Mr. MITLER. Would you tell us about the law enforcement? Are drug pushers arrested in England just the same as they are here? Dr. LINDESMITH. Yes. The English laws with respect to peddling drugs are much the same as here, except the penalties are not as severe and they are not mandatory.

If anyone is detected violating the law-for example, the addicts sometimes, even though they are receiving drugs legally at low cost, may object to the doctor's not giving them what they regard as enough, and supplementing this by forging prescriptions usually, or going to two doctors simultaneously.

In that case, the addict is arrested and punished, usually with fines. If there is a question of illicit trafficking in this drug or in marijuana, then usually there are jail sentences.

I would like to state, Mr. Mitler, that the use of opium is not-what I have said applies solely to heroin and morphine, and does not apply to marijuana or smoking opium.

Opium smoking is forbidden, as it is here, and so is the use of marijuana. This, incidentally, is a problem that has been growing, to some extent, in England.

Mr. MITLER. Is there drug racketeering in England, in drugs?

Dr. LINDESMITH. There is said to be a small black market in drugs. I can't say that I know too much about it, but apparently it is believed to be very small and to be, consisting largely of sales, sales of drugs diverted from legal sources by a few unethical doctors.

This is what I am told.

Also, perhaps a certain amount of smuggling, but the British Government reports very little evidence of any organized traffic. Cocaine and marijuana are found.

Mr. MITLER. The British did not have a traditional background of drug using, such as our country did. Am I fair about that, Dr. Lindesmith?

Dr. LINDESMITH. No. When the British-the history of the present British laws begins from 1920. Prior to that they had relatively little control, but they have never arrested, never treated, addicts as criminals.

As a matter of fact, I would like to add that I believe there are quite a few other European countries, all of them with very small drug problems, all of them, also, with almost no juvenile addicts, who handle the drug problem in the same way.

I have evidence here from the reports of these nations to the United Nations, from a number of countries like Norway, and the Netherlands, and so on, which indicate this.

So this practice is actually not unusual, the British scheme is not unusual. In fact, I think it is the most common scheme in the Western Hemisphere.

Mr. MITLER. Also, Great Britain has a different cultural setup than we do.

Dr. LINDESMITH. Yes.

Of course, our cultural-culturally, we are very closely allied with Britain. The culture is not different. But I would like to say that addicts are much the same, in essential respects, the world over, and what differences there are I think are largely the way in which they are handled.

Mr. MITLER. What do you think we can learn of value, contrasting the two systems? What things can we derive from that?

Dr. LINDESMITH. Well, sir, I believe we would have to be cautious, I am willing to concede this, in applying wholesale, and without critical examination, the experiences of foreign countries which have much smaller problems than we have.

But I believe that we could benefit by a close study of what these nations do.

The principal advantage, as I see it, in the English program and in some of the other programs of this kind abroad, is that the addict is placed in the hands of what a gentleman here has called the "healing professions," and he is not sent to jail for what is called a "cure."

Mr. MITLER. Are there any other things that you think we can learn from the British experience?

Dr. LINDESMITH. Well, I don't know if you are going to bring this up later, but there has been some talk of what is called a clinic system, and I might mention, if it is appropriate now, that this system is not a clinic system.

It involves the medical profession taking care of what I think most medical men regard as a medical problem, and I believe that most of the people who know about this problem regard it as a medical problem in a broad sense.

Mr. MITLER. Apart from this study that you made in England, you also have been making studies of the situation in the United States?

Dr. LINDESMITH. Yes. I more or less continuously have been concerned with it since 1935.

Mr. MITLER. And you have also made a statistical study based on the FBI figures?

Dr. LINDESMITH. I wouldn't say I have made a statistical study. Mr. MITLER. Well, you observed things.

Dr. LINDESMITH. I am acquainted with the figures.

Mr. MITLER. What would you say with respect to the trends and developments with respect to the drug, based on those figures?

Dr. LINDESMITH. I would say, in the first place, we have no realiable estimates, either of the number of addicts in the United States 30 years ago, or now. All we have is varying estimates, which I would call "guesses," varying so widely that they are totally unreliable.

We have figures on the number of arrests; and basing one's conclusion on the number of arrests, the arrest figures, I believe, have been setting new records every year.

I recall some figures which compared 1951-I picked 1951 because it was the year the Boggs bill went into effect-with 1955. These are from the Uniform Crime Reports issued by the Federal Bureau of Investigation, concerning the activities of local police squads, not Federal cases.

The arrest rate, that is, for narcotics offenses, per 100,000 population, approximately doubled during those 4 years.

And over all of the years since 1930, when the Federal Bureau of Investigation began to make those reports, the percentage of young persons involved in these figures has been steadily going up.

Also, I might add that the percentage of Negroes involved has also been going up steadily, and is now over half, usually.

Mr. MITLER. Is there a leveling off at present, of the use of drugs as evaluated from these standards, by young people? Or what is the situation?

Dr. LINDESMITH. There has been in the last year or so, I believe, in these figures which I refer to, there has been a slight decline, percentagewise.

But this decline percentagewise has been brought about by an increase in the number in the higher age groups, not by a decline in the numbers in the lower-age groups. I think you understand that.

Mr. MITLER. Are there any other observations that you would like to make which you think would be useful?

Dr. LINDESMITH. Well, sir, I believe that the operation of our present laws is, in my opinion, unjust and ineffective. I believe it is unjust primarily because, if I might make a distinction between the addict and the trafficker, and include among the addicts the petty pushers who support their habits by peddling, I would say that the penalties are primarily on the addict; that the traffickers, who are the ones who make substantial sums of money from the traffic, are not caught often enough to be punished by any law.

I think at a previous hearing it was proposed to get at least traffickers through the tapping of telephone conversations, but in the meantime, I don't believe that you can deter a criminal from his criminal activity by punishing his victim.

Mr. MITLER. Now, are there any other points that you wish to make? Dr. LINDESMITH. I can't think of any offhand.

Mr. MITLER. I have no further questions, Mr. Chairman.

Chairman KEFAUVER. Dr. Lindesmith, of course in Britain they have a different medical system from the one we have here. Doctors are-all come under the socialized medical system; don't they?

Dr. LINDESMITH. That is true. But this system which I spoke of was used before and has no necessary connection with socialized medicine. You understand prior to socialized medicine or what we call socialized medicine in Britain, the addicts were simply taken care of by the doctors and were regarded as patients.

Chairman KEFAUVER. So the point you make is that you think that regarding the addicts as patients and more or less bringing out into the open and with some kind of supervision and treatment it is preferable to just classifying them as criminals and throwing them in a penal institution?

Dr. LINDESMITH. The English addict or an addict in this system has an out. He doesn't have to be a criminal if he is an addict. The American addict generally unless he is favored in someway or another has to be a criminal. That is, he has to peddle drugs or engage in prostitution or steal or something like this to raise the money to buy the drug, but an addict in a system of this kind does not.

Chairman KEFAUVER. And also if a person is taking narcotics under the until he can get some kind of permanent treatment under a physician, he is not at the mercy of—I mean at least there is some limit on the amount that he gets; is that another point?

Dr. LINDESMITH. Yes. There are standards set up for the medical practitioner which are not enforced by the criminal law, by the police, but they are more or less enforced through these medical inspections carried out by the Ministry of Health in visits from these persons.

Chairman KEFAUVER. I take it from that you think rather than making a criminal in this country of a person unfortunately addicted, that if they could be placed in an institution or given some medical treatment without putting a criminal record down against them that would be a step in the right direction?

Dr. LINDESMITH. I believe that is a step in the right direction, and I believe that is eventually where we have to go.

Chairman KEFAUVER. All right. Anything else?

Mr. MITLER. I have nothing further.

Dr. LINDESMITH. Sir, I have a statement on the English system and another article.

Chairman KEFAUVER. We will have those printed in the record as exhibits 6 and 7 to your testimony. Thank you very much, Dr. Lindesmith.

Dr. LINDESMITH. Thank you. It was a privilege to appear.

(The statement and article referred to were marked "Exhibits 6 and 7," and read as follows:)

THE BRITISH SYSTEM OF NARCOTICS CONTROL

(By Alfred R. Lindesmith)

Assuming that there is a relationship between the means adopted by a country to control drug addiction and the extent and seriousness of the problem, a consideration of the British system of control should be of special interest in the United States, because it is an example of a relatively successful way of dealing with narcotic drugs. The lowest estimate of the number of addicts in the United States known to the authorities is 60,000. In the United Kingdom, 335 such addicts were reported in 1955. In Washington, D. C., alone, police estimate the number of addicts at about three times the all-Britain total. Even if one accepts the minimum estimate cited above, there appear to be more drug users in the United States than in all of the rest of the Western World combined.1 British system of control, as an example of a system commonly used in Western European countries, allows the addict to have legal, but regulated access to legitimate low-cost drugs.

The

There is, of course, more than one type of drug problem. However, when reference is made to the narcotics problem in the United States, it is generally understood that what is meant is the use of opiate drugs (morphine, heroin, etc.), and their equivalents. It is this type of drug abuse with which we shall be primarily concerned in this paper.

BRITISH DRUG LAWS

British practices with respect to controlling addiction have not changed materially since the act of 1920, which was the first legislation on this subject. This law, known as the Dangerous Drug Act of 1920, with subsequent additions, interpretations, and consolidations over the years, puts the treatment of addicts squarely into the hands of the medical profession. It defines the addict as a patient, treats addiction essentially as a disease, and makes the doctor the final judge as to the circumstances under which drugs are to be prescribed and in what quantity. Thus, in the British Government's annual report to the United Nations for 1955, it is stated, "In the United Kingdom, the treatment of a patient is considered to be a matter for the doctor concerned. The nature of the treatment given varies with the circumstances of each case." In line with this conception, there is no compulsory treatment or registration of addicts; and doctors are not required to notify the authorities when they begin to treat an addict, although they are encouraged to do so.3 Similarly, the National Health Act

1 See the 1956 report or the U. S. Senate Subcommittee on Improvements in the Federal Criminal Code (of the Committee on the Judiciary); chairman, Senator Price Daniel. 2 The Traffic in Opium and Other Dangerous Drugs. Report to the United Nations by Her Majesty's Government in the United Kingdom of Great Britain and Northern Ireland, 1955, p. 4.

3 Memorandum as to Duties of Doctors and Dentists, Dangerous Drugs Act, 1920-32. D. D. 101 (5th edition), Home Office, October 1948, p. 9.

applies to addicts as well as to all other types of medical patients, so that the doctor who has addicts in his care receives compensation from the Government for treating them, and the drug user gets his supplies at a nominal cost of one shilling (14 cents), per prescription. However, an addict securing a regular supply of drugs from one doctor violates the law if, at the same time, he secures drugs from a second doctor without informing him that he is already under treatment. The punishment in such a case, it is important to notice, is not for securing a dual source of supply, but for withholding information from the second doctor. Practitioners who provide such dual supplies are therefore not in violation of the law.

The act of 1920 and all subsequent laws require that all persons and firms handling dangerous drugs from manufacturers and importers to pharmacists, doctors, and dentists, be licensed or authorized to do so. They are required by law to keep full and accurate records of all drug transactions, and to preserve these records for at least 2 years. Records of retail pharmacies are routinely inspected by the police, while the records of doctors are examined by specially appointed medical inspectors of the Ministry of Health, these inspectors also being available for advice on cases of addiction.

Pharmacists are required to keep their drug supplies in locked receptacles, and doctors are urged, though not required, to do the same as far as possible. A doctor is not, however, required to keep a written record of the drugs which he personally administers to a patient, but only of those which he gives by prescription. If he fails to keep the proper records because, for example, he is trying to cover up his own addiction, he is soon detected by the medical inspectors because the records will show that he is receiving unusually large quantities of drugs not accounted for by the needs of his patients. Such a practictioner, if convicted of an offence under the dangerous drug laws, can be deprived of his authority to possess, supply, or prescribe drugs, but he cannot be deprived of his right to practice medicine. Among the 335 addicts reported in 1955 there were 70 doctors, 2 dentists, and 14 nurses.*

In the early years of enforcing the act of 1920 a question of interpretation arose with regard to a regulation specifying that the doctor was authorized to possess drugs "so far as necessary for the practice of his profession." The home office, which has general control over drug law enforcement, interpreted this to mean that doctors were not to be permitted to prescribe drugs regularly for addicts. In a 1948 memorandum of instructions to doctors and dentists which is still in effect, the home office called attention to the above qualification and added: 5 66* * * a doctor or dentist may not have or use the drugs for any other purpose than that of ministering to the strictly medical, or dental needs of his patients. The continued supply of drugs to a patient, either direct or by prescription, soley for the gratification of addiction, is not regarded as a 'medical need'; and in a number of cases doctors who had purchased drugs for the gratification of their own addiction have been convicted of unlawfully procuring and possessing these drugs."

On the other hand, doctors who had previously prescribed regular supplies of drugs for addicted patients continued to do so after the 1920 legislation in apparent contravention of the law. The home office noted this fact, but was reluctant to prosecute because it was felt that this was a matter for the medical profession to consider. As a consequence, in 1924 the Government appointed a committee of prominent medical men, with Sir Humphrey Rolleston as chairman, to investigate and make recommendations to the home office. The report of this committee affirmed the right of doctors to provide drug users with regular supplies of drugs, and, in effect, defined this as "treatment" rather than as the "gratification of addiction."

The 1948 Home Office memorandum includes an appendix which reproduces those sections of the Rolleston report pertaining to the medical treatment of addicts. These sections have guided the interpretation and enforcement of the law ever since. On the central problem of whether the doctor could legitimately prescribe regular supplies of drugs for an addict, the Rolleston committee stated: "

Op. cit., p. 5.

Op. cit., p. 4, par. 6.

Report of Departmental Committee on Morphine and Heroin Addiction to the Ministry of Health, H. M. Stationery Office, London, 1926, p. 1.

7 Quoted in appendix A of the 1948 Home Office Memorandum, op. cit., p. 10.