A comparison of Canadian narcotic addicts in Great Britain and in Canada

Sections

Summary
Introduction
Method
Findings
Discussion
Acknowledgements
APPENDIX
Prevalence
Bibliography

Details

Author: J. ZACUNE
Pages: 41 to 49
Creation Date: 1971/01/01

A comparison of Canadian narcotic addicts in Great Britain and in Canada

B.A. M.Sc. (Lond.) J. ZACUNE Addiction Research Unit, Institute of Psychiatry, 101 Denmark Hill, London, S.E.5

Summary

A study based on interviews with twenty-five Canadian narcotic addicts, who have lived in both Canada and Great Britain while addicted, is reported. Because the two countries have different medical and legal approaches to the control of drug addiction, comparative data are presented for the sample as regards social functioning, work history, drug use and criminal involvement. Differential adjustment of individuals to living in Great Britain is evident. Social consequences that may follow from a particular national response to drug addiction are discussed.

Introduction

What happens to a heroin addict is determined by a complex interaction between the facts of his addiction and his drug taking, his personal and social attributes and the response of his environment to addiction. The response of the environment is a matter of great complexity which has a host of variables. At two extremes, a society may seek to control narcotic addiction by prescribing heroin in a National Health Service (as in Great Britain) or seek to imprison addicts for possession of heroin (as in Canada). The response can not be clearly specified because most societies have various proportions of medical response, penal response and of laissez-faire. A particular national policy is adopted partly because of a logical appreciation of the problem and partly as a result of experience and history.

Comparing the efficacy of a specific method of treatment is now a familiar exercise in medical science and has successfully furthered effective treatment of many illnesses. For instance, work by Vaillant (1966) in the United States compares hospital treatment programmes to a régime of prison and parole for narcotic addicts. This important type of investigation leads on to a question of what might befall an addict, for better or worse, by larger alteration of a total national response. To take an example from the field of alcoholism: there can be useful research as to the relative efficacy of hypnosis, antabuse or group therapy (Wallerstein, 1957), but the effect of changing the public's whole conception of pathological drinking from "badness" to "sickness" may result in a change in laws, a greater willingness of doctors within existing facilities to treat alcoholics, the provision of new treatment facilities, a different attitude among neighbours, wives, employers-a change in the total package.

How is the impact of a total national response to be measured? Prospective cross-cultural studies are obviously much needed. However, an "experiment of nature" does appear to offer a small but interesting research possibility. A group of Canadian addicts have, during the last decade or so, come to live in England and it is possible to compare their addiction and their general life adjustment in the two countries.

This paper describes an interview study on this group. It should be stressed that the insights gained from a retrospective study of a small sample is limited and that the sample is not representative of either the Canadian or British addict population. The data does, however, offer a comparison of the possible social consequences of living under two different medical and legal approaches to the problem of addiction. A brief account of the legal and medical frameworks in the two countries is set out in the appendix.

The results should be regarded as leading to further work, rather than as conclusive findings. It would be entirely inappropriate to use the data as a basis for support or condemnation of the national response of either country.

Method

SAMPLE

The survey attempted to interview persons who had become addicted to narcotics in Canada and were now living in Great Britain. The interview sample, therefore, includes two subjects who were born in England but their addiction career began and continued for more than ten years in Canada. It would not include addicts from other countries who had made temporary visits to Canada, or Canadians who might have wholly acquired their addiction in Great Britain. An initial search was made of the records at the Home Office on known addicts, and all persons whose addiction originated in Canada were found. These records were abstracted with special note made of the subject's last known location. Those persons, who were known to have left England or died, were then eliminated from the sample and efforts to trace all the remaining subjects were made. If a potential respondent was located, an interview was carried out only if the physician in charge of the subject, and the subject himself, granted permission.

INTERVIEW

The interview employed a structured questionnaire asking the subject's personal and social background, his reasons for coming to Great Britain and staying, his criminal involvement if any, in Canada and Great Britain, his social functioning and work history in both countries, his interaction with other Canadian addicts in both countries, and details of his drug use. Subjects were asked a life history chart from their school leaving to the present day, including work status, drug use, imprisonment, hospital admissions and place of residence. In addition, subjects were asked about Canadians they knew in Great Britain, asked to estimate the total numbers who might have come and who still remained, and whether they knew of any Canadians who were addicts obtaining drug supplies illicitly. Finally, subjects were asked why they thought those who left Great Britain voluntarily had done so. These interviews were completed in a variety of settings, including clinics that the addicts attended, the author's office and in the homes of several subjects. A few subjects were seen on a number of occasions, either to complete the formal interview or to talk about the work more informally.

Findings

CANADIAN ADDICTS KNOWN IN GREAT BRITAIN

The record search indicated that Canadians with a history of addiction were not known to have come to England with the specific intent of being able to obtain opiate drugs legally until 1959. In the next ten years some 91 addicts came to Great Britain, with the largest surge of migration being between 1959 and 1964 when some 70 Canadian addicts migrated. The reasons for the delay between the beginning of the Canadian heroin problem in the late 1940s and 1950s (Richman and Humphrey, 1969) and the surge of Canadian migration in the early sixties, remains obscure. However, by 1961 the idea of coming to England for heroin maintenance or the treatment of addiction seems to have become widespread. Respondents in the sample reported hearing of the "virtues" of the "British system" from other addicts in Canadian prisons or on the streets of Vancouver. The migration was further encouraged by the privileged immigration status Canadians held as Commonwealth citizens, and the publicity given to the visit of a well-known private British physician to Canada in 1963, who claimed success in treating addicts (Frankau and Stanwell, 1961). Spear (in press) has detailed the migration of Canadian addicts to Britain and their influence on heroin addiction in this country.

The exact fate of all known Canadian addicts to have come to Britain is difficult to ascertain and only the barest details can be recovered from official records. Their length of stay varied from approximately one month up to ten years, with an estimated average of just over eighteen months. It is difficult to establish the exact date of entry and departure from Great Britain. The table below indicates the probable fate of the Canadians who came to Great Britain.

TABLE 1

Location of Canadian addicts known to have come to Great Britain (1969)

In England
 
Interviewed
25
Known, but not interviewed
4
Possibly in England but unlocated
7
Died in England
10
Deported
10
Assumed to be in Canada or elsewhere.
35
TOTAL
91

On the basis of this information, there are thirty-six individuals who were not reported to have left England by 1969. Of this number, twenty-four have been interviewed or, if the interview was refused, case notes and all other sources of information gathered (1 case). An additional four subjects are thought by the author to still be in England. Two are reported to be off drugs but unwilling to be interviewed, and two others could not be interviewed although several attempts were made. A further seven subjects have not been reported to have left the country, but there has been no indication of where they might be in Great Britain for one year in four cases, two years in two cases and six years in one case. None of the subjects who have not been interviewed appear in official records as receiving a prescription for narcotic drugs. These most doubtful six subjects do not seem to be known to those addicts who were interviewed.

The table indicates that thirty-five Canadians left Great Britain without direct compulsion and there is little evidence that they were cured at the time of departure. While it has not been possible to speak directly with those subjects who have left the country, some ideas have been gained by asking the interviewed Canadians why they thought associates they knew had gone back to Canada. The most commonly stated reasons that those interviewed mentioned were: (1) family reasons, (2) because they could not adjust to living in the U.K. and were lonely, and (3) they missed the bustling conditions in Canada. Other reasons mentioned were: they did not like working here, things were too easy, they did not like young English heroin users, the popular music did not appeal to them, and that the heroin was not as good as the Canadian variety.

THE INTERVIEW SAMPLE-BASIC CHARACTERISTICS

The interviewed sample has twenty male subjects and five females. All but two were Canadian born. Their average age is 40.8 years with a range from 22 to 53 years. The sample has been in Great Britain for an average of 5.8 years with a range of six months to ten years. All but five persons have been here between four and eight years.

Seven subjects are married and living with their spouse. Three of these are married for the second time, and the other four subjects are Canadian addicts married to each other. In addition, four subjects are separated, two are divorced and not re-married, and the rest are single (12). Of the thirteen subjects who have ever been married, only three are still living with their first wife.

Fifteen subjects failed to finish secondary school, seven completed their secondary school matriculation and three went on to finish further full-time education.

WORK STATUS

Of the twenty male subjects, only one claims to have worked steadily in Canada while addicted. Two males were musicians working various engagements and the remaining seventeen had only intermittent employment. Before becoming addicted, fifteen males held jobs of the manual sort, such as shipyard worker, labourer, sawmill hand, plumber, gas-fitter and traveller with a carnival. Of the five females in the sample, two had worked briefly as secretaries, one as a telephone operator, one as a student and one was a housewife.

The present work status of the sample in Great Britain is set out below.

TABLE 2

Present work status in Great Britain

Full-time employment
13
Part-time employment
4
None or irregular employment
8
TOTAL
25

Those employed full-time held their present job between six months and seven years. Six subjects have been employed at the same job for three years or more. Seven subjects have semi-skilled or skilled manual jobs such as welder or gas-fitter, two are employed in offices, one has a sales job, and the remaining are a croupier, a housewife and a student.

RESIDENCE

The demands of drug use in Canada plus long terms in prison made it difficult for subjects to have stable accommodation in Canada. Five seem to have maintained a constant residence for more than three years, but the rest moved about often to avoid detection and arrest.

Twenty of the sample are living in the greater London area and five are living elsewhere in England. The table below shows the amount of time subjects have lived at their present address.

TABLE 3

Duration of time subjects have lived at present address

2 or more years
10
1-2 years
8
Less than one year
5
In hospital
2
TOTAL
25

CRIMINAL RECORDS, CANADA

While in Canada, the sample had a long record of convictions. The average number of offences for which a conviction was obtained was 7.3, with a range of 0 to 25 convictions. Two subjects had no convictions in Canada. The distribution of offences is set out in table 4.

TABLE 4

Criminal offences in Canada

Offences

No. of subjects

0-4
9
5-9
7
10-14
7
15-19
1
20+
1
TOTAL
25

The total number of offences committed by this sample in Canada was 182. These are broken down in table 5.

TABLE 5

Type of criminal offence in Canada

 

Offences

Subjects

Theft (incl. breaking and entering, safe-breaking tools, attempted theft, robbery with violence, receiving)
88 16
Possession of narcotics (incl. trafficking)
59 22
Vagrancy
6 6
Violation of immigration laws
4 3
Forgery and false pretences
4 3
Motoring offences (incl. motor manslaughter)
4 3
Drinking offences (incl. breaking of Liquor Act)
4 3
Damage to property
2 2
Miscellaneous
11 1
TOTAL
182  

PRISON, CANADA

The sample spent a total of 141 years 2 months in prison in Canada, which is an average of 6.75 years (including the two subjects who served no time at all). Of the total number of years spent in Canada since becoming addicted, 24.6% of that time was spent in prison by the sample.

CRIMINAL RECORDS, GREAT BRITAIN

Thirteen of the sample have had convictions in England. This is detailed in table 6. The total number of convictions is twenty-seven. This is set out in table 7.

TABLE 6

Criminal offences in Great Britain

Offences

No. of subjects

0 12
1 5
2 3
3 4
4 1
TOTAL
25

PRISON, GREAT BRITAIN

Six subjects have been to prison for a combined total of two years five months with a range of one day to one year. The proportion of time spent in prison is less than 2% of the total of addicted years spent in England.

TABLE 7

Type of criminal offence in Great Britain

 

Offences

Subjects

Theft (incl. larceny, receiving)
8 5
Possession of opiates (incl. supply)
8 7
Forgery and false pretences to obtain drugs.
4 3
Possession cannabis or methylamphetamine
2 2
Fraudulent use of electricity
1 1
Smuggling heroin into a prison
1 1
Grievous bodily harm
1 1
Offensive weapon
1 1
Indecent exposure
1 1
TOTAL
27  

HISTORY OF ADDICTION

Taking as a base the time at which a subject said he first became addicted and calculating until the end of 1969, the average span since first addicted is 19 years, with a range of 4 to 32 years. All but two have been addicted more than ten years. The sample of 25 has combined to total 484 years since addicted. Not all this time was spent physically addicted to heroin as it was interrupted by imprisonment and occasionally by hospital treatment. Only one subject claimed more than one year abstinence outside hospital or prison since being addicted.

SOURCES OF SUPPLY

While in Canada, the sample obtained their supplies wholly illicity, as there were no experimental methadone maintenance programmes at that time. When they were not in prison, the subjects always bought heroin from criminal sources.

On arrival in England, the Canadians knew where they might get prescriptions. Eighteen said they knew before arrival the name and address of a physician who specialized in treating Canadian addict patients. Twenty-two of the sample were prescribed heroin and ten were prescribed cocaine by this physician; two of the three Canadian addicts who were not given prescriptions by this physician, arrived after he had died.

In England, except for the two subjects who arrived after the introduction of the hospital clinic system, the subjects had at least two physicians to prescribe for them at different times. Twenty subjects had 2-4 different physicians; five subjects had 5-8 physicians. In all, the sample found thirty different practitioners willing to prescribe. Five practitioners have treated five or more Canadian patients. The clinic system has introduced more stability into the changing of physicians, as only one subject has changed his clinic since they were started in 1968. All the Canadians in the sample have had a nearly constant legal supply.

DOSAGE

A comparison of heroin dosage that the individuals received in Canada and England is nearly impossible, as the Canadian heroin is variable in purity and in quantity for given price. In contrast, the British prescribed heroin is pure and supplied in the form of 10 mg. tablets. While it seems probable that the sample has built up a heavy dosage in Canada, it is unlikely they could afford the equivalent of the high dosage often prescribed. While it was difficult to ascertain the exact dosage all members of the sample received in England, because of changes of physician or faulty memory, prescriptions for as high as 1,800 mg./day (30 grains) of heroin were known, and 600 mg./day (10 grains) were not uncommon.

At the time of interview all subjects were receiving opiates from a clinic. The prescribed drugs were as follows: eighteen subjects were receiving heroin with an average dose of 597 mg./day (9.65 grains) and five received cocaine as well, with an average of 480 mg./day (8 grains); four were receiving only methadone (Physeptone) in ampoule or linctus form; and one was receiving morphine, 480 mg./day (8 grains).

HOSPITAL TREATMENT

All subjects denied having hospital treatment for drug withdrawal in Canada. Prison was not considered by the subjects to offer a form of treatment by withdrawal and rehabilitation, though indeed the Canadians were taken off their drugs more often than many British addicts.

In England, ten subjects have had treatment in mental hospitals for their drug addiction. They accounted for a total of 31 separate admissions with a range of 1-9 admissions for individuals. In addition, three subjects were in private nursing homes while under the care of a private physician. None of the hospitalized remained abstinent for more than six months after treatment.

CONTACT WITH CANADIANS IN ENGLAND

All subjects were asked to estimate the total number of Canadians who might have come to England, what had happened to them, how many they knew personally or met frequently in England. The estimates were intended as a check on the official Home Office figures. All but one subject underestimated the number of Canadians officially known, and this one exception gave a figure of 1,000-an incredible estimate that would represent one-third of the entire Canadian addict population. The other subjects all estimated less than 80, with the mode being between 30-40 addicts (56%).

In response to how many Canadian addicts they had known in England, the answers of addicts gave the number as from 5 to 40, with the mode being 15-20. Subjects varied in the numbers of Canadians they saw with some regularity from none to nine, this being some indication of the general social stability in this group. In general the more socially stable saw fewer Canadian addicts, and did not want to have any contact with them.

REASONS FOR COMING TO ENGLAND

When asked why they had originally come to England, the most common answer by the subjects was that they had spent too much time in gaol, or were frightened they would soon be sent there (76%); that drugs could be legally obtained in the United Kingdom or that addicts had heard a lot about the way addicts were treated in England were the next most common reasons (68% and 60%). Other reasons given more than once were: family reasons (marriage breaking up or for the sake of a child), to get out of the "rat race", because it was too hard to get by in Canada, to get away from the "scene", and because England was said to be a "hustler's paradise".

MAJOR DIFFERENCES FOR SUBJECTS IN ENGLAND AND CANADA

The most common response was that they could "lead normal lives" (64%), and this was followed by drugs being legal (60%). In addition, subjects said: there was less trouble from the police, they need not live in constant fear, that they could work and live like "humans", there was less pressure, there was no need to steal, there were fewer interfering people and that "things were easier".

CROSS TABULATIONS WITHIN THE SAMPLE

A number of differences were found between the Canadian subjects who are currently employed full-time in Great Britain (13 subjects), and those who are presently employed part-time or unemployed (12 subjects).

The employed are younger, on less heroin, more likely to be married and living with their spouse and addicted a shorter time. The employed have fewer convictions, although this just falls short of significance at the .05 level and there is a non-significant trend for the employed to have spent less time in prison. This is set out in tables 8-13.

TABLE 8

Age and employment in Great Britain

 

30-39 years

40 years and older *

Employed
9 3
Part-time, unemployed
1 11

x 2 = 8.6; p.>.01.

* Excluding one employed subject under 30.

TABLE 9

Heroin dosage and employment in Great Britain

 

Less than 10 grains heroin daily

10 or more grains * heroin daily

Employed
7 3
Part-time, unemployed
2 9

x 2 = 3.9; p.>.05.

* Excluding four subjects on methadone (three of these are employed).

TABLE 10

Marital status and employment in Great Britain

 

Married and living with spouse

Unmarried or living apart from spouse

Employed
6 7
Part-time, unemployed
1 11

x 2 = 4.3; p. > .05.

TABLE

Length of addiction and employment in Great Britain

 

Up to 20 years addicted

20+ years addicted

Employed
10 3
Part-time, unemployed
3 9

x 2 = 4.8; p. > .05.

TABLE 12

Imprisonment in both countries and employment in Great Britain

 

0-7 years in prison

8 or more years in prison

Employed
10 3
Part-time, unemployed
5 7

Not significant.

TABLE 13

Convictions in both countries and employment in Great Britain

 

0-7 convictions

8 or more convictions

Employed
11 2
Part-time, unemployed
5 7

x 2 = 3.3; p. > 0.1.

Discussion

SELECTION

The Canadians in this sample are a product of many selection processes. All the Canadian addicts known to have come to Great Britain represent less than 3% of the Canadian addict population. Of the Canadians who did come, those that remain have neither died, nor been deported, nor left the country-the fate of the majority of addicted Canadians who came to Great Britain. The introduction of the Commonwealth Immigrants Act meant that those who had parents born in England found it easier to remain here than those who did not, and it is possible that the pressure of obtaining work permits and similar difficulties led some to return, although they were not compelled by law to do so. Further, the sample may be self-selected by being more experienced at avoiding legal trouble or, perhaps more positively, by being the most stable. In either case, these Canadians might be different from any other section of the Canadian addict population.

SOCIAL FUNCTIONING IN CANADA AND GREAT BRITAIN

Within the limits of the selection factors above, there does seem to have been a difference in social functioning for this sample in the two countries. Schur (1963) has drawn several implications for the differing legal systems of America and Great Britain (Canada's legal system is similar to that of America), which find some limited support in this study. The Canadian system imposes criminal status upon the opiate user through strict enforcement of laws on possession and trafficking in opiates, and although it is possible for opiates to be prescribed as "good medical practice" (see appendix), this was rare when these subjects were in Canada. With virtually no legal source of heroin available, the organized "black market" has infiltrated Canada quite completely. It is estimated that a fully addicted Canadian would need between $6 and $21 per day to support his habit (Interim Report, Commission of Inquiry into Non-Medical Use of Drugs, 1970). This is beyond the legitimate means of most addicts and illicit means of support are necessary. The end result might be interpreted as the Canadian addict necessarily having to make a double commitment-to be an addict and to support his habit by some means of theft, trickery or by trafficking in narcotics himself.

The findings on convictions and imprisonment in Canada as well as the inability of subjects to hold a legitimate job in Canada support this view. When not in prison all but two subjects were involved in some criminal "hustling", that is stealing or confidence trickery to get money for drugs, finding supplies and suppliers, and all the time avoiding detection and arrest. The life history data taken as a whole indicates that most Canadian addicts were involved in a "full-time career" seeking out drugs from illicit sources and obtaining means of support. A wide network of contacts and friends were necessary to get opiates at need. Some Canadians positively valued this type of activity, and seemed to miss this interaction and "excitement" in Great Britain.

In Great Britain the availability of a legal supply of heroin from a physician means that criminal activity is not a necessary consequence of addiction. However, this only means that an alternative of "leading a useful and fairly normal life" (see appendix) exists and does not mean that all people will function in this way. For those who remained there has been less frequent prosecution and imprisonment, a greater ability to work, more opportunity for stable accommodation, no necessary involvement in the illicit drugs market and more willingness to have voluntary hospital treatment.

DIFFERENCES WITHIN THE SAMPLE

The social functioning of individuals varied within the sample. Differences were found between those subjects who were employed full-time and those part-time employed or unemployed. The employed subjects were younger, addicted a shorter time, on a lower dose of heroin in Great Britain, more often living with their spouse, and had fewer convictions in Canada. These findings, though consistent, are difficult to interpret. It is possible that the employed subjects are younger addicts who left Canada earlier in their addiction careers and therefore had a better chance of adjusting to Great Britain in a stable manner. However, the order of differences complicates the matter. Although the employed subjects were addicted a relatively shorter length of time-this included addiction of twenty years standing. The employed had many convictions and long imprisonment (up to eight years), but this was relatively less than the part-time and unemployed group. This cannot be interpreted in the light of any theories of "maturing-out" (Winnick, 1962; Richman, 1966), because neither of these groups have given up opiates and in this case the older subjects seem to function in a less stable manner. It would seem that individuals with extremely long histories of addiction and imprisonment cannot lead stable lives under a favourable legal system (though their lives are certainly more stable than in Canada), and others with less extreme histories in this respect are more stable.

THE CONTEXT OF THE CANADIANS' OPIATE USE IN GREAT BRITAIN

This sample is a small and special group in the context of opiate use in Great Britain. Stimson and Ogborne (1970) studied a random sample of 111 addicts being prescribed heroin at London treatment clinics with emphasis on current social functioning. In comparison to their sample, on average the Canadian sample is more than fifteen years older, addicted nearly four times longer, receiving three and a half times more heroin daily and has more convictions and imprisonment over-all. The differences emphasize the relative recency of an opiate problem in Great Britain and the young age of most addicts which is shown in the prevalence data in the appendix. Despite the disparity in age and length of addiction, on four crude measures of social functioning-employment, length of time at current address, convictions in England and imprisonment in England-the present sample does not appear to be more unstable than the London clinic population.

The indicators of social stability used in this study are very crude and leave areas which are difficult to ascertain. The Canadian subjects, like the young British addicts, were not medical or therapeutic addicts in origin and, whatever their long term motivation might have been, a primary initial desire was to receive heroin legally on prescription. This poses problems because it is difficult to assess the exact amount of heroin needed by an individual (Gardner and Connell, 1970). The problem of assessment was made even more difficult with this sample because it is difficult to know the equivalent amounts of legally prescribed pure heroin and the illicit market adulterated heroin. In any case, a legal supply of heroin does not ensure that an addict will not try to obtain other drugs illicitly and does not ensure that an individual uses all his heroin himself. The establishment of special clinics for the prescribing of heroin indicates the awareness that specialist skills are needed to counteract the above possibilities. The so-called "British system" is not a unitary way of solving all the opiate problems, but rather an approach to the legal prescription of opiate drugs which has been evolving for many years and is now trying to cope with new aspects of the problem. It is too early to evaluate the clinic approach, although the number of new heroin addicts seems to be abating (Connell, 1970).

This paper is only a crude attempt to begin to examine the complex notion of national response. The examination of this comparative data highlights some basic assumptions and implications for an individual's functioning under a particular system. A national response has many elements which need much deeper research and analysis (Canadian Commission of Inquiry into the Non-Medical Use of Drugs) and the present work in no way intends to condone or condemn a national response. The application of comparative findings needs to take into account varying circumstances in different countries (Edwards, 1967). Nonetheless, addiction forms a focal point for many of a society's legal, medical and social attitudes, all of which should be taken into account in any over-all view.

Acknowledgements

I am deeply indebted to the many people and departments who kindly assisted me with this work and made the research possible.

The Home Office, especially Mr. P. Beedle and Mr. H. B. Spear.

The Department of Health and Social Security, especially Dr. A. A. Baker, Dr. E. R. Bransby and Mr. T. A. Dibley.

The following consultants: Dr. T. H. Bewley, Dr. I. G. Christie, Dr. P. H. Connell, Dr. G. B. Oppenheim, Dr. J. L. Reed, Dr. J. Willis, and their colleagues and staff who made my task much easier.

Mr. H. David Archibald.

The addicts who kindly agreed to participate.

APPENDIX

Legal control and prevalence data in Canada and the United Kingdom

The main statute for controlling opiate drug use in Canada is the Narcotics Control Act, 1961. This law provides penalties and regulations pertaining to possession, trafficking, importing, exporting or cultivating a narcotic drug. In comparison to the legislation which this Act replaced (the Opium and Narcotic Drug Act), the penalties for trafficking and possession for the purpose of trafficking were made more severe, and a minimum penalty of seven years' imprisonment was imposed for importation. The Act also made provision for preventive detention and compulsory treatment, but these provisions have not yet been put into force by proclamation (Commission of Inquiry into Non-Medical Use of Drugs, 1970). Under these regulations, a physician may prescribe and administer a narcotic only if it is required for treatment of the patient (this includes treatment of addiction since 1961). The key word is " required", and essentially the decision is a medical one in that it is not explicitly condoned or forbidden by law.

Ferguson et al. (1965) wrote, after an enquiry for the Canadian Medical Association:

"Our answer to the question which prompted this enquiry is that it may, in certain circumstances, be good medical practice to prescribe maintenance doses of narcotics for long periods of time to an addict at liberty, if other components of good medical care are also provided. If they are not, the doctor may be guilty of trafficking. Our advice to general practitioners is that they should, if possible, avoid prescribing narcotics for long periods for addicts under their care."

In Great Britain the general and legal social policy toward opiate addicts was set down in 1926 by the Rolleston Committee (Departmental Committee on Morphine and Heroin Addiction, 1926). They introduced the concept of the "stabilised addict" who was defined as a person from whom "after every effort has been made for the cure of addiction, the drug cannot be completely withdrawn, either because (1) complete withdrawal produces serious symptoms which cannot be satisfactorily treated under the conditions of private practice, or (2) the patient, while capable of leading a useful and fairly normal life so long as he takes a certain non-progressive quantity, usually small, of the drug of addiction, ceases to be able to do so when the regular allowance is withdrawn". This policy was the mainstay of the so-called "British system". The fundamental ethic is that the addict in Great Britain is to be treated as a sick person and that it is the medical profession which is required by society to accept responsibility for the addict's care. These principles were embodied in the Dangerous Drugs Acts of 1965 and 1967.

The first basic alteration in the laws since 1926 came into effect with the Dangerous Drugs (Notification of Addicts) Regulations, 1968 and the Supply to Addicts Regulations, 1968. These Acts specify the following between them:

  1. Heroin and cocaine "unless given for the relief of pain due to organic disease or injury", may be prescribed only by doctors specially licensed by the Home Secretary. National Health Service consultants who treat heroin addiction in hospitals or in units nominated by a Regional Hospital Board or Board of Governors will be considered for licence, as will junior staff with sufficient seniority and, in some circumstances, private doctors. It is not proposed to issue licences to general practitioners.

  2. The Government is empowered at any time by the introduction of further regulations to limit prescribing of other dangerous drugs (i.e. as defined in the relevant Acts) in a similar manner. This does not include the amphetamines or barbiturates.

  3. A licence is valid for prescribing only at a named hospital which, in London at least, largely means the new special centres sited in teaching hospitals.

  4. Any doctor seeing a patient whom he has reason to suppose is addicted must, within seven days, furnish in writing certain particulars to the Home Office-this is a statutory requirement and is not dependent on the patient consenting to such a notification, or on the doctor taking the individual as a patient. (Edwards, 1969.)

The British legal framework also contains laws pertaining to the illegal possession and trafficking of narcotic drugs, however, the penalties are less severe than the Canadian equivalent. The British laws expressly allow the prescription of opiate drugs to addicts at a physician's discretion and clinics are provided under the National Health Service. By contrast, the Canadian law neither explicity condemns nor condones medical prescription of opiates to addicts, but the phrase "good medical practice" is tightly defined and there are virtually no legal supplies of heroin in Canada.

Prevalence

Known addicts in Canada and the United Kingdom

Canada

United Kingdom

 

1956

1968

 

1958

1968

Criminal addicts
1,678 3,459
Non-Therapeutic addicts
68 2,420
Medical addicts
352 200
Therapeutic addicts
349 306
Professional addicts
211 145
Professional addicts *
(74) (43)
     
Unknown origin
25 56
TOTAL
3,341 3,804
TOTAL
442 2,782

* Included in one of the two previous groups.

Set out below is a table of the known narcotic addicts in Canada and the United Kingdom at two points in time. The classification used is as follows for the Canadian addicts:

  1. Criminal addicts include all cases known to the Narcotic Control Division, who have either a criminal record or are suspected of criminal activities or criminal associations.

  2. Medical addicts are those whose addiction has arisen through medical treatment and who have no criminal record.

  3. Professional addicts are members of the medical profession, nurses, pharmacists, etc.

The United Kingdom classification is:

  1. Non-therapeutic addicts are those whose addiction did not arise through medical treatment or through being a member of the medical or allied professions.

  2. and 3. These have the same meaning as similar terms in the Canadian classification.

It should be noted that in both countries the number of therapeutic and professional addicts has declined in the periods shown, and that there has been some increase in the criminal addict population in Canada. However, the narcotic addict population has declined in proportion to the total population of Canada (Commission of Inquiry into Non-Medical Use of Drugs, 1970). In Britain there is a great increase in the non-therapeutic addict category, and this is accounted for mainly by young heroin addicts who began to appear in some numbers after 1962 (Spear, 1969). The reasons for the upsurge in the younger age groups is not yet known. The table below sets out the ages of known addicts in Canada and the United Kingdom.

Canada All known opiate addicts 1969 Total: 3,733

United Kingdom Age of known criminal addicts 1968 Total: 2,782

 

Percentage

 

Percentage

Under 20
1.5
Under 20
27.5
20-34
44.2
20-34
54.9
35-49
31.1
35-49
5.3
50+
11.8
50+
9.3
Unknown
11.4
Unknown
3.0
TOTAL
100.0
TOTAL
100.0

Bibliography

Commission of inquiry into the non medical use of drugs, 1970. Interim Report. Queen's Printer for Canada, Ottawa.

Connell P. H., 1970. The impact of the new approach to the problem of drug dependence in Great Britain. Proceedings of the 29th International Congress on Alcoholism and Drug Dependence. Melbourne.

Departmental Committee On Morphine and Heroin Addiction, 1926. Report. H.M. Stationery Office, London.

Edwards G., 1969. The British approach to the treatment of heroin addiction. Lancet. i, 768-772.

Edwards G., 1967. Relevance of American experience of narcotic addiction to the British scene. British Medical Journal. 3, 425-429.

Ferguson M. et al, 1965. Good medical practice in the care of the narcotic addict . Canadian Medical Association Journal 92.

Frankau I. and Stanwell P., 1961. The treatment of drug addiction. Lancet. ii, 1377-1379.

Gardner R. and Connell P. H., 1970. One year's experience in a drug dependence clinic. Lancet. ii, 455-458.

Richman A., 1966. Follow-up of criminal narcotic addicts. Canadian Psychiatric Association Journal II, 107-115.

Richman A. and Humphrey B., 1969. Epidemiology of criminal narcotic addiction in Canada. Bulletin on Narcotics. XXI, 31-38.

Schur E. M., 1963. Narcotic Addiction in Britain and America. Tavistock, London.

Spear H. B., 1969. The growth of heroin addiction in the United Kingdom. British Journal of Addiction. 64, 245-255.

Spear H. B., The influence of Canadian addicts on heroin addiction in the United Kingdom. In press.

Stimson G. and Ogborne A., 1970. Survey of addicts prescribed heroin at London clinics. Lancet. i, 1163-1166.

Vaillant G. E., 1966. A twelve year follow-up of New York narcotic addicts. American Journal of Psychiatry. 122, 727-736.

Wallerstein R. S. et al, 1957. Hospital Treatment of Alcoholism:A Comparative Experimental Study. Menninger Clinic Monograph No. 11. Basic Books, New York.

Winick C., 1962. Maturing out of narcotic addiction. Bulletin on Narcotics. 14, 1-7.