5. While the subjects on which the Committee was appointed to advise are mainly medical, they also include administrative questions. The main object of our deliberations has been to consider whether or not we should recommend any modifications in the Regulations made under the Dangerous Drugs Drugs Acts which relate to matters falling within the scope of our reference. We have thought it desirable, therefore to preface this report by a short summary of the provisions of the Dangerous Drugs Acts and the Regulations made thereunder and the present system of administration, so far as these bear on the subjects of reference, followed by a statement of certain difficulties which we are informed have been experienced in the course of administration, and which it is hoped that our recommendations may be helpful in overcoming. These statements are based on memoranda placed before us and oral evidence tendered by the Home Office, the Ministry of Health, and the Director of Public Prosecutions.

PROVISIONS 0F THE ACTS AND REGULATIONS AND ADMINISTRATIVE ARRANGEMENTS.

6. The Dangerous Drugs Acts place restrictions on the import, export, manufacture, sale, distribution, supply and possession of the drugs specified therein, which include morphine and heroin and preparations containing these drugs in more than a certain strength; this being 0.2 per cent. in the case of morphine and 0.1 per cent. in the case of heroin. A Secretary of State is empowered to make regulations, subject to the approval of Parliament, that are necessary for carrying the Acts into effect, and Regulations have been made from time to time by the Home Secretary accordingly. Under the Regulations the import, export, manufacture, sale, distribution and supply of the drugs is restricted to persons licensed or authorised for such purposes. Possession is restricted to persons so licensed or authorised, and to persons to whom the drugs are supplied by registered medical pracitioners for the purpose of medical treatment (or by registered vetirinary surgeons  for use in the treatment of animals) or supplied by chemists on and in accordance with prescriptions issued by registred medical practitioners (or by registered dentists for local dental treatment, or veterinary surgeons for the treatment of animals.
A registered medical practioner is authorised to be in possession of the drugs and to supply them, so far as is necessary for the practice of his profession. (The qualification contained in the words italicted is of special importance in relation to the matters which it has been our duty to consider.

Medical prescriptions for the drugs must comply with certain requirements as to dating and signature, they mast bear the doctor's address (except in the case of National Health Insurance prescriptions), as well as the name and address of the person for whose use the drug is intended, and the total amount of the drug to be supplied must be specified. The Home Secretary has power, which it has not yet however been thougt desirable to excercise, to require the use of an official form on which prescriptions for Dangerous Drugs should be written.

7. All persons authorised to supply the drugs, including medical practitiorers who dispense medicines for their patients, are requirod to keep records of drugs purchased and issued, but this requirement does not apply to drugs administered by medical practitioners personally, or under their immediate supervision. Practitioners who do not dispense, and therefore do not supply drugs otherwise than by way of personal administration; are not at present required to keep a record even of their purchases.

8. The records kept by wholesale chemists and by pharmacists are inspected by Home Office Inspectors or by the police; but it was considered preferable that these kept by medical practitioners should be inspected by medical officials, ans such inspection is carried out, on behalf of the Home Office, by the Regional Medical Staff of the Ministry of Health in England and Wales, and by the Medical Staff and District Medical Officers of the Board of Health in Scotland.

9. Through the system of inspection described, the distribution of morphine and heroin imported into or manufactured in the country can be traced and cases are from time to time brought to the notice of the Home Office in which it has been observed that exceptionally large quantities of these drugs have been supplied to particular practitioners, or that individual patients have received unusally large quantities of them on medical prescriptions.

10. As a result of further inquiries in such cases, and in cases brought to notice in other ways, it has been ascertained:-
(i) That in a very small number of cases, medical practitioners have, by their own admission, ordered or supplied Dangerous Drugs, not as a part of medical treatment, but simply to enable  persons who had become addicted to the drugs to satisfy their craving;
(ii) That in certain other cases, in which there was no such admission, as circumstances have suggested at least a doubt whether the supply of the drug could be regarded as forming a part of bona fide medical treatment;
(iii) That sometimes practitioners have issued supplies of, or precriptions for, the drugs in unusually large quantities or over long periods, to persons whom they saw only at long intervals, in some cases the drugs, or prescriptions for them, were sent by post;
(iv) That sometimes practitioners have supplied drugs, or prescriptions for drugs, in relative large quantities to persons previously unknown to them, on the ground of some alleged urgent need, e.g., acute pain, and without making any effort to ascertain the name of, and communicate with, the patient's ordinary medical adviser;
(v) That there were cases in which persons had obtained supplies of the drugs from several practitioners concurrently;
(vi) That in some cases large supplies purchased or prescribed by practitioners were found to have been used mainly for adminstration to themselves, it being doubtful if the use of the drug was medically necessary.

11. Difficulties of Action.-- In the light of such cases it has appeared to the Home Office that, in some instances, the drugs were being supplied and used in contravention of the intention of Parliament. namely, that the use of Dangerous Drugs should be confined to that which was necessary for medical treatment. The Home Office, as the Department responsible for carrying out the law in this matter had to consider, first, whether there had been infraction of the intention of the Acts, even if not of the letter of the Regulations at prsent made under the Acts; secondly, in the event of such infraction, what course could be taken, either under the present Regulations, or after appropriate modifications of the Regulations, to secure better observance of the law in future.

12. In most cases, the question whether the law had been broken turned essentially on whether the drugs had been supplied for purposes of medical treatment only, and the Home Office have informedi that in this connection they have found it necessary to consider various points. The first of these was whether it was medically necessary that in any circumstances morphine or heroin should be supplied continuously for long periods to persons who were not suffering from any organic disease for the relief of which such drugs were eesential. They were aware that some eminent physicians, especially in the United States, had expressed the opinion that persons who had become addicted to the use of the drugs could always be cured by sudden withdrawal under proper precautions. At the request of the Home, the Minister of Health had the literature on the subject carefully collated. As a result, the Home Office were advised that even in the United States, where opinion is on the whole more favourable than in this country to this method of treatment, abrupt withdrwawal was advocated in those cases only in which the addict could be treated in an institution and carefully nursed and looked after. No statement by any responsible medical authority had been found to suggest that such a method was practicable in the treatment of an addict under the conditions of ordinary private practice.
In some cases, abrupt deprivation of morphine or heroin might cause not only intense suffering, but even fatal collapse. The method of sudden withdrawal called for close supervision, under expert judgement and skill, and trained nursing. The practicability of the method depended, therefore, on the possibility of inducing the patient to such an institution and institutional treatment is much more difficult to carry out in this country than in the United States, on account of the relative dearth of appropriate institutional accomidation in this country as compared with the United States.

13. Assuming the abrupt withdrawal treatment to be impracticable (even if thought advisable) in a large proportion of the cases of addiction occurring in this country, the question then arose whether this would justify the practice, which had in some cases been observed, of administering morphine or heroin over very long periods in non-diminishing doses. The Home Office assumed that the object of treatment in cases of addiction must be the care, if possible, of this condition, by means of a steady diminution of the dose, with a view to its ultimate complete discontinuance if found practicable. On this assumption, could the observed fact of continuous administration for an indefinite period in undimished doses be regarded as compatible with the end aimed at, or must it be held to constitute evidence, prima facie. that the drugs were not being administered solely for the purposes of medical treatment? Inquiries respecting this point showed that some physicians of great experience in the treatment of such conditions held the view that there were two classes of persons from whom, at all events: under the conditions of ordinary private practice the drugs could not be entirely withdrawn. In one case such attempted complete withdrawal produced severe distress or even risk of life; in the other, experience showed that a certain minimum dose of the drug was necessary to enable the patients to lead useful and relatively normal lives, and that if deprived of this non-progressive dose they became incapable of work.
While this view as to the possible necessity of even life-long administration in certain cases was not universally held, the fact that it was held by some eminent authorities made it difficult to base action on the assumption that continuous administration of non-diminishing doses, for however long a period, was nessarily inconsistent with bona fide medical treatment.

14. A question of another kind required consideration in cases in which doctors supplied or ordered dangerous drugs for persons whom they saw infrequently or for persons whom they saw for the first time, and respecting whom they had no communication from the patient's ordinary medical adviser. In such cases it had to be considered whether the practitioner's opportunities of observation had been sufficient to justify the statement that the drugs were being administered for purposes of treatment in any legitimate sense.

15. In cases in which the conduct of the doctor appeared to call for action of some kind, various courses presented themselves for consideration. The first was that of communication with the doctor, either by a letter from the Home Office, or by instructing a Regional Medical Officer of the Ministry of Health to see him, with a view to elucidating facts, calling attention to the requirements of the Acts, and inducing the practitioner to have due regard to these requirements. Such action has in many cases been followed by beneficial results. Secondly, it would be possible to prosecute doctors in the police court for offences against the Acts, on the ground that they had supplied the drugs or had administered them to themselves, otherwise than for the purpose of medical treatment. Thirdly, it would be open to the Home Office, to bring a case to the notice of the General Medical Council in which, primo facie, it appeared that the doctor's conduct had been such as might be regarded by the Council as "infamous in a professional respect."

16. The Home Office however, were reluctant to take proceedings in either of the two ways last mentioned with regard to cases in which the issue must turn largely on questions of mediical opinion, until various doubtful points had been further elucidated by an inquiry such as this. Moreover, even if it were established that continuous administration of morphine or heroin indefinitely in non-diminshing doses might in some cases constitute proper treatment, it appeared possible that such an inquiry might suggest precautions which should be observed by practitioners during the treatment of such cases or of other cases of addiction. Such an inquiry might also have a valuable ressult in the suggestion of measures which should be adopted in the ordinary use of morphine or heroin in medical practice, with a view to avoiding, so far as possible, the development of addiction.

17. Some cases have raieed questions of the desirability of certain amendments of the Regulations. In the first place, in view of doubts that have arisen, the question is raised of the need for a provision expressly forbidding the issue of prescriptions for Dangerous Drugs except for purposes of medical treatment. Secondly, doctors who do not themselves dispense, but obtain the drugs for the purpose of personal administration, or administration under their immediate supervision only, are, as has been stated under no obligation tokeep a record even of their purchases. Suspected abuses in the practice of these doctors are therefore in some respects more difficult to deal with than in the case of dispensing doctors, and the Home Office have had under consideration the question whether doctors who do not dispense ought not, nevertheless to be required to keep some simple record of their purchases of Dangerous Drugs. Thirdly, the action of some addicts in obtaining supplies or prescriptions from several doctors concurrently, clearly contravenes the intention of the Acts, and is moreover highly prejudicial to the best interests of the patient. Such cases ar, however difficult to detect, and we have conisdred whether some kind of notification might not be introduced to overcome the dificulty.

18. Lastly, questions of exceptional difficulty have presented themselves in the cases of doctors who are themselves addicts.Owing to the authority possessed by medical practitioners to obtain the drugs in their professional capacity, or to prescribe them for themselves, they do not encounter the same obstacles in obtaining excessive supplies as an ordinary member of the community, who can only obtain them from a doctor, or on a medical prescription. They cannot at present be deprived of their authority to be in possession of the drugs except after a conviction for an offence under the Acts, and a Regulation providing that doctors might not prescribe for themselves was withdrawn by the Home Office on account of the objections raised by the medical profession

19. The Home Offices have asked us to advise in our Report on the various matters mentioned in this Section.