not carefully earmarked for individual purposes, and also his view that these new centres and the new provisions may not be particularly expensive. But it will not have 145 escaped the right hon. Gentleman that hospitals from time to time find it difficult to do certain things because of shortage of money.
It is essential that a programme of this kind should not be held up by lack of money. There will be arguments within regional hospital boards and hospital management committees about priorities and the amount to be spent on various services. But this particular matter is too grave to be prejudiced in any way by shortage of money. It is something upon which the country cannot afford not to spend every penny that proves to be necessary in order to implement these various measures.
I welcome the Government's proposals. I hope that they will put them forward speedily. I hope at the same time that they will watch them carefully to see that they are operating with humanity, in view of the various considerations I have mentioned. This is not merely because of consideration for the drug addicts, although they should be considered, for addiction is an illness which must be accepted as such. It is because, if the regulations are not operated with humanity, they will fail—and if they fail We shall have the same situation which has arisen in the United States and from which there can be no possible return.
§ 8.32 p.m.
§ Mrs. Renée Short (Wolverhampton, North-East)
Like many hon. Members on both sides of the House, I have been very concerned about this problem and, since the publication of the Brain Report, I have put down about 10 Questions to various Ministers, including the Prime Minister. Like the right hon. Gentleman the Member for Ashford (Mr. Deedes), I pressed the Prime Minister to nominate one Minister to be responsible for co-ordinating the work on this dreadful and urgent medical and social problem, and I still feel that as long as the responsibility is divided there is the danger that our handling of the problem will be less urgently pressed forward and co-ordinated than it should be.
I do not know whether it will be possible for the major responsibility for this problem to be concentrated ultimately in the hands of one Minister, but it is certainly something that we should 146 think about. I agreed with a great deal of what the right hon. Member for Ashford said, but at the risk of spoiling the non-party approach to the problem, perhaps I should say that I do not think that it became him very well to chide the present Government for delay in dealing with this problem.
When I raised this subject in an Adjournment debate last August, my right hon. Friend the Minister of State, Home Office, stated that the figure of known addicts was 454 in 1959 and that this had more than doubled by 1965. During most of that period the party opposite formed the Government. I think that the Opposition were not seized of the seriousness of the problem then, and it may well be that there have been errors through delay on both sides of the House.
It is very useful that we have had the opportunity to look at this problem again and to see where the weaknesses in the present system lie. I welcome very much what my right hon. Friend the Minister of Health has said, although I have some slight criticisms of his suggestions. It is important to realise that there are certain sources of supply and certainly compulsions which, as the hon. Member for Cheadle (Dr. Winstanley) said, drive addicts to increase the number of addicts in order to get the money with which to buy the supplies they themselves need. By the time addicts get on the Home Office list, they are so addicted that they cannot get the supplies they need illegally and therefore have to go to their doctors to get supplies on the National Health Service. But the Home Office list represents only a minority of those addicted.
I have spoken to a very large number of doctors who treat addicts and also to a large number of addicts themselves. My heart is filled only with compassion for those young people who become addicted in this dreadful way, who start off really for "kicks" and who find that it is something they cannot control. It gets a hold of them and they are driven to the sort of lives we have heard about tonight in order to get the supplies they need.
It has been estimated that every addict must in a year create another three addicts in order to get the supplies that he needs. So there is this rapid expansion in numbers, and what is so alarming to so many of us is the rapid expansion in the number 147 of young people. As the number increases, the age range of people who become addicted is lowered, and we know that there are children still at school who have been addicted first to amphetamines and have then progressed to the hard d rugs.
This is something which I find so very difficult to contemplate with any kind of equanimity, and I am sure that everyone is very concerned about the problem. We know that illegal supplies are obtained in the kind of premises which young teenagers frequent—and by teen-agers I include young people of 13 years of age. They are far too young to go to these sort of clubs and coffee bars, but they do because parental control is far too lax. Coffee bars, jazz clubs, bowling alleys, and frequently, I am sorry to say, youth clubs, are premises where young people can come into contact with those who have supplies to get rid of.
We have to realise also that, contrary to what the Brain Report said, this is not a problem which is confined to London. It is certainly a very great problem in the Midlands, in my own constituency and in Birmingham particularly. It is true to say without exaggeration that it affects every port area in the country. One finds, too, that there is evidence of drug addiction among young people in country districts, so it is not even an urban problem.
I have asked my right hon. Friend the Minister of Education to give some attention to this matter and to provide guidance for teachers, because, as the right hon. Member for Ashford said, education is a very important part of dealing with the problem. My right hon. Friend assured me that in the preparation of the new circular dealing with health problems generally, which is being sent to schools, some instruction will be given to head teachers on how to recognise the signs of addiction among children still at school. I have found, in talking to teachers, both in the provinces and in the London area, that they are in favour of this kind of guidance. It is something which most local education authorities have not been prepared to tackle. When they have had evidence of this problem in their own schools, they have pushed it under the carpet, because they felt it was 148 something too difficult for them to deal with.
This is a problem which we must grasp and tackle. Head teachers have to be given the guidance they need on how to deal with the problem. We have to keep a balanced attitude about the way in which we deal with the problem. We must not be punitive, because young people who become addicted need a great deal of compassion and help. At the same time, we must not be too permissive.
The proposals which my right hon. Friend has made will certainly go a long way towards tackling the problem of how to deal with known addicts. We ought to be prepared to ask doctors to give information when they come across young people or adults who are taking drugs illicitly. This is the sort of information which comes to general practitioners all the time.
The Chief Constable of Mid-Anglia police force recently suggested that doctors ought to be willing to provide this information so that the rescue work could begin. If we do not know the full number of those addicted to drugs, whether to amphetamines or "hard" drugs, then we shall treat only the small number of patients of whom we know and leave the mass of the problem largely untackled. hope that it will be possible to gain the co-operation of the medical profession, particularly those in general practice with experience of this problem, in this work.
My right hon. Friend has said that certain recommendations of the Brain Report are to be implemented—the restrictions on supplies only through hospitals and consultants and doctors with experience of this particularly specialised and difficult kind of medical treatment. In reply to a Question recently, he said that there were nineteen hospitals in the South-West Metropolitan Regional Hospital Board area alone which were able to deal with drug addicts. My information is that only three effectively are willing to take addicts into hospital.
I have had reports from social workers in London who have tried to get addicts admitted into hospital when they have begged to be given treatment and yet the hospitals have been unwilling to accept addicts as patients. Dreadful difficulty and anguish have been created when young people have been anxious to 149 undergo the treatment necessary to get them off this terrible habit and yet the hospitals have been unwilling to take them in. My right hon. Friend has accepted the principle of control of treatment and the proper assessment of need. I was glad that he said that this would be done when patients were willing to undergo in-patient treatment by taking the patient into hospital for a few days to assess his reaction to controlled withdrawal, for this is the only way in which to assess the true needs of the patient.
My right hon. Friend said that he was to set up treatment centres in the teaching hospitals in London. I make the urgent plea that he should not confine this to London. I beg him to give an assurance that centres will be set up in those parts of the country which I have mentioned, and probably many others, where the need is considerable and where we have doctors, consultants and psychiatrists anxious and willing to carry out this work.
I hope that we can reconsider the recommendation of the Brain Report which my right hon. Friend has rejected by saying that the detention of certain addicts so that treatment can be continued is not to be contemplated, at least for the time being. I know that this is a difficult problem affecting the liberty of the subject, but I wonder whether it would be possible to apply Section 26 of the Mental Health Act. Once a patient has embarked on the long difficult and painful process of treatment and withdrawal from addictive drugs, I wonder whether it is not kinder to insist that he continues treatment which is for his own sake and for the sake of those who might be contaminated if he leaves his treatment and starts again on the miserable, depressing and dangerous circle of acquiring drugs illegally and selling them to more people.
When she replied to my Adjournment debate in August, my right hon. Friend the Minister of State for the Home Department gave the assurance that the Government were prepared to look favourably upon a Private Member's Bill, being introduced in another place, to provide stricter control of clubs. I hope that we can be given the assurance that legislation is to be introduced, and early, on the lines of the Manchester Bill, so that all the premises which are frequented by 150 young people and where, as we know, supplies of drugs are bought and sold will come under the control of the local authority and the police be given the power of entry. This applies to coffee bars and to other premises which are open all night, to bowling alleys and places of this type. A register of known addicts is essential, and I hope that we shall have the co-operation of the medical profession to make this as complete and effective a register as possible.
My right hon. Friend said that the narcotics squad has been increased not only in London but in other cities. I press again that we ought to consider this problem. In London there are nowhere near enough members of the narcotics squad who are willing to work in the field, as it were, among young people in particular. We need to enrol the help and active assistance of social workers in all our large towns and cities, and the employment of police cadets, men and women, to work particularly among young people would be very useful. I hope that we shall take steps to recruit suitable people and to use, much more than we do, the help of voluntary bodies, who are already doing a good deal of work in this voluntary capacity.
The problem of what to do with the young people when the treatment is concluded is very difficult, and I do not think that we shall overcome it without being prepared, as a Government and a nation, to spend rather more money than my right hon. Friend implied in reply to an intervention by the right hon. Member for Leeds, North-East (Sir K. Joseph). We must be willing to expand the provisions in the hospitals for treatment and it is essential that when treatment has been concluded—it may be treatment lasting six months, nine months or even longer—instead of thrusting people back into the same environment and milieu from which they came, and in which they learned to be drug addicts, there is some half-way stage between treatment and a return to their old environment.
The provision of hostels will have to be accepted by the Government, even though this may well cost a lot of money. Young people who become encapsulated by drugs as a barrier against the ordinary problems of life will find it very difficult to go back into ordinary jobs straight from treatment and without any half-way 151 stage. If hostels can be set up under the supervision of voluntary organisations, as with Borstal after-care hostels, a great deal of help can be given. Where possible young people ought to go back into a completely different environment and a different part of the country, but this may be difficult to ensure.
The figures which have been quoted so many times do not reflect the whole extent of this problem. There are an enormous number of young people who are drifting into a very serious part of their lives, in and out of jobs, running the risk of getting into touch with prostitution—this applies both to young men and to young women—sleeping in derelict buildings, spending hours on underground trains and sleeping in public lavatories. We hear fantastic and dreadful stories of the effects of addiction on young people. I hope that we may take it from what my right hon. Friend has said that we are at last starting to tackle this problem.
I do not suppose that we shall have spectacular results or that we shall stamp out the problem of drug addiction. We have to approach the problem from many different aspects. There is the problem of trafficking and of security arrangements at manufacturing chemists, drug stores, and so on. I know that my right hon. Friend is exercised about these aspects. But at least we are making a start. If we can proceed with energy, and if, above all, we can provide the money necessary to take the right steps in giving treatment and protection and care afterwards, we shall save some young people from a premature death and a life of great unhappiness.
§ 8.50 p.m.
§ Mr. John Brewis (Galloway)
I am glad of the opportunity to be able to make a few short points.
I should like to take up the point which the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short) made about the lack of treatment centres. She said that there were only three hospitals in the London area dealing with this matter. There is a tremendous lack of treatment centres and of doctors and nurses and others who understand this problem. The Minister painted too rosy a picture of what he will do unless very much more money is 152 made available. I hope that it is made available so that we can deal effectively with this problem.
On balance, I agree with my right hon. Friend the Member for Ashford (Mr. Deedes) that there should be limited power to detain drug addicts in treatment centres. This is something which we could leave to the medical profession—to perhaps two doctors and, if necessary, an appeal, rather on the basis of the Mental Health Act. It is dreadful that, after getting over the withdrawal stage, doctors should be deprived of a weapon which is necessary to carry on to the next stage in the treatment of the addict.
We are talking mainly about two drugs—heroin and cocaine—but there are undoubtedly other drugs which are dangerous and habit-forming. Paragraph 39 of the Brain Report states that this particular problem was not within its terms of reference,… but we feel obliged to say we are disturbed at the large quantity of habit-forming drugs currently in circulation.From the Appendix, one sees that of the very small number of addicts known since 1964—the figure of 753 which has been bandied around—over one-quarter were not addicts to heroin and cocaine. What is being done to deal with addicts to other drugs like methedrine? We have had no mention of that.
I come to the question of prescribing. One of the difficulties is that many general practitioners have been prescribing, not as we see from the Brain Report, enormously in excess, but slightly in excess. The addict's need has been for six grains and the doctor has prescribed ten. The addict has been able to sell the remainder which has enabled him to buy food. This has contributed to what the hon. Member for Cheadle (Dr. Winstanley) said, that the number of addicts was increasing. But if the addict cannot go to his family doctor and get a prescription, we are up against the danger of illegal entry of drugs from overseas. If this starts, it will be immensly difficult to stop.
Motor cars are going abroad in increasing numbers. One hears of young people going on Land Rover trips across Europe to places like India and Persia. It seems to me to be a problem quite beyond the power of the Customs and 153 Excise to examine cars and people returning to this country and to detect these drugs. Furthermore, I understand that the drugs can be put in such a small packet that they can be sent by registered airmail, which is practically never interfered with. If this happened, the problem could well get very much out of hand.
I am, therefore, rather unhappy about cutting off from the family doctor the power to prescribe, because this might push the problem over the edge and we might rind an illegal organisation—the Mafia has been mentioned—corning into this market. It is largely a question of balance, but I am a little perturbed.
The penalties for drug peddlers cannot be too severe. Another matter which we have not heard about today is the question of penalties for those who incite young people to take drugs. In the Sunday papers, we have seen an example of a so-called "pop" star making records which could well have that effect. I do not know whether there is any offence in the criminal law of inciting others to take drugs—I do not think so. This is something which we should consider seriously. On the other side of the coin, however, if we punish those who incite others to take drugs, let us have more publicity and better education and let us show people the real danger of this habit.
§ 8.57 p.m.
§ Dr. David Kerr (Wandsworth, Central)
The title of this Adjournment debate is "Drugs". We have debated, I suppose aptly, ad nauseam the question of addiction, and an important question it is. We have debated it in the context of young people. Even though there have been references to the problems of other drugs, to which the hon. Member for Galloway (Mr. Brewis) has just referred, one would think that the problem was new; it is certainly dramatic.
One would think that the problem affected predominantly young people. It does not. The problem of addiction has been with us and on a very big scale, and recognisable on a big scale, since the prescribing habits of doctors in the National Health Service revealed their propensity to prescribe drugs, particularly the barbiturates and the amphetamine series, to very large numbers of 154 patients, the majority of whom benefited from them, some of whom became dependent upon or habituated to them and a certain number of whom became, strictly speaking, addicted to them.
We had better start by making up our minds what an addict is. The Brain Report defined him, I think hopelessly badly, asA person who as the result of repeated administration has become dependent upon a drug controlled under the Dangerous Drugs Act and has an overpowering desire for its continuance but who does not require it for the relief of organic disease.None of the phrases used in this definition has the clarity that would allow it to be entirely acceptable.
The World Health Organisation, by contrast, defined addiction in these terms:A state of periodic or chronic intoxication"—note that term; not dependence, as the Brain Committee said—detrimental to the individual and societywhich the Brain Committee forgot about—produced by the repeated consumption of a drug, natural or synthetic. Its characteristics "—that is of addiction—include an overpowering desire or need to continue taking the drug and to obtain it by any means, a tendency to increase the dose and a psychological and sometimes a physical dependence on the effect of the drug.That is an infinitely preferable definition of the subject which we are striving so hard to elucidate.
The Minister has described certain solutions which he is accepting on the basis of the Brain Committee's Report. The Brain Committee had very restricted terms of reference. Its inquiry was limited and its recommendations, to say the least, not always acceptable, particularly to members of my profession. To my hon. and charming Friend the Member for Wolverhampton, North-East (Mrs. Renée Short) I would say that her plea to doctors to reveal to some central register or local health authority the state of health of one of their patients would be extremely difficult. I would remind her of the very unhappy experience during the war when, under, I think, Regulation 33B, there was a requirement to notify contacts of venereal disease.
155 I am rebutting this suggestion for one very good reason. We are a little carried away by the highly charged atmosphere in which drug addiction is discussed. It is tragic, sordid and dramatic, but I doubt whether the problem of addiction among young people justifies the priority which we have given it in this debate—to set up special treatment centres in hospitals—at least in relation to the very much greater need, in terms of numbers to be treated, of for instance adolescent units for disturbed young people. Perhaps if we had had them, the drug problem would have been much smaller.
It is at least questionable whether we do not need more of that kind of provision than of the provision for this, as yet, small problem. Everybody agrees that the Home Office list is hopelessly misleading, yet we keep quoting it. One of the things quoted is that the list is growing larger, but there are many reasons why it should, without there being any increase in the total number of addicts. If there were a pool of 10,000 or 15,000 addicts to various drugs, it is not inconceivable that, as public censoriousness of the problem grew and more treatment facilities became available, more of this pool would go on to the list. That would not necessarily mean that the size of the pool was growing, although some of them might be coming in for treatment.
Nevertheless, all the other information which we have indicates that the problem is extending. When we talk about the Home Office list, why do we not refer, for instance, to the lists of patients distributed to doctors on executive council lists, warning them to expect that patient on their doorstep demanding one of the drugs of addiction—barbiturate or nembutal—or the mixed drugs like amphetamine. There cannot be a doctor in the country who does not receive regular information of this kind indicating the wicked extent of drug dependence and habituation of a horrific kind.
No one has referred to the alarming growth in deaths from barbiturates—
§ Dr. Kerr
I apologise to the right hon. Gentleman if he did. I of course heard him refer to barbiturate addiction.
156 The growth of deaths from barbiturate addiction is a much greater factor than those from heroin. We must see this whole problem of addiction against the broad background of a growing dependence upon these drugs. I want to refer specifically to two. One has been mentioned again and again, the "Purple Heart", or Drinamyl. I am not allowed to advertise, as a practising doctor, but I hope that I am allowed to do the opposite and to warn any patient who dares to approach me for Drinamyl that he is wasting his time. It is a wicked drug and we should strike it off the list of prescribable drugs. It does nothing which other, later drugs do not do better and more safely. I will welcome the irate letter from the director of Smith, Kline and French tomorrow, disputing everything that I am saying.
This is a bad drug and I cannot condemn it strongly enough, in the slender hope, perhaps, that some of my practising colleagues will take note of what is being said and look again before they prescribe it for the first time for any patient.
Another great source of minor addiction is the growing demand for slimming tablets, many of which are of the amphetamine series to which the right hon. Member for Ashford referred. However, there are others, not strictly amphetamines or derivatives, which are nearly all addictive, which have adverse effects on blood pressure and on one's psychological outlook. They are primarily stimulants of the central nervous system.
I could not find it in my heart to plead with my right hon. Friend to ban all slimming tablets, although I do plead as loudly as possible to my professional colleagues, more and more of whom are recognising the nature of these drugs. As to their effect on slimming, I am sure that thousands of people would write saying how they have lost weight as a result of taking them. Nevertheless, I would wager that, having lost weight by taking them, they would put it on again the moment they stopped taking them. That is why the use of these drugs should be discouraged and frowned upon. They are addictive and dangerous. Indeed, I know of no such drugs which can be used with safety. My advice is that if people want to become thinner—as so many of us do and should—they should use an effort of will.
157 The final point with which I wish to deal is that referred to by a number of hon. Members; the social background to addiction or habituation. In an article written by Dr. Bewley—whose work, I am happy to note, is done in my constituency in Tooting Bec Hospital—it was emphasised that because the treatment is such a hopeless undertaking, the only answer is to look more to prevention for a solution of this problem.
Despite all the talk about treatment centres and the way we must tackle the problem of the addict, we might as well wake up to the sad fact that these measures will lead the addict only a short way along the path to rehabilitation and recovery. What we must look at—and l was glad to hear that my right hon. Friend is establishing a social research unit to go into this problem—are ways of discovering why people become addicted.
The reference to addiction being a sort of infection is not an entirely good simile. Nor is it analogous to the spread of an epidemic. Important social factors are involved and the nub of the problem is to discover the means of preventing addict on and the means of discouraging it. Reference has also been made to education. The biggest contribution which education could make would be that of doctors and other health workers contributing towards a solution of this problem. We are bad at this, as we are in most spheres involving the mental health of the community.
If we are to concentrate all our justifiable enthusiasms on eradicating addiction, drug habituation and drug misuse, we should concentrate it in the sphere of prevention and social research. That way lies salvation. The other way lies discouragement and even damnation.
§ 9.9 p.m.
§ Mr. Marcus Worsley (Chelsea)
The hon. Member for Wandsworth, Central (Dr. David Kerr) contributed to the debate by somewhat widening its scope. One of the difficulties of discussing this subject has been the narrow terms of the Brain Committee's Report. The Minister spoke in terms of that Report and was rather narrow in what he said. I do not criticise him for that, but if we merely look at the question of controlling the sources of supply and so on, 158 then we will fail to get to the nub of the problem.
The hon. Member for Cheadle (Dr. Winstanley) referred to the good record of this country in the past in terms of drug use and addiction. In spite of what the hon. Member said, I am sure that we are seeing an increase in both these things at present. We have to ask ourselves why this is happening. I do not believe that it is merely a matter of a society where drugs of various sorts are used more. There is surely some much more fundamental reason why people, particularly young people, feel much more tempted than my generation at the same age did to experiment with drugs. I am certain that it is linked with the increase in juvenile drunkenness and juvenile delinquency generally. These are problems which have deep roots in our society. We shall never cure them merely by political action. It lies rather in the field of religion.
Secondly—and here I am repeating much of what my right hon. Friend the Member for Ashford (Mr. Deedes) said at the beginning of the debate—I plead for more information. In this debate there has been much talk of the new drugs—I think rightly. Concerning a drug which has been much publicised, like L.S.D., we find on the one hand what may almost be called a promotion campaign on the part of certain writers in certain publications. On the other hand, we hear very severely worded warnings. What we want to know are the facts about these things. It is no use whatever merely taking up a moral, disapproving attitude in matters of this kind. The only possible argument which will be listened to by the potential addict, the potential misuser of these drugs, is facts.
It was with great pleasure that I heard of the right hon. Gentleman's plan to set up a research unit. He is on the right lines. Research in these matters must be international. It is a merciful fact that in this country, compared with some other countries at the moment, we have relatively little evidence to put forward. We want a truly international research into these drugs and new drugs as they come forward. We want research—this also was touched on by my right hon. Friend—into whether there is a necessary link between these sort of drugs and hemp and addiction to hard drugs later.
159 We need to know whether there is truth in what is often said that people come into this country precisely in order to take advantage of our system whereby drugs can be supplied in the National Health Service. Is there some movement into this country to get National Health heroin as we have sometimes been told there is to get National Health teeth and spectacles?
I am sure that the right hon. Gentleman is right in principle in his desire, echoing the Brain Committee Report, to bring treatment into centres. What worries me slightly is whether the psychiatric department of a big teaching hospital is necessarily the best place to expect an addict, or a person who is in danger of becoming an addict, to go. These are large and forbidding places, and the decision to go to such a place involves a very different decision from that which must be taken before a patient goes, as he has had to go in the past, into a doctor's consulting room. I am afraid that it may be much more difficult for people to take the decision to seek treatment and to get in touch with a doctor if it means going into such a great institution, with all the clerks and paraphernalia there involved, compared with the relatively informal approach which is the present situation.
I therefore suggest that at least experiments should be carried out on rather a different type of treatment centre, perhaps run by and linked to a teaching hospital, but nevertheless separate from it and perhaps more informal and easier to get at.
There has been some criticism of the Press in this debate. Most of us who have followed this matter will have seen the article in the Daily Telegraph on 8th December. 1966, by Kenneth Leech, who is described as the Assistant Curate of the Most Holy Trinity, Hoxton. Mr. Leech quotes the Minister's statement thatthere are already centres for treatment of addicts, and more beds would be made available if the demand increasesMr. Leech goes on to quote a letter sent from the Ministry about the availability of beds and then says:These statements are ludicrous misrepresentations of the truth, as anyone knows who160has ever tried to get one addict into hospital, evasions, equivocations, and interminable delays are the order of the day, while the addict's condition deteriorates and his family are heartbroken.This description is by somebody who is involved in this matter.
It is no good attempting to set up these new treatment centres and, at the same time, fail to provide the necessary additional finance. The provision has been hopelessly inadequate in the past. If it is to be adequate in the future, a real increase in provision is necessary.
§ 9.17 p.m.
§ Mr. Bernard Braine (Essex, South-East)
I agree with the hon. Member for Wandsworth, Central (Dr. David Kerr) in one particular. Talks with medical men who have made a close study of this problem have convinced me that it is far greater than the official Home Office figures would suggest, that there may be up to three times as many hard drug addicts as registered with the authorities, and that most of these are in the 17–25 age group.
I agree, too, with those who have expressed regret that the terms of reference of the Brain Committee were drawn narrowly so that they were limited to the problems of heroin and cocaine. The result was that the Committee wasdisturbed at the large quantity of habit-forming drugs currently in circulation.but did not deal with the problem of dependency on amphetamines and barbiturates leading up to the addiction to more dangerous drugs which the hon. Member for Cheadle (Dr. Winstanley) swept over so lightly.
Nor did the Committee deal with the pressing need for effective education of both the public and the medical profession about drug abuse, except in the sense that doctors were urged to prescribe dangerous drugs in words and figures. This failure to come to grips with the problem as a whole must be seen against the background in which in our increasingly permissive society it is not uncommon to find that pop stars, writers, artists, and even university dons take drugs and glory in it. There is a positive duty on the part of the Government and of the medical profession to prevent sickness of this kind from spreading by warning the people of the dangers. That is why I entirely agree with the hon. Lady the 161 Member for Wolverhampton, North-East (Mrs. Renée Short) about the importance of education in this regard.
If the Brain Committee took 15 months to come to its conclusions, a further year has elapsed until tonight without any positive action to deal with the situation which, in my view, could escalate very quickly into a national tragedy. In the Interval it has become worse.
Moreover, a new problem has emerged. We have had for some time the evidence of leading psychiatrists in this field that this problem is with us. I refer in particular to the work of Dr. Glatt, the consultant psychiatrist at St. Bernard's Hospital, Southall. He has said that the more adventurous youngsters taking hemp and amphetamines begin to experiment with heroin obtained from registered addicts. They become addicted themselves and introduce a fresh circle to the habit.
In the Lancet of 24th July, 1965, Dr. Glatt quotes cases which have been in his care. Last year he drew the attention of the Society of Medical Officers of Health to what was happening. He said that 19 young male narcotic addicts admitted to St. Bernard's Hospital, who previously had taken amphetamines, started to do so at an average age of 16.5 and that 11 female young narcotic addicts began to do so at an average age of 15.8 years.
These trends have been observed by ether workers in the field for some time past. Dr. Glatt came to two significant conclusions; first, that this addiction to narcotics among teen-agers, hitherto restricted largely to Greater London, is now spreading to cities elsewhere in the country: and, secondly, that there are many addicts not yet known to the Home Office. We all welcome the promise of legislation, and I hope that when it is brought before us it will be seen to deal with the realities of the situation.
The first requirement, it seems to me, is that it is crucial to success in containing and overcoming the drug scourge that the Government secure the fullest co-operation of the medical profession. Secondly, we should regard the abuse of "soft" drugs as part of the same problem as the abuse of "hard" drugs. Treatment centres should not be restricted to dealing with addicts of "hard" drugs. 162 Thirdly, we should see the addict not as a criminal but as a person who is ill and in dire need of treatment.
One reason why the problem of addiction is smaller in this country than in the United States is that, by and large, the practice has been to leave discretion to doctors in prescribing dangerous drugs. In reversing this, the Brain Committee were, in effect, saying that the majority of the medical profession could not be relied upon to prescribe in this context intelligently. It is not for me to say whether that is justified. On the other hand, there is evidence to suggest that if the prescription of drugs to addicts is restricted solely to treatment centres, there will be a sharp fall in the amount of heroin and cocaine prescribed legally, but it is almost certain that this will encourage a black market and criminal trafficking on a big scale.
We have the experience of the United States of America. Despite the death penalty and armies of policemen, the attempt to keep heroin out of that country have failed disastrously. True, up to now few doctors in this country who have wanted to help addicts have really been able to do anything except handing out prescriptions. Presumably the setting up of treatment centres would end this practice. I wonder whether this is wholly wise.
It is possible to look at this from two angles. First there is very little chance of curing an addict unless he is kept under hospital surveillance for a long period. The Brain Committee came to the conclusion that the special treatment centres should have powers of compulsory detention. The medical argument for this has been put by Dr. Dale Beckett, the consultant psychiatrist at the admirable Salter Unit, Cane Hill Hospital in Surrey. He is emphatic that the treatment of narcotic drug addicts needs to be prolonged, and that such treatment is likely to last up to six months. He bases this opinion on two considerations; first, that it has been found that the prognosis for these addicts who leave hospital prematurely is correspondingly worse the shorter their length of stay in hospital; and secondly, that heroin addiction leads to a physiological dependence on the drug by all the cells of the body which appear to incorporate it into their metabolic pathways. Put shortly, the 163 result is that withdrawal of the drug causes an overpowering demand by the body for heroin. Dr. Beckett argues that there is a need for powers similar to those in Section 26 of the Mental Health Act, 1959.
I wish to give sufficient time for my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) to speak, so I hope that the House will forgive me if I gallop over this point, yet it is one of enormous importance. It touches not merely upon the question of effective treatment of the addict but also upon the vital principle of the liberty of the subject.
The B.M.A. working party on drug dependence came out against compulsory detention and treatment, saying that this would not be acceptable. I note that this is the Government's view now, but it is significant that the B.M.A. Council, after hearing Lord Brain, modified its view and agreed with his recommendation that compulsory detention in treatment centres be accepted.
I recognise that this is a serious step. We are here dealing not with criminals but with sick people, though it must not be forgotten that the purpose is not merely to take addicts into these centres to protect them; if they are not cured of addiction, they will inevitably draw others into the net. If the Government are not prepared to use compulsory powers at this stage, it is vital, therefore, to establish a network of approved doctors to whom addicts can go, doctors who are specially trained and equipped to deal with the problem. The B.M.A. working party sensibly recommended that in addition to the treatment centres there should be panels of approved doctors throughout the country. I envisage panels resembling the obstetric list, with the doctors working in close co-operation with the treatment centres and with consultant psychiatrists.
Time does not permit me to say more. I hope that the right hon. Lady will tell us a good deal more about what the proposed legislation will contain. This problem is causing acute anxiety throughout the country not merely to doctors but to social workers and churchmen, indeed to everyone who cares for the future of our youth. It will no longer wait upon the 164 Government's indecision. We must know tonight what they propose to do.
§ 9.27 p.m.
§ Sir Keith Joseph (Leeds, North-East)
The House will wish me to leave the maximum time to the right hon. Lady for her reply, so I shall not repeat the cogent points made by my right hon. Friend the Member for Ashford (Mr. Deedes) and by hon. Members on both sides. I shall limit myself to asking the Government five simple—simple to ask—questions. First, I ask in all seriousness that the Prime Minister reconsider his refusal to give one Minister responsibility for this vital problem. The House has seen today an example of what happens when responsibility is divided.
My right hon. Friend the Member for Ashford, in a survey which I thought masterly, covered a wide range of the inter-related components of the subject. In reply, we had a serious and constructive but highly compartmentalised speech, a departmental speech, from the Minister of Health. I make no complaint about the content of his speech. I complain about the number of subjects on which he never touched at all when leading for the Government in this debate.
Here are two subjects the right hon. Gentleman did not mention. He did not, so far as I know, deal at all with the vast part that is played by the so-called non-addictive drugs. It was his hon. Friend the Member for Wandsworth, Central (Dr. David Kerr) who rightly reminded him of the large number of deaths caused by barbiturate poisoning. The Minister did not tell us of the link, if there be a link, between the so-called nonaddictive and the hard drugs. Thus, here am I replying for the Opposition to a debate without knowing the Government's view on this large part of the subject.
§ Mr. K. Robinson
We understood from the Opposition that they wanted to debate dangerous drugs. I have already explained what dangerous drugs are in the statutory context.
§ Sir K. Joseph
I find that a totally inadequate reply. The Home Secretary was present during the opening speeches but has since left the Chamber. We appreciated his presence, but one would have thought that as Cabinet Minister he 165 would have been responsible. He is the senior Minister dealing with the subject, and one would have expected him to be here. But he has not been here since the opening speeches. One would have expected—the right hon. Lady laughs. Perhaps she will tell us during her speech what she fines to laugh at.
I think that the House will agree that whether it be in Government or business, or indeed any affairs of man, the most effective attack on any problem will come when one person is put in charge. One Minister should be put in charge of this subject. Without any question of politics entering into this, I ask the Prime Minister to note again the appeals from both sides of the House to reconsider his decision. At present, one Minister can say in reply to a question, "That is for my right hon Friend"; one Minister can pass the buck to another.
Nobody impugns the integrity and zeal of the right hon. Members concerned. But it is not in human nature to try as hard as a human being can, if the blame for failure is shared. That is why I ask the right hon. Lady to take delivery of this request to the Prime Minister from both sides of the House to reconsider Ministerial responsibility and put one Minister in charge.
The second question is—and it will be a sad demonstration of divided responsibility if the right hon. Lady does not reply direct: what will the Government do about money? Are we really to take the Minister of Health's answer to my right hon. Friend as final? Will there be no extra money for the treatment centres? If the right hon. Gentleman really believes that the matter can be tackled within the existing budgets of hospitals, he shows a total failure to grasp the scale of the staff, and therefore the money, that will be involved in providing the service to which the Government are setting their hand. Will the right hon. Lady, therefore, please tell us whether there will or will not be extra money for those treatment centres?
The third question is where the Department of Education and Science comes into the Government's campaign. Do the Government agree that education of the young is part of their task? If so, where does the Secretary of State for Education and Science come in, and why has no 166 representative of his Ministry been present throughout the debate? So far as I can find from the files, there is no evidence of either the Home Secretary or his predecessor having made any speech on the subject of dangerous drugs. I may be wrong, but the speech has not been recorded so far as I can see in the newspapers. Does that mean that the Government do not recognise education of the young as part of their task? How long are we to wait for an authoritative view from the Government for the guidance of the young and their parents of the dangers of the amphetamines and the barbiturates, and of cannabis and L.S.D.? The question to the right hon. Lady is, do the Government recognise education as part of their task, and when will the Department of Education and Science be involved?
The fourth question to the Government is relatively simple, and one which I hope the right hon. Lady will also answer. Where will an addict who is a criminal be treated? Will there be treatment facilities in prison, or will such an addict be treated in the treatment centres about which the Minister of Health has told us?
My final question—I promised the right hon. Lady 25 minutes for her reply—is about the black market. Is there or is there not a black market, in the Government's view? Is there trafficking in narcotics, and if so, what are the Government doing about it? Have some addicts lost touch with their general practitioners and are they, in the Government's view, already drawing supplies from a black market?
I think that the House has had a serious debate. I congratulate again my right hon. Friend on the masterly speech with which he opened. I hope that the right hon. Lady will now give us some evidence that the Government have a grip on this subject and are not simply supplying the House with a series of departmental briefs unconnected and un-driven forward by the will power, energy and force of the single Minister that we believe should be in charge of this national problem.
§ 9.35 p.m.
§ The Minister of State, Home Office (Miss Alice Bacon)
The debate has clearly shown the present deep public 167 concern about drugs. The Government fully share this concern. Drug abuse is a very great scourge which wastes lives. It kills. Here I am not thinking only of the young man who recently fell to his death as a result of the LSD25, but of the young heroin addicts, some of whom die a very early death, and of other drug users killed in accidents when they are "high". Those most in peril are our young people. In spite of what the right hon. Member for Leeds, North-East (Sir K. Joseph) said at the end of his speech, the Government are determined to tackle this very serious social evil.
My right hon. Friend the Minister of Health has already explained the Government's attitude to the recommendations in the Brain Committee Report and has outlined the steps he is taking in consultation with the hospital authorities and the medical profession to set up treatment centres for heroin addicts. We hope it will be possible to arrange for addicts to be introduced to the new centres as soon as these are brought into operation. I believe that a smooth transition to the new system will help addicts and centre staff alike, and that there is no need for a statutory D.-day for the change-over.
The Bill which my right hon. Friend the Home Secretary intends to introduce this Session will give effect to the Brain Committee's recommendations on the prescribing of heroin and cocaine to addicts and on the notification of addicts. It will empower the Home Secretary to specify a new category of "restricted" dangerous drugs and provide for the licensing of doctors to prescribe restricted drugs to addicts. It will impose on doctors generally a duty to notify any case of addiction coming professionally to their notice, and it will allow the Home Secretary, by regulations, to specify the particulars to be notified. It will provide for a tribunal to investigate cases of unauthorised prescribing of restricted drugs or of failure to notify an addict, and it will empower the Home Secretary to withdraw authority to prescribe or supply all or any dangerous drugs where this is recommended by the Tribunal.
I should like to emphasise that none of this will affect in any way the existing rights of doctors to prescribe or supply any dangerous drug for the treatment of organic disease.
168 A number of doctors already notify the Home Office drugs branch when they give treatment to an addict. We welcome this. We are now working out the administrative arrangements needed for the statutory scheme. We want to devise steps which will effectively identify all known addicts but give as little work as possible to notifying doctors, centre staff and the central authority.
These two Measures—the organisation of centres and the notification scheme—should help us to see more clearly than we do now the current extent of addiction to narcotics, the sources from which new addicts obtain their supplies, and the scope for successful treatment. Present indications are that the trend studied by the Brain Committee is continuing. As my right hon. Friend the Minister of Health said, at the end of 1960 the Home Office knew of 437 addicts; in 1964 and 1965 the totals had risen to 753 and 927, respectively. Full information is not yet available for 1966, but the provisional figure for the first three-quarters of the year was 1,036 and the final figure for the year will certainly be higher.
The increase is disturbing even though the numbers are relatively small, but the trend in heroin addiction is more serious, as the right hon. Gentleman the Member for Ashford pointed out. The Home Office knew of 62 heroin addicts in 1958; of 132 in 1961; of 342 in 1964, and of 521 in 1965. The figures so far available for 1966 is a total of 670, of whom 279 are new cases. We do not yet know the number of those known to be no longer receiving heroin or who have disappeared.
The general situation shows other changes. In 1966, there were more convictions for drug offences than in any previous year. The provisional total for convictions under the Dangerous Drugs Act, 1965, was 1,174, including 978 for cannabis offences. This compares with a total for 1965 of 767 convictions, including 626 for cannabis. In other words there has been an increase of over 50 per cent. in one year, and convictions under the Drugs (Prevention of Misuse) Act, 1964, also show an increase. There were 958 convictions in the 14 months ending December, 1965, and 1,261 in 1966, including 676 in the last half year.
The House might ask how far these recent figures indicate a general increase 169 in drug abuse during the last year. It may well reflect a more successful enforcement of the law and deeper local interest and inquiry into what is happening, so to speak, below the surface. But we do not know whether this is so or whether it is that addicts are increasing at this enormous rate.
The right hon. Member for Ashford, the right hon. Member for Leeds, North-East and my hon. Friend the Member for Wolverhampton, North-East (Mrs. Renée Short) raised the question of dual responsibility. In this worrying situation, it is natural to consider whether or not vie have the right organisation. It has been asked in the debate that a senior Minister should be nominated to take charge and to co-ordinate the efforts of the Home Office, the Health Departments and the Department of Education and Science.
I fully understand the concern. Those who have raised the subject want, as we all want, rapid and effective action to solve the drug problem. But we have to face the fact that we are not dealing with one problem but with many. There are problems raised by the good and bad effects of each drug; of controlling the circumstances in which drugs are needed, used and handled; of guiding those who prescribe drugs; of educating those who want to take them and of discouraging those who want to peddle them.
Inevitably, some of these problems spill across the responsibilities of Government Departments, local authority committees and voluntary bodies, and there is nothing unique about that, because many social problems require concerted action by several authorities. The difficulty with drugs abuse is not to pin down responsibility, but to choose the right course of action. From what we have seen, there is no established pattern overseas of integrated control over drug abuse. It is certainly not so in the United States. In the United Kingdom, the Home Secretary is responsible for the control of drugs, and our aim has been to co-ordinate action on the basis of existing responsibilities pending further experience. This still seems to be the best approach. I hope that the right hon. Gentleman the Member for Ashford as a most welcome member of the Advisory Committee on Drug Dependence, will agree with my view that 170 the Committee itself has a very important part to play in the matter of co-ordination. It will have full opportunity to review interdepartmental problems and suggest co-ordinated action. Let me repeat that we fully agree with the concern for proper direction of effort. We will keep an open mind on the need for administrative adjustments and we will review experience as we go.
Several hon. Members on both sides of the House have raised the question of amphetamines. It is quite true that many young people continue to misuse these drugs and to obtain them easily on the black market. This is a very serious menace about which we do not know nearly enough. How big is our black market? So far—and I want to be quite honest with the House—we have found no basis for a reliable estimate. We are trying, with the help of the industry, to produce some information for study by the Advisory Committee.
I have been looking at reports from America. There it is estimated that more than one—half of the 10 billion—billion, not million—stimulant and depressant tablets manufactured each year are sold illegally—5 billion of them are sold illegally.
Where do our black market pills come from? Certainly most of them come from theft. Last July one-quarter of a million tablets were stolen from the warehouse of a pharmaceutical company—one-quarter of a million in one theft. Forged prescriptions, perhaps over-prescribing, and petty pilfering all feed the traffic. The figures of prosecutions for December—for just one month—perhaps show something of the pattern of supply. Last December 117 persons were charged with possession of 73,620 tablets and capsules. Of those persons, six held between them 62,414 tablets. Of the remainder, 55 persons held 20 tablets or fewer. Most of the others held more than 100 tablets.
That suggests that there are a large number of pedlars holding relatively small amounts and relying on well-established sources of stolen or diverted stock.
We have to curb this traffic. It may take some time and a number of measures. We hope that the Advisory Committee will give guidance. The problem is enormously complicated by the 171 very large use of amphetamine tablets for legitimate medical treatment. [An HON. MEMBER: "Excessive use."] The hon. Gentleman says, "Excessive use". Hon. Members who have raised the matter will be pleased to know that the Government are supporting the Lord Chief Justice's Bill to require certain private places of entertainment to be licensed for music, dancing, or similar entertainment. The Bill is due to have its Second Reading in another place at the end of this week, on 3rd February. The Bill will allow the granting of licence to be made subject to conditions—for example, reserving a right of entry to the premises for the police. Control of this kind has already helped to discourage drug abuse in clubs catering for young people in Manchester and elsewhere, where similar power has been taken by local Act, and the right hon. Member for Leeds, North-East will know that it only needed the threat of such legislation in the City of Leeds for some of those undesirable places to close down.
We are looking intensively at the security of amphetamines in distribution. Last year, all firms registered under the Drugs (Prevention of Misuse) Act, 1964, were asked for and gave information about their security arrangements. Drugs Branch Inspectors are visiting selected firms to see whether proposals can be drawn up for improved security and it is hoped to complete these visits in time to give the Advisory Committee a preliminary report at its next meeting.
§ Mr. Eldon Griffiths (Bury St. Edmunds)
Can the right hon. Lady tell the House whether she has consulted M. Jean NepÔt, Secretary-General of Interpol, about the international traffic into this country of the drugs about which she is speaking and, if so, with what result?
§ Miss Bacon
I could not answer that question without notice. Perhaps I can write to the hon. Gentleman about it.
The problem is to be reviewed in discussions with representatives of the trade shortly. Legislation in the United States imposes no requirements for the safe keeping of stimulant drugs, but it calls for records of transactions to be available for inspection. We are looking at this subject of records and we have also 172 discussed the problem of the security of drugs in pharmacies with the Pharmaceutical Society and with the Proprietary Association of Great Britain and we hope to devise more safeguards.
Some hon. Members expressed very great concern about the drug L.S.D. I cannot stress too strongly the dangers of taking this drug without medical supervision. The recent report of the death of a youth is by no means the first. American reports leave no doubt about the dangers of mental damage resulting even from a single dose. We are keeping a very close watch on this problem.
The figures which I have given today show that the police are acting vigilantly to check drug abuses and trafficking. A number of forces have made special arrangements for attention to drug problems, including liaison with the Drug Squad at Scotland Yard and with local health and other authorities. The demands of this work will be considered in the current reviews of police organisation and manpower. The subject raised by my hon. Friend the Member for Wolverhampton, North-East will also be studied—that is the question of attaching social workers to the Drug Squad at Scotland Yard.
§ Sir K. Joseph
Will the right hon. Lady be sure to leave enough time to answer questions about money for the treatment centres?
§ Miss Bacon
I have answered one or two of the questions which the right hon. Gentleman fired at me so quickly during his speech. I shall come to one or two others.
As for the education of the young and the rôle of my right hon. Friend the Secretary of State for Education and Science; the Department of Education and Science is soon to issue a new edition of its pamphlet "Health Education" which will give much fuller information to teachers and others and advise about drugs and it is taking all possible steps within the schools to see what it can do.
The right hon. Gentleman asked where an addict, if a criminal, would be treated. I had not given this a great deal of thought until the right hon. Gentleman raised the matter, but I would think that the court would have a good deal to do 173 with it and would order whether a person should be treated in hospital or in prison and, of course, in prisons we have some facilities for the treatment of those who have taken drugs.
I cannot add anything to what my right hon. Friend the Minister of Health has aid about money for treatment centres. I am sure that this is a matter to which he will give the greatest attention, but at the end of this debate I could not add anything to what he has said.
§ Miss Bacon
My right hon. Friend did not say that there would be no money. He dealt with the question and I cannot add to what he has said. Perhaps the right hon. Member for Leeds, North-East will read what my right hon. Friend said when it is reported in HANSARD tomorrow.
§ Mr. Braine
The Minister did not mention the scale of the problem upon which the right hon. Lady has touched. If there are a thousand hard drugs addicts who are under treatment, and this is an understatement of the size of the problem, is it not clear that the reason for not to taking the appropriate action is lack of money?
§ Miss Bacon
What the hon. Gentle-mail said is not true. I can give an assurance that the money will be available to deal with this problem, otherwise all our discussions today and the Bill which we are to bring forward will be as nothing. I give the assurance that the money will be available to deal with this problem.
§ Sir K. Joseph
But that is not what the Minister said. In answer to a question he said categorically that there would be no extra money.
§ Miss Bacon
If the right hon. Gentleman will read what my right hon. Friend said he will find that my right hon. Friend did not say "No extra money". He said "No earmarked money". I can give an assurance that the money will be available to deal with this problem.
§ Sir K. Joseph
The right hon. Lady must realise that if there is no extra money, then money for this must come 174 from something else for which it has been budgeted. The Government are not making themselves clear. Do they intend to provide money or do they intend to take money for this purpose from something for which it is already provided and which they will not then be able to finance?
§ Miss Bacon
My right hon. Friend dealt with this. He said that there would be no earmarked money. But I can give an assurance that the money will be available for these centres. Obviously we could not promise to have these centres running unless the money were available.
I wanted to deal with research, but my time is nearly exhausted. Research into this problem is very important. The right hon. Member for Ashford raised the relationship between drug addicts and those taking amphetamines, on the one hand, and crime, on the other hand. I assure him that we are carrying out projects to see what relationship there is between the taking of drugs and crime, because this is a very important subject.
This has been a valuable debate. We shall study carefully all the suggestions and points which have been made. The measures which the Government have set on foot will be pressed forward with vigour. The problems, however, cannot be solved by the Government or the police or doctors alone. The public must play its part. From time to time suggestions are made that the dangers of drug taking are exaggerated and that the casualties are trifling. We need to resist those who minimise the problem just as much as those who exaggerate it.
Drug abuse in one form or another has been a major social problem in most parts of the world for many years, and it threatens to be with us for a long time. I ask parents and all others concerned with young people to be alert to the dangers of trafficking or misuse. We all have a duty to prevent young people from becoming dependent on drugs, and the Government intend to discharge that duty to the utmost.
§ Mr. Joseph Harper (Lord Commissioner of the Treasury)
I beg to ask leave to withdraw the Motion.
§ Motion, by leave, withdrawn.