ministry of health . department of health for Scotland . drug addiction . report of the interdepartmental committee . interdepartmental committee on drug addiction . report . to the Rt Hon J Enoch Powell , M.B.E , M.P , Minister of health . the Rt Hon John Maclay , C.M.G , M.P , Secretary of state for Scotland . appointment . 1 . we were appointed on 3rd June , 1958 , with the following terms of reference : to review , in the light of more recent developments , the advice given by the departmental committee on morphine and heroin addiction in 1926 ; to consider whether any revised advice should also cover other drugs liable to produce addiction or to be habit-forming ; to consider whether there is a medical need to provide special , including institutional , treatment outside the resources already available , for persons addicted to drugs ; and to make recommendations , including proposals for any administrative measures that may seem expedient , to the Minister of health and the Secretary of state for Scotland . procedure . 2 . we have held eleven meetings . we decided as a first step to seek information from a number of organisations and persons having an interest in the questions before us and at a later stage we arranged for publication of a press notice inviting anybody interested to submit representations . we compiled a list of the points which we thought were of importance , but we made it clear that the replies need not be confined to these particular items . as a general rule we did not ask for oral evidence , though we found it an advantage in certain instances . appendix 1 gives a list of the bodies and persons consulted . the department of health for Scotland , the home office and the ministry of health submitted evidence to us ; officers of these departments attended our meetings and have given us valuable assistance . interim report . 3 . on 23rd November , 1959 , we submitted an interim report . this dealt with two questions which arose from our terms of reference and which had been brought specially to our notice . first , we were asked to examine the risks attending the abuse of carbromal and bromvaletone and preparations containing these substances . the poisons board had already considered this problem but , in the absence of sufficient evidence that these compounds were widely abused , had not recommended them for control as poisons under the pharmacy and poisons act , 1933 . 4 . on examination of the evidence it became clear to us that carbromal and bromvaletone were examples of a number of drugs on sale to the public which were not appropriate for restriction to supply on prescription under the dangerous drugs act , 1951 , or the therapeutic substances act , 1956 , and had not so far been recommended for control as poisons . 5 . we recommended that , in general , any drug or pharmaceutical preparation which has an action on the central nervous system and is liable to produce physical or psychological deterioration should be confined to supply on prescription and that an independent expert body should be responsible for advising which substances should be so controlled . 6 . as an interim and urgent measure , the Secretary of state for the home department , on the recommendation of the poisons board , has made rules under which certain substances having an action on the central nervous system are included in a new list of substances which may be sold by retail only on the prescription of a duly qualified medical practitioner , registered dentist , registered veterinary surgeon or registered veterinary practitioner . 7 . we are glad to note the action that has been taken and we hope that arrangements will be made to ensure that , as other preparations affecting the central nervous system become available , they too will be brought to the notice of the poisons board , or such other advisory body as may in due course be appointed for the purpose , to consider whether there are sufficient grounds for restricting any of them also to supply on prescription . 8 . the second part of our interim report was devoted to anaesthetists who become addicted to the gases and vapours which they use in the course of their professional duties . we ascertained that the incidence of this irregularity was very small indeed . however , over a period of eleven years , patients &apos; lives had been endangered in two known instances . 9 . we were assured by our expert witnesses on this subject that , with the apparatus at present to hand , the preliminary sniffing of the gases immediately before administering them to a patient was a recognised and necessary precaution . we accepted this . 10 . in view of the heavy and direct responsibility carried by every anaesthetist we were convinced that anyone addicted to the inhalation of gases and vapours should never be entrusted with their administration . intervention in the first instance , we thought , should be by the anaesthetist &apos;s professional colleagues . the ethical questions arising have been discussed between Ministers and representatives of the medical profession and we are glad to see that a memorandum embodying the agreed arrangements was sent to hospital authorities in England and Wales on 27th May , 1960 , and that one was sent to hospital authorities in Scotland on 18th August , 1960 . report of the departmental committee on morphine and heroin addiction ( the Rolleston committee ) 1926 . 11 . the main tasks of the Rolleston committee , whose advice we were invited to review , were to advise on : ( a ) the circumstances , if any , in which the supply of morphine and heroin , and preparations containing these substances , to persons addicted to those drugs might be regarded as medically advisable ; ( b ) the precautions which medical practitioners administering or prescribing morphine or heroin should adopt to avoid abuse and any administrative measures that seemed expedient to secure observance of those precautions . 12 . through the system of records and inspection then in operation cases were brought to the notice of the home office at that time in which exceptionally large quantities of morphine and heroin had been supplied to particular practitioners or prescribed for individual cases . on further enquiry it was ascertained that sometimes the doctor had ordered these drugs simply to satisfy the craving of the addict ; in some instances there was a doubt whether the supply was for bona fide medical treatment ; in other cases the drugs had been prescribed in large quantities either to persons previously unknown to the practitioner or to a patient receiving supplies elsewhere ; occasionally , large supplies had been used by practitioners for self-administration . 13 . it appeared then that in some circumstances dangerous drugs were being supplied in contravention of the intention of parliament that a doctor should be authorised to supply drugs only so far as was necessary for the practice of his profession . before deciding on measures to secure proper observance of the law , it was felt necessary to have some authoritative medical advice on various aspects of the treatment of addiction , the use of dangerous drugs in medical treatment , and the action which might be taken where a doctor appeared to have misused his authority to possess and supply them . 14 . the Rolleston committee &apos;s recommendations in 1926 on the supply of morphine and heroin to addicts to these drugs and on the use of drugs in treatment are discussed later in this report . they have , up to now , been included in the memorandum on the dangerous drugs act and regulations which is prepared by the home office for the information of doctors and dentists . 15 . as a result of the Rolleston committee &apos;s proposals for administrative measures , amendments were made to the dangerous drugs regulations in 1926 to the following effect : ( 1 ) . provision was made for the constitution of a tribunal to which the Secretary of state could refer cases in which , in his opinion , there was reason to think that a duly qualified practitioner might be supplying , administering or prescribing drugs either for himself or other persons otherwise than as required for purposes of medical treatment . ( 2 ) . the Secretary of state was empowered , on the recommendation of a tribunal , to withdraw a doctor &apos;s authority to possess and supply dangerous drugs and to direct that such a doctor , or a doctor convicted of an offence under the act , should not issue prescriptions for dangerous drugs . ( 3 ) . it was made clear that prescriptions should only be given by a duly qualified medical practitioner when required for purposes of medical treatment . ( 4 ) . it was made an offence for a person who was receiving treatment from one doctor to obtain a supply of dangerous drugs from a second doctor without disclosing that he was being supplied by the first doctor . ( 5 ) . all doctors , dentists and veterinary surgeons were required to keep appropriate records of all dangerous drugs obtained . with the exception of provisions relating to tribunals , which we discuss later , all these amendments remain in the current regulations . the changed situation . 16 . in the thirty-four years since the Rolleston committee reported there have been developments in two directions which are of interest to our own committee . on the one hand pharmaceutical research has produced a number of new analgesic drugs , many of which are capable of producing addiction . some of these have been derived from opium and others have been produced synthetically . it is possible that many more addiction-producing drugs will be produced . a potent analgesic which is not addiction-producing has so far not been forthcoming . we have had to direct our attention to the question whether these drugs should be used with the same precautions and subjected to the same control as the morphine and heroin considered by the Rolleston committee . 17 . the second development has been in the methods of treatment of drug addiction . the withdrawal from addicts of the drug to which they are addicted has been the subject of experiment in several countries and particularly in the United States of America . these experiments have included the substitution of newer addiction-producing drugs and their subsequent gradual withdrawal , and also the use of other new drugs , such as tranquillizers , for the alleviation of the withdrawal symptoms . it has therefore been necessary to consider whether there are still circumstances in which the continued administration of dangerous drugs , even under the conditions strictly defined by the Rolleston committee , can be justified . 18 . we therefore had to consider : ( 1 ) whether any new advice could be brought effectively to the notice of doctors and dentists ; ( 2 ) whether the principles underlying the advice could be emphasised clearly to avoid misinterpretation ; ( 3 ) whether any action was necessary to prevent the unjustifiable prescribing of dangerous drugs by some doctors ; ( 4 ) whether there was any way of preventing the unjustified use of dangerous drugs by any doctor for himself or for members of his family ; ( 5 ) the suggestion made in certain international organizations that governments might set up special institutions for the treatment , care and rehabilitation of addicts on a compulsory basis . 19 . in addition there has been an increase in the use by doctors and by the general public of drugs liable to cause habituation . because they do not give rise to ill-effects substantially the same as , or analogous to , those produced by morphine or cocaine they are not within the scope of international agreements . we have considered this development . definitions adopted . 20 . from the outset we felt it necessary to have a clear and consistent idea of the phenomena confronting us . we therefore adopted the following definitions , realising that they are somewhat arbitrary and may need to be revised in the light of increasing knowledge . drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug ( natural or synthetic ) ; its characteristics include : ( 1 ) an overpowering desire or need ( compulsion ) to continue taking the drug and to obtain it by any means , ( 2 ) a tendency to increase the dose , though some patients may remain indefinitely on a stationary dose , ( 3 ) a psychological and physical dependence on the effects of the drug , ( 4 ) the appearance of a characteristic abstinence syndrome in a subject from whom the drug is withdrawn , ( 5 ) an effect detrimental to the individual and to society . drug habituation ( habit ) is a condition resulting from the repeated consumption of a drug . 