CHAPTER FOUR SENTENCING AND TREATMENT

Drug cases invariably embarrass the courts. Either the magistrate is intolerant and ignorant;

"...it seems that this magistrate ... goes by the appearance of the accused before him.. . . The magistrate had been told that I had been out on bail of my own surety and that there was no objection from the police as to bail. He took a look at us both and said, 'Oh yes, they both look sick. As the Sessions say we shouldn't have drug addicts walking around the streets, remand these two in custody.'
So I asked for a chance to speak and told him that I was not a drug addict, and that the person who stood next to me, I hardly knew. He asked the police if we were registered drug addicts. The police told him that the person with me was and that I wasn't but just the same we were both remanded in custody."

Or if he is basically sympathetic, he is handicapped by the limited means at his disposal. The alternatives on conviction are absolute discharge, conditional discharge, probation, fine, and imprisonment. Minors can either be sent to detention centres or borstal. Additionally, since the Criminal Justice Act 1967 came into operation, it has been possible for magistrates to pass suspended prison sentences. While this has safeguarded the first offender from going to prison, it has had the effect of producing a number of first offenders with suspended sentences who should not have heard the word "prison" mentioned at all. That the option exists now means that magistrates can sentence persons to prison while protecting themselves from the knowledge of their own actions.

The Dangerous Drugs Act 1967 made amendments to the 1965 Act and is mainly concerned with the control of drug addiction, as opposed to drug use. As a result of the amendments, general practitioners are now required to report any patients considered to be dependent on drugs to the Home Office. Prior to the Act, it was left to the police to go through the records of prescriptions held by chemists and report new names to the Home Office. The 1967 Act pro'hibits any "medical practitioner" from prescribing heroin or cocaine.

The National Health Service Treatment Centres, where doctors are able to prescribe the so-called "hard" drugs, were set up to take over from the general practitioner, thus providing improved out-patient facilities for addicts. 'This was the ideal solution. In fact, these facilities have turned out to be inadequate. The doctors are overworked and see their patients for as little as five minutes a week. Little more than regular prescriptions are administered. Many of the hospitals willing to treat addicts are also coping with alcoholics and people suffering from minor and major mental disorders. Frequently, these groups of patients are mixed in the same wards. There is a general shortage of hospital staff and doctors, but the shortage of doctors specialising in the treatment of drug dependency is even greater.

In one of our cases, a bay was given three weeks remand to find a vacancy in a hospital. He was faced with the possibility of prison if he could not find this vacancy. A girl who came to us for help was told by her doctor to "come back tomorrow" as there was no bed in his hospital for her. This was repeated for several weeks. The girl's condition rapidly deteriorated, aggravated by her pregnancy. She was admitted to the hospital having a miscarriage.

Many of the Treatment Centres put pressure on addicts to "withdraw", using in-patient facilities. There is relatively little difficulty in "curing" an addict if he is willing to stay in the hospital to which he has been sent. However, cases of addicts who have been "cured" more than twice have come to our notice. "Cure", in this sense, amounts to gradually reducing the addict's intake so that his body can function without the addictive drugs. Physically, the addict has been brought back to the state in which he existed before becoming addicted. This treatment is of no use because he is still in the same mental condition which led to his drug dependency in the first place.

Drug dependency is usually the outward sign of a deeper personality problem. Unless the patient is given psychiatric and social support, it is almost certain that he will return to drug use. It is too often the case that people returning to their previous environment after "cure"quickly relapse because of the lack of follow-up treatment. Treatment Centres will not be able to operate effectively until social and medical care are fully integrated.

The police have no idea of how to treat addicts since, quite rightly, they are not trained to treat people who are in mental difficulties. The only medical care that a "junkie" will receive while in the police station will be from the police doctor. This will only be available if the addict is quite, clearly in danger of making a nuisance of himself. Police doctors have little experience of drug dependence and may allow the patients to suffer considerably before making any attempts to help them. In some cases, addicts have been left to undergo withdrawal unattended, which can cause suicide or severe permanent injury through attempted suicide.

It is the "junkie" who most needs help but is least likely to get bail or be able to make arrangements to see a solicitor. The addicts arrested often have no fixed addresses and are therefore usually remanded in custody. While it is possible to obtain medical treatment in prison, this is likely to consist of controlled withdrawal with no psychiatric care unless directed at a later stage by the court.

When we know that a person dependent on drugs is being sent to prison or remand centre, we are able to telephone one of the doctors at the prison who can make sure that medical treatment is available and may arrange admittance -into the prison hospital. Even then, it frequently happens that an addict is withdrawn in prison and after three weeks remand, released relatively healthy. But, unless the addict is able to obtain the necessary supportive care while finding work and accommodation, he will return immediately to drugs. Prison cannot be considered an adequate place for the treatment of drug addiction. None of the intense psychiatric care necessary for understanding the problem is available. Even for the non-addicted drug user, the prison environment could not be considered curative.

Magtstrates can make a compulsory treatment order under terms set out in the Mental Health Act 1959. It is also possible for treatment to be a condition of probation. If the person does not comply with the terms of his probation, he can be brought before the court for breach of probation. In the majority of drug cases, these measures are not needed and are not desirable in view of the facilities available.

Compulsory treatment can do more harm than good, even in instances in which such measures might be considered necessary. When treatment originates from the jurisdiction of the court, the elements of punishment and compulsion are likely to destroy the addict's motivation to be cured.

When a person has been found guilty of an offence, the magistrate can call for probation, medical and psychiatric reports and further remand the person, either in custody or on bail, while the reports are being obtained. Medical and psychiatric reports are put together after consultation with the appropriate doctors. The probation officer, psychiatrist, or doctor submitting the reports can make direct recommendation to the courts about treatment procedures in a particular case. These reports, however well intended, can never be very thorough but they are frequently used as the bases for sentencing by the magistrate. In the case of probation reports, particularly when drugs are involved, there can easily be a break down of communication between the probation officer and defendant. What is basically the manifestation of the "generation gap" can become the reason for a young person being called sick or criminal. If the probation officer is sympathetic, he can do a great deal to help the person (Case 22, p. 107). If he is unsympathetic, his report can change for the worse the course of a person's life. (Case 15, p. 97.)

"l am pleased that he now recognises a need to be punished for his offences, as this indicates a real move towards the acceptance of the rules and therefore the right to hold a place for 'himself in society in future."

"I would suggest therefore that a prison sentence of at least six months . . . will be the period of stability that he needs and is asking for himself. Hospitalisation at this stase would not, in my view, achieve the necessary purpose, with the added fear on my part that if he were given drugs there, he could be back where he began seven years ego, addicted to barbiturates.'

The 21-year-old boy that this probation officer refers to had been under pressure to "reform" from most of the adults who he was in contact with. After an interview with this probation officer, in which the importance of returning to college was stressed, the boy had felt an overwhelming sense of anxiety and had stolen some sunglasses from a shop counter. The judge accepted the probation officer's recomandation and sent the boy to prison for nine months.

Addicts generally are treated by the police and courts with complete lack of understanding, the central London courts being an exception. At best, the attitude adopted seems to constitute punishment by an enforced withdrawal in a detention centre or prison. It is yet to be realised that to take a person off drugs without finding out why he is taking them is a waste of time and energy. The police and public fail to understand that addiction is a sickness and, further, that even supervised withdrawal in a prison hospital achieves no more than a temporary break of habit. The physical withdrawal from drugs must be followed by a long and careful period of social readjustment which is very difficult for an addict who has found an identity through his relationships with addict-criminal friends, perhaps in prison.