has not thought it necessary to suggest a fresh inquiry, since the scope of the problem in the United Kingdom would not justify the time, trouble, and expense involved. I would, however, emphasize that this advice should be carefully read, and in particular should be read in conjunction with the explicit statement in the memorandum that "the continued supply of drugs to a patient, either direct or by prescription, solely for the gratification of addiction, is not regarded as a medical need." Considered in this light, the advice reduces to a very small number the cases in which addiction-producing narcotics may properly be prescribed for an addict otherwise than as part of withdrawal treatment. With regard to the prescription or administration of the drug as part of the gradual withdrawal method, there will, I imagine, be no disagreement. The second type of case is limited to those where a prolonged attempt at a cure has already been made and has failed, and where the use of the drug cannot, in the view of the responsible doctor, be safely discontinued entirely on account of the severity of the withdrawal symptoms produced. The obvious instance where this might occasionaly happen would be where the patient was enfeebled by old age. Obviously, if a doctor considers that by using modern techniques he can safely withdraw the drug, he is under a clear obligation to do so. It is probably the third type of case that has given rise to such misunderstanding of the so-called British system and I would invite honorable Senators to read this condition with particular care and notice how extremely restrictive it is in fact. Here, too, before administration or prescription of the drug is considered permissible, there must have been a prolonged attempt at cure. It must be further demonstrated that the patient is incapable of leading a useful and relatively normal life, and further that he cannot do this without the drug. If these conditions are conscientiously applied in the light of modern medical knowledge, the number of instances where a drug may properly be administered or prescribed in a case of this sort will be very small indeed. Moreover, the advice tendered to doctors by the committee and included in the appendix to the Home Office document to which reference has already been made does not stop there. The committee's report contains the following paragraph. "When the practitioner finds that he has lost control of the patient, or when the course of the case forces him to doubt whether the administration of the drug can, in the best interests of the patient, be completely discontinued, it will become necessary to consider whether he ought to remain in charge of the case and accept the responsibility of supplying or ordering indefinitely the drug of addiction in the minimum doses which seem necessary. The responsibility of making such a decision is obviously onerous, and both on this ground, and also for his own protection in view of the possible inquiries by the Home Office, which such continuous administration may occasion, the practitioner will be well advised to obtain a second opinion on the case." In the United Kingdom a doctor's right to prescribe what he thinks best for his patient in accordance with his conscience and professional judgment, is regarded as virtually sacred, and for the Government to give advice in the terms I have just quoted is most unusual, and is a clear indication of the gravity with which the departmental committee (which included a number of eminent doctors) regarded the administration of narcotics to a drug addict. This in itself should serve to refute the view widely held in parts of North America that the United Kingdom permits and even encourages the unrestricted administration of narcoties to addicts. Lastly I would emphasize that this policy is related to a population in which, as I have already said, the criminal addict is virtually unknown. Our Government has never had to consider the problem of the habitual criminal who is also an addict and I cannot say what would be the view of the Secretary of State if this problem ever arose. But it is clear that existing policy would have to be reviewed in the light of different circumstances and it may not be irrelevant to note that at present addict prisoners in gaol do not receive narcotics. All this is not to say that no addict in the United Kingdom ever gets a prescription for a narcotic, or a supply of the drug from a doctor, in circumstances where the prescription or the supply is not justified. This can, and on occasion, does happen. Nor are the doctors' motives necessarily improper when it does. Few doctors in the United Kingdom have any real experience of treating drug addicts, and addicts are a notoriously difficult class of patient. Sometimes it undoubtedly happens that doctors, through lack of experience, or occasionally through mistaken kindness, prescribe parcotics for an addict where the condi tions laid down by the committee cannot be said to apply. So far as possible, when such cases come to notice, we remind the doctor of his responsibility and of the views of the departmental committee, and try to persuade him to encourage his patient to accept systematic treatment. Until 1953 the dangerous drugs regulations contained a provision empowering the Secretary of State to withdraw the right of a doctor to be in possession of or supply or procure dangerous drugs if a special medical tribunal set up under the regulations so recommended. This tribunal consisted of three medical practitioners, one being nominated by the General Medical Council, one by the British Medical Association, and one by the Royal College of Physicians (the London College for cases arising in England and Wales and the Edinburgh College for cases arising in Scotland). There was also a legal assessor. This tribunal was never used in Great Britain throughout its existence, since it was nearly always found possible to deal with an erring practioner in some other way, either by persuasion, or, more rarely, by depriving him of his authority after a conviction under the act had been obtained. The disappearance from the current dangerous drugs regulations of 1953 of the provisions relating to the tribunal, did not mean that the body had been dissolved as an act of deliberate policy. The provisions disappeared simply because, when the regulations came to be consolidated in 1953, it was realized that the rules of procedure governing the conduct of cases before the tribunal were badly out of date and inappropriate by modern standards, and it was recognized that the agreement of new rules with the medical profession would take some time. These have in fact now been agreed as regards England and Wales and it is intended to restore the tribunal in that part of the United Kingdom very shortly. Incidentally, a similar tribunal exists in Northern Ireland, and this has been used successfully on a number of occasions. International obligations In 1931 a Convention for the Limitation of the Manufacture and the Regulation of the Distribution of Narcotic Drugs was drawn up to which both Canada and the United Kingdom are parties. This convention requires parties to limit the quantities of drugs, manufactured or imported, to those fixed in estimates submitted by them to the Permanent Central Opium Board. The convention expressly stipulates that "every estimate furnished *** so far as it relates to any of the drugs required for domestic consumption in the country or territory in respect of which it is made shall be based solely on the medical and scientific requirements of that country or territory." We in the United Kingdom have always interpreted this requirement as precluding the administration of narcotics to addicts for the mere gratification of addiction. The Government of the United Kingdom felt that this obligation in the 1931 convention was in no way incompatible with their policy based on the departmental committee report on morphine and heroin addiction quoted above. Treatment of drug addiction Subject to what has already been said about the need to avoid the mere gratification of addiction, treatment is left in the hands of the medical profession and there is no compulsion of any kind except that on occasion a court attaches to a probation order a condition that an offender addict shall undergo treatment in an institution. There are no public institutions wholly devoted to the treatment of drug addiction. Addicts can secure treatment in public hospitals and a small number of private nursing homes, most of them primarily concerned with alcoholism, accept drug addicts. There are not and never have been in the United Kingdom drug clinics in the sense in which this phrase is sometimes misused in North America to describe an institution where an addict may receive supplies of a drug either gratis or at a nominal charge. Conclusion To sum up, dangerous drugs are subjected in the United Kingdom to a wide degree of control of the exacting standard demanded by the international agreements to which, in common with Canada, the United Kingdom is a party. The indiscriminate administration of narcoties to addicts would be incompatible with those obligations and it is not now, and never has been, a feature of United Kingdom policy. 1955 THE SENATE OF CANADA PROCEEDINGS OF THE SPECIAL COMMITTEE ON THE TRAFFIC IN NARCOTIC DRUGS IN CANADA No. 4 VANCOUVER, B.C., MONDAY, APRIL 18, 1955 The Honourable TOM REID, Chairman WITNESSES Dr. G. H. Stevenson, Director, Drug Addiction Research, University of British Columbia. Dr. J. Ross MacLean, Physician, Vancouver, B.C. Senior Major John Steele, Public Relations Depot., The Salvation Army, Vancouver, B.C. Captain William Leslie, Officer in Charge, Harbour Light Center, The Salvation Army, Vancouver, B.C. His Worship Magistrate Oscar Orr, Vancouver Magistrate's Court. APPENDICES A Argument for and Against the Legal Sale of Narcotics. B. You Can Prevent Drug Addiction and Cure Victims of Habit. EDMOND CLOUTIER, C.M.G., O.A.. D.S.P. QUEEN'S PRINTER AND CONTROLLER OF STATIONERY OTTAWA, 1955. ORDER OF REFERENCE Extract from the Minutes of the Proceedings of the Senate, Thursday, February 24, 1955: 1. That a Special Committee of the Senate be appointed to inquire into and report upon the traffic in narcotic drugs in Canada and problems related thereto. 2. That the said Committee be composed of the Honourable Senators Baird, Burchill, Gershaw, Grant, Hayden, Hawkins, Hodges, Horner, Howden, Hugessen, Kinley, Leger, McIntyre, Quinn, Reid, Stambaugh, Turgeon, Vaillancourt, Veniot and Woodrow. 3. That the Committee be empowered to send for persons, papers and records. 4. That the Committee be instructed to report to the House from time to time its findings, together with such recommendations as it may see fit to make. L. C. Moyer, |