Chapter Four: THE BRITISH SYSTEM UP TO 1945

Once the broad framework of control had been established by the 1920 Act — and there were few departures from this by subsequent legislation which merely extended the range of controlled drugs — the problem facing the legislators was one of interpretation. Early controls under the Defence of the Realm Regulations required few interpretations — they were justified on grounds of the national emergency and decision involving delicate issues could always be postponed until after the war. Once the war ended the more mundane questions of implementation assumed their own importance. These were dealt with by the Rolleston Committee in 1926 which was largely responsible for producing the British system and which remained virtually unchanged for four decades.

The 1920 Dangerous Drugs Act came into operation on 1st September 1920. In May of the following Year the first set of Regulations were operative. These dealt with certain aspects of control, most of which had already been introduced under the Defence of the Realm Regulations. Other Regulations followed over the next three years. Briefly, these were aimed at restricting the possession of drugs to authorised persons, which included medical practitioners, veterinary surgeons, dentists and pharma-cists, i.e., those who handled drugs in the course of their medical work. A medical practitioner was authorised to possess and supply drugs only so far as was necessary for the practice of his profession, but this also included self administration. At first Regulations made in 1922 prohibited the use of all controlled drugs for self administration.1 A number of cases had come to the notice of the Secretary of State in which "medical men who were vic-tims of the drug habit had procured considerable quantities of cocaine and morphine by giving prescriptions to themselves." Seven months later in May, this was changed as a result of pressure from the medical profession who saw this as a limitation of their professional judgement. This is the first record of an argument that occurs frequently over the next 40 years, and reflects the uneasy relationship between those who supply the drugs and wish to retain independence over their ability to supply, and those who want to restrict this independence. However, in 1923 the victory went to the medical profession. It was reported that during the debate on the third reading of that Bill, Sir S. Russell-White on behalf of the medical members of the House, expressed great appreciation of the courtesy and consideration shown by the Home Secretary to their representations. He said the Home Secretary had accepted in spirit every suggestion put before him and he thanked him for removing the Regulations which stopped doctors prescribing for themselves.

Other Regulations required that records were to be inspected by the Home Office or police with the exception of medical prac-titioners' records which were inspected by registered medical staff of the Ministry of Health.2 Doctors who used drugs for themselves were not required to keep records ot this; they were only required to record drugs supplied to patients.

In the 4 years following the Dangerous Drugs Act, it had been noted by the police and the Home Office during the course of inspecting records that certain anomalies existed. It appeared in some instances that "drugs are being supplied or used in con-travention of the intentions of Parliament." It was also noted, for example, that exceptionally large quantities of manufactured drugs had been supplied to certain medical practitioners and that some individual patients had received unusually large quantities on medical prescriptions. The Home Office in a Memorandum dated 19th January 1923, pointed out that "The Secretary of State had reason to believe that at the present time there are very numerous irregularities in giving prescriptions for drugs." 3 Further enquiries by the Home Office or police showed that these doctors had sometimes given drugs to patients "not as part of medical treatment . . . but to satisfy . . . craving." In other instances large supplies of drugs were sent to patients through the post, and there were other cases where patients had received large supplies without the doctor ever having seen them. Some patients were receiving supplies from more than one medical practitioner whilst some doctors were using large amuunts themselves "when it is doubtful if the use is medically necessary."

The difficulties which confronted the Home Office and the police broadly speaking came under 2 headings. The first issue was to decide if the law had been broken either in letter or in spirit, and secondly if it had, what could be done about it, both now and in the future. The situation which confronted the authorities at the time was a completely new one, although similar problems were to reappear with greater force in the middle 1960s. In 1924, however, the Home Office and the police were reluctant to take action without the situation being clarified. The result was that a Departmental Committee was appointed on 30th September 1924.

The Committee's terms of reference were "to consider and advise as to the circumstances, if any, in which the supply of morphine and heroin (including preparations containing mor-phine and heroin) to persons suffering from addiction to these drugs, may be regarded as medically advisable, and as to the precautions which it is desirable that medical practitioners administering or prescribing morphine and heroin should adopt for the avoidance of abuse and to suggest any administrative measures that seem expedient for seeing such observance of such precautions." It is interesting to note that cocaine was not included in the terms of reference in spite of the recent outbreak. Later, on 12th February 1925, the then Home Secretary, Neville Chamberlain, added additional terms of reference at the Committee's own request. These only marginally affect the issue and were added when it came to the Committee's notice that cases of addiction were said to have resulted from the use of large quantities of preparations containing morphine and heroin which were of a lower percentage than that which would bring them within the scope of the Act, i.e., lower than 0.2%.5

The Chairman of the Committee was Sir Humphrey Rolleston, an eminent physician, and the Committee consisted of 8 other members, all of whom held medical qualifications. The matter was therefore seen almost entirely as a medical problem and one of interpreting relationships between doctor and addict patient.

This was also reflected by the witnesses from which they took the evidence. There were 34 witnesses, of whom 24 were doctors-4 from the Prison Medical Service—and there were 8 others who had direct connections with the pharmaceutical industry, e.g., Secretary of the Pharmaceutical Society of Great Britain. The remaining 2 were the Director of Public Prosecutions and the Under Secretary of State for the Home Office. It is clear from the Report that the Committee also saw the matter as being mainly a medical problem, and in parts of the Report it seemed to be at great pains to make recommendations which would be acceptable to the profession as a whole. For example, they did not think it necessary or desirable to recommend that medical practitioners should be obliged to seek a second opinion before prescribing heroin or morphine as "the evidence . . . given on behalf of the British Medical Association justifies the belief that there would be no general support in the profession for this proposal." Or again, when discussing the question of the possible authorisation for registered medical practitioners to supply drugs, they were opposed to the Home Secretary "taking the case to a Police Court to obtain a conviction [as] further consideration must be given to the public odium of a criminal trial and con-viction ... when the prosecution takes place in a district in which the doctor practices." 6 The Committee's justification for this approach seems to be because they believed that drugs could only be obtained through the medical profession. It was hardly considered that they could also come from illicit sources, nor was there any mention of the possibility of organised crime.

The Committee reported on 21st January 1926. As this was the only Departmental report on the subject for a further 35 years, and was of major importance in shaping British policy, its contents are considered in some detail.

The Committee thought that there was not very much informa-tion on the nature of addiction and as it had previously not been available in such an accessible form, it was important to state the full results of their enquiries. After defining the term addict a section is devoted to prevalence and aetiology of addiction. No figures were presented in the report as at the time none were collected nationally. From the information of the witnesses the Committee concluded that addiction to morphine and heroin was rare, although they thought morphine addicts greatly out-numbered heroin addicts. They believed that there had been a reduction in the number of addicts in recent years, which they attributed to the Dangerous Drugs Acts which made it difficult to obtain supplies. Some sources of illegal supplies were known to exist, but the Committee thought the addicts "lack the neces-sary determination and ingenuity" to obtain illicit supplies. They predicted that the incidence would continue to fall as a result of their recommendations as the proposed restriction of supplies would stop drugs becoming available to what they called "poten-tial addicts".

It was noted that the addicts themselves came mainly from the great urban centres, and were either in occupations which en-tailed much nervous strain, or where there were special facilities for access, i.e., amongst medical and allied professions. The predisposing factors in the aetiology were thought to be 'environ-mental', 'nervous instability', 'physical distress', 'insomnia', 'overwork' and 'anxiety'. One eminent witness thought `neuro-pathic heredity' could be traced in many of the cases, "and might reasonably be assumed to have been present in the remainder." Others less Lombrosian in their outlook merely thought the mentally unstable were more likely to become addicts, but there was a recognition that different factors may also play a part.

In addition, the Committee noted what they called 4 specific events which were regarded as leading to addiction in certain cases. The first and most important was the use of morphine or heroin in the course of medical treatment, i.e., in the creation of therapeutic addicts. Some witnesses thought about half the addicts were therapeutic in origin, others put the figure higher. An element of guess-work was inevitably involved as it was not until 30 years later that distinctions were made in the Home Office figures between therapeutic and non-therapeutic addicts.

The other specific events were dealt with very briefly. The second occurred when morphine and heroin were taken as a form of self treatment for the relief of pain or emotional distress. This was considered to be most common amongst those whose occupation gave them access to drugs. The Committee thought these would decrease in view of their later recommendations of restrictions of supply. Thirdly, some addicts were thought to have begun taking drugs as a result of the influence of others, either through imitation or example; and fourthly, others occurred where drugs were taken out of curiosity or because of indulgence. In both these latter instances, such cases were thought to be rare, and it was expected that they would also decrease when further limitations were made on supply.

Their general conclusions in the aetiology of addiction were that although varying factors may be present, drug addiction should be regarded as a manifestation of a disease and not a form of vicious indulgence. They thought that drugs, in the main, were not taken for pleasure, but to relieve a morbid and overpowering craving. Some addicts may have first taken them for a new and pleasurable sensation—these the Committee called the "under world class"--but having taken them, use was maintained by the craving for the drug, and not from the original motive of seeking pleasure. The Committee therefore mainly concentrated on the effects, not the 'causes' of addiction and their recommendations of this part of the Report were to have an important bearing on future policy.

The next 2 sections of the Report, Sections 3 and 4, deal with the circumstances in which it should be medically advisable to give morphine and heroin to persons known to be addicts, and they also discussed the precautions which were to be observed in the administration of those drugs. The Committee recognised that the prognosis was poor and noted that relapse appeared to be the rule, and permanent cures the exception; they thought there would always be a number of addicts who could not be adequately treated and whom it was impossible to deprive completely of morphine and heroin even though it was necessary to them for no other reason than for the relief of withdrawal symptoms. They concluded that morphine and heroin should be given to addicts in the following circumstances. In the first place they could be given to relieve pain, or for the purposes of gradual withdrawal, as part of a definite plan of treatment. It was not considered that any questions would arise as to the legitimacy of prescribing in these circumstances, but they reminded practitioners that the primary object of treatment was the cure of the addiction if practicable "by steady judicious reductions of the dose." The patient should be seen frequently and always be under sufficient medical control. If the medical practitioner thought he had lost control he would be well advised to seek a second opinion, especially "in view of the possible enquiries of the Home Office which such continuous administration may occasion", i.e., a straight-forward deterrent argument.

The other circumstances in which morphine and heroin could be supplied are more contentious. One was where, after every effort had been made to cure the addict the drug could still not be completely withdrawn because of serious difficulties which might arise and which could not be treated satisfactorily under the ordinary conditions of medical practice. The Committee thought that ideally addicts ought to be treated in institutions, but they recognised that there was only a small number of these, whilst the cost was usually prohibitive to most patients. Many would there-fore have to be treated in general practice, and if deprived of drugs, serious distress might follow, or in some cases even risk of life. There were other circumstances in which the patient might be capable of leading a useful and relatively normal life with a regular minimum dose, but would become incapable of doing so if the drug was withdrawn. The same problem would apply here as in the previous example, as withdrawal of the drug could lead to distress if treated in normal general practice and not in an institution.

Whenever the last 2 conditions existed, and the medical prac-titioner decided to supply morphine or heroin, special precautions were thought to be needed. First, supplies should be kept within the limits of what was strictly required. Second, the patient was to be seen not less than once a week and supplies should be no more than was sufficient to last until the next visit. Third, if a new patient asked for morphine or heroin the medical practitioner should only give that which was immediately necessary, and if further supplies were required, "the request should not be acceded to until after the practitioner has obtained from the previous medical attendant an account of the nature of the case." However, no recommendation was made that these circumstances should be controlled by Regulations.

The Committee then added a general note on the question of the precautions to be taken when morphine and heroin were used in ordinary medical praétice for persons not addicted. Their view was that other drugs should be substituted wherever possible, and if it were not possible then heroin and morphine should only be given in small doses. The patient was not to know the name of the drug, and in no circumstances should he be allowed to inject it himself. This point fits in well with Professor Lindesmith's theory where he says that the knowledge or ignorance of the meaning of withdrawal distress determines whether or not a person becomes addicted.

The earlier Regulations made under the Defence of the Realm Act, and later under the 1920 Act, allowed the Home Secretary to withdraw a person's authority to possess and supply drugs if a conviction under these Regulations had been made in the Courts. These powers were first invoked in May 1922 when authority was withdrawn from a retail chemist in Glasgow; the first medical practitioner to have authority withdrawn was a doctor in York-shire in August of that year. Over the years a small number of doctors appeared at Court charged under these Regulations.' The Rolleston Committee argued that these Regulations should be changed and the power to withdraw authority should be given to a suitably qualified medical tribunal composed of 5 members plus a legal assessor. At least one member was to be nominated by the General Medical Council, another by the Royal College of Physicians and the third by the British Medical Association. Separate provisions were made for Scotland. The Committee thought this recommendation would have several advantages, both administratively and from the point of view of the medical profession. They thought that for public protection it was undesirable to take the case to a Police Court to obtain a con-viction; there were many cases in which withdrawal of authorisa-tion could be met without recourse to penal sanctions. Secondly, some consideration had to be given to the public odium of a criminal trial and conviction which was specially felt if the prose-cution took place in the district in which the doctor practised. It was also argued that a medical tribunal would have the obvious advantage of being comprised specifically of medical members, as most of the issues would understandably centre around medical 1 matters. The magistrates would not have this expertise except by the use of special medical witnesses. The tribunal would be expected to deal with cases where drugs had been prescribed, supplied or administered, other than for legitimate medical reasons. It would also hear cases where the medical practitioner improperly administered drugs although it was never made clear in the Report what this phrase meant. The Committee made the distinction between possessing and supplying drugs and prescrib-ing them. Where authorisation to possess and supply had been withdrawn it was clearly necessary to deal with the right to prescribe. This also could be dealt with by the tribunal.

Finally, 3 other questions were considered.8 The first was whether it was desirable to oblige medical practitioners to notify cases of addiction to the Home Office. This they rejected on the grounds that it would impair the confidential character of the relationship between doctor and patient, and that as the number of addicts had decreased and was likely to continue to decrease, they were not satisfied that the benefits would outweigh the disadvantages. The benefits were recognised as enabling the Home Office more readily to detect cases in which patients were obtain-ing drugs from more than one doctor, to diminish doubtful supplying and to help medical practitioners exercise finer control over their patients, presumably by letting them know that the
k Home Office was watching them. No thought was given to the question of the need for information on new addicts for point prevalence and incidence studies, or of the possibility that the Home Office might be able to help with details of previous history. It was 40 years before this system was changed.

The second question concerned the possibility of providing by Regulations for a doctor to obtain a second medical opinion before prescribing morphine or heroin for an indefinite period to an addict patient. Some witnesses argued that a second opinion was desirable. They thought it would encourage more careful use of the drug and protect both patient and doctor, especially if the doctor's conduct about over-prescribing was ever questioned. The Committee did not agree. They thought it neither desirable nor necessary, nor did they think there would be general support for this in the profession as a whole. They considered that it would be sufficient to impress on doctors that a second opinion on these matters should be regarded more or less in the light of the need to obtain second opinions on other delicate medical matters. Although it would obviously be unwise to create too many special precedents, the Committee seemed to have ignored a fundamental difference. In other delicate medical matters presumably the aim is to help with the cure; in the case of continuous prescribing of heroin or morphine it is a way of prolonging the 'disease' or sickness. As it later turned out, by the 1960s the recommendation to obtain a second opinion might have protected both doctors and patients in the light of a large number of acrimonious comments about doctors over-prescribing.

The final question concerned the case of the doctor-addict. It had been suggested by some witnesses that chemists should have a list of doctor-addicts with a request that they inform the Home Office of purchases made by any of these doctors. The Committee saw "grave objections to the carrying out of such a proposal" and flatly refused to consider it further. Yet the problem of the doctor-addict had clearly worried the Committee as they were considered to be "a special danger to the community" and that "withdrawal of authorisation to possess drugs is especially valuable in the interests of the doctor himself", but they never came to grips with the problem other than in this general way.

The Report was accepted by Parliament. No new Act was required, but a draft set of Regulations first appeared some 6 months later on 4th June 1926, and were confirmed in August of that year. In the main, the Regulations followed the recom-mendations of the Committee. Regulation I adds to the 1921 Regulations and states, "a prescription shall only be given by a duly qualified medical practitioner when required for purposes of medical treatment." This forms the basis of the "British system", but to be properly understood it needs to be seen in the light of the Committee's Report. "The purposes of medical treatment" meant prescribing drugs under the conditions which they specified, since addiction was a manifestation of a disease. A good deal of misunderstanding has arisen, especially in the U.S.A., where there has been considerable discussion about the British system.° As late as 1953 the Home Office attempted to clarify the position—"a doctor may not have or use the drugs for any other purpose than that of ministering to the strictly medical needs of his patients. The continued supply of drugs to a patient either direct or indirect or by prescription solely for the gratification of addiction is not regarded as a medical need." 1°

It is doubtful if this clarified the issue at all unless the term 'medical need' is seen in the context of the Rolleston Committee's Report. If not, it could appear that maintenance doses of drugs were for gratification with no bona fide attempt at medical treatment.

The other important Regulation dealt with the question of tribunals. "If the Secretary of State is of the opinion that there is reason to think that a duly qualified medical practitioner may be supplying, administeri4 or prescribing any of the drugs either to or for any other persons otherwise than is required for pur-poses of medical treatment, he may refer the case to a tribunal constituted in the manner described in the Schedule for examina-tion and consideration, and if the tribunal so recommends, the Secretary of State may by notice . . . withdraw the authorisation of such practitioners to be in possession of or to supply the drugs . . ." This Regulation which was at the centre of the Com-mittee's recommendations about the safeguards over the control of supply and prescribing was in fact never put into practice. The reasons are still partly obscure, yet in March 1927 the Home Secretary had already appointed the members of the tribunal, and on 12th March 1927 it was reported that 2 tribunals had been designated, 1 for England and Wales under the Chairmanship of Sir Humphrey Rolleston, 1 for Scotland.

Other Regulations in 1926 dealt with dispensing and supplying drugs, and covered such matters as requiring drugs to be kept in a locked receptacle. This had already been recommended in a Home Office Memorandum in 1923, and the Regulations merely enforced this. A further Regulation not explicitly recommended by the Committee covered the case of the addict attempting to receive extra supplies from more than one doctor. These extra supplies were not to be considered as a form of medical treat-ment if the addict did not disclose to the subsequent medical practitioner the fact that he was already receiving drugs as a form of treatment from the other doctor. A Leader comment in the British Medical Journal expressed its approval. "To this, no exception is likely to be raised by any member of the profession."11

In general the Rolleston Committee's Report seems to have been accepted by the medical profession. The British Medical Journal was particularly pleased and members were urged to read it, for it was said "to have much sociological significance." The B.M.J. seems to have been pleased not only about what was included, but also what was left out. "It is of interest to note that no steps are being taken to enforce notification of drug addiction, or to make compulsory the seeking of a second medical opinion in the treatment of cases of drug addiction and that no authoritative rules have been issued for guidance in the use of scheduled drugs. The British Medical Association raised strong objections to all these proposals. Its chief contention that drug addiction is a manifestation of a disease frequently associated with nervous instability and frequently requiring treatment and not merely a vice demanding punishment appears now to be definitely recognised."

A particular feature of the Rolleston Committee was their abounding optimism. They believed that the number of addicts had decreased and would continue to decrease as a result of their Report. In what was virtually an unknown field and with little reliable evidence, their certainty about future trends is a little surprising. But in many respects the Report changed very little, and it has been described as a typically laissez-faire document which posed a solution to a problem when there was no problem there in the first place. Other critics have thought that the Com-mittee's recommendations could not be seen as producing a 'system' but were much more in line with clarifying the relation-ship between the medical profession and a small number of middle class women morphine addicts. In this sense the only system the Rolleston Committee produced was to permit doctors to prescribe as much morphine and heroin as they wished.
There is some force in these arguments, but it is still important to note that the lack of change was in one sense a political decision. No attempt was made as in the U.S.A. to reinterpret or introduce Acts such as the 1914 Harrison Act or the 1930s Marihuana Tax Act. Furthermore, the difficulties and defects of the British system in the 1960s could not wholly be attributed to the Rolleston Committee, but more to the failure to implement all of Rolleston's proposals.

Most arguments put forward by the Rolleston Committee, although new and in some cases original, were nevertheless in accordance with some of the influential thinking of the time. Norman Kerr, who was an authority on "inebriety" in all its forms, had argued many years before that addiction should be regarded as a disease rather than a wilful vice.12 Other authorities in 1922 saw that "the only treatment that gives a hopeful prospect of complete cure is one which recognises that drug addiction is a disease." Or again, "The taking of a narcotic drug of addiction for a few doses may be termed a vice, but if the administration is continued for a month or so a true disease condition becomes established with a definite pathology and symptoms." 13

The conditions in the United States also appear to have been known to some authorities in Britain and may have had some influence. A lecture by Dr. H. A. Burridge in March 1921 to the Medico-Legal Society was given on "State effort to rescue victims of drug addiction". This paper dealt with "the hardships caused to drug addicts and to the medical profession in the U.S.A. by the rashness of the existing laws and regulations". It was thought that the Narcotic Drug Acts and Regulations appear to have been framed on the assumption that drug addic. tion was a vice and not a disease. The result was that "the restrictions as regards medical practitioners have been such that large numbers have refused to have anything whatever to do with drug addicts. They are often prevented from obtaining by legiti-mate means any supply of drugs to tide them over a period preceding the commencement of a course of treatment with the result that the illegitimate traffic in narcotic drugs has become most expensive." 14 •

Outright criticism of the Rolleston Report seems to have been rare. Up to 1934 only one criticism could be found in the main medical journals and this was an editorial in the British Medical Journal in 1930 which was referring to conditions in Canada and the United States, and was critical of the Rolleston Committee's views only by implication. "Such evidence [i.e., from Canada] should serve to dispel the notion still prevalent in some quarters that the drug addict should be an object of compassion. Police evidence testifies abundantly to the fact that such drugs as heroin and cocaine not only conduce to moral degeneracy and criminal acts, but that they are resorted to by criminals both male and female such as the gangsters of Chicago to nerve them to the commission of crimes of desperate violence." Conversely, a letter in 1932 suggested that it was wrong even to bring addicts to Court in Britain as the publicity meant social and professional downfall. Of course it must be realised that as most addicts were thought to come from the 'professional classes' this could be interpreted as merely another example of the middle class looking after its own.

The more usual criticism from the medical profession was not in terms of the Committee's recommendations, but on what would be termed "bureaucratic grounds". One doctor called the Acts and the Reports, "legislation gone mad . . . by faddists and cranks passing vexatious laws." Another wanted to know where all these addicts were. ". . . Plain men like myself want to know where the drug addicts are that call for such measures. I have never seen a case in general practice, my partner has never seen one, more than that a very eminent London neurologist . . . told me he had been asking practitioners their experience of such cases for 2 years and none of them had ever seen one! " 15
This report not only formed the basis of the British system, but the Regulations stemming from it remained largely un-changed for over 4 more decades. Even when changes were made, the basic principle of legally supplying addicts with drugs was retained, albeit with some modifications as to where and from whom supplies could be obtained. It is perhaps astonishing that a report concerned with the doctor/addict relationship should have had such a lasting impression, but to understand this it is important to locate the discussion in terms of the extent of addiction in Britain over the next 40 years.

Whilst issues in Britain centred around the doctor/addict patient relationship and were confined to a somewhat cosy assess-ment of drug taking, other countries were grappling with rather larger problems. This comparison did not go unnoticed by the British Medical Journal who in 1936 somewhat smugly suggested that "Britain might serve as a model for some other governments which are parties to several conventions." Dr. E. W. Adams in one of the very few books for that period gives some figures for other countries." In the U.S.A. there were about 100,000 addicts, but in 1941 it was thought there were 1 per 1,000 of the popula-tion." A study of 1,600 addicts by the U.S. Public Health Service showed a male/female ratio of 6: 1, 60% becoming addicted between the ages of 20-32.18 Some were said to be "of good social standing" and in lawful occupations, but the overwhelming majority came from the 'underworld'. In Mexico there were a large number of cannabis "addicts', and in China, although no figures were given, there were said to be 597 hospitals for the treatment of addiction.

In Europe Adams noted a surprising lack of information regarding the incidence of addiction. In Germany there were about 5,000 addicts; a high proportion were medical practitioners, although he noted that working class addicts had increased dur-ing the early 1930s. In Britain there seemed to be more addicts in urban centres and "among persons who are engaged in occupa-tions which entailed much nervous strain and among those that had easy access to drugs." The relationship between prevalence and ease of access was first discussed by the Rolleston Committee and appears again in the work of Dr. Adams. It was taken up again by Dr. Brain in a lecture to the Royal Society of Medicine in May 1939 where he thought that there were "only 700 addicts in Britain compared with 100,000 in the U.S.A., undoubtedly because in this country is is extremely difficult to get drugs." That it' was probably more difficult to get drugs in the U.S.A. than in Britain seems to have been ignored by Dr. Brain, but he recognised that a study of the system of controls is likely to be as important as a study of the addict himself.

REFERENCES
1. Regs. SI 1086 and 1087. See also Appendix I for further details of Regulations up to 1970.
2. This was incorrectly reported in The Times on 13th January 1923 as inspection to be carried out by 'Medical Officers of Health'. This brought forth immediately a letter to the B.M.J. "Is the profession to which one has devoted one's life fallen so low that one's stock of opium pills must be counted, one's tinctures and solutions sampled for analysis and the ingredients of one's prescriptions disclosed at the demand of the Medical Officer of Health (possibly a rival practitioner) entering one's private house in one's probable absence and without previous warning?" Brit. med. J. 1923, i, p. 171.
3. Home Office Memorandum 9.1.23—See also Brit. mcd. J., 1930, 1, 69.
4. Departmental Committee on Morphine and Heroin Addiction, 1926, para. 11.
5. Article 14 of The Hague Convention states the contracting parties shall apply the law and regulations respecting the manufacture, import, sale or export of morphine, cocaine and their respective salts to all prepara-tions containing more than 0 2% of morphine or more than 0.1% of cocaine.
The Committee's additional terms of reference were "to consider and advise whether it is expedient that any or all preparations which contain morphine and heroin of a percentage lower than that specified in the Dangerous Drugs Acts should be brought within the provisions of the Act and Regulations, and if so under what conditions."
Whilst this was being considered, Britain agreed in February 1925 at the Geneva Convention to bring within the scope of the D.D.A.s all the preparations of heroin without distinction of percentage, and this agreement was made operative by the D.D.A. 1925. This left only morphine to be considEred. The Committee eventually concluded that very little abuse occurred anyway, with the possible exception of Dr. Collis Brown's mixture. Three alternatives were considered: either require the percentage of morphine in any mixture to be labelled on the bottle, or require a definite standard of morphine and bring it above the level of 0.2% required by the D.D.A. and thereby control it, or reduce the permitted level from 0.2% to 0.1%. The first alternative would clearly not stop abuse, the second might reduce sales, and so the third alternative was the one adopted—see Departmental Com-mittee. op. cit., para. 103.
6. See Departmental Committee, op. cit., paras. 67-85.
7. Typical was the case in 1926 when a doctor was convicted at Marl-borough Street Police Court on 3 charges of failing to keep a register. He was sentenced to 2 months' imprisonment on each charge to run consecutively and fined £100 on each. It was said in the course of the trial that he had prescribed 575 grains of morphine to an addict on 13 occasions but had seen her only 6 times. She was also obtaining sup-plies from more than one doctor. On appeal at the London Sessions the sentence of imprisonment was remitted, but the fine allowed to stand. Brit. med. J. 1926, i, 677 and 764.
8. There were in fact four other questions, the other considering the records of doctors who did not dispense drugs. Para. 88.
9. See King, R. Appendix B., Foreign Practices in Drug Addiction, Crime or Disease, Indiana University Press, 1936, p. 126, and also Lindesmith, A. R. The Addict and the Law, op. cit., p. 162-178.
10 Quoted in King, R. ibid, p. 126.
11. Brit. med. J., 1926, i, 998.
12. Reported in the Norman Kerr Memorial Lecture, Brit. med.    1922, ii, 1013.
13. lbid, 1922, i, 271 and 221.
14. Brit. med. J., 1922, ii, 1013.
15. Mid, 1932, i, 316.              
16. Adams, E. W. Drug Addiction, 1937, Oxford University Press.
17. Adams, E. W. Bulletin of Hygiene, 1936.
18. See National Research Council Report of Committee on Drug Addic-tion, 1929-41.