French Narcotics Legislation
Pages: 1 to 4
Creation Date: 1955/01/01
Prepared by the Secretariat of the United Nations in consultation with the Central Pharmaceutical Services, Ministry of Health and Population
The purpose of this study is to show how French legislation has been formulated with regard to the medico-social aspects of drug addiction as it occurs in France.
The fight against the illicit traffic, which exists in France as in other countries, is carried on by special branches of the police and Customs as well as by means of penalties imposed on traffickers.
The "Office central de Police",1 entrusted with co-ordinating the prevention and repression illicit traffic, directs these activities.
Moreover, by providing severe penalties for traffickers, the law has given a role of " general prevention " to the act of repression. Finally, by placing narcotic drugs under regulation the authorities have tried to prevent drug addicts from procuring their drugs on the licit market.
Although drug addiction per se is not an offence in France, and indeed there is no legal definition of either "drug addiction" or " drug addict", the regulations determine very specifically the conditions under which drugs may be obtained or held legally, and any infraction of these regulations constitutes a punishable offence and is subject to the penalties set forth in the pertinent article of the Public Health Code.
The Public Health Code 2 gives the Government the power to publish administrative regulations concerning narcotic drugs. It lists the penalties incurred by persons who violate these regulations and it further specifies certain offences in this connexion, such as: the use of narcotic drugs in society; facilitating the use of narcotic drugs by others, by any means; obtaining narcotic drugs on false or "compassionate" prescriptions; knowingly delivering narcotic drugs on such prescriptions, or holding narcotic drugs without legitimate reasons.
The courts may also, in addition to fines and prison terms, impose accessory penalties such as deprivation of civil rights, the right to residence and prohibition of the right to practise the profession held at the time of committing the offence. The penalties are doubled in the case of illegal manufacture or cultivation, when the infractions involve minors, and for habitual offenders.
The narcotic drugs and the material involved in the offence are confiscated.
Attempted offences are penalized as if they had been committed. The same is true of conspiracy or agreement to commit these offences, and the different acts which constitute the offence are also punishable, even if they are committed out of the country.1
This office is attached to the Ministry of the Interior.2
Articles 626, 627, 628, 628 bis and ter, 629 and 630.
Any person accused of an offence under these articles must appear before an examining magistrate who, in conformity with article 64 of the penal code, may require an expert opinion on the state of his responsibility. In the case of suspected drug addicts, an examination is carried out by a psychiatrist who reports back to the court. If the accused is found to use narcotic drugs without legitimate reason, article 628 ter provides for his compulsory disintoxication in a special institution on the order of the examining magistrate.
The regulations which are to govern the conditions of admission, treatment and discharge of the addict and of the distribution of costs have not yet been published. A commission appointed by the Ministry of Justice and the Ministry of Health and Population, a majority of whose members must be doctors, will have to agree to the findings of a report on the subject which is being elaborated by the services of these two Ministries. However, by admitting the principle of compulsory medical treatment for addicts, an important step has been taken in the fight against drug addiction. It is probable that voluntary patients will also be accepted under certain conditions as in the United States. Traditionally, the members of the French medical profession have always had complete freedom of decision regarding the treatment of patients, and this will no doubt be respected in the case of the medical treatment of drug addicts in any state institution. The medical staff of the hospital will, however, be appointed by the Government.
Offences cited under the Public Health Code are specified as being intentional offences (the court must prove unlawful intent), whereas violations of the regulations concerning narcotic drugs are regarded as police misdemeanours; that is, they are considered as purely material offences. It therefore follows that they cannot be excused on the ground of " good faith ". They may be punished simply on the ground that the forbidden act has been committed. The law therefore punishes in equal measure fraud or negligence as well as ignorance of the regulations.
Legislation governing the use of narcotic drugs in France may be considered in two parts: controls over the import, export and manufacture of, and wholesale trade in, narcotic drugs, which have been imposed in order to prevent large quantities of narcotic drugs reaching the illicit market; and controls over the methods of supplying and delivering narcotic drugs to the public for therapeutic use.
It is easy to understand that the same provisions could not apply to persons who manipulate narcotic drugs by the kilo-gramme, if not by the ton, as to persons who handle them only in grammes or even centigrammes.
To facilitate the administration of these provisions, all narcotic drugs subject to control have been placed on a schedule, which appears on Table B of the Decree of 19 November 1948.3
Products are put on a schedule by a decree signed only by the Minister of Health. A decision of this kind can be carried out with the greatest rapidity.
The provisions relating to all commercial and industrial operations concerning narcotic drugs may be found in the Decree of 19 November 1948, chapter III, articles 37-59.
Section I of this chapter covers operations carried out outside pharmacies which deliver medecines to the public.
Points at which diversion from the manufacture or wholesale trade in narcotic drugs into the illicit traffic might occur in France have been given particular attention in the legislation governing these processes.
A dangerous situation would immediately arise if strict authority was not maintained over persons allowed to deal in narcotic drugs. In France any person desiring to carry out any operation involving a substance appearing on Table B must possess an authorization or licence;4 and the conditions governing all such operations on the manufacturing or wholesale level are expressly defined.5 The licence mentioned above must be delivered to a "personne physique" and must indicate each substance for which authority has been granted and what operations are permitted; any person not in possession of a licence cannot obtain narcotic drugs except on a doctor's prescription.6 The licence of a person convicted of illicit traffic is automatically revoked.
Import and export of narcotic drugs are subject to the import certificate and export authorization system required by the international conventions, and need not be elaborated here. Raw materials, i.e., opium leaf and cannabis, are not produced in France and must be imported.
To prevent theft or pilfering from factories or warehouses, all narcotic drugs must, by law,7 be kept under lock and key in special cupboards. Each container has a reference number, which it retains until it is finally used therapeutically, and special labels are provided for storage and for transport.8
One of the most effective methods of preventing diversion into the illicit traffic is the obligation to keep a special register 9 in which every purchase or disposal of a narcotic drug must be entered, with all relevant details, including the reference number.7 The pages of this register are inspected and initialled by the appropriate authority and the licence 10 is noted. Each transaction entered in the register is numbered and the register must be kept for ten years and be constantly available for inspection.113
Products placed in group II under Article I of the Limitation Convention of 1931, for example, codeine, are listed in another schedule of poisonous substances, Table A. However, all operations in connexion with them, except for their delivery to the public, are subject to the same rules as apply to narcotics included in Table B.4
Chapter II, article 16, Decree of 19 November 1948.5
Chapter III, articles 38-46, Decree of 19 November 1948.6
Article 38, Decree of 19 November 1948.7
Article 40, Decree of 19 November 1948.8
Article 41, Decree of 19 November 1948.9
Article 42, Decree of 19 November 1948.10
Article 44, Decree of 19 November 1948.
This system of reference numbers facilitates the tracing of any narcotic drug abstracted for illicit purposes from a given consignment back to the point at which it entered the illicit market.
The number of manufacturers in France has been reduced to the strict minimum: two for the extraction of opium alkaloids and the manufacture of their derivatives, two for the extraction of cocaine from the coca leaf, one for the manufacture of pethidine. The number of "manufacturers of galenical drugs" (opium extract, laudanum, etc.) has also been limited.
Control is thus facilitated and the economic monopoly given to the manufacturers is one of the surest guarantees that they themselves will control their own production strictly.
Each year the Minister of Health, in conformity with the provisions of article 6 of the Limitation Convention of 1931, fixes by decree the maximum quantity of each narcotic drug which may be supplied in France during the current year and the maximum level for manufacturers' stocks.
This decree sets out every year the special obligations laid upon manufacturers; and this procedure makes it possible for the regulations to be adapted to the special and essential problems which are of concern to the manufacturers.
Every month the manufacturers must provide the Narcotics Office with a statement of all the operations carried out during the month and must request a monthly authorization for the manufacture of particular amounts of narcotic drugs. This system makes it possible to check on the movements of narcotic drugs at sufficiently short intervals so that the estimates are not exceeded.
Every manufacturer of medecines which contain narcotic drugs must furnish quarterly complete statistics 12 on the purchase, use for manufacture, sale and stocks of all narcotic drugs. The wholesalers, i.e., persons who buy and sell wholesale only, must provide an annual statement showing incoming and outgoing amounts of narcotic drugs and their stocks. These reports are sent to the Central Pharmaceutical Service (Narcotics Office).
Certain preparations listed in a schedule established by governmental decree are exempted.13 The quantities of narcotic drugs entering into these preparations must, however, be accounted for. Thus it is possible at all times to have a complete picture of the amount, location and availability of narcotic drugs which are in the hands of manufacturers or wholesalers in France.
French legislation also requires a permit for any new pharmaceutical specialty.14 The French Government has met the danger inherent in the development of new synthetic drugs by refusing, in principle, to permit the manufacture or import of such drugs. Pethidine is the one exception to this rule and is manufactured by only one firm.
Section II of chapter III of the Decree of 19 November 1948 sets forth the obligations of persons who prescribe and deliver narcotics to the public.
Although the regulations concerning 15 operations elsewhere than in a dispensary seem to have solved the problem of preventing any large quantity of narcotic drugs from escaping from the licit to the illicit market, and as a consequence have made it more difficult for illicit traffickers to supply drug addicts, an equally important problem has been to prevent drug addicts from obtaining their supplies from the licit market. In order to do this, it was necessary to know what elements made up the population of drug addicts in France, what means they used to procure their drugs and which drugs were used. A series of studies of the medico-social aspects 15 of drug addiction as it occurs in France have aided French authorities to formulate new measures adapted to the situation in that country.12
Article 43, Decree of 19 November 1948.13
See page 4.14
Article 601 of the Health Code, and article 7, Decree of 24 June 1942 (regulations for the application of the Code).
In an analysis 15 of the cases of all drug addicts detected in the Department of the Seine since 1945, the authors have clearly shown that a high percentage of the addicts obtained their supplies from the licit market. 768 cases were examined and of these, 63 % were of non-therapeutic origin and 37 % had had their first contact with a drug on medical prescription. Of the same 768 cases, 344 obtained their drugs on the licit market by illicit means, 329 used the illicit market and 91 used both simultaneously. Recidivism was high-30 %-whereas drug addicts who were also traffickers amounted to 14 % of the total and some 16 % were married couples (generally cases of proselytism because of sexual incompetence). Women slightly outnumbered men; and their peak age was ten years younger (35-39 as compared to 45-49 for males).
Persons with no regular occupation showed a higher incidence of drug addiction and also a greater tendency to obtain their drugs on the illicit market than addicts with steady employment. However, the medical and para-medical professions showed a high percentage-15%- among the professional group, a phenomenon which occurs in most western countries. The authors were able to consult 574 medical case-histories by the same psychiatrist from among the 768 cases detected. A striking fact emerged: of 275 drug addicts using medical prescriptions to procure their drugs, only 52 seemed to furnish any valid medical reason for such treatment. This seemed to be due sometimes to a reluctance on the part of the doctors to refuse the insistent requests of the addicts on "trumped up" symptoms and some-times from sheer ignorance of the symptoms described or the medicaments asked for. Very few doctors sold prescriptions or wittingly connived with the addicts and the authors conclude that "many addicts became such because of the incompetence of the doctors treating them", and emphasized the extreme caution which should be exercised in prescribing narcotic drugs. After analysing the 574 case-histories, the authors concluded that psychotic reasons were not necessarily at the root of abuse of narcotic drugs by drug addicts of medical origin, nor were the mental difficulties apparent in certain addicts necessarily characteristic of drug addiction; but that these factors, as well as social background, age and the professional activity of addicts should be taken into account when planning their treatment. Most addicts were found to use the so-called white drugs (morphine, heroin, cocaine, etc.) and opium-smoking and the use of cannabis did not seem to present a major problem in France.
The same authors described some of the methods most frequently used by drug addicts to obtain drugs on the licit market. These included: ( a) simultaneous application to several doctors; ( b) false prescriptions; ( c) irregular prescriptions (given out of kindness, not observing the seven days' rule); ( d)fictitious prescriptions; ( e) misappropriation of supplies for professional use.
We shall see how the regulations currently in force in France have been successful in ending most of these abuses.15
Ch. Vaille and G. Stern: Medical and Social Aspects of Drug Addiction in France. Bulletin on Narcotics, Vol. VI, No. 2, United Nations, May-August 1954.
One of the most effective controls imposed has proved to be that of the obligatory use of a counterfoil book16for the prescription of narcotic drugs.
This practice, instituted by the Decree of 28 August 1945, at first met with considerable opposition from the medical profession, who felt it might infringe some of their rights to free prescription. But its value is now universally acknowledged. The book is issued to each doctor by his local Ordre des médecins, which is responsible for controlling its delivery and use. Each book and every page in it bears the same serial number. Each page is in two parts, a stub to be retained for three years by the doctor and the prescription proper. Each page also bears the seal of the Ordre national des médecins, the doctor's registration number and the number of the individual prescription. Prescriptions may be delivered only after examination of the patient and must be legibly written and give particulars, including the name and address of the doctor as well as of the patient, the dose, the means of using the drug and the date of the prescription.
Since the counterfoil book has been adopted by the French medical profession, prescriptions given out of kindness and false prescriptions have practically disappeared.17 The special characters used in printing the counterfoil book make it almost impossible to forge forms and the very fact of having to prescribe on official forms has made it much easier for doctors to withstand the pleas of drug addicts who may beg for some leniency in the strict application of the regulations. The legal obligation to make a physical examination of the patient before prescribing any substance on Table B has put an end to a frequently used ruse-the request for a prescription in an alleged emergency-before the doctor has an opportunity of visiting a non-existent patient.
The seven days' rule18prohibits prescriptions for narcotic drugs being written or filled for a longer period than seven days. Prescriptions for narcotic drugs may not be given, filled or renewed if the patient is already in possession of a prescription covering the period in question. It is an offence for a patient to obtain a new prescription for substances on Table B while still holding a valid one, unless the doctor prescribing has been informed of the first prescription, and mention must be made of this on the new prescription. When the prescription has been filled, the date and stamp of the pharmacy must be affixed to it as well as the number allotted to it by the pharmacist.19
The purpose of the seven days' rule is to prevent the patient from having excessive amounts of narcotic drugs at his disposal and using them without medical control.
In practice it is an efficient barrier against abuse of drugs. All legitimate use of narcotic drugs in France is thus the consequence of a continuous medical action. Any other course involves committing an offence.
Pharmacists must require persons requesting narcotic drugs to identify themselves before filling their prescriptions20 and this information is noted on the record book, together with other pertinent details. Non-renewable prescriptions must be kept by the pharmacist for three years; copies are supplied to the patient.
The seven days' rule has also helped to put a stop to illicit use of the licit market. The detailed system of accounting has made it particularly difficult for drug addicts to consult several doctors simultaneously in order to obtain delivery of sufficient narcotic drugs for their addiction. The periodic inspection of record books by the competent services quickly brings to light infractions of the rule, such as that of a patient going to several pharmacies in the same quarter, or using different names to obtain prescriptions. Pharmacists themselves are asked to point out all such suspicious cases to the inspection services.16
Article 49, Decree of 19 November 1948.17
Bulletin on Narcotic Drugs, op. cit.18
Article 50, Decree of 19 November 1948.19
Article 51, Decree of 19 November 1948.20
Article 54, Decree of 19 November 1948.
Pharmacies are also subject to minute controls over the way in which they may obtain supplies of narcotic drugs, i.e., by using double-entry forms from a numbered book supplied by the Ordre national des pharmaciens;21 complete records of all incoming and outgoing supplies must be kept for ten years and strict precautions and rules followed for the keeping and labelling of narcotic drugs, etc. Records of the quantities of substances on Table B used in making up exempted preparations must also be kept. Pharmacists must make quarterly reports on the stocks requested urgently by doctors and dentists,22 and must keep the relevant forms for three years.
Strict application of the use of the counterfoil book and of the seven days' rule has, French authorities believe, effectively closed the licit market to drug addicts who do not belong to medical or para-medical professions. These latter deserve special attention. The high incidence of drug addiction among doctors shows that the availability, and even the knowledge, of the temporary "fortifying" effect of narcotics is a potential temptation. Doctors who are drug addicts seldom prescribe for themselves, 23but are more likely to write false prescriptions for fictitious patients or simply to draw on the emergency stocks which they are allowed under article 55. However, certain restrictions are imposed on the supply of these emergency stocks, e.g., a single pharmacy must be chosen and must always supply the doctor for this purpose, and the council of the Ordre des médecins must be informed of this choice. A prescription form from the counterfoil book must be used for requesting the drugs. Any exaggerated demands for narcotic drugs can be easily detected by the inspecting pharmacist. Veterinaries and dentists are subject to similar controls.
If a doctor is suspected of being a drug addict, it is usual for him to be called before his local council of the Ordre des médecins. If adequate assurance is given that he will undergo a disintoxication cure, under the supervision of a colleague, it is rare for formal penal action to be taken. The Ordre national des médecins acts as a moral and disciplinary body and has the right to suspend a doctor's licence to practise, to withdraw his counterfoil book or to expel him from the Order if it deems such action necessary.
Special regulations have been enacted for the control of narcotic drugs in hospitals.24Narcotics can only be delivered by the hospital pharmacy, upon written prescriptions made out by authorized doctors or internes, etc., on prescribed forms taken from a numbered book. These forms are kept for three years.21
Articles 47, 52, 54, 58, Decree of 19 November 1948.22
Articles 55, 56, 57, Decree of 19 November 1948.23
Bulletin on Narcotic Drugs, op. cit.24
Code de la Pharmacie, Etablissements hospitaliers, Arrêté du 18 janvier 1949.
If the narcotic is to be injected, the empty ampoule must be returned to the hospital pharmacy.
In conformity with the provisions of the International Narcotics Conventions of 1925 and 1931, certain preparations containing less than a specified amount of narcotics are exempted from the regulations governing the trade in narcotic drugs, but the quantity of narcotic drugs entering into their composition must be accounted for in the statistical reports made to the Central Services.25 French administration has exempted certain pomades, liniments and suppositories which have never been particularly utilized by drug addicts. Where exemption might be given under the International Conventions, but practice has shown the product to be abused, such exemption has been denied; as, for example, in the case of laudanum, which is not allowed without prescription in France, although that is permitted under the 1925 Convention. Should an exempted product suddenly become popular among the addict population, measures could rapidly be taken to remove it from the list.
All the regulations and controls which have been discussed would be of little or no value if their application was not supervised by a constantly alert inspection service. Inspectors, who are all registered pharmacists, and under the control of the Ministry of Health and Population, are constantly on the lookout not so much for flagrant infractions, as for cumulative evidence of abuse. Registers and record books are examined without warning, stocks are checked, precautions tested. The inspectors of pharmacies work closely with the examining magistrates before whom persons accused of offences 26 must appear. The service has proved of inestimable value in the control of drug addiction in France.
To sum up, the main principle of the methods successfully used in France to prevent drug addiction has been strict supervision over any substance designated as a narcotic drug "from its birth until its death" and in this way preventing it from being abused. Repressive methods and strict application of penalties are the most effective arms against drug traffickers and the illicit market. Measures designed to stop the illicit use of the licit market have given particularly successful results. The use of a counterfoil book and the observance of the seven days' rule have cut down abuse of the licit market in large measure. These regulations were formulated with particular regard to the medico-social aspects of drug addiction in France. The Decree of 24 December 1953, providing for the compulsory treatment of drug addicts in a special institution, will fill the gap which might have been felt to exist in an otherwise efficient preventive approach to a problem, which although not a major one in France must always be regarded as a potential danger to modern society.25
Tableaux d'exonération, Médecine humaine, Arrêté du 24 février 1951, Tableau B.
Article 5 of the arrêté stipulates that the manufacture of exonerated preparations containing narcotic drugs must be accounted for in the same conditions as provided under articles 43 and 58, Decree of 19 November 1948.26
Article 60, Decree of 19 November 1948.